A cousin of mine just passed away a few months ago after a long illness.  He was fortunate to be able to spend his last few weeks at home with the family and friends he loved around him, either looking out the window at his beautiful backyard or some days, on the back porch.  “Fortunate” is a relative word: he was in his early 50’s and should have lived a lot longer.  On the other hand, after weeks in hospitals and long term acute care (LTAC) facilities, he (and his family) were grateful that he was able to spend his last days at home.  During those last weeks, he tapped into the durable medical equipment industry more than most people do in a lifetime.  

Consider from the patient’s perspective: A previously healthy 50-year-old man suddenly found himself needing a wheelchair, a hospital bed, a “Geri” chair, and eventually oxygen and BiPAP.  After several weeks in facilities, a medical transport brought him home and he was met by a delivery van full of DMEPOS.  A delivery technician brought the equipment into the house and did a quick, but thorough instruction on how to use the equipment.  DME (the chairs and bed) showed up first; the respiratory equipment came a week or so later.  As the “medical guy” in the family, I stopped over a day or two after he came home to check on him and help monitor his care.  Prepared to step in and advocate if needed, I found the care, instruction, and equipment/supplies he received high quality and well done. 

During the 20 days before he passed, the family called the DME provider multiple times for additional equipment and supplies.  When his breathing and pulmonary status declined, a hospice nurse called and ordered oxygen and later BiPAP.  Every delivery was efficient and speedy and every interaction was kind and sympathetic.  When my cousin passed, it was late on a Friday night.  The family had been prepared for his passing and immediately called the provider to pick up the equipment.  I got to their home about the same time as the funeral home and the DME provider and was able to help coordinate getting the equipment out of the house.  On his way out the door, the technician, who had been to the house several times over the course of my cousin’s care, stopped to say a few kind words to his wife and adult daughter.  I don’t know exactly what they said, but they all hugged before the delivery tech left. 

My cousin’s situation was hopefully no different than that of any other homecare patient.  He had cancer.  He ended up on Hospice, which had a contracted DME service in the local area.  As far as I know, the Hospice benefit covered pretty much 100% of the home care including a team of nurses, nurse’s aids, pharmacy technicians, and all associated DME.  What impressed me the most wasn’t the quality of equipment or their flexibility delivering and later picking up equipment after hours, but rather the empathy, kindness, and patience exhibited by the staff.  To a person, they had obvious care and concern for their patients and knew how to navigate through this difficult time in their patient’s life. 

DME companies, by virtue of the nature of their work, deal with death and dying on a daily basis.  Companies that work with Hospice organizations deal with it as a specialty and perhaps more frequently or more intensely than others.   All staff should be aware of some basic “ground rules” with regards to death, dying, and grieving:

• In most dealings with patients and family members, it is always best to be completely honest & frank.
• Don’t hesitate to convey sympathy & empathy to patients & family members.
• Grieving is natural and starts before death for patients with terminal illnesses. Be aware of where the patient (and family) is in this cycle of grief.  For instance, it is helpful to understand how they are coping with their illness and share that on a plan of care so that other staff members know how to deal with the patient and family. 
• Depending on company policy, it is generally the norm to be responsive to calls at all hours of the day and night. When a patient passes away, the family may prefer to immediately get equipment out of the house.  This sometimes means picking up DME in the middle of the night. 
• Particularly with patients on Hospice services, comfort is key and usually the goal. Make sure you have physician orders –either at the DME or in the patient’s Hospice chart—to support keeping a patient comfortable.  A good example of this is oxygen, which is often ordered PRN (as needed) at the time of admission to Hospice service.  This order allows a patient to have oxygen to keep them comfortable at any time. 

All medical equipment companies should consider providing some specialized training on death and dying to all staff.  Hospice providers do a particularly good job of this because it is their specialty.  But all DME providers will encounter death and dying on a regular basis.  Providing training, typically in the form of an annual in-service, helps preps staff for what can be awkward encounters with dying patients or family members of a deceased patient.  Our human tendency is towards kindness, but training helps staff be better prepared to extend that kindness.  Hospice chaplains, hospital social workers, and even funeral home directors are excellent resources for these in-service programs.  Dealing with these issues head on prior to staff encountering a situation is much better than leaving it to chance and hoping your staff can cope themselves and present a sympathetic voice on behalf of your organization.