This year marks the 40th anniversary of hospice care in America.
The first hospice organization was founded in Branford, Connecticut.
Three years later, the country’s 12th began here when Hospice of Spokane pioneered the concept of caring for the terminally ill and their families.
Most of its patients receive that care in their own homes or extended-care facilities. But two months ago, the nonprofit opened Hospice House North, a 12-bed, $4.7 million stand-alone facility similar to the one it launched seven years ago on the lower South Hill.
During a recent interview, Hospice of Spokane CEO Gina Drummond discussed her organization’s evolution, its future, and what qualities help caregivers bring comfort and emotional healing to patients during their final days.
S-R: Where did you grow up?
Drummond: In Miles City, Montana, I did a lot of farming and ranch work, and thought I was destined to be a veterinarian but changed my mind and went into nursing.
S-R: What did you do for fun back then?
Drummond: I played tennis through high school. And I was a cheerleader, which in some ways is still part of my job.
S-R: Was there a moment that changed the direction of your life?
Drummond: When I was 25 and working in an oncology unit at the University of Washington Medical Center, I was introduced to a hospice team, and I remember thinking, wow, these are amazing people. Later, when I was working for an oncology group in Great Falls, I was recruited by a hospital-based organization called Peace Hospice of Montana, and was director there for about a decade. I joined Hospice of Spokane as CEO in 2005.
S-R: Has Hospice of Spokane had some lean years?
Drummond: Yes, particularly in the beginning. But I would say we’re in a good place now.
S-R: How long do people typically get hospice care?
Drummond: The average is 52 days. But the average stay in Hospice House is eight to nine days, because limited space means we can only accept people in the last few weeks of life.
S-R: Where does your operating revenue come from?
Drummond: Medicare accounts for about 86 percent, since most of the folks we serve are over age 65. We also get money from Medicaid and private insurance. And because we’re the only nonprofit hospice care in Spokane, philanthropic support has been important to us over the years.
S-R: How much does hospice care cost?
Drummond: If you have Medicare, Medicaid or private insurance coverage, there’s no bill. But if you’re in Hospice House for an extended stay by choice, there’s a room-and-board charge that’s comparable to what you’d pay in an assisted-living environment – about $170 a day.
S-R: How many other hospice-care providers serve Spokane?
Drummond: We have two for-profit competitors.
S-R: Are their charges comparable to yours?
Drummond: Yes, because charges are dictated by Medicare. But we don’t have shareholders making decisions about how to spend operation margins. We have a volunteer board focused on what’s best for the community. That’s why we have two Hospice Houses.
S-R: Do other caregivers, such as nursing homes, complain that Hospice House takes potential patients away from their facility?
Drummond: We work very hard to be good partners with the community’s hospitals and long-term-care providers, because those relationships are essential to our business. When nursing homes have patients who are dying, they invite us in and we work hard to bring value to their residents’ end-of-life experience. When we started planning for the second Hospice House, I made the rounds with our partners and asked how much impact they’d experienced with the first one. For the most part, they said zero. And I said, “If you take that and double it, that’s probably what you’re going to experience with the second one.”
S-R: How has Hospice of Spokane evolved?
Drummond: We’ve grown and added programs. We’ve expanded into palliative care (which focuses on relieving and preventing suffering for people still in active treatment). That’s more of a consultative service, where people pick and choose the help they need.
S-R: How has the industry changed in recent years?
Drummond: When I was starting out, we didn’t hear much about for-profit hospice. Everyone was struggling, trying to provide excellence with what they had. Things have changed a bit over the years, as major for-profit companies have gotten into this.
S-R: How has that changed the hospice landscape?
Drummond: Our competitors are really big on marketing, and they’re very good at it.
S-R: How might that impact Hospice of Spokane?
Drummond: Volume is very important when you’re staffed for a certain caseload of patients. But it’s not so much what you charge – it’s what you provide. We do children’s bereavement camp free of charge. We provide bereavement support for children in the school system. We’re busy meeting needs for which there’s no reimbursement.
S-R: What do you like most about your job?
Drummond: I love our mission, and I love the people who work for this organization.
S-R: How do you and your co-workers handle continually getting to know patients and then watching them die?
Drummond: Those of us who choose this work are drawn to it. It’s not a job as much as a calling. Part of my job is taking care of the people who take care of the people – making sure they feel nurtured and supported, and have the tools to do the job.
S-R: What mistakes do you see people make as they approach the end of life?
Drummond: They put hospice off too long. At that point we can help manage their symptoms, but there’s not enough time for the emotional healing and life closure that could have happened.
S-R: Are there certain words you avoid in hospice care?
Drummond: We don’t say things like “I know exactly how you feel” or “He’s in a better place now.” And we avoid phrases like “passed on” – especially with kids, because we don’t want to confuse them. We’ll say, “I’m sorry your mom died.”
S-R: What’s your staff breakdown according to specialty?
Drummond: Among our 160 employees, we have 78 registered nurses, 29 certified nursing assistants and nurse practitioners, 16 social workers, five bereavement counselors and five chaplains. We also have a full-time medical director and several part-time medical directors.
S-R: What do you look for in prospective employees?
Drummond: Confidence. Compassion. Competence. The ability to tolerate silence. And I always look for a sense of humor in interviews. Patients and their families want someone who can walk into a gloomy situation and bring some light. Life is really important when you find out you don’t have as much time as you thought you would.
S-R: Any big changes ahead for Hospice of Spokane?
Drummond: At the ribbon cutting for Hospice House North, people asked when we were going to build one in the Valley. But I don’t know that more bricks and mortar are in our near future. We need to focus on relationships with our long-term-care providers, hospitals and community members. My mantra has always been relationships – whether it’s on our deathbed or the way we run our business. As a free-standing nonprofit, we need to be everybody’s beloved community partner.