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Case Statement – Niagara Hospice House


"The Wings of Serenity" Campaign

Challenge
Currently, terminally ill patients residing in Niagara County that are forced from their home must turn to expensive hospitals or inappropriate nursing homes instead of a residential or short-term inpatient facility that can bring quality Hospice services to them 24-hours a day, seven days a week. This inappropriate care costs more and provides an unsatisfactory environment for dying persons.

(Patient Testimonial about Need for Residential Facility)

Solution
Niagara Hospice proposes to build The Niagara Hospice House, a 22,000 square foot residential facility to be able to provide hospice service to patients, and their families, who are not able to receive care in their own homes. The Niagara Hospice House will provide 8 suites for patients needing longer residential care (up to 6 months) and 10 suites for those patients needing short-term care (up to 18 days), but don’t need to be hospitalized.

While in-home care will always be the first priority of Niagara Hospice, the patients needing these new residential services typically have an inadequate support system at home but are not in need of admission to a nursing home or hospital.

Current patients who are in need of care beyond the scope of home care services must now go to the hospital. Annually, about 38 % of Niagara Hospice home care patients die in the hospital, incurring unnecessary costs and dying in a place not suited for a quality end-of-life experience. Nationally, only 9% of all Hospice patients in 2002 died in the hospital.

The foundation of the hospice philosophy is for every patient to have a dignified, pain-free death. The absence of a residential facility poses a significant threat to that standard. Niagara Hospice will not be complete from a service perspective until dying patients have a suitable alternative to the hospital or nursing home when it's needed.

(Patient Testimonial about How a New Facility would Benefit them currently)


The Niagara Hospice House

Niagara Hospice proposes to build The Niagara Hospice House, a facility with two different services under one roof. One wing of The Niagara Hospice House will be the Hope Residence, designed for patients who need residential Hospice care for up to six months. The other wing will house “Sunset Haven”, designed for patients needing short-term medical monitoring and patients who have only a few hours or days left.

Niagara Hospice has already acquired the land for the facility adjacent to its current headquarters off Sunset Drive in Lockport, New York. The location is central to Niagara County and offers convenient access just off of Route 31 and Route 93, close to where Route 93 intersects with the primary east-west highway, Route 104.

The Hope Residence of The Niagara Hospice House will have 8 patient suites. The Sunset Haven will have 10 suites. Careful study indicates that 18 suites are sufficient to meet current needs, and the facility is being built so that it can be easily expanded if demand is greater than anticipated.

Plans for The Niagara Hospice House have been on the drawing board for years. Recent changes to New York state law enable smaller counties to have cost-efficient residential hospice services. These changes have opened the door for Niagara Hospice to meet long-time need for a residential hospice facility.

While patients from throughout the county can utilize the facility, patients will need to be enrolled in the Hospice program prior to transfer to The Niagara Hospice House. This facility is designed to meet a specific need and, as such, only those patients absolutely needing these services provided will be able to use it. Hospice is, and will always remain, primarily a home-based service.

The Hope Residence

Patients and their families deserve the right to have a choice in their end-of-life care. In choosing Niagara Hospice they are looking for exceptional care and support. Our mission is to have every death a dignified one. In striving towards that goal, Niagara Hospice must be able to offer an alternative to death in a hospital or nursing home whenever possible.

For those patients with adequate support systems and living arrangements, hospice home care services are ideal. However, more and more Niagara Hospice patients find that receiving hospice care in their homes or apartments is not possible because they lack either a family or friend support network or because their home or apartment is not suitable for the dying experience. These situations are increasing as older parents find their children moving away for educational or economic opportunities and as more and more people live in assisted living or senior housing.

For many hospice families, keeping their loved one out of the hospital can be very expensive. Around the clock care is costly and intrusive. Needless to say, most families can not afford that type of care. The Hope Residence offers the much needed alternative to institutional care in the final days, weeks or months of life.

Without a residential facility, patients’ only other option is to accept admittance into a long-term care nursing home. Most nursing home facilities are not hospice focused, but are designed to expect months or years worth of care, instead of helping a patient and their family accept the end-stages of life. From a practical standpoint, nursing homes are expensive, not conducive to a quality dying experience and experience shows that Hospice patients want to avoid going into a nursing home at virtually all costs.

When Niagara Hospice case workers determine that a patient can no longer receive quality hospice care in their home, Niagara Hospice patients could be referred to the new Residential Center, offering the patient around the clock supervision.

The Sunset Haven

For patients who need short-term medical care for symptom control or who are in the final hours/days of dying but do not need hospitalization, Sunset Haven wing of The Niagara Hospice House is a way to avoid unnecessary hospital stays. Patient care-givers will also find the supportive environment of Sunset Haven more adaptable to their needs than a traditional hospital setting.

Patients, and their families, will access Sunset Haven for a variety of reasons. Adjustments of pain and other medications that require medical monitoring for a period of a few days can be performed more comfortably and cost-effectively in Sunset Haven than a hospital. Patients in the final hours or days of a terminal condition will likely find the medical environment of Sunset Haven easier on their families and themselves.

The services provided in Sunset Haven are quite extensive. In addition to traditional hospice services, patients will receive comprehensive medical care which may include non-invasive symptom control measures to make the patient comfortable. The setting will be non-threatening and peaceful, with accommodations for families to be with the patient. The suites are special places, designed to be non-institutional with patient comfort as the primary goal.



