Dynamic Dozen No. 9: Community Hospices of America

When faced with the inevitable, terminally ill patients and their families are increasingly turning to hospice for comfort and support at the end of life.

Jan Badgett, vice president of community services for Community Hospices of America, attributes increased use of hospice to a public that is more educated about end-of-life issues.

"People have become more vocal about how they want to spend the last days of their lives, and many more people want to stay at home, rather than die in a hospital. And we can provide that for them," Badgett said.

"The number of patients that we serve increased by about 300 patients" each year between 2001 and 2003, Badgett said.

Established in 1979 as The Hospice of Southwest Missouri and serving Greene, Christian, Dade, Dallas and Webster counties, the organization became Community Hospices of America in 1994. It has since grown to a network of eight health care facilities, Badgett said.

The company's revenues have almost tripled, from $974,105 in 2001 to approximately $2.8 million in 2003.

Community Hospices is owned by Rick Williams, president; Rocky Levell, vice president of marketing; and John Sherwood, vice president of pharmacy services and purchasing.

In September, Community Hospices expanded its corporate operations to 2135 S. Eastgate from 1465 E. Primrose, where its hospice care facility will remain, Badgett said.

Jonna Montileone, program director for the Springfield office, said there are about 90 hospice employees in Springfield's hospice care facility with about 25 more at the corporate office.

Hospice expansion to communities around Springfield was a natural consequence of the city's regional health care facilities, Badgett said. People coming into Springfield for treatment of their terminal illnesses would return home without a hospice resource to assist them, she added. The company expanded to meet that demand.

Including the Springfield offices and its six other Missouri hospice centers, Community Hospices has 225 employees on staff in Missouri, Badgett said.

The Branson and Mountain Grove locations began in 1994, Columbia in 1995, Joplin in 1998, Jefferson City in 2001 and Monett in 2002, she added.

Community Hospice has out-of-state offices in Galesburg, Ill., and Bluefield, Va., which were launched in 1995, Badgett said. About 20 people are employed in each office, she added.

Hospice care is provided as an entitlement to qualifying individuals under income-based Medicaid or age-based Medicare guidelines, Badgett said. Hospice is paid a per diem for services and care rendered. "All the care that we provide for them comes out of this per diem," she added.

In some cases, private insurance companies offer benefits, while some individuals set up a self-pay arrangement, she added. On occasion, indigent care is offered, too, Badgett said.

The physical requirements for hospice care are, understandably, severe.

The physician-approved patient must be diagnosed as having a terminal illness with a life expectancy of less than six months, Badgett said. Additionally, the patient must be seeking only pain and symptom relief and not curative treatment and must live in the service area, she added.

Hospice care includes social worker visits to identify community resources available to patients or to identify financial needs, Badgett said. These workers can assist patients in qualifying for government benefits, she added.

Also, nursing and counseling services are available, and home health aides can be utilized for personal care like bathing and dressing, Badgett said. Volunteers can be called in to relieve caregivers from patient responsibilities, she said, and, if requested, spiritual care can be delivered through hospice services, she added.

"Hospice isn't there just for the patient, we're there for the entire family. Although the patient is the one who has been diagnosed with the terminal illness, that illness is affecting everyone in that patient's life," Badgett said.

Follow-up services, such as bereavement counseling, are available to family members for up to a year following the patient's death, Badgett said.

Badgett said her 16 years with Community Hospices, beginning in 1988 as a case manager, have brought rich rewards. "I feel like dying patients have taught me so much more about life than I could ever teach them about dying," she said.