By Alan Prendergast
By Michael Roberts
By Michael Roberts
By Amber Taufen
By Patricia Calhoun
By William Breathes
By Michael Roberts
By Melanie Asmar
And hospices are facing another problem, too: Medical advances have given dying patients more options, meaning hospice care is considered only after every kind of treatment has been considered. As a result, patients sign up for hospice care with only a few weeks or days left to live.
"People reason, 'If I continue on a strict regime of radiation or chemotherapy, maybe I can lick this cancer,'" Canner says. "When someone elects hospice, they have to cease that treatment. Also, doctors don't have much training on having difficult discussions with patients. It's easier to say, 'There's a new chemo treatment that might help,' than it is to say, 'Let's discuss quality of life for your limited time here.'"
In the 1980s, patients received hospice care for two to three months; now they stay about a month. Colorado ranks at the bottom in the country in that regard; the median length of hospice stay in Colorado was 19.2 days in 1999, compared to 35 days nationwide. And since hospices receive Medicare reimbursement by the day, shorter stays mean less money. The most expensive days of hospice occur at the beginning of a patient's stay, when all of the team members are on hand to assess physical problems and to coordinate a care plan with family members, and at the end of the stay, when more medication is needed to control pain, funeral arrangements need to be made and government paperwork must be completed.
Bezuidenhout has been trying to get patients to stay with Namaste longer. "We lose our shirts if a patient stays less than seven days. We get about $113 a day [from Medicare] whether we spend $2,000 a day or $2 a day. The costs are almost always triple the per diem," she says.
"I would suspect that 100 percent of hospices in the country are struggling to survive," Canner adds. "The only way hospices are able to stay in existence these days is because of the generosity of the community."
Since January 1999, six hospices in Colorado have closed because of financial problems, a shortage of nurses or a lack of community support: Hospice of the Rockies in Glenwood Springs; Hospice of Custer County in Westcliffe; St. Vincent Home Care & Hospice in Leadville; Banner Hospice in Sterling; Life Source Services in Trinidad; and Caring Unlimited in Walsenburg. There are now just 36 hospices in Colorado.
Hospice of Metro Denver has recently overcome serious financial struggles. "We had some patchy times, but in the last twelve months, we tightened our belt and took stock. Now we're on strong footing again," Sloan says.
Rising costs and dwindling Medicare reimbursement forced the hospice to cut sixteen jobs in the last year. The nonprofit also streamlined its services to save money; for example, it used to include chaplains in every patient's caregiving team, but now only those who request one receive that part of the service. In 1998, Hospice of Metro Denver held its first Mask Project, a huge fundraising endeavor in which celebrities and local journalists designed masks for auction at a gala benefiting the hospice; the project netted $400,000 that year and $600,000 last year. Sloan hopes that the next Mask Project Gala, in 2002, will raise $1 million. "None of us breaks even from what the government or commercial insurance pays us, so all hospices have to hold big fundraising events," she explains.
And that's what sets organizations like hers apart from Anam Chara: Sloan's nonprofit knows how to raise money. Anam Chara hadn't the first clue.
By February 9, Peggy Quinn decided she wouldn't willingly resign as executive director of the organization she'd founded, so the board removed her (they had agreed to let her remain on the board, however).
With just five residents in the Boulder home at the time -- all of them on Medicaid -- money was scarce. "In late February, I announced at the board meeting that we'd be lucky just to make payroll," Berzins says. "We had no money to operate the Boulder home after March 1."
By this time, Namaste was managing the Denver home, but without a contract, and although the boardmembers never got a final answer on the budgets of the two homes, they decided to continue to let Namaste run the Denver home while they focused on the Boulder one.
When Berzins asked Anam Chara's accountant for a year-end financial statement for the Boulder home, it showed that donations of $10,000 and $4,000 had been made. Berzins was relieved; they needed that money to run the Boulder home until they could figure out what to do with it. But when Berzins called the bank to confirm the balance in the donation account, he learned that it contained only $4,000. Quinn says she hadn't deposited the $10,000 check because the donor didn't want the new boardmembers to be able to use it unless Quinn was running Anam Chara.
The staff members at the Boulder home were worried about getting paid, so the board set up a meeting on February 27 to discuss what to do. Despite everyone's hope that the Boulder home could remain viable, the boardmembers realized it would have to be sold. The plan was for Namaste to operate the Boulder home until then.