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A Better Understanding of the Patients We Serve

We’ve been caring for patients and families for more than three decades. Yet, we find some people still thinking hospice care is only for cancer patients.  In 2013, 322 area physicians made 1,722 referrals to Center for Hospice Care (CHC). Nearly 1,000 referrals came from other sources including hospitals, extended care facilities, patients and families themselves, with a wide scope of diagnoses.  This was the ninth consecutive year that non-cancer diagnoses surpassed cancer diagnoses upon admission.  The percentage of cancer as a primary diagnosis for a terminal condition has been shrinking since 2004.  In 2013, 37% of the patients were diagnosed with cancer upon admission.  Of all patients admitted, 63% had non-cancer diagnoses in 2013.  Our agency cared for a significant number of cardiac, vascular, pulmonary, neurological and renal patients.  The top five non-cancer causes of illness for hospice admission included:  cardiovascular disease (21%), dementia or neurological (13%), lung disease (10%), end-stage liver, kidney and related diseases (4%), and failure to thrive and all other illnesses (15%).  CHC patients had 281 different diagnoses in 2013. The average age of a CHC patient at admission was 79. While CHC served 24 patients over 100-years-old in 2013, patient age at admission ranged from one-day old to 106-years-old.

Unlike some hospice programs, CHC routinely accepts patients with complex treatment issues, and works collaboratively with the physician, and when necessary, ancillary healthcare providers to serve the needs of patients.  CHC also works with patients regardless of where they call home.  CHC is contracted to provide hospice services to more than 80 nursing homes, group homes, assisted living centers, and other facilities, but we have also provided care to patients in jail, and at a homeless shelter.  The majority of care, however, continues to be in the residential home setting.

CHC continues to operate the only Medicare certified hospice inpatient units, commonly referred to as Hospice House, within our service area.  CHC owns two seven-bed inpatient units, one in South Bend and one in Elkhart.  They complement our original mission by allowing patients to receive short-term hospice inpatient care in a home-like setting.  Hospice House is intended primarily for management of pain and symptoms that cannot be controlled in the residential home or other settings.  When the reason for the admission to Hospice House is resolved, patients often return home or to an extended care facility.  About half of all Hospice House admissions come directly from area hospitals.   Both CHC Hospice Houses offer a comfortable, residential environment, 24-hour-a-day visitation with no age restrictions, a family room, a spiritual reflection room, a kitchen for family to cook for the patient if they desire, and pet visitation.  In 2013 our South Bend Hospice House celebrated its 17th year of operation and our Elkhart Hospice House saw its fifth full year of operation.

So far in 2014, we have received 1,505 referrals for hospice care. Unfortunately, nearly seven percent of those patients die before we can admit them. So no matter what the diagnosis is, or where home is, we encourage everyone to call us sooner. We will respond to your call within hours. No one should be denied comfort at end of life. All of us deserve to die comfortably and with dignity.

Looking Back at 2013...

In 2013 Center for Hospice Care (CHC) had the highest annual percentage increase in patients served in the last four years.  At 1,993, we cared for more patients than in any year in our 33-year history with a 7% increase over 2012.  CHC continues to rank in the top 5% of the more than 5,500 hospice programs operating in the United States.  Since our first patient was admitted in January of 1980, we have cared for 26,447 patients on an annually added basis.  50% of all the patients served by CHC over the course of 33 years were seen in the last seven years alone and nearly 25% in just the last three years.  Mission-driven quality care, remarkable clinical skills capacity, and a focus on charity are the hallmarks of CHC and its Hospice Foundation (HF).  Today, with 221 professional staff and 350 devoted volunteers, we believe there is no other local organization more proficient or more experienced at providing high quality, patient and family-centered care at the end of life.

            The completion of Phase I of the Mishawaka Campus was a momentous achievement during 2013 -- a historic event for our agency.  The move of three separate offices to one location was a significant logistical undertaking.  Details of our new campus and future projects are available at

            The Mayo Graduate Education Committee of Mayo Clinic, Rochester, MN approved an inpatient hospice rotation with CHC. The Practice Letter of Agreement between Mayo Clinic and CHC allows for Hospice and Palliative Medicine Fellows to rotate for training through our agency.  CHC also signed a clinical affiliation agreement with Indiana University to provide clinical experiences for medical students enrolled in the University’s Undergraduate Medical Education Program. Each of CHC’s three fulltime medical directors was given an Associate Clinical Instructor status with the Indiana University School of Medicine.  CHC also continues its current and past practice of providing teaching experiences to Family Medicine Residents from both programs at Memorial Hospital and Saint Joseph Regional Medical Center.  Thirteen residents had a teaching experience at CHC in 2013.

