Six months ago, the staff of Carroll Hospice wasn't even thinking about using music, aroma or color as therapy for the terminally ill patients they serve.
Plans for alternative therapies to help dying people feel more comfortable and relaxed are among the changes sparked by the federal government's approval of Carroll Hospice for Medicare reimbursement in September 1992.
Eligibility for reimbursement of $92 a day per patient from Medicare required the hospice, which had relied primarily on volunteers, to increase its professional staff.
"We're able to bring in a whole medical team now," said Julie A. Flaherty, executive director. "In the past, it was just that volunteer who sat at the bedside and gave TLC, [but] that was important. Volunteers are still the backbone of our organization."
The hospice staff has grown from four to 18 full-time and part-time employees, including nurses and home health aides, a physician, social worker, nutritionist and physical therapist. The service relies on 193 active volunteers, who in 1992 gave 9,000 hours to patients.
To accommodate the growing staff, the service moved at the end of December from 600 square feet of office space at 30 Carroll St. in Westminster to 2,000 square feet at 95 Carroll St.
Even that is not enough, Mrs. Flaherty said. The hospice may need to expand into offices across the hall to give the nursing department more space.
Carroll Hospice has begun offering massage therapy, with three therapists who volunteer their time for sessions that range from a standard massage to a simple stroking or touching for patients with bone cancer whose bones are too brittle to tolerate a massage.
"A lot of patients aren't touched because they're cancer patients," Mrs. Flaherty said.
Alternative therapies can help make the last days of dying patients more comfortable when chemicals alone are not enough, Mrs. Flaherty said. Her eventual goal is to employ an alternative-therapies nurse, but in the interim, the staff is starting to use music as a therapy tool and exploring color and aroma.
Hospice volunteers or staff members can't repaint the walls in a dying patient's room. But color therapy can be something as simple as putting a comforter in a soothing pastel color on the bed, Mrs. Flaherty said.
The impact of color was brought home to her by a cancer survivor. The former patient said she now gets nauseous in blue rooms because the room in which she took chemotherapy was blue.
Patients can be made more comfortable with changes in lighting or in the color of the sheets, Mrs. Flaherty said.
"It's a little thing, but it might make the patient feel a little bit more relaxed," she said.
Scents can help terminally ill patients cope with the odors of foods they might once have loved, but can no longer tolerate. A hint of roses, lavender or cinnamon tucked under the pillow can reduce the nausea caused by food odors, Mrs. Flaherty said.
The reimbursement of $92 a day for Medicare-eligible patients doesn't cover all the costs of medical care, medicines, oxygen and special equipment, Mrs. Flaherty said. For example, a pain-management pump that allows a patient to self-administer morphine costs the hospice $192 a day to operate.
Medicare eligibility "has enabled us to provide a lot more, but it has caused us to increase our fund-raising," Mrs. Flaherty said.
The hospice operates on a budget of about $200,000 a year. In 1992, it served 130 patients with about 500 family members.