The Hospice and Palliative Care Team and the Role of the Nursing Assistant
The hospice philosophy and team structure
Hospice care is comfort-focused, interdisciplinary, and available when curative treatment is no longer pursued or the patient elects a palliative goal. Palliative care, by contrast, can begin at any point in a serious illness alongside curative treatment. Questions often blur these two; anchor yourself on the goal of care and the eligibility criteria, not the setting.
The interdisciplinary team (IDT) typically includes the physician, nurse, social worker, chaplain, nursing assistant, and sometimes a volunteer coordinator, bereavement counselor, or therapist. The nursing assistant is a member of the team, not a helper outside it. The assistant reports observations and changes to the case manager or supervising RN, contributes to the plan of care, and documents care given. Assistants do not develop the plan of care, make prognosis statements, or give medical advice.
Scope and reporting
Know your scope: personal care, mobility, nutrition support within the plan, comfort measures, and observation. Report changes promptly using objective language ("ate two bites at lunch, refused fluids since 0800") rather than interpretation ("patient is giving up").
Traps to watch
- Confusing palliative care with hospice eligibility.
- Assuming the assistant can revise the plan of care or answer family questions about prognosis.
- Reporting only at end of shift when a change is urgent.
Rule of thumb
If a task requires clinical judgment, teaching, or a change to the plan of care, it belongs to the RN or another licensed team member - your job is to observe, report, and document.
Worked example: A family asks the assistant, "How long does Mom have?" The correct response is empathetic and honest about role: "I don't make those predictions, but I'll let the nurse and social worker know you'd like to talk about what to expect."