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Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives� An International Program of Psycho-Social Health Research and Cittamani Hospice Service Research Collaboration


IPP-SHR is a collaborative initiative jointly funded by the National Health and Medical Research Council and CQUniversity. The primary aim of this international program in research is to examine and document the human experience of serious illness (both physical and mental). IPP-SHR is a broad program addressing a wide range of topic areas including: haematology/oncology; mental health; palliative care; acute medicine; bioethics; rural and remote health; Indigenous health; spirituality; paediatrics; birth studies; and service delivery evaluation. The program is concerned with contributing to the development of psycho-social services that assist people to deal with the many challenges associated with significant physical and/or mental health events. The core work is to ‘make a difference’ through research, publication, education and collaboration. © International Program of Psycho-Social Health Research. CQUniversity 2010 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the International Program of Psycho-Social Health Research. Requests and enquiries can be directed to Dr Pam McGrath, International Program of Psycho-Social Health Research CQUniversity, PO BOX 1307 Kenmore Q 4069.

Table of Contents Methodology

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Aim of Report

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Manner of Referral to Cittamani Hospice Service

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Feedback on Services Used

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· Equipment

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· Twenty-four hour care

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· Supportive care

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For a complete list of IPP-SHR Publications please visit www.ipp-shr.cqu.edu.au

· Preparedness and confidence to handle dying at home

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Suggested citation International Program of Psycho-Social Health Research, CQUniversity. (2010). Feedback from Bereaved Participants in A Telephone Survey. Brisbane, Australia. International Program Of Psycho-Social Health Research, CQUniversity

· Acknowledgement of the benefits of dying

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· Bereavement care

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· Memorial service

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· Other feedback

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Director: Dr Pam McGrath Program Manager: Mr Hamish Holewa Acknowledgements IPP-SHR would like to thank Central Queensland University Merit Grant program for providing funding for this research project. IPP-SHR would also like thank the many participants who gave their time and insights to this research project. IPP-SHR also extends its appreciation to the staff and volunteers at Cittamani Hospice Service. IPP-SHR wishes to acknowledge team members contributing to this report including: Mr Michael Bouwman, Ms Nicole Rawson-Huff and Ms Bo McGrath This is a publication of the International Program of Psycho-Social Health Research (IPP-SHR), CQUniversity Australia. www.ipp-shr.cqu.edu.au

Public Profile

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Financial Viability of CHS

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Carer Gratitude and Desire to Help

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Need for Government Assistance

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Methodology A qualitative telephone survey was conducted with caregivers whose spouses had died during 2005 and 2006 whilst receiving support from the Cittamani Hospice Service (CHS). This survey was undertaken for research purposes by the International Program of Psycho-Social Health Research (IPP-SHR) in collaboration with the Cittamani Hospice Service. Full details of the methodology are outlined in a paper published from the research, the details of which are: McGrath P., Holewa H., McNaught M., (2010) Surviving Spousal Bereavement: Insights for General Practitioners. Australian Family Physician, In Press.

Aim of Report This report aims to provide Cittimani Hospice Service with an overview of the findings and language texts derived from the study that provides feedback from the participants on the services provided by the Hospice and commentary on a range of service delivery issues.

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives�

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Manner of Referral to Cittamani Hospice Service Some participants received referral to CHS by informal means •

I always advise people to contact, if they ever need anybody I always give them the Cittamani number and say ‘look ring them they’re just wonderful’

Other participants received formal referrals from hospitals and nursing staff •

They told me that we couldn’t bring (patient’s name) home from hospital unless we had palliative care and then the ladies from – they always have somebody at the hospital representing - one of the nurses representing Veteran’s Affairs and she said she would look around and then we could take him home if they could find someone and that’s how we came to have Cittamani and we bought him home on the Wednesday I’m pretty sure it was and we had them visiting on the next morning Like I always knew Cittamani was there and what they did but the hospital or the nurses at the hospital sort of and the His doctor rang me and said ‘I’m going to doctor arranged that we would be able to use them ring Cittamani’. At that stage I didn’t even Fortunately the nurse in know who Cittamani were. They came to oncology realised [he needed a] referral or I don’t the door and they were like angels to me know how I would’ve got through

Referrals from General Practitioners were also welcomed • • •

Our compassionate doctor... who knew my husband was terrified of dying in a hospital away from his family, immediately put us in contact with Cittimani I didn’t know they existed until my GP advised me to get in touch with them and just went from there ... His doctor rang me and said ‘I’m going to ring Cittamani’. At that stage I didn’t even know who Cittamani were. They came to the door and they were like angels to me

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

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One day the doctor in charge of her case said to me, ‘look I think it would be wonderful if (patient’s name) went home for the time that she has left particularly while your family are all with you’ and they organised with Cittamani to provide a magical, hospital-type bed. Well my husband had cancer and a doctor was actually really great, he got Cittamani involved for us which was absolutely fantastic She wanted to die in her own home and that was very difficult for me for quite a while until her GP suggested that I might contact Cittamani so which I did and from that time on the whole picture changed

Not all participants reported that formal referrals were timely •

Because I was struggling to care for him at home without any help whatsoever and we only had Cittamani involved for about six weeks. Interviewer: Right so you would’ve preferred them come in earlier? Participant: Well it would’ve helped if we’d had assistance earlier Yep because there was just no referral... They just assumed I was managing but I was struggling... Yeah, I mean just physical aid. He needed a shower suit, he needed a wheel chair, he needed things. He became house-bound because he couldn’t go anywhere. But hospital never picked up on the fact or offered any help at all. That was the trouble I took him into the [hospital] to get his denture fixed and while I’m there I’ll get his port-a-cath flushed because he had a port-a-cath. And the nurse up in the oncology unit there said ‘do you – Cittamani are having a meeting today, how about we do a referral?’ I said ‘that would be fantastic’. And they were there the next day but look he died within six weeks but up until then I’d managed somehow

Feedback on Services Used Although varying in the services they used, the participants were overwhelmingly positive in their feedback on the services provided by CHS • •

Well I’d say you’d get 100% from anybody that has had the service. They’d give you 100% because they were just fantastic I, my memory of them was how wonderful they were to me. How wonderful they were to my husband you know, they were just kindness itself and I don’t think I really realised how bad he was. I don’t think you do when you’re living with the person all the time and you’re – don’t

