Transitions LifeCare – Power of 10: Case Statement for 10 Additional Hospice Home Beds

Power of 10: Case Statement for 10 Additional Hospice Home Beds

Transitions LifeCare, founded as Hospice of Wake County in 1979, seeks to expand the agency’s inpatient facility (also known as the William M. Dunlap Center for Caring, or the Hospice Home).

Community Need
This request is the result of several years of study and analysis of the changing demographics in the area. The population of Wake County is growing and aging at a rapid rate, and this community must be prepared to handle this growth. Projected growth is critical as it is occurring most significantly among older residents who are more likely to need community resources. The North Carolina State Data Center issued a report in 2012 indicating that by the year 2025, the 65-and-over segment of the population in Wake County will increase by 194%. Growth in the 75-and-over age range will be even more dramatic with a projected increase of nearly 23 9%, over year 2000 census data. One of the most significant issues of this coming shift is the potential strain that this demographic will put on already limited community resources—especially those in human services.

According to the North Carolina State Center for Health Statistics, terminal illness (specifically cancer in this 2013 study) was the leading cause of death in North Carolina, accounting for nearly 25% of all deaths. When a high rate of death by terminal illness is combined with a growing elderly population, many of whom live on a fixed or limited income, the result is a community that is highly dependent upon access to affordable health care at end of life. Residents who cannot afford care for serious and terminal illness may be more likely to turn to the emergency room or not receive care at all, putting strain on residents, caregivers, and the community.

The best way to address this growing community need is to increase the number of beds available at the Transitions LifeCare Hospice Home. Studies have shown that the best and least costly option for end-of-life care is hospice care. Patients who receive hospice care live longer than those who do not receive it—at reduced cost to both the patient and the healthcare system, and with less depression and better quality of life (Journal of Clinical Oncology, September 2010). The study shows that the cost for end of life care in a hospital is up to 400% higher than that in a hospice facility. This is primarily due to the fact that hospice care focuses on comfort and quality of life which results in patients being more likely to complete helpful treatments, eat better, exercise and socialize more, which improves both their physical and emotional state. As a result, they are less likely to experience medical crises, hospitalizations, and invasive procedures. Transitions' unique facility provides the most patient- and family-centered, and cost-effective, solution to acute, end-of-life needs in this community.

The usage rate at Transitions LifeCare, especially in the Hospice Home, has mirrored this community growth. Over the past 10 years, patient census has risen dramatically from serving 1,466 patients annually in 2005 to serving 5,223 patients per year in 2014, a 256% increase in the number of patients served. In addition, by the end of 2014, the Hospice Home had served over 3,000 patients and their families, reaching the trigger point set by North Carolina’s Medical Facilities Plan for hospice providers to begin expansion plans. Since that time, daily patient census is at full occupancy of 20 patients most days. These numbers mean that without expansion, soon patients in need of care at the end of life will be turned away, and family members will be forced to seek other options for their loved ones in a time of crisis.

In response to this growing and urgent need among residents, Transitions has begun plans to construct an additional 10 rooms to the current Hospice Home. This response was driven not only by the agency Board and staff, but also by the North Carolina Department of Health and Human Services who called for an additional 10 inpatient hospice beds to be created within Wake County to prepare for this growing and aging population.

The people served by this expansion will be the residents throughout the seven-county service area—those in Wake, Durham, Franklin, Chatham, Harnett, Johnston, and Orange Counties. This service area includes 1.9 million people—19% of the entire state’s population. Patients come from a wide variety of backgrounds and diagnoses, as Transitions LifeCare will serve anyone who is medically eligible and needs care.

The Hospice Home
The Transitions LifeCare Hospice Home ("Hospice Home") provides patients with a comprehensive program of medical care, emotional support, and spiritual guidance. Led by a compassionate, well-trained team of physicians, nurses, social workers, volunteers and more, care is provided 24 hours a day, seven days a week. For many, the Hospice Home offers a higher level of around-the-clock skilled care to manage crisis situations than can be provided in their own homes. For others, the Hospice Home is a place of respite to give family members temporary relief from the stresses of caregiving. To accommodate extended stays by family members, the Hospice Home features a communal living room, kitchen and dining room, a laundry room, children’s playroom, home office, and a meeting room. Within steps of the Hospice Home are the Dorothy Kerr Spiritual Sanctuary, Kit Boney Grief Center, administrative building, and beautifully landscaped gardens.

The expansion will increase the home’s interior space by 37% and will allow the agency to meet the needs of an additional 400 patients annually, allowing the home to serve 1,200 patients and families each year. The Hospice Home expansion will feature:

• 10 private patient rooms with private bath and patio
• A sunroom for patients, families, and visitors
• A nurses' station with a medication room
• A nourishment station and three additional storage rooms
• Additional gardens and outdoor spaces, including a Veterans Garden to honor those at end
of life who served in the military.

The total construction and operating budget is $6 million. When construction on the original Hospice Home was begun in 2008, the long-term vision to add these additional 10 rooms was established. As a result, the 20-bed facility was created to accommodate an eventual expansion—the original infrastructure (oxygen tanks, HVAC and electrical) was built to hold a total of 30 patient rooms. As a result, this expansion will be streamlined in both cost and construction efforts, with a goal of meeting the community need while minimizing impact on current patients.

Expansion will be led by a dedicated and experienced team, including CEO John Thoma, VP of Marketing and Business Development Cooper Linton, VP of Development Kristye Brackett, and a steering committee. This team is experienced in major capital projects, as they successfully led the initial $14 million project on the Hospice Home.

By providing a high-quality medical home for seriously and terminally ill residents, Transitions will continue to improve the quality of living and dying for all those in Wake County and beyond. The benefits will be a reduced burden to hospitals and other community resources, a reduced burden on the families of patients, and an increase in the quality of life for those in this region.

The goal of this project, and Transitions LifeCare, is to provide the best possible end-of-life care to the residents of this community. This vision can best be summarized through the letters Transitions receives each day from the families of patients served:

From the sister of a patient: “I was so very grateful for the care team that helped us Out, everyone was wonderful. I knew of your organization by reputation, but had not yet experienced it. Now I see what everyone else was talking about. I am so grateful for all that you have done for us.”

From the wife of a patient: “The Home there was truly a sanctuary for our family, for me in particular. You all made it so much easier for all of us. He was more comfortable there than anywhere else. The staff did so many special things for me. One morning someone brought me coffee in a china cup. One day I was napping and someone laid a prayer shawl over me. Most of all, we had privacy which was so important. Please thank everyone for all they did for us.”

From the son of a patient: “I got so tired of seeing people who just don’t care; at nursing homes and at the hospital. When we came to hospice I saw people who had a true love and care for the person they were caring for. The people at hospice are not just there to collect a paycheck and it shows. Hospice has restored my faith in the healthcare system.”

From the daughter-in-law of a patient: “Hospice has been like the best in the world... they not only care for the patient but they care for the whole family! How many organizations do that?! I have a survey that you all sent me and I am going to fill it out right now because I want to make sure your whole organization knows how wonderful you are!”

 
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