There's a misconception Arohanui Hospice is a sad, gloomy, depressive place, Dr Simon Allan says.
It's anything but, according to the director of palliative care. And he should know as in November he will have worked at Arohanui for 30 years.
The Palmerston North-based hospice turned 30 on May 4 and this week is National Hospice Awareness Week.
"Most people entering hospice discover it to be a happy, positive, encouraging work environment and most of the natives are friendly," Allan says.
He moved to Palmerston North from Scotland 32 years ago as a medical oncologist.
In his second year of being here, Allan was asked if he wanted to help support the hospice medical team as it started. He would also cover the medical director when he went on leave, but within 18 months found himself working as the medical director.
He'd always been keen on palliative care. As he moved from oncology, he did both for quite a long time. For the past seven years, he has been full time in palliative care.
"If you can find a job which satisfies you, it's a major part of life. Why change. And if it gives you opportunity in all sorts of ways, again why change."
Allan says Palmy is a wonderful city, an unknown gem, and great for bringing up kids.
He's also been motivated by fighting in the underdog space. Scots like to fight for the underdog and Palmerston North is not New Zealand's favourite place, he says.
As director of palliative care, he is the maintainer and guider of excellence and brings any new clinical innovation to the bedside and to the community.
A third of his time is spent leading and the rest of the time he's a practising clinician.
"The heart and soul of palliative care has not changed. The individual care given to our patients and families remains very high."
Arohanui has moved from a small number of patients benefitting from hospice involvement, something like six patients a week, to today 240 in a week.
The hospice has sustained the same number of in-patient beds - 10, as it had 30 years ago, but vastly increased the number of patients seen each week.
The hospice provides specialist palliative care for people with a life-limiting illness, not just cancer, in Manawatū, Tararua, Horowhenua and Rangitīkei.
Instead of a focus on beds, which would have been the case 30 years ago, the vision is to keep people feeling safe at home with the care hospice staff can give.
"The vision is to keep people safe in their chosen home environment so if patients and families feel safe at home it means we're doing a good job."
There are only a few patients who do not want to die at home, and that is usually because they don't want the memory of the death to be with their nearest and dearest.
Changes in palliative care
Allan says the biggest two changes in palliative care over the past 30 years are in medication. The first is the use of battery-operated syringe pumps.
If someone is not able to take medication by mouth, the preferred route, then staff can offer pain, nausea and other forms of symptom relief through a syringe driver.
In the early days injections were administered on a regular basis, though staff moved quite quickly to clockwork pumps then to battery operated, sparing patients a lot of injections.
A plastic line under the skin will last for up to five days so patients have one jab every five days to put the line in instead of multiple jabs in a day, Allan says.
The second major change is the clever use of drugs - much more knowledge around the activity of different medications that can do a good job for symptom control.
"That means we've got better results from drugs and we've got less side effects, particularly with morphine."
Allan says the community buy-in over the years has been fantastic. About 48 per cent of the hospice's income needs to come from the community.
"As we have grown, the community has grown with us and has supported our effort year on year. Yes, it's getting harder but the community has shown fantastic support. "
Arohanui's reputation is "absolutely central" to its success.
"Your mum is every bit as important as my mum if it comes to dying. So the standard that we offer is the standard of each and every person that we see."
Average cannot prevail in hospice. "It is about excellence because every single person deserves that."
Allan says nurses are the heart and soul of the clinical workforce, absolutely vital in terms of the necessary hands-on care that patients require.
Allan grew up in Aberdeen and did his medical training in that city and in Edinburgh.
His grandfather asked him when he was 6 what he wanted to be when he grew up. "And for reasons that I don't know, I said 'I want to be a doctor'. He said why and I said because I want to help people. That remains my basic motivation. "
In 2015, Allan was appointed an officer of the New Zealand Order of Merit for his work in palliative care.
Another misconception about palliative care is if you go in to hospice you die. However, three quarters of Arohanui's patients who go into hospice go home again.
The in-patient beds are the intensive care part of palliative care where staff deal with very difficult symptoms or stresses on families.
Only 20 per cent of its patients will ever go into the in-patient unit. Eighty per cent are cared for in their home or aged care facility.
Another misconception is it's a difficult place to work. "No doubt it has its challenges but we find satisfaction in meeting people's needs in an honest and appropriate way."