            CHC became a Level Four “We Honor Veterans” partner.  To reach this highest pinnacle level, CHC focused on increasing access to and improving the quality of care Veterans received throughout our eight-county service area by increasing the integration of Veteran-specific education for staff and volunteers, evaluating and growing our Veteran-to-Veteran Volunteer Program, developing resources to help our Veterans and their families’ access benefits and implement better ways to improve care and service to veterans and their families throughout our organization.  Nationally, there are nearly 2,000 “We Honor Veterans” hospice program partners and at the time of CHC’s designation, only 96 have achieved Level 4.  “We Honor Veterans” is a national hospice provider awareness program conducted by the Department of Veterans Affairs and the National Hospice and Palliative Care Organization.

During 2013 CHC recruited 71 new dedicated, trained community volunteers, bringing the total of active volunteers to 350.  Volunteer hours increased 3% and totaled 17,310.  Savings to CHC through the efforts of our volunteers totaled  $402,413 -- up 5% from 2012.  Traveling throughout our eight-county service area to patient homes, nursing homes and other extended care facilities, CHC volunteers drove 42,599 miles -- a 9% increase from 2012.  CHC is grateful for our volunteers!  We’re always welcoming new volunteers.  See and click the volunteer tab at the top.

In June of 2013, researchers at Giving USA published that it could take at least five more years for most charities to raise as much as they did in 2007 before the recession.  For HF in 2013, cash gifts were up 17% from the prior year and totaled $1,185,323.  The 2013 value of CHC charity care, write-offs, adjustments, community services, and other CHC support, etc. totaled $1,265,264.  Stewardship at CHC / HF is evident in our 2013 combined functional expenses.  Our auditors report 84% of all expenses went toward program services (mission), 14% to management and general (administration), and just 2% toward development efforts (fundraising).

            As always, we thank you for your role in supporting CHC and its mission during 2013.  Together, we continue to Improve the Quality of Living in our communities.

2013 Referrals and Patients Served Up; Length of Stay Down – Again

In 2013 Center for Hospice Care (CHC) had the highest annual percentage increase in patients served in the last four years. At1,993, we cared for more patients than in any year in our 33-year history with a 7% increase over 2012. However, for our patients on census last year, it continues to be a case of more and more for shorter and shorter periods of time.

Average and median length of stay (ALOS) were both down for CHC hospice patients last year, continuing an ongoing trend that’s replicated at most of the 5,500 hospice programs across the U.S. CHC’s ALOS dropped to 70 days and the median fell to 13 days, down from 75 and 16 respectively for the prior year. Today, half of all CHC hospice patients die in two weeks or less.

During 2013, one in nine hospital referrals to CHC saw the patient expire before we could even get there to perform an assessment – and we usually arrive within hours. Of those who do survive long enough to be admitted to CHC, the ALOS of hospital referrals was just 19 days and the median was only six days. Hospitals accounted for 42% of our 2013 referrals. Medicare patients are entitled to receive hospice for at least six months as a point of entry.

We understand that the “hospice talk” is a difficult conversation to have...for anyone. It’s no secret some healthcare professionals will delay having it as long as possible. Some won’t bring it up at all. Still, our local research consisting of interviews with over 300 residents in our service area each year continues to indicate that consumers
expect their trusted healthcare professional to provide them with all the choices and information necessary to make an informed decision. Even the difficult ones.

It’s clear to us that the benefits of hospice care become clouded when patients hear the word “hospice.” Fear can be paralyzing. Physicians can help eliminate that fear by explaining that hospice improves the quality of life and dramatically reduces caregiver stress. If this is an area you’re struggling with, we can help. We have “the talk” many times a day. Just call us for assistance.

Referrals to CHC totaled a record 2,717 in 2013. But where our referrals are coming from has changed over the last three years. Since we began a comprehensive public education campaign, referrals from the “Self and Family” category -- the public directly calling CHC -- has continued to increase year over year. Self/Family referrals in 2013 were up 50% from 2011. The fact that our community is taking matters into their own hands may be a good thing.

Some hopeful data comes from looking at lengths of stay from the Self/Family referrals. For patients and families who call us directly, meet eligibility requirements and become admitted to CHC, the ALOS in 2013 was nine days longer and the median seven days longer compared to referrals from all sources. Why does all this matter? While our surviving family satisfaction survey scores offer very high praise for CHC care, the most frequent complaint we receive continues to be “Why couldn’t we get into hospice sooner?”

Our Five Promises to You

It's no secret there is more than one hospice program operating in our area. Within the eight counties served by Center for Hospice Care (CHC) there are now a record 28 different hospice agencies.

