The Pillars of Hospice: A Deeper Look at Home Health Aides

The Pillars of Hospice

A Deeper Look at Home Health Aides

In our society, there are a lot of pre-conceived notions about hospice care. Often those presumptions stigmatize the core intention of hospice and prevent patients and families from taking full advantage of the services available, sooner rather than later.

To provide our community with an in-depth look of the core values of hospice, we have decided to create a series featuring the pillars of Hospice. For our second installment, we’ve spoken with Stella Felix-Villarreal, CHHA, one of our very dedicated, passionate, and caring Home Health Aides, to learn more about her role in the hospice experience, significance to both the patient and the family during this challenging transitional time of life, and the vast number of memories and stories she cherishes.

We interviewed Stella through a Zoom call while she was in her car. Due to COVID-19 restrictions at our office, our staff are asked to not come into the building unless necessary, to prevent potential spread amongst staff. Since the Wi-Fi at the office can reach the parking lot, Stella ends her days with her charting and documentation from the warmth of her car.

What is the significance of home health aide care as a discipline of hospice? How does your role and what you do relate to the overall interdisciplinary hospice care?
As the healthcare provider, we assist in the very hands-on care of our patients. We help provide personal care, usually in a home setting, but it can also take place in nursing homes and acute care hospitals. We work directly under the clinical supervisor nurse and or case manager. We get our orders from the nurse and they determine the care for each individual patient.

We also offer support to both patients and their families by being able to encourage and expand on their own knowledge of providing care within the activities of daily living for their loved one within our scope of practice. Often we’ll hear comments from the families such as “I don’t know what I can do. Can I do this? I don’t know what I’m doing. Can you show me how to bath or dress my loved one?”

The role consists of a lot of active listening and being present in the moment, a lot of encouragement, and being able to validate their concerns and being supportive—letting the families know that they’re doing a great job. They don’t do this as a profession, but just because they are there, being present in the moment, providing for their loved one and giving them the emotional support that they need is, I feel, more than enough. We come in and supplement that. I’ve also felt that the whole idea behind hospice is being able to provide wonderful care in a private home, in their own setting. Which we all know, when you feel really comfortable at home we tend to do better and feel better.

From your perspective, what is the impact of the care that you provide on our hospice families and patients’ experience?
By being able to actively listen to what the needs of both the patient and the family—we’re not only there to take care of the patient, but also the family as a whole. If the home health aide (HHA) isn’t able to provide answers to some of their questions, we’ll bring it to the attention of the nurse supervisor or case manager. We can give them the tools to assist the patient, and by tools, I mean a lot of information and support through demonstration. Some of the fears I constantly encounter are “How often do I have to turn them? How often do I have to change something as personal as their brief? What about if they don’t want to eat? I want to feed them and they’re not taking in fluids.” We always direct them to the hospice handbook for what signs to look for and to further understand what the whole end of life process consists of. And if it isn’t the HHA it’s the social worker or the nurse. If it hasn’t been asked, we also inquire if they have any spiritual support, because we also offer that as well.

Sounds like you are a coach.
When I first started doing this line of work, I was told that, out of all the disciplines, it’s with the HHA that the patient really “lets their hair down” because we’re in such an intimate setting. I can be doing something as simple as a shampoo, and it’s just like when you go to your hair salon and you start talking to your hairdresser, you just let your hair down. It’s the same with an HHA. I guess it is because we are very non-threatening and we’re there present in the moment—whatever is on their mind they share with us, which I find to be such an honor and a privilege. Where else can you have a job where you can get that kind of a one-on-one with an individual? I’m always amazed when I get to say to myself, “Wow, how lucky I am to get to come into their life during this chapter of their book of life.” It’s very special.

Do you have any memories from your time working as a HHA that you’d like to share?
That is a very tough question. I have 41 years of experience and 14 years working in hospice, and there are just so many memories. Each one is so unique. When I’m with a patient I love to ask “So tell me how you met your spouse? Who asked who out first? How did you meet?” The stories are amazing, and some have been hysterically funny.

There was this one where the husband said both he and a friend went on a blind double date, each one setting up the other with a gal, and both of them ended up being attracted to the other’s date! Years later, when I was taking care of his wife, he told me that he’d be going away for a month on a yearly hunting trip with a group of male friends and he said to me “There’s lesser and lesser of us getting together.” When he came back and I ask him how it’d go he said, “I don’t think there’s going to be a next one.” And I just listened to him reminisce on the fond memories. As he was reminiscing, he glanced over to his spouse and you see—even though he may be looking at her 80-year-old body, he was seeing his young bride. Just to be able to be there in that moment and see that, it’s really such a gift. It makes you realize what is important in life.

