Hospice Training In The Philadelphia Prison System

By Phyllis Taylor, R.N.
It is 7am. The night shift is ending. A new day and a new shift are about to begin in the fifth largest jail system in the country. The Philadelphia prison system houses close to 7000 inmates and employs over 1400 correctional officers.

On this morning, like on other shifts in, each of the five facilities, roll call is being extended to provide hospice training to the correctional officers to further support this system’s existing hospice and pre-hospice program that started in 1998.

With the support of the Administration and input from the five Wardens, an overtime commitment was made to allow all officers to receive a half hour of training. Attaching the training to roll call reduced overtime expenses by allowing colleagues to cover the housing units at the beginning and end of shifts and minimized the pulling of officers from their posts.

With the officers assembled, training begins. The first step is to bring home the universal experience of pain and death. This is done by drawing on personal experience and asking if any of them have ever known someone who has died in pain. The room stirs as hands are raised and heads nod. I explain that no one has to die in pain and that one way to approach terminal illness is hospice. After explaining three approaches to illness: cure, control of the illness, and comfort or hospice care, I talk about hospice care in the ‘free world’ and emphasize what is available to them and their families.

Only after informing them about hospice in the outside community do I talk about the Philadelphia prison system and its program for inmate patients. The officers are provided with a one-page handout; I solicit and answer their questions; and offer and provide follow-up to their concerns.
By informing them of what is available to them and their families both inside and outside the prison system, they can both appreciate the personal support and in turn develop an appreciation of the value of the Hospice program for inmates.

Following are two examples that came out of the training.
A correctional officer explained through her tears that her father had cancer and was suddenly in terrible pain. She said that she always phoned her folks before coming to work and on this morning, she heard him screaming in the background. His cries in her head made it very difficult for her to concentrate on her work. I asked permission to call her folks and I too heard his agony. Her mother gave me permission to call those caring for him. By the end of the day he had been admitted to hospital; placed on a morphine drip to break his pain cycle, and discharge planning was underway. Following-up with the officer the next day, she said that now she really understood the benefit of hospice and was in the process of enrolling her dad in a program.

The other example was an officer who, recounted that his dad had died two years ago but he found himself having all kinds of feelings as Father’s Day was approaching. Giving him materials on grief and bereavement helped him personally cope and also helped him be more present and effective at his job.

Key to the success of our program has been the initial and on-going support of the senior administration. The Hospice and Pre-Hospice Program became a reality through the support, guidance, and commitment of four key individuals: Commissioner Thomas Costello, Deputy Commissioner for Correctional Administration John Murphy, Deputy Commissioner for Policy Press Grooms and Director of Training, Deputy Warden Judith Rushall.

It was Deputy Commissioner Murphy who suggested that all correctional officers receive training. He also recommended training for all administrative staff and Inmate Services staff. They receive 1½ hours of training. This includes an overview of hospice care in the community and in corrections, reviewing the Inmate Hospice Program Policy and Procedure, and showing the Angola Inmate Hospice film. An 8-page handout and a certificate of attendance at the training supplement this presentation. Also at the suggestion of Deputy Commissioners Murphy and Grooms we have met with the Correctional Officers Union and the Social Workers Union so that they are informed of the program.

Training also has been provided to the medical and nursing staff, mental health staff, social work staff, chaplains, HIV/AIDS staff from the City Program assigned to the prison, and the inmate block representatives in each of the prisons/jails. Those on the Hospice Interdisciplinary Team receive on-going training at our weekly meetings.
As word of the training spread, Internal Affairs came on-board and the training program has been incorporated into the Training Academy. All new recruits will receive 1½ hours of training. The wisdom of thoroughly incorporating training throughout the system is now bearing fruit. Increased understanding and growing interest have replaced the initial skeptical questions that surfaced when the idea of a hospice program was first seeded. This change is primarily due to the unwavering support of key individuals; to all staff being better informed; and all staff knowing, through training and personal experience, that the hospice program not only offers compassionate care and resources to terminally ill inmates and their families but also that those same resources, either inside or outside the system, are available to staff and their loved ones. Furthermore, incorporating hospice training into the Training Academy is a breakthrough step that deepens the Philadelphia Prison System’s commitment to pre-terminally and terminally ill inmate patients and to its own staff.