Laguna center for palliative care
Service to the neediest: this was one of the resolutions awakened in many people by the centennial of St. Josemaría’s birth. And for several months now the Laguna Palliative Care Center has been in full operation.
Scientific progress now offers the possibility of curing many diseases that formerly were incurable and of prolonging the lives of the sick. In addition, the aging population means that in the years to come the number of patients with chronic and degenerative diseases as well as the number of geriatric patients will increase.
Thus the number of persons affected by the suffering from a progressive terminal situation is constantly growing. In the face of this social need, and inspired by the teachings of St. Josemaría, in 2002 the Laguna Palliative Care Center was opened in Madrid. This project is aimed at caring for persons with advanced debilitating or neuro-degenerative diseases, and patients who require constant care. The Fundación Vianorte is the group fostering this initiative.
St. Josemaría Escrivá, as a young priest, cared for many sick people in the neighborhood in which this new hospice is located. Today, the Latina district includes a high percentage of disadvantaged and elderly people. Therefore the city council of Madrid provided a piece of property there for the construction of a building for this purpose.
Since 2002 the Laguna Center started offering part of its services in a provisional center and through home care. But for the last few months, the newly-built facility has been in full operation.
What is palliative care?
Palliative care is active and total attention to patients whose infirmity will not respond to curative treatment. It seeks to control the pain and other symptoms, and alleviate social, psychological and spiritual problems. These are problems that not only affect the patient but also the patient’s family and surroundings. This medical specialty originated in England towards the end of the seventies.
This type of treatment affirms life and considers death as a normal process: it neither accelerates nor delays death, but tries to assure quality of life until its end. “Palliative care is made up of very simple things, small things. It stresses that an advanced illness is not a failure, but a situation in which one can still do a lot,” points out Dr. Antonio Noguera, assistant medical director of the Center.
Care for the sick person is integral, not just medical. The teams are formed by doctors, nurses, clinical helpers, social workers, and other specialists such as psychologists, occupational therapists, physical therapists and even podiatrists and hairdressers.
“Working in an interdisciplinary team is enriching and allows each professional to learn from the others” said Dr. Noguera. This integral attention is one of the principal novelties offered by the Laguna Center. It is attained not so much through the quantity of resources, but thanks to a vision of the full needs of the person, which are not only physical or psychic, but also social and spiritual.
Aside from the global attention to the sick person, a second fundamental aspect is continuity in care. “In palliative care,” Noguera says, “people speak more and more about the plan of care, which includes good care of the patient regardless of where the person is: whether admitted to the Center or living at home.” The plan is carried out through “coordinated teams that can provide attention at any point. A common team with a common clinical history and professionals who exchange information quickly.”
To ensure the personalization of the care of each person and continuity in their plan of care, Laguna offers stages of service: medical attention at home when conditions are adequate there, with 24 hour telephone support to resolve problems or to arrange for admission; external consultations for those with sufficient autonomy; out-patient facilities, with provision for check-ups, analysis, x-rays, physical and occupational therapy… The out-patient clinic is an intermediate stage between care at home and admission to the hospital for palliative care, which is the final stage.
The out-patient clinic can care for 55 persons, 40 of whom come by arrangement with the local authorities. This is a service directed to persons with neuro-degenerative sicknesses, especially Alzheimers. The hospital for palliative care, which is the nucleus of the work at Laguna, has 38 beds.
A “rest” for the care giver
In addition to hospital and home care, Laguna offers the following services: a Family Rest Unit, an outpatient Pyschogeriatric Center, a Family Social Service Center, a Radiodiagnostic Service, Physical Therapy and Rehabilitation, Psychological Services, Religious Assistance Services, Mortuary, and a Center for Formation and Research.
The Family Rest Unit is aimed at helping the families of the sick person to rest properly, avoiding over-stress of the principal care-giver. The Center for Formation is putting into operation courses for persons who have a patient under their care at home, so that they can learn to care for the patient properly, and sessions for auxiliary personnel in geriatrics and nursing.
In Laguna the terminal patients are surrounded by care, but no attempt is made to have them “die without knowing it.” The dignity of the patient requires that they have an opportunity to prepare themselves for that critical moment.
Laguna also offers spiritual and religious attention to those who request it. Since it is an urgent need in the face of approaching death, this is usually very well received. This attention involves visits from the chaplain and access to the sacraments, so that patients can unite their suffering to Christ’s redemptive passion. In addition the Center has a chapel where the Blessed Sacrament is reserved and where Holy Mass is celebrated periodically. The work of the chaplain is reinforced by the team of social workers.
A patient, a family
“Confronting a chronic and progressive sickness, one can say that the sick person is also in some sense a sick family,” says Dr. Noguera.
Based on this viewpoint, the social services department seeks from the first interview to detect problems and concerns within the family setting and to study their implications for the patient’s care. The family members caring for the sick person “often have concerns about whether what they are doing is correct or not. On a purely material level, teaching them how to provide proper care and assuring them that they are doing things well gives them a lot of confidence,” Dr. Noguera explains.
At the same time, “getting them to see that what they are doing is very important even though the person cannot be cured,” helps them “to set new goals and prevents frustrations and emotional crises.”
Dr. Noguera speaks of “micro deaths,” since the process of a terminal patient involves the progressive loss of many capacities before death itself arrives. “They are gradually being left without the capacity “to do” and all that is left is “to be.” The care given shows them “that the important thing is what each person is, even if they can no longer do anything.” And all of these “micro deaths” are undergone both by the patient and by the patient’s family.
Often “the family members are overburdened because, in addition to caring for the patient, they have to do all the things that the patient used to do. This is a double burden.” For this reason, the medical director points out, “families need a lot of emotional support, and in some cases the support of a specialist, a psychologist.”
In addition to psychological care, other forms of help that are offered at Laguna for families are the above-mentioned Family Rest Unit and programs to help family members accept peacefully the death of their loved ones.
One of Laguna’s stated objectives is the development of initiatives aimed at fostering concern and support for dependent persons. For example, the Center has a network of volunteers made up especially of retired people and a small group of young people. At present there are 50 persons involved, although the intention is to double this number. They dedicate two hours a week to visiting and caring for the sick and receive beforehand courses of formation oriented towards encouraging the generosity of the volunteers themselves and reminding them of the human and supernatural fruit that this work of charity provides. At times it is enough that the volunteers learn to listen to the problems of the sick and give them some smiling words of encouragement and affection, showing them that someone is concerned about them. Other times it means providing some pleasant conversation, or even singing some songs if the situation is appropriate.
Romana, n. 48, January-June 2009, p. 136-139.