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cause the doctors you know, we use to go regularly to the doctor but they never ever mentioned tumours or anything like that till six weeks before he died so that was very, very hard to cope with for him and for me. But you know, Cittamani were lovely, they talked to me and they talked to (patient’s name) and you know. No I have – I’m full of praise for Cittamani I truly believe that their gentle calmness and obvious efficiency was what helped me give my husband and our kids a peaceful and loving last few months to his life in his own home It was just, made it so, so good and he wanted to die at home and he didn’t want to go to hospital and he didn’t ever have to. They were on the ball about everything My experience with them was absolutely fabulous and I’ve told everybody. Everyone I come across I tell them how wonderful they were so they might end up with a whole lot of work to do (laughs) And then whenever we wanted, needed them they – we asked them and they came “They dispelled the panic, fear and confusion that gripped us. Because of Cittimani, our memories of that tragic time are of love and closeness, rather than the damaging angry and resentful chaos that it could have been. For this I am eternally grateful to them” Nothing was too much trouble for them, They came every day, they would do whatever was Their gentle calmness and obvious necessary for him; massage, efficiency was what helped me give wash, administer any sort of medication if it was needed my husband and our kids a peaceful you know, for them to do it. They supplied me with – what and loving last few months are those blankets called that you put under? Anyway different sorts of blankets to make it easier for him lying in bed. They were just superb and at the time of after he had died they still kept in touch with me, they’d ring every - occasionally you know, every month or six weeks and just check to see how I was coping Oh well I just think they were brilliant Well I just think that they’re a very good organisation. I still get an occasional newsletter from them and I just think that they are very good and everything that they did for me was spot on, it was really good and I can’t recommend them too highly because they were very good Incredibly practical and all of the ladies that came out were just, they

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

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spoke of their own experiences as well and they helped guilt, things like that to sort of disappear. Only came across one fellow but he worked in the office but he had the same sort of demeanor – very gentle but very helpful and straightforward, yeah they were fabulous The affection and love that they gave my husband in the last few weeks of his life was fantastic And as I say the follow up was excellent, I always advise people to contact, if they ever need anybody I always give them the Cittamani number and say ‘look ring them they’re just wonderful’ Yes well I think they’re, it sounds a bit trite but I use to say to them ‘I’m sure you’ve got lumps under your shoulders where your wings are’ I said ‘you’re like angels’ Anyone who does that sort of caring service to other people are gosh, they’re treasures, they’re angels Absolute angels, we’re so lucky to have contact with anybody like that when you need them, just I can’t speak highly enough of them He was, he couldn’t cope. He thought he was God Almighty. He didn’t think he’d ever get sick and he was an alcoholic and he was a very, very hard patient and the doctor suggested – his doctor rang me and said ‘I’m going to ring Cittamani’. At that stage I didn’t even know who Cittamani were. They came to the door and they were like angels to me Well I just say that they exceeded all our expectations and they were extremely helpful so, and they knew what they were doing too which was a good thing Aw they were fantastic, they’re incredibly supportive, they’re just so peaceful and gentle and they’re just there without question. They help with any – they were suggesting items that I didn’t even think about cause the state we were in but they just helped us out in untold ways, fabulous bunch of people

The quick response time was noted by participants •

I wasn’t aware that Cittamani existed until my husband was really, really sick and I must admit, once they knew they sort of jumped to and it was only a matter of sort of one night I had somebody round the house so I could get a night’s sleep And they came and then well they had to put him on the morphine, it was the end of the story but they were there straight away

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Equipment

Some participants were not aware of the extent of their own needs in regards to equipment

Many participants reported that the provision of equipment by CHS was an important adjunct to their other services

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I only had my husband at home for about eight days before he passed so it was through those eight days that they were part of my time and what would happen is they basically liaised with the doctor and had things set up and they would leave little cups of needles and they hooked him up with a driver, which is a little machine that injects pain killers and then they would leave you set up with the pain killers that you needed to use. So that allowed you to do it at home and they would come around at least once a day and help you make sure you had all the needles and everything and check up and see how the patient was going and as I said they would liaise with the doctors or with the doctor who was in charge of everything It was just that you know as I said before, it was the stuff that they brought me and to try out to make it easier for me to handle my husband for him to be comfortable and you know they just, different things I said ‘no that’s not good, that won’t work’ and they put it away and they brought something else and we got to a happy medium where I was able to you know use just the one appliance which I had to get him from his chair into this appliance so I could put him into the shower and push him round the house. Not a wheelchair cause I’ve got a passageway but it was a fabulous thing that they let me have, yeah it was They left a whole lot of products here for me to use and got me a mattress, a soft mattress to go on top of the bed and all the equipment and I could give – when he had to have subcutaneous injections they hooked it all up for and I was able to give it to him and so I could keep him at home, keep him comfortable and he loved his house, loved his little house and he loved being at home. He was a homebody and they enabled me to do that Cittamani were absolutely beautiful, they came with all the gadgets and all the things he needed, you couldn’t ask for any better service but not only for him, they were so nice to me as well And then in the last couple of days they came with the chair, an automatic recliner so he could get up and move a little bit but he couldn’t move anymore in the long run so no, and the way they cared for him was beautiful. You couldn’t ask for anybody better I think

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

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They’re just so supportive, not only did they come but a whole pile of hospital equipment came, like a new bed and a potty chair and you look at it and think, ‘oh we don’t need that’ but next to no time you do need the potty chair and you do need a different bed and it’s all there for you, it’s quite incredible really Mate they offered some [equipment]– I’m a paramedic by trade and they offered some stuff I didn’t even think of so that was fantastic, yeah They just brought it in, everything that I needed before I’d even – like stuff that I didn’t realise was available you know to do with the bed and to move him around and they brought in a chair so that I could shower him and a toilet seat so that I could get him to the toilet. It was just amazing

That the equipment and supplies provided was free was important to some participants •

First of all I yes, used some of the equipment that was there which was really good because um it was all free and they had a great um selection of different things that you could use and that was really good to be able to get those cause um my husband was terminally sick and of course you can’t just go out and buy all those sorts of things... Yes well as I said, Cittamani made no call on my finances at all although I was able to get the best. They helped me immensely. I would’ve been up for a lot of money, I am a part-pensioner and would’ve made things very difficult for me if I hadn’t had their help, it really would. Particularly things like the oxygen you know, not only the oxygen itself but the equipment for it and all that. You have to hire out and use the oxygen, it costs quite a lot of money

