In hospice, clinicians in the field have the closest relationships with patients and families, giving them direct insight into their needs and the challenge of providing care when many operators are understaffed.
Akunesokwu (Neso) Obiora entered the palliative care field nearly 20 years ago as a hospice aide. Today she is a hospice- and palliative care-certified nurse practitioner at MJHS Health System in Brooklyn.
Her career in hospice began after she immigrated to the United States from Nigeria. As her devotion to the field grew, she sought training to become a licensed practical nurse (LPN) before advancing in time to her nurse practitioner role.
Obiora joined MJHS in 2021 and recently received the Nurse Practitioner/Physician’s Assistant Community Advocacy Award from POCN, a professional organization for those clinicians.
Hospice News spoke with Obiora about her journey, how she connects with patients and the impact of the staffing shortage on frontline clinicians and the people they serve.
You have had a very interesting journey through the profession. What was your experience like as you took this trajectory through the field?
I started as a home health aide, actually, for the hospice patients. So I found myself in hospice, and now I’m a certified hospice and palliative nurse practitioner, focusing on helping to improve the quality of life for patients in the community.
Meeting the patients in their own homes gives you the opportunity to have a holistic assessment of the patients and their living environment. You see the community that they associate themselves with, their beliefs and values, and some of the family dynamics that are also going on.
These things are very important in developing a plan of care that will address their needs, in association with the referring physician. So I get involved in making sure that they get the services that will improve their quality of life and also help them to stay at home, so they don’t go back and forth to the hospital.
Can you tell me a little bit about how you connect with the patients and families to identify the family dynamics and their values? What kind of conversations do you have?
Most of them, you learn by asking questions of the patient from the families, and sometimes others.
You see what’s going on, and you want to explore that, coming into the patient’s home, introducing yourself, and earning their trust. They open up to some of the questions you will ask them, even basic things like how they get their meals, how they navigate daily tasks and how they spend their days. This helps you to know what kind of services and support they might need.
By the time you’re meeting them, you’ve seen that some used to walk around, but now they’re having difficulty. They can’t go to meet their doctors where they used to, and you now know it’s time to call for home-visiting physicians, so they can still get those services at home.
Hospice News has spoken with a lot of CEOs and executives about the workforce shortages in the space. But I’d love to hear from you, the frontline clinical practitioner, on how this is affecting you and the work that you’re doing?
It’s really an issue. It’s really a problem in health care industry at this point. Because these are the patients need these services, especially when it comes to home health aides. [The patients] cannot help themselves and need assistance.
And unfortunately, those staff are no longer available. Many people can’t find anybody to come help, and it affects the quality of lives of the patients.
It’s the same thing with some of the nurses who are supposed to visit, like wound care.
Your point about the impact on patients’ quality of life is well-taken. I am also curious as to how does it affect your quality of life as a clinician.
You have to go above and beyond to help. You find yourself doing the wound care, because you want this patient to have some comfort. You even try to help with personal care, and things like that. So you try to bridge that gap.
What are some of the things that you think hospice organizations really need to hear from their frontline clinicians to help them understand their experiences and their needs?
The organization needs to understand that the services we are providing are very needed for these patients, and the toll of the traveling that is involved.
When you’re in the field, you have to navigate how much time you can spend with each patient in their homes. We are doing our best to work through meeting patient needs in the home while also traveling from one patient to the other.
If there was anything you could change about hospice care in 2022, whether it’s care delivery, or something to do with regulation or payment or any other issue, what would that be?
It will be providing more time with the patients, more hours. Often, by the time they give the patient just a bath that time window is over, especially in the hospice setting.
We need to provide more hours for homebound patients, and also have a better ratio between the nursing care and the services assigned to the patients. If we can bridge that a little bit, have more nurses in the field, that will really help to improve the quality of care we are providing to the patient.
What are you seeing in terms of the caregivers within the families that you’re working with and how they’re managing the financial, emotional and logistical burdens? What would you like to see happen to better support them?
Thank you for raising that issue, because caregiver stress is a real problem. I’ve met some of the caregivers, and all they’re asking for is respite care: “Can you put my loved one somewhere so I can get a break just for a few days or a week or two?”
Now in the hospice setting you can get respite care for only five days. It creates a lot of stress for them. We can improve on that and give them more time.
And a lot of the time, they are also dealing with their own health conditions. It would be a case of really giving them that break through respite care or more hours with a home health aide to assist them.
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