Hospice has given many the opportunity to deal with end-of-life care and quality-of-life issues from the comfort of their home. But what about those who have lived for years and sometimes decades in nursing homes?
To address this need, Niagara Hospice has paired with three Niagara County nursing homes to offer dedicated units in North Tonawanda, Niagara Falls and soon to open in Lockport. All are designed to support families and residents who are facing end-of-life illnesses outside of their homes.
“We decided that there was a population in Niagara County nursing homes that we could have an impact on,” said John Lomeo, president and chief executive officer of Niagara Hospice. “We could bring a level of care to these facilities’ existing level and create an exceptional experience for that patient in the nursing home.”
He said hospice already has been serving nursing home residents in a scattered way, but this model brings patients together, which allows volunteers and staff at hospice to have much more face-to-face time with patients.
The newest site, “Rebekah’s Pathway” in the Odd Fellow and Rebekah Rehabilitation and Health Care Center in Lockport, will have the grand opening of its new nine-bed hospice unit Feb. 5.
The “David’s Path” in the Schoellkopf Health Center at Niagara Falls Memorial Medical Center opened in September and, after renovations, will have a grand opening of the dedicated wing in April. And the 22-bed “Jeanne’s House” at Northgate Health Care Facility in North Tonawanda opened May 17, 2012, as the first collaboration in the state between a hospice center and nursing home.
Lomeo said hospice units in nursing homes are designed to address “aging in place.”
“For hospice, it’s about ending your days in place as much as possible and for people that live in nursing homes, that’s their home, and many times they have been there for a very long time,” Lomeo said. “To build a facility and ask patients who are terminally ill to leave their home is not consistent with our mission.”
Lomeo said that in some cases staff at nursing homes have become the extended families of patients.
“The patient has established friends and routines – to disrupt that would be unconscionable,” he added. “Hospitals are not homes. People live in a nursing facility.”
Lisa Lundy, director of admissions and marketing for Odd Fellow and Rebekah Rehabilitation and Health Care, said, “A lot of residents have been with us for years, and their families become our families.”
Lomeo said there was a conscious decision to not only spread the partnerships out to different parts of the county, but also to choose nursing homes that already had a passion for end-of-life care and had already welcomed Niagara Hospice.
“We have had a positive working relationship with Niagara Hospice for a number of years, and both organizations have a strong sense of pride and desire to honor our similar values,” said Eugene Urban, chief executive officer of the Lockport facility.
He said the unit consists of one private room and four double rooms, a lounge area for residents and family members, a hospitality room for visiting families and a beautifully landscaped and furnished outdoor courtyard.
Northgate Administrator Terry Collins, a registered nurse, said, “Our team had a love for end-of-life care and really wanted to provide the best for our residents, the best at the end of life, to make sure that they are comfortable and every need is met.”
Collins said Northgate created an end-of-life program offered at all its sites called the Journey’s Program, which in Niagara County morphed into the relationship with Niagara Hospice, which is co-managed, sharing staff and leadership.
“The best thing about it is that it allows residents to take all the advantages of a long-term care facility and all the advantages of hospice. They get the best of both worlds,” Collins said. “The staff kind of replaces family, in terms of caregivers. Hospice adds another layer.”
Joseph Ruffalo, president and chief executive officer of Niagara Falls Memorial Medical Center, said end-of-life care is especially important, noting that according to statistics from Money magazine, one out of every four Medicare dollars, more than $125 billion, is spent by beneficiaries in their last year of life, and for two out of every five households, the bills for the last years of life ate up every penny they had – despite insurance.
“A key to our transformation has been our willingness to step outside of the proverbial box – to reduce the inappropriate use of institutional care, to seek care paths that are more cost-effective, deliver care in the most appropriate setting and to emphasize patient comfort and quality of life,” Ruffalo said.
He said rather than spend their final days and months in emergency room visits and intensive-care readmissions with worsening chronic conditions, patients have the option of being placed in a “warm environment, supported by specialized hospice services, locally with easy access for family and visitors.”
Urban agreed, noting that a hospice collaboration reduces hospitalizations and emergency room visits.
Collins said: “People get helpful advice on what’s appropriate at the end of life. We don’t do a lot of unnecessary tests and treatment when it’s really not going to affect the outcome and really might cause discomfort and distress. When there’s no chance for a cure, we really are going to focus on comfort and quality of life.”
Lomeo said hospice is not about death and dying, but about the value-added service provided by hospice.
“Families always want what’s best for their loved one,” Lomeo said. “We tell families that hospice is not a death sentence. The misperception that it’s all about cancer or you come to us on your last days is starting to dissipate.”
Lomeo said hospice has an “army of volunteers,” which is how the hospice movement started, “neighbors helping neighbors.”
“Our volunteers are difference makers,” he said. “Many of our volunteers have experienced the hospice service and want to give back,” he said. “Our volunteers make a tremendous difference in the lives of hospice patients.”
Lundy said the staff at Odd Fellows works with the staff at hospice, which offers extra services such as volunteers who visit residents or read to residents, pet visits and massage therapy. She said hospice often provides a nurse and an extra aide, and also is there for the family with spiritual support for both the patient and the family.
Kay Dekker, vice president of hospice services at Niagara Hospice, said, “When a resident receiving hospice services passes, we do not close the door on the family. Family members have the benefit of bereavement services from Niagara Hospice for 13 months. These services are extended to the staff, who often become very much like family to the residents they care for.”
“We have a unique model of care,” Lomeo said. “We take care of the patient and the family. We address the family’s anxiety and regrets about not being able to care for the patient at home. When we build confidence, the patient’s experience is better. The family has peace of mind that – ‘My mother is at Rebekah’s Pathway. Hospice staff is there. I have an advocate.’ It’s just a beautiful thing.”
Hospice care is appropriate for individuals when prognosis is approximately six months or less if the disease were to run its normal course. Many live beyond six months and can continue receiving care by meeting criteria set by Medicare. Information about Niagara Hospice services, nursing home care or volunteering is available at www.niagarahospice.org or by calling 439-4417.