Twenty-Four Hour Care The around the clock palliative care and nursing offered by CHS was greatly valued by the participants •

I found Cittamani fantastic with their palliative care because it allowed people to die with dignity at home and in comfort without being in a cold, hard hospital and without them there’s no way that you could do

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it by yourself unless you had the training of being a nurse or a doctor or whatever. They – 24 hours a day basically and you can ring them at any time of the day or night I contacted them I think on three or four occasions like in the middle of the night/early hours of the morning and it wouldn’t of been any more than fifteen, twenty minutes they were here.... I’m sure they did more than what is expected of anybody else to ever do. It’s just incredible and um yeah and it just made my final days with him more comfortable than they would’ve been otherwise and I’m sure it was exactly what (patient’s name) wanted. He died at home quite peacefully and without their assistance I don’t think I could’ve done it... It was like a lifeline you know. I just had their number and I just had it into my phone and I would just press the button and soon as I’d say ‘this is (carer’s name)’ they seemed to know exactly what I wanted and I didn’t even have to be embarrassed or feel inadequate at any stage. They just were here and yeah look it was just, as I say, it was just amazing... they checked up on me for about probably two years after How did they help me? Well I think you only had to ring up and you knew they were there 24 hours a day and on a Saturday he could really, he had hiccups and he kept on hiccupping and hiccupping and I rang up and the Sister had to come from Buderim I think it really made a big difference to me but they are The provision of useful information a very good, they are very from the staff was valued by the good and they are there and they were there for me 24 participants hours a day if I needed to call them and I think I called them once when I was really down I don’t know, the powers that be to help them continue the fabulous work that they do, unselfish – like any hour of the night or anything they were, yeah, didn’t matter to them, they would give help I liked that they were on call 24 hours a day. You could call them and you were able to ask them questions and people would get back to you straight away

Skilled nursing was an important aspect of the care •

The nurses were wonderfully understanding and extremely efficient in making her comfortable. They went to great lengths long past the call of

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

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duty to ensure that she was as comfortable as possible Aw it took a tremendous lot of pressure off me yes and one particular episode I remember was one of the nurses had been here on, I think it was on the Friday and that night I became very concerned about my wife’s condition and I just wanted some advice on the telephone and I rang the number the nurse had given me. I just wanted her telephone advice but she said ‘no’ and she lives like some 20-30k’s away from here, a wet night and she drove all the way up here and she’s up here in no time at all and settled (patient’s name) down beautifully and it was just, so appreciate them going to that extent But I honestly and truthfully and this is from the heart, I’d recommend Cittamani to anybody who’s going through what I went through with my husband. As I say I wanted to shower him, I wanted to you know, I wanted to shave him, I wanted to do everything for him and the nurses use to come and I’d say ‘aw you know he’s alright, you go see somebody who really needs you, someone who can’t manage’. [The nurses said] ‘We’ve got to do it, you need to have a break, we don’t want you hurting your back, we don’t want you getting sick’, you know There was also nurses on call 24/7 so if there was – if we had any concerns at any stage we had somebody that we could reach so I think there was a great comfort for him in knowing that It was absolutely wonderful, anytime of the day or night cause he had a terrible reaction to some of the drugs, like he hallucinated and he became violent and all kinds of things and he wasn’t like that by nature

The provision of useful information from the staff was valued by the participants •

Yeah they were good, they were always there for me if I wanted to ring them and talk about anything. Yeah they just gave good information if I wasn’t quite sure of something I’d ring them and yeah, find out more information

Supportive Care Respite care offered by Cittamani that allowed the carer to have time off was noted as important not only to the carer but the patient as well •

They did tell me that I should have some time away to get out and have

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some coffee and I did have some people who came in, a lady, a different lady who came in and sat with my husband while I just had a little break and went out for a coffee... that was fabulous and I didn’t want to do it but I realised that I did need to do it so you know just an hour you know a bit over an hour I was away and I came back and yeah, it was good... The people that came in to sit with my husband obviously didn’t have any medical experience but they were really, you know they were really good and he chatted to them. He was a very friendly guy and chatted to them and they loved him, yeah

where they responded to rather than directed people was also greatly appreciated • • • •

They were very um caring and empathetic They just suggest, they don’t pump it into you and it’s up to you then whether you go along those lines or not but you know, that’s how it is But I never had any complaint about them because they weren’t pushy, they weren’t sort of ‘oh well I’ll do that,’ you know you want to take your time to think about everything They weren’t intrusive at all but they were very supportive

Counselling if needed was appreciated • • •

Well I’ve had the experience of their counselling and of their help and I’ve appreciated it immensely For me, the support that (name), our social worker gave me was invaluable. I could go there for just a chat or counselling or give her a call Um helped me a great deal. I think um speaking to someone outside the family helped greatly. I knew my family was there for me and but speaking to someone sort of outside the family ah I felt that – I felt, to get more benefit

Participants appreciated Cittamani staff’s counselling skills in dealing with difficult issues. •

I remember the first day that the first lady come in you know and she just sat down, she said, ‘do you understand what’s going to happen?’ and they started talking to us about it you know, about what is going to happen. Takes somebody who knows their business to be able to say that to anybody. You know it doesn’t matter whether it’s you know, it’s something that they you know, they do very good. And it’s not offensive, you know, what they tell you is they tell you the truth and if you can’t live with the truth well you shouldn’t be living anyway They asked the hard questions that I couldn’t even bring myself to even think about but had to be talked about and in that way my husband was a lot more realistic and so they supported him quite a lot in the fact they were prepared to verbalise those things that you know, you were thinking or didn’t talk about as a couple but they did that very, with a lot of sensitivity and gentleness as far as I was concerned

The non-judgemental, active listening on the part of the Cittamani staff

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

Participants reported that they appreciated the compassionate care provided by the staff of CHS •

Oh well in the beginning I didn’t have to ring them, they just called in. They just made it a point of calling in and you know it was, oh no, it was just, it was good, yeah all the comfort I could ever hope you know to get. I couldn’t have gone through it as easy as I did without their help Yeah I’d get the occasional phone call and you know they could tell I guess by my voice initially that I did need somebody to phone me just to reassure me that somebody else cared and realised what I was going through and then eventually I sort of got my life on track They were pretty concerned about me in the sense that because I was the only person looking after my late husband which actually he died at home so you know he was here till the last minute, they were concerned that my lack of sleep and all that sort of thing so you know all of them were looking after him and providing him with the maximum support and making him as comfortable as he was possible under the circumstances. They were extremely concerned about my welfare because as I say, you know if I happen to collapse emotionally or physically here no support at all so they you know, I got a lot of support from them

