Worlds Apart

Dec. 16, 2004
Worlds Apart
By Rick Fitzgerald/ SUN contributing writer
U.S. and Russian Hospice Programs Offer Care in Different Ways

The expression “It’s a small world” is used to explain a strange coincidence or something people have in common. In reality, the world’s full of ways to approach a problem that couldn’t be more different. In a lecture at Le Moyne College, sponsored by their Center for Peace and Global Studies, Dr. Susan Behuniak, a professor of Political Science, compared the hospice programs in the United States and Russia. Hospice is defined as a program where the dying can get support and nursing or medical care as their life nears its end. In her presentation, she discussed each country’s practices regarding death in several contexts.

In 2004, Dr. Behuniak and Linda Watson from Hospice of Central New York traveled to Velikiy Novgorod, Russia. “Our mission,” she explained, “was to teach segments from the course offered by Hospice of CNY to the Russian staff, volunteers and medical students.” The topics discussed on their journey included listening skills, family dynamics, comfort care and hope and bereavement. Behuniak and Watson not only show them how people deal with death and dying but also brought the Russian techniques home.

The hospice program was started in the United Kingdom in 1967. “The English began this experiment with professional volunteers,” said Behuniak. “It was doctors and nurses who were giving their time to the hospice experience. They were funded by philanthropic sources and most of the care was on an inpatient basis.” she added. The first American hospice opened in Connecticut four years later with mainly non-professional volunteers. In 1982, hospice got a big “shot in the arm” when Medicare decided to help fund it. Today, there are about 3,200 hospices in this country. Some are part of hospitals, or separate buildings, while others are trained people coming into the home.

The Russians began hospice in 1990. Currently, there are 45 centers with inpatient care with nineteen more planned. Twenty-five hospitals offer hospice care with ten more coming. “These numbers represent the units for the entire country,” according to Behuniak. The number of homecare hospices is unknown. The hospice in Velikiy Novgorod is considered homecare because, as Dr. Behuniak explained, “They have no facilities in their building to house anyone. That was where the workers would come, create the files and make the assignments. Then, they went out into the community to do the work.”

In America, hospice services are given to the entire family. They can be received in the home, hospital or hospice center. “The focus of the treatment,” according to Behuniak, a hospice volunteer for over a year, “is symptom management, making the person comfortable, not curing them.” The services are available around the clock and administered by medical personnel. Social workers and clergy volunteers have an essential role in easing a person’s transition from this world to the next. “We offer patients someone else to talk to besides family,” Behuniak said. They also work with the families to ease their suffering at this most difficult time, along with providing bereavement services to families to get them through the anniversary of their loss. The Russian program isn’t funded as well as the one here. The Velikiy Novgorod center is run by just four people: the director, a doctor, a nurse and a social worker. They see forty people a week. “They get very little money from local government and at any moment the funding could run out and they would have to close,” she lamented. Comparing Russian and American costs is impossible, but they run the hospice on about $550 U.S. dollars a month. Our program receives about $120 per person a day and that still isn’t enough. The Russians can’t even afford much of the essentials like bedpans and pain medications. Not all hospices there suffer the same fate. Other centers get money from their city and can have more staff and better facilities. All hospices have religious icons in them. “It’s very important for many people at the end of life in Russia to bring religion to bare on the experience,” Dr. Behuniak said.

Another difference is the way Russians advertise hospice. Russian ads never use the words terminal, death or dying. Instead, they say, “it’s a good place to come if you’re sick.” Here, the word hospice means death is at hand. Volunteering is almost unheard of in Russia. Although goods are plentiful, they’re expensive, so citizens have to work constantly to survive. When Communism was at its peak, “It was illegal to tell anyone they had cancer,” according to Behuniak.”The church thought they should know so they can get spiritually ready to die.” Dr. Behuniak ended the evening by revealing the biggest difference in hospice care. “Under the Russian system, you can still attempt to cure your disease while getting care. In the U.S., you have to do one or the other.” U.S. Hospice patients have to be terminal and expected to die within six months.

Volunteers for Hospice of CNY are well trained. For as little as five hours a month, volunteers can help ease the most difficult time in anyone’s life. They can also be just as helpful in the office doing paperwork. For more information, call (315) 634-1100.

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