HISTORY OF HOSPICE
Our hospice is a community based in-home care program. We are non-profit independent hospice not affiliated with any other organization.
In February 1983, the public was invited to a viewing of the film “Hospice”, at the Hillsdale Community Health Center. The discussion following the film led to the establishment of a planning committee, which met over the next few months to explore the potential for hospice care in our county. Initially, the work involved writing by-laws, applying for non-profit tax exempt status, and establishment of working committees. Hospice of Hillsdale County became an official non-profit, independent organization in August of 1983. A twelve member board of directors was elected and monthly meetings were set. Dr. Larry Fowler was the first medical director. His wife, Jane, became our first program director. Both positions were non- paid. Dr. Debra Lusty and Dr. Dustin Kimball served as co-medical directors from 1993 until 1997. Since 1997, Dr. Kimball has been directing the medical aspect of our program. He is a family practice physician in Hillsdale. Dr. Samuel Wickard of Pittsford has been our spiritual advisor since 2005
Today, our hospice is governed by a 15 member board of directors made up of residents of Hillsdale County. The hospice board continues to meet monthly. Board members for 2019 are:
Rev. Jessica Hahn - President
Rick Jenkins-Vice President
Alex Simmons - Treasurer
Karen Hill - Secretary
Shea Dow-Past President
Hospice of Hillsdale County is a member of the National Hospice & Palliative Care Organization, the Michigan Home Care and Hospice Association and the Hillsdale Chamber of Commerce.
The first hospice patient was admitted to our program in September 1984. At that time, all of the hospice care was provided by volunteers both professional and lay. In the early 1990’s, our organization evolved from a volunteer run hospice to a more specialized program. Paid staff was hired including an office manager, several registered nurses, two certified aides and a social worker. Hospice of Hillsdale County became licensed by the State of Michigan Department of Licensing and Regulatory Affairs Bureau of Health Care Services in May of 1991 and certified by that same agency in September of 1992. We are periodically re-certified and licensed by that agency with unannounced comprehensive survey. Being certified allows us to bill insurance companies for the care and supplies we provide to our patients. We bill Medicare, Medicaid, Blue Cross Blue Shield, VA and all other private insurance companies.
In 1994, our offices moved from the Hillsdale Community Health Center to an office in a local dentist building in Hillsdale. In May 2003, our organization purchased an office building located at 124 S. Howell Street, Hillsdale. We continue to occupy that two-level building which is handicap accessible with ample parking.
Planning for the future of our hospice has always been a priority. The first strategic planning session began in 2002. Our board of directors with our staff developed the current three year strategic plan which will be our guide as we continue to provide quality hospice care. Since our beginnings, our mission has remained the same…to provide compassionate, quality end-of-life care and support for patients and families.
In 2018, our average daily census was 32.3 patients and our average length of stay was 89.4 days. Our median length of stay was 35 days. One hundred forty five patients and hospice families were served and out of that, 134 new patients were admitted. Sixteen patients were discharged or revoked their hospice benefit and 96 patients died in our care. In 2018, Hospice of Hillsdale County provided 11,787 days of reimbursed care and 2 days of free care.
Our office is located at 124 S. Howell St., in Hillsdale. Our office hours are 9-4 PM, Mon.-Fri. When our patients need assistance after hours, on weekends or holidays they access our on-call staff by dialing the on-call cellular telephone. Our program also has twenty four hour referral and case opening capabilities. Our office telephone number is 437-5252 and our after hours/on-call telephone number is 398-4380.
We serve all of Hillsdale County and surrounding areas of Lenawee, Branch, Calhoun and Jackson Counties.
Our program philosophy encompasses these points:
Death is a natural part of life.
Each individual has a right to be comfortable until they die.
Social, emotional and spiritual needs are as important as physical needs.
Patient independence and control is promoted.
Isolation and abandonment is lessened.
Individual values, preferences and outlook on life are recognized.
Some misconceptions of hospice care that many people have-
Hospice is only available for the elderly.
Hospice is only for cancer patients.
Hospice bills patients for charges not covered by insurance.
We only accept patients who have insurance coverage.
Patients need to change physicians.
Patients are required to have a primary caregiver.
Only available for last days or weeks of life
Hospice services are available to all persons of any age.
All terminal patients with a limited life expectancy are candidates for hospice care, not just those with a cancer diagnosis. In 2018, we served 64 patients with a cancer diagnosis and 81 non-cancer patients.
We accept any patient regardless of insurance coverage. We accept insurance payments in full and never bill our patients or families.
If the patient’s own attending physician agrees, they follow and order any medication/services. If a patient does not have a physician, our medical director will follow them through hospice care.
Patients are encouraged, but not required, to have a primary caregiver. Our social workers and nurses work with patients who need additional care that family or friends can’t provide. Occasionally this may mean the hiring of additional help, placement outside the home or transfer to another hospice in a locale where family lives.