Some feedback was about the mental preparation provided by CHS for a young child of the deceased •

He was (a small child) when my husband died. He turned (age) in the August, my husband died in the March and he turned (age) in the August, yeah. So he was actually here when he died. He came and – my husband

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Non-judgemental, active listening on the

died at home and he came part of the Cittamani staff where they and gave him a big kiss and a big hug and when he passed responded to rather than directed people away and we spent quite a lot of time, we all slept in the was greatly appreciated same room that night. Spent time with him and then he actually went away with friends because I thought that the um funeral service, people would come while he was gone but actually they came when he got home and he actually helped wrap (patient’s) body and put him on the tray and take him outside and put him in the car and waved hooray down the road as it went, so he was very much part of the whole thing actually (laughs). He got up and spoke at the funeral and yeah, so very much part of the whole thing and could see exactly what was going on and what it meant when the body’s head stopped working so we talked about that, so yeah... Look I yeah, I didn’t think it did any harm at all and it was by no means a horrific experience. I think if you suddenly come face to face with death then you know. I know people that are my age, (young middle age), that you know have seen their first dead body and they kind of like, oh, you know but for him it was very much related – you know this body was his father and he understood what it meant, you know that the body was going cold and stuff. It wasn’t gory or you know. I didn’t make him go through all those things. It just happened that he was here and as (a small child) you know, (small children) do, they’re kind of inquisitive. He’s like aw you know, ‘what are you doing, putting him on the trolley and I’ll help cover him over’ and yeah, I don’t think it did him any harm. (Name of social worker) would come to the house and talk to (name of son). So she yeah, she visited kind of once a month and she would – (name of son) would take her off to the bedroom and they’d kind of talk about I don’t know, books and all kinds of stuff. And kind of leading up to the period of time when my husband became more seriously ill I kind of went to (name of social worker) and asked for assistance on how did she feel was perhaps the best way to deal with it and she said to me, ‘well look you have a very open relationship with (name of son), you know you talk about everything to me’. So she helped me to kind of cage I suppose like well ‘daddy’s body is going, you know is going to stop working’ and what that means and put it into language that he could kind of understand, which helped as well, yeah so yeah. So they [Cittamani] were I guess involved in that

Preparedness and Confidence to Die at Home. It was noted that in many cases palliative care was a precondition in many cases for the patient to die at home •

Okay, I found Cittamani fantastic with their palliative care because it allowed people to die with dignity at home and in comfort without being in a cold, hard hospital and without them there’s no way that you could do it by yourself unless you had the training of being a nurse or a doctor or whatever. They – 24 hours a day basically and you can ring them at any time of the day or night We were going to bring him home because we – I’m going to get upset about this but that’s okay and we couldn’t bring him home unless we had palliative care so that’s where they came in and veteran affairs got them and they came out and bought everything you could imagine I was very fortunate in as much we could have him at home

Participants noted the support they received from CHS gave them the confidence to attend to the patient’s medical needs •

... It was just giving me the confidence because you know he was on so much medication and that was my role you know. Ah (nurse’s name) role was the nursing role and ah checking on the medication but I was the one you know and I kept a log book with every single thing that I gave him and everything he did from a medical point of view and they would you know, just check it over which is – and it was just giving me the confidence that I could do that Yeah, yeah in dealing with death in their families and how some people – I nursed my husband at home and some people sort of say ‘oh you know he should be in hospital’ but you know, why? He’s clearly dying anyway, that’s no help and just these ladies saying it, one particular lady, her father had died at home and it was just so much more peaceful and nicer for everyone involved. I was a bit scared about my children seeing my husband die but she sort of put those qualms to rest and I’m glad we did do it that way because then the finality of it rather than if they die in hospital and just, you don’t see it and yeah. I don’t know, people talk about closure, I’m not sure but yeah. She didn’t talk me into it, she just said that this is how it happened with her father and just very gently. I don’t know, they were just lovely

Other participants acknowledged the assistance of CHS in helping them

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

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focus on the need for end of life care •

Interviewer: And were you thinking about hospice care at that stage? Participant: No, no I really – you think, death is such a strange thing, you, even with so much time that we knew about it you just think, I wasn’t prepared for what was ahead and that’s where Cittamani were actually really helpful because once they became involved they were a lot more gentle in sort of working through the next stages so that you, it wasn’t, you know you were a little bit more familiar with what was coming before it came Interviewer: And you felt that helped you focus? Participant: Without a doubt and I think that my husband always had a very good attitude. I think I was inclined to put my head in the sand although I wouldn’t of admitted it at the time, yes it did help me focus I’ve had family associations with well meaning people full of advice, some would say that’s just politely and they talked a hell of a lot of rubbish over a long period of time but we all picked up, myself and my two daughters picked up the fact that Cittamani people were very experienced, very helpful and they didn’t pull any punches either. They had a lady come round that prepared my daughter’s more so than me, I didn’t want to talk about it, for my wife’s you know, final departure and they spelled out all the bad things that could happen and warned the girls you know, like you know haemorrhaging and things like that, could be quite awful, as it, it wasn’t, it was quite peaceful and they at least, they were prepared for the worst and then when it came it wasn’t quite so bad so again Cittamani did a good job there

Acknowledgment of Benefits of Dying at Home Many expressed that the ability to die at home was much preferable to dying in a hospital, had benefits for the whole family as well as the bereaved and allowed the bereaved to have positive memories from the end-of-life experience •

Was just on the phone to one of your researchers, and forgot to mention a crucial aspect of how Cittimani helped me. When my husband was diagnosed with a terminal brain tumour, his surgeon was emphatic with us to quickly wind up his business affairs and hold no hope of for his recovery, that he had only weeks not years left to live. She was right, he

