Not in my backyard!’ Here’s what to do if neighbors protest your hospice

Execute a well-planned public relations campaign

In 1994, leaders of Hospice Inc. in Stamford, CT, thought they had found an ideal location for a new residential hospice facility. Near an affluent neighborhood stood an elementary school that had been vacant 10 years, perfect for a hospice that would provide low-level end-of-life care.

The leaders of Hospice Inc. set out obtain the needed approvals and rezoning to purchase the city-owned property. Janice Casey, MS, president and chief executive officer of Hospice Inc. — now called Visiting Nurse and Hospice Care of Southwestern Connecticut — knew she was in for an uphill battle the moment a group of nearby residents stood up to object the planned hospice during a city council meeting.

"The fear at the time was AIDS," says Casey. "Although it was not going to be an AIDS hospice, AIDS patients would be cared for there."

Neighbors claimed AIDS-tainted medical waste would be scattered throughout the neighborhood and AIDS patients would infect the local water system. At every meeting or hearing hospice administrators attended, the same residents were there to shout them down. The furor caught the attention of local media, and the issue began to play out on the front page of the local newspaper and television newscasts.

"At every hearing, there was a major brouhaha from this small group of neighbors," Casey recalls. "We were constantly in a defensive position. The strain on the organization was incredible."

Casey and Hospice Inc. found themselves in the middle of an all-too familiar scenario: Residents set on preserving the residential characteristics of their neighborhood rallied around the "not in my backyard" battle cry.

In this case, Hospice Inc. was placed in the same company as landfills and low-income housing. While no one denies the public benefit of such projects, few residents welcome them to their neighborhood.

Despite the city’s approval of the land sale and property rezoning, Casey and her colleagues opted to withdraw their proposal to buy the old school after opponents sued the city to block the sale. The battle lasted two years. The hospice eventually merged with a local hospital system and built its residential facility on hospital property.

While there is no specific formula for getting past anti-hospice sentiment, there are tactics hospice leaders can employ in their efforts to relocate or build new facilities. According to Casey and Michael Smajd, MHA, executive director of Columbus Hospice (GA), the key is to apply the elbow grease early on.

"Looking back, we would have, from the beginning, got the public involved in what we were doing," Casey said. Both hospice executives and other business leaders inside and outside the health care industry say the following public relations tactics should be adopted to negate or soften the effects of anti-hospice sentiment:

Educate everyone involved. Be open with the local media so that reporters understand your position; provide local government officials with details of your plan; and calm nervous residents by providing plans and discussing the project’s real impact on their community. Don’t forget to play up any economic benefits.

Refute misinformation. Anticipate the type of misinformation that will be spread. For example, common misconceptions about residential or inpatient hospices are AIDS-related. Put together an HIV/AIDS fact sheet to dispel comments about endangering public health.

Isolate opponents. Show that your opponents are separate from mainstream residents. For example, juxtapose their irrational arguments with common knowledge. Counteract arguments that people can become infected with HIV through casual contact with an AIDS patient with information about years of research showing that HIV is spread through the exchange of bodily fluids, such as blood and semen. By doing this and refuting the misinformation opponents are spreading, hospice leaders will be able to destroy their opponent’s credibility.

Offer a Q&A. Give residents an opportunity to have their questions answered and concerns addressed in informative, non-threatening community forums hosted by the hospice director and staff. (See related story, p. 14.)

In the end, the only sure way to prevent neighborhood opposition is to avoid building on property that has to be rezoned or purchased from a municipality, both Casey and Smajd say.

"The fact that we had to go through so many hearings gave neighbors more opportunity to attack us," Casey says.