A physician must write an order for hospice care and certify that the patient has a limited life expectancy of 6 months or less if the terminal condition runs its normal course. With a physician’s order and medical records to support the terminal diagnosis, patient’s can be opened to hospice care 24/7. When any change in care is necessary, a physician order is always obtained. Hospice will never discontinue service to a terminal patient who outlives their prognosis if the attending physician and the hospice team feel the patient meets hospice criteria.
Services that Hospice of Hillsdale County provide and pay for are:
-intermittent nursing visits by an RN based on patient need
-twenty four hour on-call availability of an RN and the hospice team
-home health aid and homemaker services
-pain and symptom management
-medications that are related to the terminal diagnosis
-medical supplies and equipment including oxygen
-physical, speech & occupational therapy if needed
-nutritional guidance & nutritional supplements
-short-term inpatient care for pain control or rest
-medical social work services
-trained volunteer support for respite, companionship and transportation
-pastoral care for spiritual support
-bereavement care for the family for 14 months after the death
-continuous care when the patient is dying and pronouncement of death by the
Hospice nurse with no need for ambulance, police or coroner
Referrals to our program come from physicians, hospitals, patients and family members.
Our major funding source is Medicare alone with Medicaid, Blue Cross Blue Shield VA and private insurance companies. In most cases insurance companies pay us a daily rate for every day the patient is in hospice care. We also do accept patients with no insurance reimbursement. For the fiscal year beginning October 1, 2018, CMS set our rates which is now a two tiered system with an add on.
(1st 60 days) $171.36/day
(60 days and after) $ 134.65/day
(Last 7 day add on of RN/SW visit) $9.07/15 Min.
Medicaid, Blue Cross Blue Shield reimburse at similar rates.
Other insurance companies negotiate, and usually pay the Medicare per diem rate.
Gifts, memorials and donations to our program in 2018 totaled $320,059. Unlike some organizations, 100 percent of all our memorials and donations are used for services to Hillsdale County hospice patients. Income from special events in 2018 totaled $43,656. We are so grateful to the many people who continue to support our program, thus ensuring that quality hospice services will continue in Hillsdale County for years to come.
Each year in November, during National Hospice Month, a fundraising letter is sent to individuals and businesses asking for financial support. The income generated is part of our donation figure mentioned above. Grants and corporate support are also sought to supplement our budget.
Because the hospice benefit under Medicare, Medicaid and private insurance does not cover all expenses, other income is necessary. Bereavement care is mandated by Hospice regulations but a non reimbursed service. Hospice generates some additional income through special events, such as, the Bowl-a-Thon, Payroll Deduction Program, Fair Raffle, United Way donations in surrounding counties, Kroger Cares program, Annual Fundraising Letter, Great Give Day, grants and community activities.
Hospice provides these community services free of charge to those in need:
-Grief education and support groups for adults
-Individual grief counseling
-Camp Courage day grief camp for children ages 6-14yrs.
-Monthly social group for bereaved
-Monthly bereavement mailings sent for 14 months after the death
-Loan library which includes books, videos, and CDs on assorted topics
Hospice is the only Medicare program that mandates volunteer involvement. National hospice regulations mandate that each year, volunteers must provide at least five percent of the total patient care hours of all paid staff. Nationally, 400,000 plus volunteers assist and support hospice programs. In the early years of our program, volunteers provided all the care to patients. Volunteer nurses helped with basic nursing care. Other volunteers provided equipment delivery, errands, household tasks, respite and companionship. All volunteers were required to complete a training program. These trainings allowed individuals to examine their own attitudes and beliefs about death, dying and the hospice philosophy. Trainings were offered twice a year extending over a six week period bringing in professionals in selected fields. Today, volunteers don’t provide any hands on care. Training of volunteers is much more flexible. These individuals receive extensive training prior to their work with us and are a most important component of our team. Volunteer training includes mission and history of hospice, care & comfort, death & dying and grief & loss education, communication skills, patient rights, confidentiality & HIPAA, spirituality & spiritual care, safety & infection control, family dynamics, ethics and Alzheimer’s disease. Four hours each year of continuing education are required to be an active hospice volunteer. Ongoing in-service education is offered on various topics. Review of hospice related books and videos can be credited to annual continuing education hours. In 2018, 55 individuals were active volunteers in our program. In 2018, our volunteers contributed more than 2,048 hours which included companionship, respite, household chores, errands, transporting, fundraising, office and board work. In 2018, 15 percent of our hours were provided by hospice volunteers. In 2018, our volunteers traveled 4,543 miles. All this volunteer involvement represents a total cost saving to our program of $52,710. This quote from Mother Teresa perfectly describes our volunteers. “Most of us do no great things; we do little things with great love.” Mother Teresa
In summary, when a cure for illness is no longer attainable or being sought, hospice care is designed to relieve suffering and pain, so the patient’s remaining time at home may be spent with quality and dignity.
In keeping with our mission, we accept all patients without regard to disease, race, religion, age, sex, handicap or ability to pay. The hospice team of professional staff and trained volunteers has a mission of tending to each patient and their family. We dedicate ourselves to do all we can, because we believe, “You matter because you are you. You matter to the last minute of your life, and we will do all we can, not only to help you die peacefully, but to help you live until you die.” Dr. Dame Cicely Saunders