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

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died 11 weeks later. I understand her belief that false hope can be very damaging in the long run. But her verdict, so clinically given in that cold hospital room, when only days beforehand he was a vital and healthy (middle age), left me internally shattered and scattered – not much use to anyone. Our compassionate doctor … who knew my husband was terrified of dying in a hospital away from his family, immediately put us in contact with Cittamani. I truly believe that their gentle calmness and obvious efficiency was what helped me give my husband and our kids a peaceful and loving last few months to his life in his own home. They dispelled the panic, fear and confusion that gripped us. Because of Cittimani, our memories of that tragic time are of love and closeness, rather than the damaging, angry and resentful chaos that it could have been. For this I am eternally grateful to them Yes and so he, you know, in dying he had his friends here, he had his family here. It was all familiar for him and I think that meant a lot to me Well they come around, they gave me and my children counselling and stuff like that. They helped us with you know, like I wouldn’t let (patient’s name) go into hospital and you know like she’d worked all her life to buy this house and you know like I wasn’t going to put her in a 66 room and let her just you know, go to nothing and I think that that helped a hell of a lot and instead of two months she lasted roughly fourteen months and they [Cittamani] were with us for all that time... There was no other decision for me, as I said I wasn’t gonna go and put my wife into a 66 room and then you know, have somebody go and jab her with a needle every morning and night and like I – it’s just not the cancer that you know, there’s things like – Aw bringing back memories – there’s things like clotting you know like DV, Deep Vein Syndrome and stuff like that you know and they come in and they make sure they check over to make sure that you’re doing everything right and they like - I’ve never stuck anybody with a needle before in my life and they taught me how to do it you know. And then the reason I did it is because I didn’t – I wanted (patient’s name) to keep into her family life you know, the kids use to come around, like they were all living out of home, you know they’d grown up and you know the two of them got married before she you know, before she went and they were you know, terrific days and she really – her last years she really enjoyed, she loved it and she would go and do things you know normal people would do and if you looked at her you’d think, ‘there’s nothing wrong with her’. You know and it was only the last - as her organs started shutting down. My daughter’s birthday is on the, the second last day of the year and she waited around and waited around and you could see

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her doing it. She wasn’t going to let it beat her because she wanted to be here for her daughter’s birthday He always said he wanted to die at home and I’ve always made sure – and I said to him ‘that is very well for you to say but don’t forget if I can’t look after you, you might have to go somewhere else’. And he accepted that but fortunately because of all the help at Cittamani I was able to care for him at home. In the beginning they only came probably once a week to see and they’d give a call as well to see how he was going because at that stage you know, he could still do things even though he was very tired but he would still walk around. And then in March round about the twelfth I think it was, the eleventh or the twelfth of March he became very restless and then the doctor came and he said, ‘okay we’ll get the nurses in now’. And they came for the next three to four days till he died and it was very, very helpful. They’re very, oh what can I say, supportive, they’re very, very good Interviewer: Yes, yes and the decision to stay at home instead of going into hospital, that was one that you made fairly easily? Participant: Yeah I made, I promised it to my husband, of course it was difficult in the end because the cancer had gone to the brain and the part of the brain was affecting his legs so he could not move anymore. And - but I had two, my boys came up and a friend came up from Cairns and I had all the care. When the news was all finished Fortunately because of all the help he smoked and he made it most of the 66 years (laughs) at Cittamani I was able to care for [inaudible] yes, yes but it him at home was good to see. He never complained, it was incredible, I said to the kids ‘if you can learn something from dad, is how they are to die’ so… ... You know, we were able to look after him at home right to the very end and that was absolutely wonderful and you know his friends would come visiting for morning tea. I’m not sure if they came to visit for (the patient) or just the morning tea [inaudible] and no it was, yeah they [Cittamani] were absolutely wonderful

a grimace, she didn’t screw up her face or [inaudible] her eyes had been closed for about three hours and all of a sudden she just opened her eyes up and they were fully dilated admittedly but she just sort of closed her eyes with a smile on her face [inaudible]. She must of liked the place she was going, you know what I mean? He died such a beautiful death... It was so he never had a pain, it was so peaceful and all he was worried about is what was going to happen to me

Assistance on the actual day of the death was most appreciated •

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Their thought, their process in the days leading up to his death and when he did die again was outstanding. They were you know, as they said, they would be there on the end of the phone and they were and I did need them and they did come out you know at midnight or one o’clock in the morning and you know, sort of told us what to do when he died cause I wouldn’t of had a clue They came and they saw me and they sat with me and on the day they – that it happened they’d just been to see him and they said to me ‘it is time’ literally because these people know apparently and it gave me a little bit of insight to know that I had to attend him then and there otherwise I wouldn’t of been given another opportunity Yeah, in fact I think on the day that my husband died, I think they were backwards and forwards about three times so They were on call 24 hours a day and they were actually there when she died but they’d already been out twice that night, a long drive out and they – I just could not say, I have nothing but praise for them and if anybody else needs help, I recommend them, just absolutely wonderful self-less people and then after, after she had died they helped, they fixed her up because it was the middle of the night and doctors wouldn’t come and they.. They had to you know, because see they have to sort of – whatever they do you know cause you can’t leave a body just lying there for seven or eight hours

Some participants remarked on being able to observe and participate in the death in positive terms •

Watching her die was very satisfying, the way she went, she didn’t go on

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

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Bereavement Care Carers appreciated the routine follow up and compassionate care from Cittamani during the bereavement period, the sensitivity of the staff to their stage of grief and preparedness to reach out to include carers in need •

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I would get a phone call from one of the counsellors at least once a month, sometimes twice a month just to make sure I was a-okay. They really and truly, they are so supportive. They’ve got a wonderful name up here on the Coast... Yeah well it wasn’t so much grief counselling as they’d ring up and make sure that I was okay you know, the – because we had been warned what was going to happen with my husband so to a certain extent I was prepared but no, as I say, those girls – nothing was too much trouble for them. They would ring and we’d have a chat and you know, not just about my grief but about things generally. They were just such lovely people So I never went to any of the grieving things but I did, (name of social worker) did ring me every now and then for support, she sort of leaved it with me if I want to ring her I chatted with the counsellors. They were you know, very, very good, very caring and listened to me and I mean it was counselling probably soon after my husband passed so I was very, very Many mentioned they derived tearful. Very sad, sometimes I just said ‘look I just need to benefit from the bereavement go’ because I was just you know, I couldn’t talk about it support group and stuff and I was getting very upset. They were just darlings, they were lovely people, absolutely, absolutely I gave her Cittamani’s number. And she rang them, she said, ‘aw I don’t think I’m brave enough to go for a group or’. I said ‘look just give them a call and even if you just speak to (social worker) you know, you may find that a help. She may put you in touch with some people’. Anyway she’s lo and behold about a month later she came into the shop, she said, ‘I’ve just been to the first group’ and she was just beaming. She said, ‘you don’t know what it means to talk to people who understand, who’ve been through the same thing that I have’. And I said, ‘well I actually I do and that’s why I sent you there but I’m so pleased that you know, it’s been a benefit to you’

