Highlights from previous OPTIMA Award submissions: The Angel Care Program

“I wish I knew she was dying. L.R. and I have been friends for five years. We have been on the same floor. We ate in the same dining room, at the same table. We went to Bingo and outings together. I knew she wasn’t feeling well but I didn’t know she was dying. I wish I was able to go see her and pay my respect to her.” A.F.

These were the words of one of our Residents when she was told her friend had passed away.

In December 2003, the Palliative Care Committee members realized that a program was needed to honor our residents during their final days of the death and dying process. Prior to 2003, our facility did not have a formal means to address the emotional, social and spiritual needs of family, friends and caregivers during the most difficult time of one’s life: death and dying of a loved one.

Although meals were provided, upon request, to the residents’ families, there were no guidelines or ways to communicate with our staff, guests, visitors, and residents that a resident had entered into and was actively dealing with the final days of his/her life.

Facility: The Friendly Home
Address: 3156 East Avenue
Rochester, New York 14618 Contact: John Gagnon, Vice President Services
Phone: (585) 385-0294
Fax: (585) 385-0259

On numerous occasions, our residents had voiced sadness that they were learning of their friend’s death after the fact and were disappointed that they did not have opportunity to say goodbye or to pay their respect. Resident A.F. and others were voicing an unmet need.

We became convinced that a program must be developed to:

  • Honor our dying residents.
  • Communicate to our residents and staff that one of our own had entered the final stages of his/her life.
  • Support and care for all aspects of our residents and their families during this special time.
  • Care for the emotional needs of our staff, including direct caregivers, who had come to love and respect the dying resident.
Sara McKeraghan (left), food service department, and Julia Wood, nursing department, wheel an Angel Cart.

In response to these needs, the Palliative Care Committee’s main objective was to develop a program to specifically address this difficult yet important issue: honoring our dying residents and meeting the needs of their fellow residents, families, friends, and their caregivers. “We do a great job taking care of our residents when they are with us but we are failing to put closure to their final departure from us in ways that honor them and their families,” said the director of social work and Chair of the Palliative Care Committee. The committee realized that this issue should take priority and we set a 2004 goal to have a working program in place.

Our medical director, also a member of the Palliative Care Committee, proposed looking into a neighboring facility’s program and provided a contact name: The chaplain of the facility. As a result, a sub-committee from our Palliative Care Committee was formed to research and develop a program to fit our specific needs and the philosophy of our home. The sub-committee members consisted of a dietitian, a social worker, and a nurse manager.

This committee had subsequent meetings to discuss the name for the new program, the creation and writing policies and procedures to support the program’s structure, and their submission to the Palliative Care Committee for final approval.

Planning the program

The Angel Care Process

Angel on the Door

Soon after permission is obtained, an angel is placed outside the resident’s door symbolizing that the resident has been placed on the Angel Care Program. The symbol becomes a visual way to communicate to other residents, visitors, and staff that this resident is on his/her final days.

Seeing this symbol by the resident’s door, staff members of all departments will then have the opportunity to consider adjusting their assigned tasks in a manner that provides this resident and his/her family with additional consideration for their comfort and dignity. This will also give staff, residents, and guests the opportunity to stop and offer support and comfort to the resident and family.

Staff are encouraged to:

  • Keep noise level to a minimum by lowering their voices while passing by the angel on the door.
  • Postpone unnecessary cleaning and repairs in the vicinity of the resident’s room.
  • Stop in to pay their respects to the resident and their family.
  • Be available to pick up food orders and/or place orders in a timely fashion.
  • Give other residents in the facility and particularly the ones on the same unit the opportunity to visit and pay their final respects and say their goodbyes.

Angel Hospitality Cart

Upon notification of a new Angel Program participant, the food service staff sends a fully stocked Angel Hospitality Cart for the comfort and convenience of visiting family and friends. The cart is stocked with:

  • Non-perishable snacks (candies, crackers, peanut butter, tea, coffee, hot cocoa etc.)
  • Menu (selection can be ordered during the kitchen operation hours from 6:30am-8:30pm.)
  • Box containing personal care items such as disposable toothbrushes, soaps, and tissues.
  • Bible and religious readings.
  • Activity books such as word puzzles.
  • Magazines.
  • Pens, pencils, and writing pads.
  • Special box for children containing crayons, puzzles, and activity books.
  • Survey form in order to improve our services and further enhance the Angel Care Program.

