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End-of-Life Care in Your Place or Theirs

Posted on: Monday, 15 August 2005, 21:00 CDT

Hospice at 25 1980: HospiceCare begins in Kanawha County to provide pain management and end-of-life care for terminally ill patients. 1983: Congress changes the Medicaid law to permit reimbursement for hospice care. Within a few years, the local organization changes from volunteer to paid staff. 2001: Hubbard Hospice House opens a 12-bed facility. 2004: HospiceCare provides care for nearly 1,200 patients in 10 counties. Hubbard Hospice House cares for 340 patients. 2005: Hubbard Hospice House opens a second wing in August, doubling its size to 24 beds.

Hubbard Hospice House rarely has an empty bed.

"We lost a patient yesterday," said registered nurse Barbara Kessinger. "There was one waiting to come as soon as the room was cleaned."

When Hubbard House opened in 2001 as a 12-bed facility, the people running it were nervous, Kessinger recalled.

"They didn't know how a hospice house would be accepted in the community, whether it would be thought of as a death house, a last stop before eternity, or whatever," Kessinger said.

Hubbard House has now added another wing, doubling the number of beds to 24 and providing two pediatric rooms.

The new wing should shorten the waiting list, Kessinger said. Time is crucial, even though doctors and families generally call in hospice quicker than they did 25 years ago.

Hubbard House is the first and only hospice house in West Virginia, Kessinger said. Hospice of Huntington has started construction on a building. Hospice of Southern West Virginia has acquired land in Beckley and is raising money to build.

Hubbard House is a small part of HospiceCare, which covers 10 counties. Operating on a $9 million budget, HospiceCare cared for nearly 1,200 end-stage patients last year, relying on a paid staff of nurses, doctors and social workers supplemented by volunteers. "Some sing, some give massages, some just hold hands," Kessinger said of the volunteers.

Before Hubbard House opened, Kessinger worked seven years for HospiceCare, making home visits to dying patients in Boone County.

The nursing director tells new hires not to quit their old jobs until they give hospice work a two-week trial, Kessinger said. Such work is not for everyone.

"It drains you, but it sustains you," Kessinger said. "It gets in your blood and you can't think of doing anything else."

Kessinger works three 12-hour shifts a week. "That gives us more time off. You have to have that family support to help you with the stress we deal with daily."

The hospice concept has evolved from the Middle Ages, when hospices served as way stations for weary pilgrims and later for wounded crusaders, who rested, received treatment or died there.

In 1967, Dame Cicely Saunders, a nurse who became a physician so she could better care for the dying and manage their pain, began the first modern hospice in London.

In 1980, the first hospice organization in West Virginia was begun to serve Kanawha County residents nearing the end of their lives.

Becky Bailey, a nurse whose husband died of cancer, was the founder and paid director. Her husband had wanted to die at home. Doctors were no longer making house calls. He died in a hospital.

Bailey's staff, if it could be called that, consisted of part- time volunteers. Local oncologists quickly embraced the hospice concept, though other doctors, trained to seek cures, were slower to come aboard. Begun in the fall, the new organization cared for seven patients that first year.

Doctors - mostly cancer specialists and family physicians - nurses and social workers all steer people toward hospice. The only requirement is that a doctor estimates the patient has less than six months to live.

"We do discharge people who improve, and then they come back later if they need us," said registered nurse Chris Zinn, who came to HospiceCare in those early years as a stay-at-home mom volunteering to visit one patient twice a week. In 1983, Congress changed the Medicaid law to permit reimbursement for hospice care, effectively moving palliative care into the mainstream.

Now Zinn runs Hubbard House, which served 340 people last year in its 12 rooms. The new wing will have its official opening Aug. 20, though it is already accepting patients.

Here, nurses and social workers focus on comfort, pain management and sharing the remaining moments. Here, they tell families it's OK to stop hoping for a miracle.

"She hugs people," Zinn said, referring to Kessinger. "She cries with them. That's part of being a hospice nurse. It's very different from hospital nursing."

To contact staff writer Bob Schwarz, use e-mail or call 348- 1249.

Source: Sunday Gazette - Mail; Charleston, W.V.

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