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

• •

Anything we needed they were there for us and then after it was over they just kept in touch with me, I think it was about every ten days and I could’ve gone into their place at Palmwoods if I’d of wanted to but I had my boys home so I was sort of felt as though I didn’t really need it but they still kept in touch with me for twelve months But then after he passed away I um – it was a few months before I was even I suppose game to go out of the house but um I went up to group counselling which was really good And then after he died I had to have grief counselling from Cittamani and the lady came because I can’t drive and she came from Palmwoods and stayed here for an hour and a half and I talked and I cried and I cried and I talked and she said to me ‘I can’t do anything for you, you have to do it yourself’ but she kept on ringing me every couple of weeks to find out how I was going and she did it for a whole year, so I thought that was absolutely beautiful. Interviewer: For a year? Participant: Yeah for a whole year, yeah and on his birthday she rang me and she rang me for father’s day and all those kinds of things Aw look I found it very, very good. I have family who aren’t in contact with me very much so on a weekly basis one of the counsellors would ring me and talk and I found it very, very helpful to be able to have somebody to talk with. Somebody who was very sympathetic but also we had a great rapport too, the lady that helped me at that time and also the follow up with meetings and lovely lunches with other people, you know men and women there. I found the whole service was for that first year, which was when I needed it, was excellent I did, yeah I mean my husband died – it’ll be four years this Christmas and I’d say for the first two years you know I’d had the occasional either visit or phone call or contact or I’d go out there. It took me I’d say a year because my husband and I were very happily married for over 50 years and it took me about a year I’d say to sort of pick up and you know, make a life for myself which I have done now. And they were a very big help to me in that time Absolute angels. I’ll never forget them. I thankfully haven’t – after my husband passed away they rang me for a whole year. They knew because of the situation in the family they knew it was pretty difficult for me and yet they still kept in touch for a whole year to make sure I was alright And Cittamani for sure, for some months after (patient’s) death they rang me every week I think it was, to see how I was going and I really appreciated that

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Many mentioned they derived benefit from the bereavement support group •

And what was very good is that you don’t feel like you’re Robinson Crusoe ... And because most of us had children, we could also talk about you know, how it was affecting our kids and hear other people’s stories and from that sort of say ‘oh well you know my child’s going along okay’ and be able to put in like, just have open discussion with them. Yes because you really have to I suppose walk the path yourself before you fully understand

Some mentioned group counselling was not helpful, or that they were not ready for it •

Yes and I went there a few times but I found that didn’t help me, some people need to be on a sort of round table conference but I just kept looking at there’s so many people I thought ‘you’ve got to move on from that’ and then because I was the sort of new partner in the group I didn’t feel like I could say it Interviewer: Do you think there’s a potential for those bereavement support groups for the person who’s dealing with it the worst to affect the other people who want to move on? Participant: Yeah. It was good to talk but I don’t know whether it healed but I only went the once and I think with something like that you need to go – I just don’t think I was ready. The lady was really good and very helpful but I don’t think I was ready at the time

name) and went, ‘Ah you know I really, really need something’ and she looked in her books and saw that there was a couple of other families at the time and got together with us at the park and it kind of went from there. So yeah, it was kind of – we were all kind of, you know middle twenties to kind of forty. So that kind of, that carried on so yeah… Interviewer: That really shows the value of having like-minded people being able to talk to each other? Participant: Aw it is absolutely invaluable, it really is. I truly don’t believe that you can understand somebody’s journey and every journey’s different but you can’t fundamentally sum up the things they say unless you have walked the walk and that, be it for divorce, you know abortion, any story of life really. Unless you have personally been through that experience I’m not sure that you can really grasp some of the ins and outs of that situation. Yeah so I just believe it was absolutely invaluable to have that support So that was basically their palliative care and afterwards I joined their bereavement group which was the first one that they set up for younger people, previous to that I think they only had a bereavement group for everybody and obviously there are a lot of very old people there so it was good to be able to meet other people in the same situation as yourself

Mention was made that grief counselling was provided for children and the need for it •

A support group for younger widows and widowers had been established and was reported to be of much benefit since since they were outside the usual demographics of bereaved persons

Yes, (our daughter) had a lot of grief counselling,..you know my son, you know he put on a high - very you know, very big front but you know thing is that you know it affected us all and actually I’ve just been going through depression and hopefully coming out the back side of it now you know...

One participant remarked that more should be done for the young bereaved •

So but our young person’s support group – we’re having dinner together next month and we had coffee last month together so we kind of still get together once a month, once every couple of months. Kind of ring each other and there’s kind of a core of four and kind of six of us that will get together every now and again and keep each other in the loop so, yeah. So that’s been ongoing, stay – more week to week kind of relationship Interviewer: What’s the name of that support group again? Participant: It is just – well I don’t actually know what (CHS staff member’s name) called it but we called it the “Young widow/widower’s support group”. But I don’t actually know what it was labelled, it was just kind of like, yeah as I said, I just kind of went to (CHS staff member’s

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

... It would be nice if there was something more for children though, you know, more guidance in that respect, that - probably because that is one of my fears as well, that you know, ‘is my son travelling along okay, what’s all the scenarios that can happen with him?’ and support but it’s very difficult for children to have counselling or to speak openly. It’s been three, over three years for myself and my son still can’t even verbalise it in class or if people ask him you know, ‘what’s your dad do?’, he basically runs away or doesn’t answer or otherwise he gets very angry and upset and doesn’t want his emotions to show so…

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Memorial service

Other feedback

The memorial service was well attended and those who did attend reported of it positively

Some made favourable comparisons with other services

I’ve also been out to their, what do they call it? Remembrance day you know, where we take the photos out and talk about, aw yes it is the best, the most wonderful service, we’re very, very lucky to have Cittamani girls... It was lovely because there’s a big crowd, we had it out there at their home base at Palmwoods, beautiful day, we all sat outside in the sun, had a few different speakers if you wanted to get up and say something you could. We all took photographs of you know our partners or brothers, sisters or whoever had died and had the photographs there and prayers were said and flowers, it was just, it was a comforting sort of a service so all in all I’ve got nothing but the highest praise for the Cittamani Service They also ran a memorial service, they had a memorial service up there one day that we went to and yeah that was lovely