Building Costs and Campaign for County Comfort

Niagara Hospice proposes to build a 22,000 square foot, one-story facility that would include:
  • 18 private suites including sitting area, sofa sleeper and bath with shower and therapeutic whirlpools.
  • Private patios for each suite
  • Two (2) family gathering rooms with exterior porches
  • Two Gathering Rooms with fireplace
  • Physician/family conference room
  • Oval driveway with canopied entrance
  • Chapel
The total construction cost for The Niagara Hospice House, including both an 8 suite Hope Residence and the 10 suite Sunset Haven is $3,000,000, including all planning, permit, engineering, architectural and fundraising costs.

To pay for construction of The Niagara Hospice House, Niagara Hospice has launched the “Wings of Serenity” capital campaign to raise $3,000,000, the first multi-million campaign in its 16-year history. In recognizing that the Western New York area is struggling economically, Niagara Hospice leaders have pledged to use all available assets to help support the campaign and have committed a total of $500,000 from past donors, operational savings, and past fundraising to launch the project.

In the end, the need is too great to delay or not attempt such an important project at this time. After years of planning, and a successful change in New York State law, NOW is the time to raise the funds and build The Niagara Hospice House.

A Demonstrated Need and Operating Costs

Is there a true need for The Niagara Hospice House and can Niagara Hospice afford to operate it with the projected usage?

Much research was conducted to identify the types of patients who would benefit from Niagara Hospice House and whether this need could support the operations of a residential facility. The research clearly shows the need exists and the operations would be self-supporting.

Generally, four types of patients will utilize Niagara Hospice House:
  • Patients already receiving Niagara Hospice home care, but who have reached a point where they need clinical care that goes beyond what can be provided in the home.
  • Hospitalized patients whose condition and level of care make it impossible for them to safely go home. The only other option is to enter a nursing home, which costs more and is usually seen as a last resort for most patients.
  • Current hospice patients who cannot stay in their existing homes due to non-clinical issues such as no elevator to a second story, apartment complex rules and regulations or because they simply do not have a care-giver support system.
  • Patients who enter a hospital, are diagnosed with a terminal disease, and face the probability that they will never be able to leave the hospital. These patients are not candidates for nursing home placement and currently have no other alternative but to die in the hospital.
Hospice projections indicate that if even just 28.5% of the Niagara county patients described above utilized The Niagara Hospice House, the facility would have an occupancy rate of 75% - an occupancy rate sufficient to support annual operations. Niagara Hospice leaders are very confident, based on past experience, that more than 28.5% of patients needing these services will utilize them.

Finances
By reviewing similar facilities throughout the country, and carefully looking at anticipated costs to operate this type of facility in Western New York, it is estimated that the annual cost of operating this facility will be $ 2,225,000 (in 2004 dollars). Based on 75% occupancy, the daily cost to operate is $451 per day. Detailed operating budgets are available upon request.

Hospice care is generally reimbursed through Medicare, Medicaid or private insurance. On average over the last 16 years, about 87% of the care provided by Hospice has been reimbursed by some form of insurance or government reimbursement. Experiences at other residential facilities indicate that Niagara Hospice will be reimbursed a minimum of $455 per patient day.

It’s important to recognize that higher occupancy rates actually reduce the per-patient, per-day cost of operating The Niagara Hospice House, while revenue from reimbursement stays the same. As such, higher occupancy rates beyond the conservative 75% will actually allow The Niagara Hospice House to help supplement other charity care provided to patients and their families throughout Niagara County.

It's important to recognize that NO patient is ever turned away from Hospice because of an inability to pay – and this policy will continue when The Niagara Hospice House is built and open. Currently, approximately 13% of annual operating budgets are dedicated to "charity care", which is subsidized by on-going fundraising by Niagara Hospice and its volunteers.

A New Facility Instead of a Hospital or Nursing Home Renovation

Since 2000, Niagara Hospice has entertained the concept of partnering with a local hospital to establish a hospice and palliative care in-patient unit.

There are two primary challenges to building the Niagara Hospice House within a hospital or nursing home facility.

First, New York State law prohibits Residential Centers within hospitals.

Second, Niagara Hospice has looked at the possibility of renovating existing, vacant nursing home space and converting it into The Niagara Hospice House. The cost of renovating 22,000 square feet of existing nursing home space into appropriate hospice space would likely cost MORE than building new – especially considering that Niagara Hospice already owns the land to build a new facility.

Location
Clearly Niagara County offers diverse geographic opportunities for building Niagara Hospice House. Virtually anywhere in a rural, comfortable setting would be acceptable for building such a facility. However, Niagara Hospice leadership has selected Sunset Drive in Lockport for the following reasons:

1. Land: Utilizing land that Niagara Hospice already owns would negate the expense of purchasing additional land, saving Niagara Hospice and its donors at least $100,000 from the full cost of the project.

2. Hospice Campus: By building on the current site in Lockport, Niagara Hospice can create a campus environment and save money by utilizing existing parking, driveway and allow access to popular memorial and butterfly gardens. This also aids in management, as executives, patient care managers and volunteers are already on-site, without building additional, dual office space.

3. Residential Aura: Most hospices have found patients and their families need rural, peaceful locations.

Conclusion
The Niagara Hospice House will provide a quiet, comfortable and convenient place for dying patients who need residential care, but don’t need more expensive hospitalization or nursing home care. Thousands of families in Niagara County have seen firsthard the value of a quality hospice program. Now is the time to extend this care to those families and patients who can’t stay in their own homes.

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