Much has changed since Agape House opened as a hospice in 1990 with twelve beds designed to meet the anticipated crisis caused by the explosion of HIV/AIDS cases in Bermuda.

As effective new treatments evolved, far more people could be managed in the community. Rather than have beds lying empty, the hospice was opened to patients with advanced cancer and other terminal conditions such as multiple sclerosis and motor neurone disease.

Even then there was still some spare capacity so now three of the twelve beds are reserved for long stay patients who cannot be accommodated elsewhere. As a result of this, the hospice is now treating more patients than at any other time.

Sitting on top of a small hill in the grounds of the King Edward VII Memorial Hospital (KEMH) site, Agape House is an old Bermuda cottage that used to be a doctors? residence.

The pace there is much slower than the hustle and bustle of the main hospital and the peace provides the perfect atmosphere for the dedicated team of staff to provide the sort of care and attention that patients and their families need as they near the end of their illness.

The emphasis here is on making sure that for whatever time the individual patient has left they are as comfortable as possible, not only by paying attention to their physical symptoms but also to their emotional, social and spiritual needs.

All the staff form a close knit team whose work is supported by dozens of volunteers organised by the Friends of Hospice who also provide outstanding financial support year on year that serves continually to upgrade the building and equipment. Open and honest communication is valued very highly, so within a short time of any admission the team of doctor, nurses, medical social worker and often a PALS nurse will arrange to meet with the patient?s closest family to outline the philosophy of hospice care.

The team will also explain what is likely to happen over the coming days and take the opportunity to explore and address any issues of mutual concern.

There is open visiting with virtually no restrictions, children are actively encouraged and on many occasions even pets have been brought in. Food is cooked to order on site by our very excellent chef who also provides afternoon tea every Friday for patients and their families.

One of the challenges facing the hospice is to make more use of the available beds.

Some patients are reluctant to consider being admitted to Agape House even though they could be helped because there is often a misconception that people only go there to die and admission is a one-way ticket.

What they don?t appreciate is that about half of all the people admitted to Agape House eventually go home again.

This is because the role of the hospice has broadened to include the provision of respite beds so that family who care for a loved one at home can have a break from time to time, and other beds are used for short admissions requiring rehabilitation or symptom control.

So what of the future? There is always going to be a need for good quality palliative care. Many patients prefer to be at home and the team of PALS nurses work tirelessly to allow that to happen wherever possible but sometimes there is no alternative but admission to hospital.

The hospice building is old and, although it has served well, it was never intended to be a facility for in-patients when it was built well over a hundred years ago.

Now that the review of the estate and KEMH is underway, this is an ideal time to consider what Bermuda really requires to make certain that first class hospice care can be provided well into the future.

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