I think they talked about (other service) and I don’t - I have nothing against (other service) but all they do is paper work. They come in with a big pack of paper work, look on the watch, ‘oh no the time is up’ and have to go and that was never Cittamani, so and everything was free so I gave them a good donation after it was all finished but they didn’t ask for any money at all ... Look I’ve got friends in Melbourne that lost their husbands just a little bit before I did and you know, ... there’s this palliative care place but no, you know, people ringing them to find out how they were or you know, they could’ve been dead or alive, it wouldn’t – you know there was nothing like that but here at Cittamani was marvellous I chose them over (other service), the reason other than there was no phone calls with (other service) and I found them really nice, really comfortable to be with

Although CHS has Buddhist affiliations, it was noted by participants that its memorial services were non-denominational

And some made favourable comparisons with hospitals

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They have a service, it’s a non-denominational service up at the place Aw yes it is the best, the most wonderful at Palmwoods and it’s to service... it was just, it was a comforting honour all their clients that have passed away... And sort of a service it’s the most wonderful afternoon Oh yes, once a year. It’s usually in about October or so and they will have a variety of faith denominations from you know, anyone Well that’s typical Buddhist outfit isn’t it, I mean they just sort of play in the background I mean it obviously doesn’t matter what religion you are I mean [inaudible] but the Buddhist philosophy is a lovely philosophy whichever way you look at it so you know it’s um okay but I didn’t even know that (patient) was interested in it actually which I found quite funny

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

I had a friend of mine who passed away last year and he went in to that ward and like they get left in a room by themselves you know and the nurses try to go around and do as much they can for him but it’s just you know, it’s not the same contact because it’s not your flesh and blood. It’s not your loved ones whereas if it can be done at home they can pass away with dignity and that’s what it’s all about. Just because they’ve got a terminally ill you know, something in front of them, whatever it may be, they gotta be able to leave with dignity and that’s very, very important I had nursed – you know I trained in the UK years and years and years ago... I mean in hospital as I remember it and which is entirely different, it is different to the attitude now is that you know the specialists would come, he would be one side of the bed, you would stand with your hands behind your back the other side of the bed. You would talk across the bed as though that person wasn’t there... I just felt um so ah, it was so comforting and so supportive

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Very little negative feedback was reported and if so it was constructive in nature

about you know, what was going to happen next kind of thing. And they would kind of send a nurse if there was anything kind of physically wrong that I maybe thought that because I’d rung and the fact that maybe they would’ve sent a nurse down who might of just been able to give a bit of distance and a bit of perspective but yeah. But that was the only negative thing

One participant raised that they would have preferred to have heard earlier from a CHS counsellor post bereavement, since they did not have family support •

No, the only thing I brought up at the time and I don’t know if they’ve corrected it but they use to wait six weeks before they’d have sort of the post chat with you and see how you’re going and I felt that I really needed that at the beginning because I didn’t have anyone else here but I did speak to them about it at the time and they were going to look into that ... because I just – once everybody’d left I was on my own then. I didn’t know anyone here whereas most people probably have friends and family around, I didn’t... well they thought it was a time for you to be with your family and tend to back off but I didn’t have the family

One participant had concerns about having to face the patient’s death alone when it appeared imminent •

Another was concerned about the protocol when a patient had become violent •

Yeah to be honest I didn’t have any – once I remember my husband was quite, went through quite a violent - not violent in that he actually became violent but I felt that he would maybe soon be flying with a punch because he was so, innerly frustrated and angry and that’s quite a phase that a lot of patients go through and I know within our group, the girls have talked about the fact that their husband’s actually became these demonised people you know. And we know that it was the illness that was causing it and one day I was quite in fear for my (son’s name) and for myself and I rang Cittamani and went, you know, ‘you’ve got to help me, what do I do?’ My doctor was away and they kind of said, ‘... You know you’ve got to get - just go down and talk to your doctor’. And I was kind of in fear and I had maybe hoped that they would say, ‘look we’ll send a nurse down and she can maybe sit down and chat with (patient’s name)’ kind of thing. So that was kind of the only negative experience in the whole thing that I had, is that my expectation of them perhaps giving me physical help in that situation. But that’s not really their job and I understand that, so I duly go off to the doctor. That was the only negative, that I – the only experience that I had where they came up short if you like (laughs) yeah, where I – you know, I’m sure they could tell from the other end of the line that I really was deeply concerned

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

It’s not a criticism because I don’t know the full system that they work under but the day that (nurse’s name) came here and we had to put in the urethra tube and the drain and all that sort of stuff and (patient’s name) just all of a sudden, about eight o’clock in the morning she was, virtually comatose and (the nurse) came in and we gave her a wash and was talking to her and she started, fluid just started to drain to her back and that sort of stuff and she was just like a slab yet she was still talking which was half out and we were just making her comfortable and I was ringing around at that stage trying to find her a bed in a hospice cause I couldn’t do any more and I rang up a couple of doctors that I knew and one of them’s a radiologist and he was on the verge of getting me into Caloundra because I’d been looking after her at home for twelve months, well for about twelve months, it was getting a bit out of hand. Fortunately in a way she didn’t, she was gone but well (the nurse) said ‘she’s not gonna last a day’. Only thing I’d go to criticise, when she passed away (nurse’s name) sort of was, nobody there from Cittamani, no, I hadn’t got a clue what to do, (nurse’s name) left. I said something to (the director of Cittamani) about this and I’ve said it to a couple of girls, I didn’t have a clue what to do

And one other participant was concerned that they had not been briefed as to the formalities that followed the actual death •

Who do you ring, the doctor? I thought I might have to get a death certificate so I rang (doctor’s name) and he said ‘no you don’t need that, you ring the undertaker, the mortuary’

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There was a comment made by one participant about public patients receiving better information than their private counterparts

