The IDT or Interdisciplinary Team

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 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.

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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

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 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.