Esther Schmidlin, EAPC board member, and a nurse consultant, Equipe Mobile en Soins Palliatifs, Plateforme Santé Haut-Léman, Vevey, Switzerland
Part two of Esther’s summer holiday trip through Poland
Apart from the religious-run hospice-palliative care units in Poland, there are many institutions within the national health care service (around 200) created by civic associations. They have evolved from fully voluntary-based hospices and have still many volunteers in their teams. Despite existing tendencies to separate hospices from palliative care, there is concern to work together and therefore the term hospice-palliative care is commonly used in Poland (1).
Visit to Hospice St Lazarus, Krakow
The Hospice St Lazarus in Kracow opened its doors in 1991. With 40 beds in the inpatient
clinic and the care of about 50-60 people (600/year) in the outpatient clinic, it is the biggest and best-known hospice in the area. The average stay is three to four weeks in the inpatient service, whereas the home care team follows its patients for an average of three months. The centre is also renowned for its lymphoedema clinic and patients come as far as the capital to seek advice and treatment.
Because generally home care services are not very well developed in Poland, most of the care is provided by the families, along with the specialist hospice-palliative home care team caring for cancer patients (2). The home care team consists of 12 nurses and a physician and cooperates with the family physician and their assistants. Agniesza Kwiecinska, nurse coordinator of the home care team, says that patient evaluation, symptom management, as well as education and family support, are major dimensions of the team’s daily work. The nurse will visit once or twice a week, or more if needed, the physician once a week, and much contact with the patient and the family takes place through additional phone calls. Even though patients may stay at home until their death, many need to be transferred either to the hospice or hospital because of symptom burden or insufficient support and care at home.
Economic pressure, migration and social changes take a toll in Poland. Many Polish men and women need one or more full-time jobs to generate enough income to support their families. This often makes it difficult to care for their sick and dying loved ones over the 24 hours at home. Piotr Krakowiak explains: “The number of deaths at home is decreasing, but not as dramatically as in other places in Europe. Our home care hospice-palliative care is very efficient, and around 70% of deaths under hospice-palliative care occur in the patients’ homes. From the 1980s we have started our hospice movement with home care and until now it is the most common and most culturally accepted way of dying.” Nevertheless, the societal changes result in a growing need for inpatient hospice and palliative care units.
I would like to thank Dr Tomasz Gradalski, Agniesza Kwiecinska and all the other people I spoke to at Hospice St Lazarus for their hospitality and valuable information about their work and the hospice situation.
1. Personal conversation with Piotr Krakowiak, 2012.
2. Palliative Medicine is a medical specialty since 1999, postgraduate training for nurses and physicians is possible since 1994, which makes Poland a unique country in Eastern Europe with such developed standards (also see EAPC 2007, Atlas, Poland, country report).
I’ll be writing another post about my visit to Polish hospices in the next few days – I hope you’ll join me!