Financial Viability of CHS

Some participants showed concern as to the ongoing financial viability of CHS

Now if you are unfortunate enough to be a private person as I was, you walk into a doctor’s surgery and they kind of say, ‘well this is the surgery we’re going to do and this is what he’s got’ and then they send you to specialists. Well you miss all of that base support so I would be really pushing for the specialists who deal with us, like my husband’s case was oesophageal but I know another girl that had nose, ear and throat. She was private, she never even found out any of this was available. So I would really be pushing those specialists who are you know, dealing with cancer patients and doing these surgeries, to have an information pack with some support that they can give as well because if you’re public then you’re quite well made aware of all the different things, including you know, Centrelink and all that. But if you’re a private patient you’re not, you have to find that out all yourself... Yeah and you know, sometimes your doctor’s just aren’t giving that information freely as if you went as a public patient to a public hospital. Yeah, there’s a huge gap if you’re a private patient

Carer Gratitude and Desire to Help Many demonstrated strong gratitude and a desire to give back to CHS •

Public Profile

It was reported by some participants that CHS was not well known, even in their own catchment area outside of the health services •

Yeah, but I mean if you were to ask ten people in the street I would say – that’s up here on the Sunshine Coast, they possibly, eight have never heard of Cittamani. It’s only the people that are, that have had you know, dealt with them, that have needed them or people in the, in the medical profession, they know of them Yeah, lovely lady, all lovely ladies. Yeah so and it’s because my daughter was originally - she was a volunteer for them that I even knew about it. A lot of people when I say the Cittamani nurses ‘oh haven’t heard of them’

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

I mean I’ve just been talking to a friend in Brisbane and ah a place called Zoe’s has closed done and I’m just - please I don’t ever want to hear that Cittamani has closed down for the same reason. I just think - I don’t know what Noosa would do without the likes of Cittamani. I just think it’s an outstanding place

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You know I’ll tell you how grateful I was for the help they gave to my wife while she was terminally ill and I’ll never forget, I’ll never forget that. I’ll never forget that ... I probably rang (CHS staff member) about six months ago cause I did, after my husband passed away for the next two years, we did a sausage sizzle at Bunnings as a fundraiser for them once a year and that was our way of giving back some of the things that they loaned us as families. This was our own support group that did that so I kind of had a bit to do with them re the sausage sizzle thing Yeah, I had heard that they were in trouble and I was a bit concerned that they might be closing or parts of their service closing No I just think what they do up there is very, very good and um probably nice if the community supported them a little bit more. I don’t know whether that – cause I know that they struggle along a little bit too. I’m pretty sure they struggle along um but they’re great, wonderful, wonderful people In fact we, you know they needed a (piece of infrastructure), I do (infrastructure) sales and they needed a (piece of infrastructure) sale for – they have an area up there where they have a little bit of a you know, they have areas where they um you know, people can go and

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• • • • •

they have a service and all that type of stuff for different people and that, you know different problems and all that type of stuff and I organised a (piece of infrastructure) and everything like that and we put it all in there for nothing. You know we got people to do all the (infrastructure construction) and stuff like that because they’re you know, they’re a Many demonstrated strong you know like a non-profit organisation gratitude and a desire to give I just wish I had the money - to give them some money to keep them back to CHS going, the one in Nambour because they were so good Actually there was an article in the paper I think yesterday about Cittamani because they need to do some fundraising and at the moment they’re turning about 25 people away you know from the service a month because they haven’t got the funding. I think they only get about 100 to 50 thousand dollars a year from the government... That’s definitely not enough. You know whenever I’m able I’ll always make a donation but you know, it’s – there’s so many charities and I prefer to give it to Cittamani I must admit Interviewer: Yes, yes I have heard a lot of people that I’ve been speaking to have a feeling that they’d like to give something back Participant: Oh definitely, that will never stop me, unless I’m broke of course (laughs) Oh if I won the lotto tonight I’d give it all to them I give them a couple hundred dollars a year, every little [bit] helps I suppose Rely on people like myself, I’ve made provisions in my will for them and also whenever they send out their little letters asking for donations, I manage to find a few dollars I wish they could get more, I wish they could get more financial help from someone I think we should all support these places because they don’t get any funding or very little and it must cost a lot to run those cars and the nurses and all that equipment and all the knowledge they’ve got, they’re so expert at what they do you know

Report: Participant Feedback on Cittamani Hospice Service from Research Project “Does Bereavement Support Save Lives”

Need for Government Assistance to CHS There was also a feeling that more should be done at a Government level to assist CHS •

• •

They are, they are really you know like all that type of stuff should be looked at by the Council - not the Councils but the Government. You know like it’s very good for a politician to be able to turn around and put his hand out and grab a nice big fat paycheck at the end of his time but what comes around goes around. And you know, these people there, they’re trying to you know do everything on a shoe string and far as I’m concerned not only Cittamani but you know every one of them would be the same you know, you’ve got your Blue Nurses and all that type of stuff. All those types of people are people who put a hell of a lot of – and it’s not just a job to them, it’s a way of life, that’s the big thing and I found that out first hand and they’re not people that you know, come in and go ‘[humph] I’ve got to do this or [humph] I’ve got to do that’. They come in and they give you their heart and soul and that’s something pretty special They need government backing to continue, I don’t know whether they get government backing or not but I do think that they do need government backing because as the population is getting more elderly and a lot more of us are going to go through these stages um I think that you know, they need the financial I guess help as well as anything else so we need these [services] It’s a wonder the government hasn’t been pressured to do something really, they’re not are they, they’re still not doing anything are they? I suppose it’s like everything, they probably need a little bit of uplift from the government but I don’t know whether we’ll get that now. I think that all those places do, they’re always you know, they can’t run on nothing can they? I’m sure it’s going to help the government too because you know, there’s a hospital bed available that we didn’t need sort of thing you know so. Cost more for the hospital than it was for Cittamani to do that. That’s why Cittamani should get a lot more government support you know, they had you know, they should be 50, 60 percent at least support even more you know but the government, cause they look after so many people that don’t need hospital beds, you know I mean a whole ward you know and they don’t need so I think that that’s important. Yes I hope so, I was thinking, some of my thinking about it that the government should be most anxious to subsidise this service because it’s keeping people out of hospital. Saving them dollars, if you just look at it from a mercenary point of view, it’s saving the government lots of money

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Contact Details IPP-SHR, CQUniversity, Brisbane Office, Po Box 796 Toowong Q 4066 Australia Telephone: + 61 7 3025 3377 Email: ipp-shr@cqu.edu.au www.ipp-shr.cqu.edu.au


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