Gretchen Brown tells Liz French how becoming a regional provider helped this hospice organization better serve its community.

When a small group of healthcare providers in Lexington, Ky. formed Community Hospice of Lexington in 1978 with four employees and a budget of less than $100,000, they knew they had a long road ahead. At the time, the medical community considered referring a patient to hospice equivalent to “giving up” rather than an opportunity for terminally ill patients to die peacefully and with dignity.

Gretchen Brown

Expansion continued when, in 1998, Hospice of the Bluegrass partnered with Jessamine County Hospice and merged with Mountain Heritage Hospice in 1999. In all, the organization operates 10 sites, serving patients in 23 counties throughout central and eastern Kentucky on a budget of $54 million.

“As Community Hospice of Lexington, if someone needed hospice services but lived two miles over the county line, we couldn’t take care of them because of Medicare restrictions. To receive proper reimbursement and serve a wider geographic area, we began regionalizing our program,” said Gretchen Brown, president and CEO. “The bigger we get, the more we can spread our cost given the reimbursement system used by the Hospice Medicare Benefit.”

Open doors
In addition to expanding geographically, Hospice of the Bluegrass generated business by opening its doors to any and all individuals in need. In the early days, Brown explained, hospices primarily served cancer patients who had six months or less to live. The organization typically did not accept children, patients in nursing homes, or individuals who didn’t have a primary caregiver at home. “That meant anyone who lived alone couldn’t receive hospice care—they were the ones who needed us most.”

But Hospice of the Bluegrass wanted to serve the whole community—rich and poor, old and young—regardless of their diagnoses. “We took a risk in doing that, but serving the community is what hospice is all about,” Brown said. “Our business model supports open access to all those in need.”

As it grew geographically, the organization realized that the needs of the community could not be served through hospice care alone and began building its service offerings. Today, Hospice of the Bluegrass offers home care, providing hospital-grade medical care to individuals who wish to die in the comfort of their own homes; nursing home care for persons whose needs cannot be met at home; Daniel’s Care, a pediatric program; two hospice in-patient units for patients who require skilled care; palliative care, which focuses on pain control and symptom management; and Extra Care, a private duty nursing service providing care around the clock in the home, in a nursing home, or in a skilled facility. At all levels of care, the emotional, social, and spiritual concerns of the patient and family are addressed, and grief counselors are available at no charge after a patient’s death.

Spreading the word
Although geographic expansion and a wider patient base helped Hospice of the Bluegrass grow tremendously in recent years, Brown says that catering to the needs of physicians needs played a significant role as well. “That was a unique shift because hospice was a revolutionary movement that started in opposition to the aggressive, life-prolonging care going on in hospitals,” she said. “Early on, we made physicians our primary customers.”

Hospice of the Bluegrass recruited physician volunteers from the local community to work in small, patient-centric teams. These physicians continue to serve as ambassadors, educating other local physicians and dispelling myths about hospice care.

As the organization grew, it developed newsletters for physicians, as well as advisory committees. In the early 1980s, Hospice of the Bluegrass partnered with the University of Kentucky to provide formal education to physicians and clinicians in training. “Early on, we had a hard time attracting staff because people didn’t know what hospice was. And providing care to a patient at home differs greatly from working in a hospital. Not only are our caregivers on call 24/7, but watching patients die is emotionally taxing,” Brown said.

With perseverance, Hospice of the Bluegrass broke down barriers through formalized classes, one-on-one education, seminars, and physician ambassadors and was able to hire nurses, social workers, counselors, and health administrators. Today, the organization staffs 600—a far cry from its original four.

In the mid-’90s, Hospice of the Bluegrass became the first free-standing hospice to offer clinical pastoral education, an appropriate move considering many hospices were founded by spiritual caregivers. “We realized that the need for hospice can be identified anywhere. We field calls from ministers, neighbors, family members—whoever thinks a patient is ready for hospice care—and we follow up the referral with physician approval.”

Above all else, Hospice of the Bluegrass staff work to meet patient and family needs. “There is no predetermined set of services. We consider the patient and the family part of the hospice team. Do they need home care a couple of times a week? Every day? Do they need home-delivered meals? More volunteers? Do they need financial resources? Every family is different, and we strive to meet all of their needs,” Brown concluded.