Visiting Nurse & Hospice of Litchfield County (VNHLC), which has served residents of the northwest corner of Connecticut for over 100 years, serves as the site for the home hospice rotation. Hospice care is primarily in a patient's home for patients approaching the end of life who want to focus their medical care on comfort and quality of life. The care is delivered by an interdisciplinary team to patients with an estimated prognosis of six months or less. VNHLC staff see patients in their homes, in assisted living facilities, and long-term care facilities in the region. VNHLC also serves as the hospice for East Mountain House, a community-supported home in Lakeville, CT, with 24-hour staff and volunteers present, where patients enrolled on hospice can live out their final days in dignity and comfort.

During their rotation, fellows will make home visits primarily in conjunction with a member of the clinical hospice team, including hospice nurses, social workers, chaplain and/or a hospice physician. The fellow will also interact with home health aides, volunteers, the volunteer coordinator, and learn about bereavement resources in the community. Toward the end of the rotation, fellows may visit patient homes independently and report findings to the hospice physician. Fellows will participate in weekly IDT meetings, presenting patients they have seen. The didactic curriculum will include lectures on syndrome of imminently dying, non-oral routes of medication administration, and home wound care. The hospice medical director will meet each fellow to review key components of hospice administration, including regulatory, administrative, legal, ethical competencies, cost-effective policies and clinical skills appropriate for hospice patients.

On-call coverage will give fellows experience addressing and triaging the common clinical scenarios that arise between scheduled visits. An attending hospice physician is always available to provide supervision.

Fellows will spend two separate months, one in the first half and the other in the second half of the year, with the VNHLC home hospice team.