Hospices reaching out to the community must be willing to pay
Hospices reaching out to the community must be willing to pay
Outreach promotes understanding of death and dying issues
Certified hospices must provide bereavement support to the families of their deceased patients. What about those who ask for help in coping with losses otherwise unconnected with hospice care? Community grief services offered by American hospices range from individual counseling and support groups to school crisis intervention, bereavement camps for kids, counseling for the families of victims of violent crimes, and a variety of public education forums depending on local needs and the presence of other services in the community.
Some hospices charge on a sliding scale for community counseling or other grief services. Others seek mental health coverage from insurers or special funding. In most cases, community grief outreach is unlikely to pay for itself in terms of direct income. Instead, hospices must subsidize these services as part of their mission and their responsibility to transform the culture’s understanding of death and dying issues, as well as using the opportunity to raise the public’s awareness and comfort level with what hospice provides.
Judy Davis, LCSW, BCD, director of volunteer and bereavement services for San Diego Hospice, says her agency provides such services in large part because the community asks for it. "As a community-based nonprofit organization, we have a moral and ethical imperative to take what we’ve learned and pass it back to our community," she explains.
A value-added service
San Diego Hospice consults with school teachers, counselors, and nurses on how to work with children’s grief and is frequently called in to educate managers about grief and loss issues in the workplace, Davis says. Its grief support groups are open to the public and are usually divided equally between the families of hospice patients and individuals not connected with the hospice. Davis’ department gets about 200 requests for grief assistance every month, some of which receive immediate telephone crisis counseling.
The hospice doesn’t charge for these services, and it tries to use volunteers for the low-risk, routine follow-up calls, leaving counseling to the paid staff.
"We’re not interested in doing fee-for-service at all. It’s a decision we made to make the service available to the community. Our hope is that a value-added service like bereavement support eventually might find an endowment," Davis says.
"The payback for hospice is that if we, as a society, are going to re-incorporate death into life, then hospice needs to be offering these learning opportunities to people who request them. The things we’ve learned from our patients and families are life skills that have application across the life spectrum. That automatically increases the awareness of quality-of-life issues at the end of life. It’s a long-term investment, but if we don’t start making that investment, we’ll never get there," Davis says.
She offers an example of the hospice’s twice-a-year presentations on issues of grief, loss, and dying in local high schools, which include a brief explanation of hospice care. One young participant told his family about hospice when his grandmother became terminally ill. "Is that why we do it? No. But where else would he have learned about hospice, and how else would they have heard about it?"
Judith Skretny, MA, director of the Life Transitions Center affiliated with Hospice Buffalo, NY, and the Center for Hospice and Palliative Care in Cheektowaga, NY, says that hospice already enjoys a good reputation in her community.
"Community grief outreach does a great deal to support our hospice," she says. "It shows people that hospice is not so limited; it really is committed to the end of life and the idea of supporting people coping with serious illness and loss beyond the six-months-or-less requirement of the Medicare hospice benefit," she explains. "Every time we go out and do a grief program, we talk about hospice. It’s a natural marketing tool, and an opportunity to correct misconceptions. I can’t quantify the result, but I hope it helps people to find the idea of hospice more palatable," Skretny says.
We are mission-driven’
The Life Transitions Center, which was as an independent center for grief counseling prior to its affiliation with Hospice Buffalo in 1992, currently has a budget of about $750,000 and a staff of 17, Skretny says. It provides bereavement support for 2,000 families of the hospice’s patients each year, as well as all of the organization’s community grief counseling, education, and support. The center reaches out to the community in areas such as grief training for staff at local schools, a monthly bereavement ministry training for clergy and volunteers, and about 200 public education presentations on grief in a variety of settings. "We are the agency called in to respond in a crisis, because hospice is recognized as the expert on death," Skretny says.
Currently, the center offers 22 grief support groups for different target populations, such as men, suicide bereavement, younger widowed persons, and adults who have recently experienced the death of a parent. The hospice uses a sliding fee-for-service scale for both counseling and support groups, and is increasingly able to access insurance coverage for counseling, Skretny says. "We ask for donations for any crisis intervention or response. We have support from the United Way and we’re always applying for specialized grants, along with the transfer of direct costs from its affiliated hospice for services provided to hospice patients’ families. But it is a struggle. This agency will never be in the black, and we know that. Part of why we do it is because we are mission-driven. We have a commitment to this community that we will serve everyone, regardless of ability to pay," she explains.
Responding on a smaller scale
Some smaller hospices, lacking the resource base of the San Diego or Buffalo hospices, have also sought ways to provide community grief outreach. In some cases, that means finding partners in the community, such as religious congregations with active volunteer ministries for collaborative ventures. In other cases, the hospice assesses the current availability of grief support in the community in order to identify an area of significant unmet need.
Blue Water Hospice, a program of the Visiting Nurse Association of Port Huron, MI, began its outreach with a desire of its board of directors to reinvest memorial donations in the community, says Brenda Clark, hospice administrator. "We did an informal community needs assessment and found that several other organizations were providing grief support for adults and for younger school children. The gap seemed to be teens, so we started with the schools, offering a Teen Grief and Loss Class." Blue Water Hospice now offers eight-week sessions to teens through the schools in the fall and spring. The hospice also offers teens education through school health classes. Meanwhile, the hospice is expanding to the preschool population with a program called "What color is your hurt?"
Boulder, CO, enjoys a community resource that Kim Mooney, BA, coordinator of community education and bereavement for Boulder County Hospice, jokingly refers to her program as "an infestation of therapists." The hospice has recruited 30 local mental health professionals who were willing to take the hospice’s volunteer training and run grief support groups on a volunteer basis.
With this volunteer cadre, the hospice is able to offer a range of group settings, from structured and time-limited, to drop-in and ongoing, targeted at general or specific populations, Mooney says. A monthly three-session group, is designed for the newly bereaved, giving them a light combination of support and education to deal with the normal, distressing, symptoms and problems of a new loss.
"None of these groups is a therapy group. We spend time with our volunteers talking about the difference between therapy and support," Mooney explains. "We provide support and education in a very profound way, but we don’t label participants as pathological." The hospice refers those who need more assistance to its list of local grief-savvy therapists. Except for occasional crisis interventions, the hospice reserves individual grief counseling for hospice families.
"Our hospice grew out of the community, and out of a larger context," Mooney says. "What’s required of us in a larger way is to be a resource to the community on death and dying. Unless people become more open to the idea of comfort and care at the end of life, we’ll always be preaching to the choir. We want to have as much visibility as possible at times when we’re not so scary to people. Our approach to death, dying and grief is to go through as many side doors as possible."
To achieve these goals, Mooney pursues constant and steady exposure through churches, senior centers, libraries, and local media.
"I think it’s easy to reject or devalue that which doesn’t clearly show measurable results, but from what I’ve seen, these kinds of personal conversations are the primary way people become open to the hospice approach. We’re pursuing a conversation with our community, and that broadens the audience willing to look at us. I can’t prove the value, but I see community grief as hospice’s advance party."
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