I began volunteering with Fairview as part of Anthropology of Death and Dying, a course that I took during the Spring semester in 2019. Fairview is a non-profit organization that provides healthcare to Minnesotans, consisting of a network of doctors and providers at primary care and specialty clinics across the state. One branch of the organization is Fairview Hospice, which serves 15 counties encompassing the Twin Cities area. Fairview Hospice provides aid to people who have a limited life expectancy, helping patients improve their quality of life through medical, emotional, social, and spiritual care (“Hospice”, n.d.). The U.S. ranks lower in elder care compared to most other wealthy nations, with more than one in three adults over the age of 65 having multiple chronic conditions (Seegert, 2017). Thus, hospice is crucial in terms of taking care of our elderly population in the U.S.. Enrollment has increased since 2012, with 1.49 million Medicare beneficiaries enrolled in hospice in 2017 (NHPCO facts and figures, 2018). Volunteers play an important role, as they not only founded the hospice movement in the U.S., but are required, under the Medicare Conditions of Participation, to provide at least 5% of total patient care hours (NHPCO facts and figures, 2018).

Most of Western healthcare is curative medicine, where a cure is considered achievable and healthcare seeks to overcome a disease and promote recovery. In contrast, hospice relies on palliative care, focusing on the overall health and well-being of the patient with care that aims to provide relief instead of a cure. Patients within Fairview Hospice are generally expected to live less than six months and are not undergoing treatment for their conditions. This means that the patient can vary drastically in age, from a child diagnosed with a terminal illness to an elderly person with several underlying conditions. As Atul Gawande, an American surgeon, explains in his book Being Mortal, hospice forces us to confront our mortality by contemplating the unfixables of our life and actively deciding to stop curative treatment (2014).

Part of my interest in being a hospice volunteer comes from my personal experience. Two of my grandparents received hospice care and I saw how the services increased their comfort in their last months. I have also become interested in understanding the inequalities within the U.S. healthcare system through my courses, such as Race, Gender, and Medicine, at Macalester. Professor Dr. Amy Sullivan prompted us to scrutinize issues related to access for various demographics in this course; however, we did not examine age as a factor. I became interested in understanding the elderly care system in the U.S. during the course Anthropology of Death and Dying, as a result of professor Dr. Ron Barrett’s enthusiasm on this subject. I began to recognize some of the beliefs and prejudices against elderly people that I, and most of American society, have internalized. The aging process in the U.S. has become pathologized by our healthcare system, and I believe that hospice is a program that enables us to think and act outside of the medicalization of old age.

As improvements in medicine have significantly lengthened our life expectancies in the U.S., many people now live until old age. These people will likely need additional care at the end of their life, care that their family members are often unable to provide. There has been an increase of 9.6% in Medicare-certified hospices since 2014, with 4,515 hospices in operation as of 2017 (NHPCO facts and figures, 2018). Hospices across the country, including Fairview Hospice, will likely face an influx of patients as the baby boomer generation reaches old age. Within the current hospice care system, more workers and volunteers will be necessary to care for terminal patients and their families.

From my volunteering, I have learned much more about the inner workings of hospice care. I have been able to provide companionship to patients during a sad, challenging, and confusing time in their lives, which has increased the compassion that I have for these people. I have also seen shortcomings of the system, from a general lack of volunteers to a deficiency of bilingual or multilingual volunteers and medical staff. It is clear that Fairview Hospice needs the support of the community and progressive thinkers to help continue to improve this system of care.