Care with Compassion

F ive years ago, Adrian Dirschell was working as a sergeant at Charles E. Egeler Reception and Guidance Center and Duane Waters Health Center in Jackson when he noticed a trend that stuck out to him.

He had been with the department for almost 20 years, and in that time, he had watched as prisoners at the facility aged, became ill and grappled with the realities of death.

“We treated them well, and we treated them medically, but they were dying alone as a prisoner in a prison hospital,” Dirschell said.

That was something he wanted to change.

Beginnings

Facility leaders later asked Dirschell if he would serve as chaplain, tending to the spiritual needs of prisoners. Initially, he turned down the job.

“As soon as I said no and walked out the door, I felt plagued,” Dirschell said. “I knew I had made the wrong decision.”

He took time to think about it. When he was approached again about the role, he said he would take it on, only if he could submit a proposal to provide spiritual care to terminally-ill prisoners.

Chaplain Adrian Dirschell speaks with a prisoner during an Eagle’s Wings group therapy session.

Then warden, and now Director Heidi Washington was enthusiastic about pursuing the idea.

That led to the launch in 2014 of Eagle’s Wings, a group therapy program for prisoners with severe or terminal medical conditions. Then something bigger happened. Views began to shift on end-of-life care for prisoners.

In 2016, the department started a hospice and palliative care pilot program at Charles E. Egeler Reception and Guidance Center and Duane Waters Health Center. It takes a holistic approach to meeting the needs of the state’s sickest prisoners by pairing palliative care — a team-based approach to health care that focuses on providing comfort to patients — and medical care. It also weaves in spiritual care along with other therapies. Those therapies can include visits from the facility’s compassionate care dog that started making rounds in the prison hospital in 2017, and dignity therapy, which allows prisoners to tell stories about their life and share transcribed copies with their families.

Roscoe, the facility’s compassionate care dog, sits beside his prisoner handlers.

Vigils are also provided to dying prisoners, who have trained prisoner palliative care aides stay by their side until they pass. The prisoner palliative care aides assist other ailing inmates with daily hygiene, mobility, meals and socialization.

The overall aim of the program is that no prisoner dies alone, and comfort and compassionate care is provided to prisoners with severe and terminal illnesses.

“It has changed everyone,” Dirschell said. “It has changed dying and how we deal with death in the department of corrections.”

In its first year, the program provided 36 vigils for dying prisoners.

The program is optional for prisoners, as are the therapies and services it offers. There are about 10 to 17 prisoners signed up to receive services at Duane Waters Health Center at any given time, Dirschell said.

The launch of the program is reflective of a shift seen nationwide in the care offered to patients with terminal illnesses. The number of U.S. hospitals offering palliative care has tripled since 2000, according to a study published in Health Affairs.

The facility worked with the Palliative Care Research Center, Hospice of Michigan and Dr. Daniel Hinshaw of the University of Michigan to start the program and set into motion ideas that could improve it.

Hospice of Michigan assists in training prisoners to serve as palliative care aides, and prepares them to be able to train other prisoners who come after them. The department’s 40 prisoner palliative care aides must complete 30 hours of initial classroom training and 250 hours of on-the-job training, along with bi-weekly in-service training.

Changing Perspectives

From his hospital bed at Duane Waters Health Center, prisoner Michael Boyd talks about how his life has changed in the last year.

Prisoner Palliative Care Aide David Mitchell talks to prisoner Michael Boyd.

He was partially paralyzed by a stroke and struggled to speak. Today, he banters with his care providers and is regaining use of his left arm.

“Before I got involved, I would just sit here. I didn’t talk,” Boyd said. “This means everything to me. I’m not just laying in bed suffering.”

He receives visits from Roscoe, the facility’s compassionate care dog, and has three attending prisoner palliative care aides who check in on him and help with daily tasks.

He looks forward to the visits and said the socialization helped him regain his ability to speak.

“If I’m having a bad day, I know I can count on them,” Boyd said.

That appreciation has meant a lot to David Mitchell, one of his prisoner palliative care aides.

“I’m doing something that has some meaning to it,” Mitchell said. “For them to sit there and smile just because I walked in the room, I can’t complain about anything.”

It has changed his perspective in other ways too. Mitchell admitted that at one time, he thought of corrections staff more as adversaries. He now sees them as patient and compassionate after watching firsthand as they raced to help prisoners in distress or reacted to the needs of other sick inmates.

An interdisciplinary team that includes doctors, nurses, social workers and other care providers, meets regularly to discuss each patient’s case and review their holistic and clinical needs.

The program isn’t intended to cure patients, who are often terminally ill, but it improves the quality of the life they have left, healthcare providers said.

Warden Jeremy Bush said Washington and Dirschell realized the possibilities for a prison hospice program long before anyone else did.

“They saw past old-fashioned barriers to help many of us see a new perspective,” Bush said. “I have seen for myself the change in both prisoners and staff.”

Corrections Officer Richard Hemenway, who works at Duane Waters, called the program “a quantum leap forward” in prisoner care.

“They don’t need to be alone,” Hemenway said. “They can have someone in the room to give them comfort right up until the end and that’s amazing. It’s humane, it’s empowering and it provides some dignity.”

Roscoe, the facility’s compassionate care dog, visits with a prisoner at Duane Waters Health Center in Jackson.

For some sick prisoners, visits with the therapy dog have also helped change behavior for the better. Prisoners who were subdued, depressed or were acting out, now light up when they see Roscoe the therapy dog and have better interactions with staff.

The therapy dog program is led by Danielle Pietrangelo and Bush said her commitment to its success has meant a safe environment for Roscoe, the dog handlers and prisoner patients.

Roscoe spends 15 to 30 minutes with each patient in the program who has requested a visit. His prisoner handlers try to adapt to the unique needs of each patient, and have described what Roscoe looks like to prisoners who are blind.

“When you take him there and see people smile, it makes you feel better too,” said Aric Reed, one of Roscoe’s prisoner handlers.

Mitchell said working in the program as a prisoner palliative care aide has given him more respect for his own life and the choices he makes. He said he never held a job before he was incarcerated and the job he has today has been life changing. He knows other prisoners feel the same way.

“You see the change in our hearts,” Mitchell said. “The atmosphere I came from, I didn’t appreciate life, and now I do. Caring for people changes you.”

Prisoner Palliative Care Aide David Mitchell assists prisoner Michael Boyd with mobility exercises.

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