I have another memory, this one of a lady that when I came to care for her husband, before we went into his room, she expressed all her fears to me. “I don’t want to see him die” is what she told me. “I hope it doesn’t happen when I’m there.” I told her not to worry and that “I’ll get your husband nice and spiffy.” As I was bathing him, I said to her, “How did you and your husband meet?” and she told me their story. I could tell her husband he was nearing the end. She left the room to go fetch his pajamas, and as she walked out, he left this world. I was very aware of it, but since she expressed this deep fear of death, when she returned with his clothes, I let her continue to reminisce. After we got him cleaned up and dressed, I said to her “I think your husband just left us.” She said, “Are you sure? He just looks sound asleep.” I checked for a pulse and did the breathing test, and I said, “He left us.” And she said to me, “Stella, that was not scary at all!” That made me feel very relieved that I was there to guide her through that experience.

I’ve had many patients die in my hands while washing their hair. I always call it having a spa day—they get so relaxed that they decide to leave. One daughter once said to me, “My mom is such a prankster I wouldn’t put it past her to decide to leave while getting her hair shampooed.” So I’m shampooing her hair and I looked, and I thought, she just left us, and I said to the daughter, “I think the joke is on us, I think your mother just left us.” She laughed and cried at the same time. “Oh my god Mom, really?” The mom really loved going to the salon getting her hair done once a week. So right there, in the middle of the spa day, she left. I feel so honored to be there to provide comfort for both the patient and the family. Most of the time, the patient is already ready, but they’re aware that the family is afraid of them leaving. But when I’m there, they are comforted by the fact that there is someone else there to help guide their loved ones through the process and keep them from being afraid and alone.

To me, hospice isn’t a job. I have the privilege to go visit people every day and make a connection, to be there in the moment, and when they share a chapter of their life with you—it’s a wonderful honor. I always tell others, people are not knocking down our doors for a job—when they come through our doors it’s a choice that they’re making. Many may think, “Who wants to work for hospice, end of life care?” I believe you must be in the right mindset.

What do you say to people that you talk to about what hospice is and how it is actually a great service they should utilize?
When I first heard about hospice, I was 18, I had no idea what it was. When I attended an in-service, I was I awe, and I thought “that is how it should be.” I learned how a lot of patients don’t want to be in a hospital, they want to be in their own homes, with their families and possessions, in their own bed. What’s a better way to be at the end of life than in your own home? That really resonated with me.

I’ve worked in many hospitals in different states, and always in my back of my mind was hospice. But first, I wanted to gain the physical and emotional capabilities I needed to come to work for hospice. Emotionally, I wasn’t quite ready for awhile because when you bond with your patient and their moment comes and they pass on, we may not be blood related, but we’ve bonded and created a relationship and you have to say goodbye. And you grieve. And all you have left are those beautiful memories of another human being who allowed you to come in during this chapter of their book of life. That to me is what hospice is about, the individual, and their families. And the families can be blood related or not; in some instances, a neighbor that has lived next to them for 30 years becomes a part of their family.

We often get to our patients one or two days before they pass, and as I’m bathing the patient and the family member is there asking questions, and I tell them all that we have to offer—the nurses, the doctor, the musicians, spiritual counselors, and our volunteers. I wish people came on service sooner so that we could offer them our support for longer. I tell them people have this morbid idea of hospice. They think hospice just comes in on the last day of life, or two days before, and that we come in with all our medications—and some people have even said—to put you to death. Where did they get that idea from? Especially in the Hispanic community, morphine is so terrifying to them, they have no idea that morphine is used in many ways. And I’ve been guilty of this too—I’m Mexican, and I once went to one of my supervisors in the hospital and I said we’re very afraid of morphine, and I come to hospice, and you use morphine. In my culture, morphine is used at the very end. We have this idea that they are going to take our loved ones away. I told her my fears and she educated me on how morphine is used in this setting. I’ve had a few patients ask me to bring them their morphine and it freaked me out. So I knew I needed to educate myself and it was a learning experience. You always think you know everything, but you are always learning. When people express their fears to me about medications, I say, “It sounds to me like you need more information. When your nurse comes ask them, and they’ll explain. They know more about it than I do!” Once it’s explained it just removes that fear. And that impression of it—even to this day I run into friends who say they don’t know how I work in hospice. I tell them, they’re not dying right there each and every day, they’re one their journey and we’re right there with them. What more could you ask for?

Anything else you’d like to share?
Each and every HHA has their own story. They have so many skills and they can really work anywhere, but we all chose to be here. We all want that one-on-one connection. Many years ago, when working in the hospital, I had the realization that when my patients became a number it was time for me to leave, and so that’s when I started to make my way into hospice. I just had my 14th anniversary working for Wilshire Hospice and I feel as if I only started less than a year ago. Time has flown because I love it so much. I always say to my supervisors, thank you for allowing me to come to work, because that is how I feel. It is the paradigm shift; I don’t have a job I have a career that I’m so passionate about.

I like to say, when someone has a beautiful death, we have done our job. I feel that hospice has found its niche in our society, because we are so afraid of death. And I think with hospice, with everything that it involves, it just makes it feel so much less frightening.

For more information about Wilshire Hospice and the services we provide, give us a call at (805) 782-8608 or visit our