Bermuda's only hospice dedicated to the needs of terminal patients is failing badly in its mission, according to its founder and former coordinator.

Hilary Soares, a nurse with over 20 years experience in palliative care, founded Agape House to help terminal patients come to grips with the physical, emotional, spiritual and practical challenges associated with dying.

But today, Mrs. Soares said the hospice is failing its patients in all those categories.

She told The Royal Gazette doctors do not refer terminal patients to Agape House, local clergy have been reluctant to offer spiritual counselling, staff in the hospice are overworked and, increasingly, beds are used simply as an extension of the hospital.

"In my opinion, the hospice does not now exist as a hospice," she said. "It has become just another ward of the hospital. We have taken a backward step in health care just to satisfy a hospital administration that has been unwilling or unable to solve a problem in its midst - such as palliative care referrals."

Yesterday, however, hospital ombudsman Aldwyn Savery denied that the hospice had lost sight of its mission.

"What we've done is reduce the number of beds because we didn't have enough patients to fill it," Mr. Savery said. "Now we're using three beds for patients with terminal illnesses from extended care.

"The hospice is still a hospice in every way. There has been no change whatsoever."

But the problems at Agape House go much deeper, Mrs. Soares said.

Although the hospice has been operating over 11 years, local physicians never really came behind the idea of referring terminal patients to it, she charged.

"Its mission was to admit dying patients with all and any diagnoses and to provide those patients with total symptom control using all means possible," Mrs. Soares writes in an opinion piece on Page Four of today's Royal Gazette.

"That meant expert medical, physical, emotional, (and) spiritual care (as well as) providing absolute comfort allowing the patient to finish any unfinished business he or she needed.

"This would allow the patient to complete his life to his or her satisfaction."

The diverse services intended to be offered included writing and revision of wills, handling finances and property, visiting favourite places, having final conversations, making funeral plans, talking with God and perhaps asking for forgiveness, she added.

"Tidying up one's life so that it is complete," Mrs. Soares termed it. "Dying from a life-threatening illness is serious business and all of its implications must be taken seriously, particularly an illness that creates multiple problems that in themselves can kill.

"This is not a time to provide that patient with minimal care, this is a time to pull out all the stops and intensively solve the problems at hand, so the patient can cease dying from the symptoms and focus on life."

But these hospice services were dealt a severe blow in 1997 when the hospice was paired with the extended care unit (ECU), she added.

"The thought was that the Hospice and the ECU would take part in cross training. Why? Nurses of the Hospice were already very well trained in Palliative Care and already knew about the care of the elderly dying patient."

As a result of the pairing, Mrs. Soares said trained staff were drained from Agape House while inexperienced staff replaced them.

"Two more diverse types of care could not be imagined," she said. "Although it is laudatory that cross-training is the perspective - it is foolhardy to send staff into a minimally staffed area, the hospice, when those registered nurses are too few and too busy to focus on training as well as their daily routines looking after acutely ill people."

A more effective solution would have been to offer special training programmes within the other wards, she suggested.

Several years ago, she said, the hospital linked with St. Christopher's Hospice of London - "the premiere hospice in the world" - to bring in a tutor to train and certify local nurses.

Also, while a desirable patient to nurse ratio is one-to-one, Mrs. Soares said hospice staff can tend to up to 12 patients a day.

"It is quite possible for that nurse to have 12 very ill patients," she said. "Some of them may die on one shift. The degree of care they all need, together with their relatives, is awesome."

Without a proper referral system on the part of physicians, patients who should be in the hospice end up in regular hospital beds, she said, although the cost of keeping a patient in Agape House is $200 less per day. Without the critical support of both doctors and spiritual leaders the hospices' services are further crippled.