By Johnson-Swagerty, Marty
Corrections Today , Vol. 70, No. 4
Kathy Baxter, RN, director of patient services for Hospice Care of America--a hospice agency founded in Rockford, Ill., in 2004-was a bit surprised to receive a call in February 2008 from Capt. Timothy Owens of the Winnebago County Jail in Rockford. Owens called to learn about the availability of hospice services for an inmate who had been diagnosed with advanced esophageal cancer and was beginning to experience rapid physical decline. Baxter assured Owens that hospice provides services for anyone with a life-limiting illness, wherever they may live.
Thus began a complex and very rewarding partnership between a health care agency and a detention facility, a first-time experience for both that culminated in a peaceful death with comfort and dignity. This partnership raises a number of issues faced by detention and correctional facilities with aging populations. How can one inmate be given preferential treatment, logistically and psychosocially, over others? How can maintaining the security of many be balanced with meeting the physical, emotional and spiritual needs of one who is dying?
Championing the cause to incorporate comprehensive medical care into the secure environment of the Jail system was nurse practitioner Sandra Nienaber, CNP. Undaunted by comments from some detention staff like, "There she goes, breaking all the rules, and nobody is stopping her," and "You're just spoiling him," Nienaber embraced the judicial philosophy of avoiding "deliberate indifference" and went out of her way to provide the little things that made a difference in the inmate's comfort and quality of life. In addition to administering and monitoring his medications under the direction of the jail medical director Dr. Eric Henley, she also managed to bring the inmate, who was housed in the medical unit, popsicles in flavors that did not make him nauseated, as well as watermelon, peaches and special sandwiches. However, even Nienaber admitted it was a challenging situation. "After I gave [him] a pillow, I had four or five other inmates wanting pillows. But we have to set boundaries, and sometimes we have to say 'no,'" Nienaber said, explaining that the inmate's medical needs determined that he received these additional privileges. "Most of the inmates were accepting of that. I believe many of the inmates, if they had pillows, would have given them up for him," she said.
"How do you treat someone who has broken the law? You do the right thing for the right reason. You suspend judgment," Nienaber said. Security staff and inmates eventually followed her lead and joined the hospice team in supporting the inmate's needs. When hospice home health aide Valerie Murphy, CNA, who was responsible for providing personal care for the inmate, needed extra time bathing him in the shower, the correctional officer who monitored her biweekly visits adjusted the shower stall so the hot water would stay on for as long as necessary. Security provided a lockdown of the other inmates during those times of personal care, and when Murphy was not there, the inmate's cellmate helped him clean up.
As part of the hospice team's security clearance, each member of the team--the nurse, hospice aide, social worker and chaplain--underwent a thorough background check. This level of clearance is the equivalent of what is needed for volunteers serving at the jail. The hospice team also went through a comprehensive orientation introducing them to the jail environment, outlining the security restrictions and explaining how any potential safety concerns would be handled. Conversely, hospice worked with the administrative and medical staff of the jail to develop and implement a plan of care that would provide symptom management and emotional/spiritual support for the inmate, as well as prepare for the increased medical care needs anticipated during the final stage of the inmate's disease progression and death.
"Certainly, our population is aging just like the rest of the community," Winnebago County Jail Superintendent Andrea Tack said. …