Caring for Patients in an Inner-City Home Hospice: Challenges and Rewards

This article describes the work of the Johns Hopkins Home Hospice, with a focus on the inner-city patients who make up much of its population. Through interdisciplinary teamwork, the hospice strives to provide these patients with the same high-quality end-of-life care as those in more affluent areas receive. Particular care challenges in the inner city include finding staff members and volunteers who are comfortable working in this environment and ensuring their safety and working with families that may have limited resources. Nurses, physicians, and aides may have to work to overcome barriers to pain management and caregiving. Volunteers often play a special role in caring and companionship. Social workers may need to overcome negative perceptions of the social work role and be accepting of different views of support networks. Spiritual caregivers need to work in the patients’ cultural context, and bereavement coordinators often deal with disenfranchised grief and multiple losses.