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July 2008
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Serenity House
Where We Die...
In the late 1970's a gathering of like-minded individuals, who wanted to make a difference in end-of-life care, initiated the hospice movement in the United States.
Concerned about situations described by patients and their loved ones in books like “On Death and Dying,” by Elizabeth Kubler Ross, they created the Medicare Hospice Benefit Law, established in 1983. The Medicare benefit includes many services not generally covered by Medicare. Today, twenty-five years after the law was enacted, Medicare certifies more than 90 percent of the over 2,500 hospice programs in the United States.
The Medicare benefit has been a blessing to millions of people. Plus, it prompted the insurance industry to include end-of-life care as a benefit in their health care plans. Realizing the tremendous savings of hospice care, the government expanded hospice funding in 2003, effective January 1, 2004, to include Medicaid as well as Medicare patients, and added other benefits.
Today, communities need not be concerned so much with “how we die” but in “where we die.” The hospice benefit includes a provision for shortterm hospice respite stay as well as general inpatient care. Respite is provided when family members are in need rest, while general inpatient care is used when a patient requires round-the-clock symptom management and nursing care. With the variety of today's medications, nurse/patient ratios of 10 to 12 patients, social workers, spiritual care providers, volunteers and nursing assistants, the provision of massage and other relaxation techniques, general inpatient hospice care is rarely needed. The hospice movement has saved the government and insurance companies, as well as private individuals and hospital facilities, literally billions of dollars.
There has been tremendous growth in the use of hospice care agencies and programs over the years. In Reno, Carson City, Fallon and surrounding areas we have several excellent programs: Saint Mary's Regional Medical Center Hospice, Barton Memorial Hospice (South Lake Tahoe), Tahoe Forest Hospice (Truckee, CA), VistaCare (Sparks), Incline Village Community Hospital Hospice, and the Circle of Life Hospice in Reno. Those of us, myself included, who have been involved in the hospice movement since the beginning, are in themselves a “dying breed.” Interpretations of who should receive hospice care and where it should be delivered can vary greatly. As a result, the government is looking at the industry with interest and investigating those areas that fall outside the norm in the delivery of care, such as the appropriate utilization of General In-Patient care.
Percentages for GIP care for hospice providers vary from 2 to 3 percent to as high as 11 percent of total patient care days for some providers. As with every industry, there are those who take advantage of the system. It is important that the variations are understood and addressed, in order to protect this important benefit.
Death itself is a natural event in the circle of life. In and of itself, death doesn't require a setting other than the comfort of one's home and the love and compassion of family, friends and hospice support. For various reasons, some people prefer not to die at home, a parent, perhaps, who does not want to leave difficult memories for children to live with. Then there are those who are alone in the world, unable to care for themselves as their health declines and the end of life is close. These “orphaned elders” carry a personal burden of concern that is overwhelming and frightening.
Today we are living longer.
As we watch friends and family members die, we ask, “What about me? Where can I go? Who will help?” In Reno, these questions are being addressed by another “gathering of likeminded individuals.” The Circle of Life Foundation, established in 2002, has reorganized its Board and rewritten its Bylaws, with representatives on the Board from every area of the community. An endowment and building fund have been established, open for donations, gifts and memorials. The Foundation's Board and Associate Members are working together to build a residential hospice, Serenity House, a peaceful end-or-life care facility open to patients from area hospice programs and those who need end-of-life supervised care, as well as a center for excellence and education in end of life care.
In Europe, there is an ancient hospice. The inscription on the wall says, “Not only this door, but the hearts of the people inside stand open to you.” Representatives on the Circle of Life Foundation Board from Saint Mary's, Circle of Life Hospice and Renown Health Care are joined by active and retired physicians, nurses and members from UNR and TMCC, as well as community members who recognize the need for a community supported residential hospice facility. Some Board members have lost family members. Their dream for a facility like Serenity House is no longer a dream, but will soon be a reality.
Those interested in becoming an Associate Member of the Circle of Life Foundation may contact Chairman Deb Girard at (775) 827-2298, or Secretary Jean Myles at the same number. You may also contact the Foundation Board Chairman or Secretary if you are interested in making donations, gifts or memorials to the Foundation Endowment or Building Fund. Please note that each Hospice in the area has its own financial needs. Individual hospice programs are listed in the Reno Phone Book, and most have their own websites if you wish to financially support their hospice programs