As Du Page County hospitals expand with technological and innovative programs aimed toward specific markets, a different kind of health-care agency is quietly targeting another significant patient population, the dying.
Called hospice, after the medieval shelters for travelers and strangers, it is not a building or a place but a concept of care for the terminally ill. ”Hospice originated in Europe,” said Cindy Santee, executive director of the Hospice of Du Page in Glen Ellyn. ”There, it`s more of a place to go to die. In the United States, hospice is more of a home-centered program. We provide support to the family that wants to care for the patient at home.”
Dr. Cicely Saunders, an English physician, pioneered hospice in London in the late `60s, and the idea took root and flourished in the United States in the `70s. Today the National Hospice Organization (NHO) reports a membership of approximately 850 hospices. In addition to Hospice of Du Page, five others serve this area: West Towns in Berwyn, St. Thomas in Hinsdale, Hospice Care/
Chicagoland in Lombard and Fox Valley in Batavia.
”Hospice is for the whole patient and the whole family, in contrast to traditional health care where you focus on the patient and the disease,” said Santee, an oncology nurse. ”It`s only for people with a life expectancy of six months or less, who no longer want curative treatment for their disease.
”We`re not there to take over the patient`s total care, but we can help the family and guide them.”
A nurse and a social worker introduce the new patient and family to hospice and identify any needs. ”These might be physical in terms of pain control or symptoms; emotional; or just the practical things: teaching the care giver little tips to make bathing or changing sheets easier.”
Typically, the nurse and the hospice volunteer visit the patient once a week.
”It depends on how much they want us to get involved,” she said. ”We ask them to tell us what they want. Also, the patient must know he is dying. Otherwise, how can you explain the physical changes which will occur? Some patients may be working through their acceptance of dying, and we can work with that. We`re not there to take any hope away.”
Hospice of Du Page recently expanded its services to qualify for licensing as a full hospice under Illinois` two-tier system, full and volunteer. It plans to apply for Medicare certification this month.
”Up to now,” Santee said, ”we have not charged any families, and we do not plan to, but we`ll receive third-party reimbursements through Medicare or insurance.”
Full hospices must offer a menu of services under a medical director. These services include nursing; social work; nutritional, pastoral, and bereavement counseling; and making arrangements with hospitals for in-patient beds for short-term management of pain and symptoms. Volunteer hospices must offer two or more of those services. The use of volunteer workers on the hospice team is assumed for both full and volunteer hospices.
Since its founding in 1981, the Naperville-based Illinois State Hospice Organization has grown to include more than 90 per cent of the state`s hospices. Now the big trend, according to executive director Mary Ellen Coombs, is a rush among those members for Medicare certification. Medicare approval means extra dollars in government reimbursements that help pay the hospices` bills.
Coombs says, ”Medicare-certified hospices increased gradually in Illinois (after Congress approved the program in 1983), but then about a year and a half ago, I started to get more and more calls for information on applying for Medicare. We`re up to 16 Medicare-approved hospices in Illinois now, up from 4 in 1984. There are no numbers to indicate how many hospices are considering it now, but I know from the number of calls and inquiries I get that many are seriously thinking about it.”
Although all Illinois hospices must be licensed, Coombs says, ”It`s important to know that a hospice has a choice whether or not to seek Medicare approval. That step requires a commitment upfront of many different services that you must carry on staff, not contract out for. Not all hospices are ready for that. Those in smaller communities have to think long and hard about the requirements of Medicare approval.”
In spite of the costs involved in adding services and staff to qualify for Medicare reimbursements, Coombs says, ”It`s the wave of the future. I don`t think any hospice wants to consistently depend on donations, memorials and grants to operate. If you have other reimbursement sources-Medicare, Medicaid, private pay-then you are more financially viable.”
Fox Valley Hospice, which has a volunteer license, has seen its patient load nearly double since opening in 1981. Although it does not receive Medicare reimbursements, ”our services are all free,” said executive director Vivian Nimmo.
”We have incredible support from the community, businesses, corporations, foundations,” she said. ”So much of the care we provide is given to the family without any strings attached. It`s just people caring for people.”
The hospice is currently considering applying for a full hospice license. ”We want to stay in touch with our community and change as their needs change,” Nimmo said.
At least one hospice, West Towns, has plans to provide hospice care to the homeless. Director Laura Ferris says the proposed home-like building will serve young or old, particularly AIDS patients, on a long-range basis. West Towns, a division of West Towns Visiting Nurse Association, received the first Illinois Medicare approval in April, 1984.
Another Medicare-approved hospice, St. Thomas, is growing by enlarging its service area. Director Ray Brockill said, ”Effective in July, we got state approval for extending our boundaries to take in all of the Fox River Valley.”
Brockhill said the St. Thomas staff also would like to acquire a permanent location. Such a move would depend upon the success of fund-raising and grant applications, he said, because ”money is an on-going problem for all not-for-profit hospices. Overall, we lose a little money on each patient, and that`s why we do fund-raising.”
The newest hospice in Du Page, Hospice Care/Chicagoland, which opened last January, is for-profit, one of the few in the country, according to NHO president John Mahoney.
Older area hospices express concern that a for-profit organization may skim off those who can pay and leave those who cannot to the not-for-profits. Nancy Smith, director of Hospice Care/Chicagoland, responded, ”Our basic philosophy and premise is to afford hospice care to any and all people who are dying, regardless of pay.”
Audrey Gordon, vice president of the Illinois State Hospice Organization, explained the rising interest in hospice: ”It`s very much a consumer movement. In an age of increasing medical technology, it`s saying, `I will control my own dying, just as I`ve controled my own living.` Hospice is a strong advocate for patient and family making their own decisions from the options available.”
Mahoney, of the NHO, said, ”Somebody called hospice a high-touch response to high-tech medicine.” But, he cautioned, ”it`s not just hand-holding. It is the best medical care possible.”
Dr. F.B. Barhamand, oncologist on the staffs of Edward and Good Samaritan Hospitals, agreed that hospice is an integral part of total cancer care at a certain point. He said, ”You have an incurable patient; you`ve exhausted all the (treatments aimed at curing). To pursue further treatment when they have no hope, I think that`s wrong.
”Hospice offers to the patient, family and friends a lot of emotional support to accept the crisis they`re going through.”
For more information: Fox Valley Hospice, 113 E. Wilson St., Batavia, 879-6064; Hospice of Du Page, 600 S. Lambert Rd., Bldg. M, Suite 117, Glen Ellyn, 469-5556; Hospice Care/Chicagoland, 200 W. 22d St., Lombard, 495-8484; St. Thomas Hospice, 7 Salt Creek Lane, Hinsdale, 920-8300; West Towns Hospice, 2140 S. Wesley Ave., Berwyn, 749-7171.
