The IDT or Interdisciplinary Team

 The  IDT  team is composed of individuals who are employees of the hospice and will provide substantially all core services. The services  will include at least:

 

    ■ Physician who is a Doctor of Medicine or Osteopathy - Together with the team , will create a care plan

       that  manages pain and control symptoms associated with the patient's  terminal illness or disease

    ■ Registered Nurse - Assess the needs and manage the pain and symptoms of the patients. The nurse will

       educate family or caregivers  in how to assist or care their loved ones.

    ■ Social Worker- Look after the emotional needs, helping patients with feelings of fear and anxiety or communication

       issues with family, insurance benefits and other difficulties.

    ■ Pastor or  Chaplain or  Counsellor- Provide emotional and spiritual support, guide family  through tough decisions

      concerning end of life issues, provide understanding to relieve strained relationship between loved ones, strengthen

       faith of patient or family.

    ■ Bereavement Coordinator - Help through the different phases of the end of life process, prepare for the situations of

      end of life  and  provide counselling and support for up to 13 months  

    ■ Volunteer Coordinator  - Prepare the volunteer care plan  for volunteer to support the need of the family or patient

 

Additional members may include the physical therapy, occupational therapy, speech therapy,  dietitian , pharmacist, and  home health aide. A Bliss Care  will designate a registered nurse to coordinate the implementation of the plan of care  for the patient. The nurse will develop a hospice aide plan of care  for the hospice aide to follow  which is specific to the needs of the patient.

The IDT responsibilities will include but not limited to:

     ■ Participation  in the establishment of the plan of care with the patient/family  and attending physician.

     ■ Provision and supervision of  hospice care and continuity of services

     ■ Periodic reviews and updates of the plan of care  for each patient  receiving hospice care , and for each family receiving 

        bereavement service and establishment of policies  governing  the day  to day provision of hospice care and services

 Other services include  coordination of  ■ Durable medical equipment ; ■ Medications related to the terminal illness for

 comfort  and symptom management and ■ Respite/inpatient care to support family /caregiver.