The Quilt

At the time of the passing of the Resident, and as the undertaker is leaving with the body, a quilt is placed over the body. This idea was actually suggested by our residents. Rather than seeing the body exiting with a plastic black cover, a quilt is draped over the bag so that when passing others, a person is only seeing the colorful quilt. A staff member from building services accompanies the undertaker and returns the quilt to the unit.

The Chime

Twenty-four hours after a resident’s death, the receptionist rings a chime during morning announcement. This symbolizes that one of our residents has passed. She then announces the name of the resident, reads a brief prayer, and offers a moment of silence. The chime serves as another opportunity for staff and residents to be informed of someone’s passing and honor the resident.

Memorial Service

This is the final stage of the Angel Care Program. On a quarterly basis, the facility’s chaplain officiates a half-hour religious service. Families of residents who have passed during the previous three months are sent a special invitation to attend. Staff and residents are invited, as well, if they choose to attend. To date, attendance has been to capacity in our auditorium. The service is designed as a memorial service and each name of the deceased residents is on the event program and publicly cited by the chaplain. This is usually a very emotional time for attendees.

After the service, refreshments are served by our facility as a time for reconnecting with each other in memory of those who have passed.

The Meditation Room

Our facility has an “open door” visitation policy. When a resident is on the Angel Care Program, the need for privacy is crucial. A few months after initiation of the program, a special room providing this privacy and quiet area became a necessity. With the help of our building services department, we were able to transform a storage room on the main floor into a beautiful cozy one where families can feel comfortable gathering for quiet moments and discussing their plans.

The room was remodeled and stocked with comfortable furniture, reading materials, a television, and a selection of movies for all ages. Meals and beverages are also provided here upon request. Families may choose to spend the overnight hours either by the resident bedside or in the Meditation Room.

The program’s purpose was to promote a facility-wide approach to the care we provide for our residents in their final days of life.

Our goals were to:

  • Address the spiritual, psychological, emotional and physical needs of residents at the end-of-life;
  • promote and pay tribute to residents;
  • provide end-of-life support and comfort to residents, families and caregivers; and
  • maintain quality of life and increase awareness during this sensitive time.

The following materials were needed prior to implementing the program:

  • Two rolling carts, or “Angel Hospitality Carts”
  • Angel ornaments
  • Chime
  • Quilts for each unit (total of five)
  • Quarterly memorial service
  • Meditation room

Our means of introducing and explaining the program included:

  • Education of our staff through a number of classes provided and attendance at staff meetings to describe the program;
  • informing our residents through resident council meetings; and
  • informing our families through mailings, brochures and newsletters.


Introducing the program. The first week of April 2004, members of the committee sponsored a facility-wide awareness day. We had a large poster in the main lobby that was displayed for a few weeks so that residents, staff, and guests could ask questions about the program. We had an informational table by the poster and provided brochures and angel stickers.

Staff acclimation.
Soon after the Angel Care Program policies and procedures had been approved by the Palliative Care Committee, all staff needed to be introduced to the program prior to implementation. Mandatory informational meetings were set up. Classes were provided several times a day and on all three shifts for a period of two weeks. New employees are now provided with a brochure and instructed about the program during their orientation.

Staff are instructed to communicate with residents, particularly those who share the unit with the dying person to give them the chance to see their friend if one chooses to do so.

Resident awareness. A Resident Council meeting was set up by the director of social work to inform residents about the program. Responses from the residents were very encouraging: “You get to know someone for a long time, you eat with them and you go to Bingo with them and one day they’re not there. This is very nice and needed program. It will give us a chance to say good bye,” said one resident. Our residents were excited about the program and even suggested to work with the Recreation department to make their own angel ornaments to provide as gifts for their families.

Family awareness. Families were mailed a letter to introduce the program. The letter highlighted that this program needs their prior approval to maintain compliance with HIPAA regulations.

Policies and procedures

In order for a resident to be placed on the Angel Care Program, a member of the medical team (a physician, a nurse practitioner, a physician assistant, or a registered nurse) makes the decision that the resident has entered into the final stages of his/her life. A member of the interdisciplinary team then contacts the family asking permission to place his/her loved one on the Angel Care Program. (Family approval must be obtained first. Without permission, the formal program is not initiated but families are still provided with meals and other needs upon request.)

After obtaining family permission, a symbol of an angel is placed on the resident’s door. An e-mail message is sent out to all staff to indicate the name of the resident who has been placed on the Angel Care Program. The Home’s chaplain makes a visit to the resident to offer prayer and comfort. Each department manager determines and shares with their staff what adjustments are needed to ensure needs are met with utmost care, sensitivity, and dignity.

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