Community Health & Wellness

Hospice chaplain helps patients find peace

When Pierre Allegre joined the United States Air Force 23 years ago, he had a master’s degree in divinity. He worked for 23 years as an Air Force chaplain.

Allegre recently retired from the United States Air Force Reserves, and for five years he has been working for MultiCare Home Health and Hospice as a chaplain, or spiritual counselor. He covers the area from the Tacoma Narrows Bridge north, including Gig Harbor, and into Kitsap County.

Pierre Allegre

His day begins with calls to families to ask if the patient is up for a visit. Instead of preaching, the spiritual counselor listens, he said. Some visits are 20 minutes, and others can be more than an hour.

“The quarterback on the hospice journey is the caregiver,” Allegre said. “They are there full time. We emphasize supporting the family.”

Hospice provides visits from the hospice team of healthcare workers and volunteers. It does not provide full-time care. Family members in the home provide full-time care.

Patients needs drive the experience

Chaplaincy, or spiritual counseling, is one of the options for Hospice patients, Allegre said. Not every patient chooses to have visits with a chaplain. For those who do, he said, the experience is completely led by the patient’s needs. 

“I think you have to learn to be fully present for that person, and lay aside your agenda, and trust that in the relationship there is something special that is going to happen to help the patient on their journey,” he said. “If we have a thing that we want to communicate, that might get in the way of good care with Hospice. You want to listen to them, to what they need, and not what you want to give to them. It has to be about what they need, not what you might think they need.”

He said around 60 percent of the patients choose to meet with a chaplain, and it is a career field that is highly regarded. While clergy members sometimes receive negative feedback, Allegre said being a hospice chaplain has been entirely positive. 

“Some patients can’t have a conversation, so obviously our presence is what we can offer. But, if they are (able to converse) I’ll say something like, ‘When you got the prognosis for hospice how did you feel, how did that hit you?’ And I let them tell me how that felt, what did they think, and that is a good conversation-starter.”

Whether the patient has gratitude, peace, worry, or fear, Allegre said he will be there for them. He also asks if they have unfinished business.

“Sometimes you have to reconnect with someone to get something right, and sometimes they might have the physical ability to do some things,” he said, “so it depends on where they are at in the decline of health. It’s often the internal work of the soul that they need to do before they can face death with some peace in a healthy way.”

Preparing to face the end

Death is certain for all of us, Allegre said. 

“There’s wisdom in considering your mortality, and preparing for it. Every day we are preparing for it in the way that we live, and I think we need to face it.”

Spiritual counselors can provide guidance and comfort to patients. By facing death, and getting emotional things in order, Allegre said he believes we can have a better death. But, he said he doesn’t lead with that. 

“We don’t go gangbusters talking about death,” he said. “We help them gently toward that, and help them say what needs to be said, review life, and have a series of conversations that help them to prepare.”

It’s all about what the patient wants and needs, Allegre said. Hospice care is designed to focus on what the patient wants.

“Patient need drives our care,” he said. “We do our best to listen and pay attention to what is going on in their emotions, and provide spiritual care as appropriate. It’s not a religious agenda. We support the journey the patient is on. If they are Christian I can speak directly to that, but if they are of a different religion, I offer to call and get referrals to the appropriate clergy to offer religious rites and services for them.”

Death with Dignity laws

His work through MultiCare Hospice can include sitting with patients who have opted to utilize their rights to Death with Dignity. In this state, those facing a terminal diagnosis have the right to medically-aided death. It passed the legislature in 2009. 

“I’ve supported people who’ve gone that route with no judgement,” he said. “I’m Christian, and I believe in the value of human life, but how can I judge a person who says, ‘I don’t want to endure the pain?’ We support. We’re not directly supporting that part of the treatment, but we come alongside them. That’s their call. I might be able to counsel a patient considering that, I might be relevant to that decision, but I don’t think Death with Dignity is a dealbreaker for a chaplain.”

There are many hospice care options in the area, and across the nation. All of them must meet guidelines set by Medicare, said Jake Johnson, registered nurse and clinical supervisor for MultiCare Hospice. 

Hospice care began in England in the 1950s. Dame Cicely Saunders created the first hospice there in 1967. Hospice care focuses on providing pain and symptom control with compassionate care for those given a terminal illness diagnosis.

The focus is on the patient, and the family, quality of life, and individual wishes. Those dictate the measures needed to manage the patient’s symptoms. Physicians work with their patients to determine when, or if, the patient should utilize the hospice system. 

Hospice history

In its original inception, hospice was run by volunteers, Johnson said. It also included spiritual counselors, and Johnson said that when Medicare Hospice Benefit became permanent, the government wanted to retain the team concept, which included volunteers, and also the spiritual counselors. MultiCare Hospice currently has five spiritual counselors who offer services to patients, Johnson said. 

“In 1985 the Medicare Hospice Benefit became permanent,” Johnson said. “We provide hospice to all ages, and Medicare is an insurer that essentially you can be entitled to due to disability, or age. It also covers the cost for some pediatric patients.

“Our core services include a registered nurse who visits at least once every two weeks; a social worker who helps with counseling, advanced care arrangements, funeral home, and working through insurance needs; a home health aide or certified nursing assistant who comes once or twice a week for bathing, and personal care, and help with cleaning the home; and a chaplain, who we like to call a spiritual counselor,” he said. “We serve those of all, or no denomination.”

Though patients on hospice are typically living with a terminal diagnosis, Johnson said the goal is to have the best quality of life possible, and focus on living life.

 “A lot of folks see hospice as dying, and death, but it’s really about living life to the fullest. We have no crystal ball, and we make no promises of when the end of life will be. It’s common for family members to ask us, and we say we will be here regardless.”

Fulfilling work

Being a hospice spiritual counselor, or chaplain, is the best job Allegre said he could ever have. Sitting with patients and families is fulfilling work, he said, and he can’t imagine doing anything else.

“We love what we do. If you’re called to do it, you love it,” he said. “It’s an amazing, sacred privilege to be invited into people’s journey through the valley of the shadow of death. I never take it for granted.”

For more information on the history of hospice care, visit nhpco.org/hospice-care-overview/history-of-hospice/