To continue to differentiate our program from others, we believe we must go beyond simply listing a set of unique features that make us the right choice. We must articulate the benefits of choosing CHC for yourself or your loved ones.

Why choose CHC for yourself or your loved ones? We answer this question by applying our core values of Compassion, Dignity, Integrity, Innovation, Quality, Service, and Stewardship to these five promises.

1. As the area's first and most experienced hospice program, we will provide you with the most comprehensive range of end-of-life care services.
As Indiana's number one hospice program, nowhere in our community will you benefit from a more proficient or more experienced staff to provide high quality, patient and family-centered care at the end of life. After 33 years and more than 25,500 patients, CHC is the leading local expert in caring for people facing serious, advanced and life-limiting illnesses. With a vast range of nationally recognized benefits for patients and families, the depths of our services are unmatched within our community.

2. To provide the best care and expertise for you, our three full-time, board certified Hospice and Palliative Medicine physicians will work with your physician to the extent you desire.
Today there are around 5,000 board-certified specialists in hospice and palliative medicine in the nation. It's estimated 50% of them work half time or less in this field. For the benefit of our patients and referral sources, CHC is proud to employ three board certified hospice and palliative medicine physicians full-time. Additionally, each CHC staff physician is also board certified in either Family Medicine, Internal Medicine, or Emergency Medicine. In addition to assistance with pain and symptom management treatment options, CHC staff physicians are also available for palliative care consults and to help you with hospice eligibility decisions and disease specific criteria for hospice program admission.

3. A CHC staff Registered Nurse will answer the telephone whenever you or your caregivers call 1-800-HOSPICE outside of regular business hours seven days a week.
During a life-limiting illness, time is a precious commodity and CHC will do all it can to meet the needs of our patients and families as expeditiously as possible. While some hospice programs use answering and triage services located in other states, we deliver a "speed to service" benefit for our patients and their families. Answering our own calls 24/7 removes an unnecessary and time consuming step for everyone.

4. For acute symptom management needs you will have access to the region's only freestanding hospice inpatient facilities.
If at any time you experience pain and symptoms that cannot be controlled in your home or other settings, CHC offers the only freestanding Medicare certified hospice inpatient units in the region. More than 500 patients each year experience one of our two units located in South Bend and Elkhart. These units are owned, operated and staffed by CHC professionals whose single focus is making you as comfortable as possible.

5. For your benefit, a full range of essential interdisciplinary staff is standing by 24/7 to provide not only emergency nursing and physician support, but also psychosocial, spiritual and emotional support.
The heart of hospice care lies in its interdisciplinary approach. Quality end-of-life care is much more than treating physical symptoms. Like CHC, many hospice programs have an RN on call after hours, but CHC takes the extra steps. Not only are our board certified hospice physicians available, but core interdisciplinary team members are also accessible around the clock. Whenever you or your family need counseling, emotional or spiritual support, CHC staff social workers and spiritual care counselors are always just a phone call away.

A Snapshot of 2011

We hung up on our after hours answering service.  When the telephone rings outside of regular business hours, it is now answered directly by a CHC staff nurse.  This allows for a faster response to patient emergencies and enhances the level of service provided to our families. 

Work began again to complete the final phase of our 11 acre Elkhart Campus project, which included the development of a memory garden, walking trails and other finished outdoor spaces.  

CHC won the “2011 Business of the Year Award” at the Age of Excellence Awards luncheon.  REAL Services sponsors the awards each year to acknowledge those in the community who have provided exemplary service to older adults or the disabled. 

Work with our African partner organization, the Palliative Care Association of Uganda (PCAU) continued to thrive in 2011.  In August, Hospice Foundation VP/COO, Mike Wargo, presented a plenary session at PCAU’s bi-annual education conference held in Kampala.  The conference saw the world premier of our film, Okuyamba, which played to an audience of more than 300 attendees representing 13 African countries. 

2011 saw much progress toward the development of our new St. Joseph County campus to be located on the northern banks of the St. Joseph River immediately between Central Park and Cedar Street in Mishawaka.  This is a multi-year, multi-phase project, with Phase I expected to be completed during 2013. 

An interdisciplinary team of CHC physicians, social workers, nurses, and administration offered the first-ever “Introduction to Hospice and Palliative Care” class at the University of Notre Dame.  More than 90 students from the Pre-Professional Studies program, among other majors, attended the one-credit course. 

None of the accomplishments of 2011 would have been possible without the dedication of our hundreds of CHC volunteers and our thousands of generous donors.  CHC is whole-heartedly committed to improving the quality of living within the communities we serve.  Many thanks to whatever role you played last year in helping CHC continue to serve and grow.  I am honored to be working with you and I sincerely appreciate your involvement and support.

Center for Hospice Care | Improving the Quality of Living
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