Carroll Hospice staff members and volunteers are skilled at dealing with crises.
The nature of their work -- helping families care for a dying loved one in a home setting -- requires them to function daily in crisis-fraught situations.
Generally, the management of the crises is gradual.
But what happens if a hospice patient threatens suicide? What does a hospice nurse or volunteer do if a family member becomes violent? How should hospice staff members handle calls from nursing homes or hospitals asking for their services?
Carroll Hospice attempted to answer those questions yesterday in a crisis-response training session for hospice staff and volunteers.
"We wanted to help our staff feel more comfortable in responding to crises," said Jill Englar, a medical social worker with the Hospice.
Although hospice staff members are accustomed to handling difficult situations, "when you get a call in the middle of the night, it takes on another dimension," Ms. Englar said.
About 25 hospice staff members and volunteers attended the training, led by social worker Ginnie Whittington.
Ms. Whittington said the most important thing to remember in a crisis is to remain calm. "Go in nonexcitable, very assured, knowledgeable and help the person through this passage," she advised.
Hospice staff members said threats of suicide by hospice patients are becoming more frequent and that some patients mistakenly believe the hospice supports assisted suicides.
"We have to say very clearly, 'I will not and cannot support you in this,' " said Julie Flaherty, the hospice's executive director. "They need to understand that is not hospice philosophy -- to hasten or postpone death."
If a patient threatens suicide, hospice staff members and volunteers were advised, ask the person if he has a specific plan to carry out the threat and then make decisions based on answers to a series of questions.
The outcome may involve calling the police, a doctor, a mental health agency or the hospital emergency room. In some cases, the person just needs someone to talk to, Ms. Englar said.
Ms. Flaherty said hospice volunteers, for their own safety, should not try to take a gun from a suicidal patient. Instead, she said, they should call the police.
Ms. Whittington told hospice volunteers that if they are in a potentially violent situation with a patient or family member, their first responsibility is to protect themselves.
"You don't try to stay and talk them down," she said.
Ms. Whittington gave hospice workers a practical tip on how to avoid injury. She said state hospitals teach workers to crouch down to avoid a punch instead of moving sideways.
Recently, local nursing homes have called Carroll Hospice when a patient has taken a turn for the worse and is near death.
In such instances, group leaders said, their main role is to educate family members and, sometimes, nursing home staff members.