‘What's there to be afraid of?’ Inside one family's hospice journey with Sentara

Bob Hamlin has been a Sentara Hospice patient for more than a year. 

The retired realtor is 90 years old, a widower and has terminal prostate cancer and advancing dementia. He lives with his son, Rick, and Rick’s wife, Cusi, as well as their son and his wife, their two kids and two dogs. Four generations under one roof.
 
“I love the chaos,” Cusi Hamlin said about the crowded, busy home in Suffolk, Virginia, which is also the impromptu headquarters of a nonprofit Cusi founded, Kalamoo Community Outreach, that helps underprivileged kids with STEAM (Science, Technology, Engineering, Arts, and Math) education. 
 
Bob holds court in a corner of the family room in a recliner by a window. A corgi mix snoozes on a nearby sofa.
 
Sentara Hospice nurse Hannah LaVine arrives for a visit with Bob to monitor his vitals, give him a shower, and take stock of his dementia and current state with some casual questions: what he had for breakfast, what shirt he chose that morning, what he’s reading, and when he last had a shower.
 
“I don’t need a shower,” Bob said. “I just had one.” A home health aide would normally bathe a hospice patient, but Bob resists that. He trusts LaVine to do it. 
 
“That was Tuesday,” LaVine replied. “This is Friday. You get a shower twice a week, so let’s just do this.” 

She used to see Bob once a week, but his cognitive decline is accelerating, and now she visits twice.
 
"Bob and I are buddies,” LaVine said. “We joke with each other and tease each other. Building that relationship and trust over time is why he's comfortable allowing me to care for him."

Building that trust, she explained, is one of the best parts of hospice nursing – a profession she regards as a privilege.

“Hospice is a sacred time,” she said. “It is an honor to be invited into someone's life during such an important chapter and help patients and families feel less afraid.”
 
Hospice is still widely misunderstood, according to Medical Director Dr. Brooke Thomas. Many people still see it as “giving up” on patients nearing the end of life. In reality, it’s a multidisciplinary protocol with diverse services to support patients and their families.
 
Hospice gives patients the opportunity to remain in their homes, surrounded by the people and things they love, while receiving support focused on comfort, dignity, and quality of life.
 
That model of care works best when patients take advantage of the six-month window for hospice services, which are covered by most insurances, plus Medicare and Medicaid, after two doctors affirm that death can be expected within six months. That can change. Patients rally. They can be discharged from hospice, then readmitted later. 

For the Hamlins, this process is now familiar. Bob’s current care plan is not their first experience with hospice.

Cusi’s parents moved in with them in 1991. Her mother, Maria, died in 1998 from complications of diabetes, including amputations and a feeding tube. They had to learn how to use a Hoyer lift to move her safely. Later, they enrolled Cusi’s father, John, in hospice when he developed congestive heart failure.

Bob Hamlin, son Rick and daughter-in-law Cusi stand in the family room of their Suffolk, Virginia home. 

In 2017, Bob moved in, about six years before Cusi’s father passed. The two men, who did not get along well, lived on separate floors.
 
“It was not an easy decision,” Cusi said. “They had their routines and we had ours, but we made it work, and it has been rewarding.”

After Cusi’s father died in 2023, the Hamlins moved Bob downstairs into John’s first-floor living quarters. “It was God’s timing,” Cusi said of her father’s death.

“The Bible says to honor your father and your mother,” Rick said. “It was easier to have them with us than in a facility, but we didn’t realize it would be so long term.”

It is a demanding commitment to care for loved ones in this stage of life — and one that hospice is designed to make more bearable, for patients and families alike.

Hospice provides palliative care to manage pain, nausea, anxiety, depression, and other symptoms, so that patients are as physically comfortable as possible and can spend quality time with family and friends.

There are chaplains if requested, social workers to help navigate available services, and a year of bereavement services for families after a loved one dies.
 
The frustrating part for many hospice providers is that families often wait until death is imminent before enrolling a loved one in hospice. When death comes in days, providers don’t have time to introduce the full range of medical, emotional, and spiritual support available through hospice. 
 
“It’s harder to build rapport and trust when the patient and the family are in crisis, and you’re new to them, and you’re managing bad symptoms, and patients are declining rapidly,” LaVine said. “Hospice works best when we have time to learn the family dynamic, build trust, and assess how we can best help them through this period.”
 
Rick and Cusi have taken these experiences in end-of-life and palliative care in stride. With Rick’s 31 years in the U.S. Coast Guard, the Hamlins are accustomed to change. They have lived in Seattle, Galveston and Hampton Roads, and they relocated Bob from the West Coast in 2017, months after Bob’s wife, Sue, died and his mental health began to decline.

They placed Bob on hospice last year, when they learned his prostate cancer was terminal. Now, dementia and memory loss cause additional issues.
 
“We’ve had to tell him over and over that he has cancer,” Cusi said. “But it’s important for us to give him the best quality of life we can, and it’s better for him to live with us.” 
 
They're supported by Sentara Hospice Services, which offers a 24-hour nursing hotline to call when medical issues arise. The service also stocks Bob’s medications at the Hamlin's home, where they can give them as needed, which can reduce trips to an ER. 
 
“We roll with the punches,” Rick said.
 
Bob clearly enjoys the banter with LaVine and his family. Humor finds its way into most exchanges. Bob’s chair is next to a fireplace mantle with a wooden plaque perched on it that reads, “Be happy. It drives people crazy.” 
 
Asked if he fears death, Bob shrugs and shakes his head. “What’s there to be afraid of? I know it’s coming someday.”