The future of hospice care is right around the corner

By Amber Hollingsworth | May 2022 (updated February 2023 by Eric Walsh, M.D.)

From 1987 to 2019, Hopewell House provided high quality advanced inpatient hospice care to more than 19,000 people. 10,000 died there and more than 9,000 others had their symptoms and care plans altered in such a way that they could return home. 

In October 2019 facility closed because of the financial challenges associated with the high-cost medical model and restrictive Medicare criteria for admission. Within days after the closure, a community-based 501(C)(3) corporation — Friends of Hopewell House — was formed. This community organization has raised just under $6 million, purchased the building, and reopened Hopewell House in January 2023 as a hospice specialty residential care facility (see the amazing rescue story in The Oregonian).  

Being a residential care facility instead of a general inpatient hospice facility (facilities that are regulated as hospitals), the reopened Hopewell House will still be able to provide state-of-the-art/state-of-the-science end of life care without being directly regulated, punished, or fined by Medicare.

The new collaborative model will allow patients to stay with their OHSU Family Medicine providers, as long as the OHSU providers continue to act as the attending physicians/NPs for the patient. It's possible, legal, and desirable for OHSU Family Medicine providers to continue to provide end-of-life care when their patients end up in a Medicare-certified hospice agency. As is true with all Medicare-certified hospices, patients will receive visits from an interdisciplinary hospice team of physicians, nurses, social workers, chaplains, and hospice-trained volunteers while Hopewell House provides 24/7 care by nurses, CNAs, social workers, and volunteers under the plan of care designated by the visiting hospices.

And the hope is that Family Medicine PCPs come to Hopewell House to continue to care for their patients and their families, by maintaining their role as attending physician or NP. Unfortunately, it's rare for FM attendings to continue to direct care for their patients whom they've referred to hospice. Family physicians and NPs often feel unprepared to care for the kinds of problems that come up at the end of life, but hospice medical directors and experienced hospice nurses are available 24/7 for suggestions on how to best care for dying patients. 

“The population that’s aging now, they want the dying experience to be less of a medical event,” said Susan Hearn, former interim co-executive director of Friends of Hopewell House. “Our priority is to be a family dying center focused on palliative care for the hospice patient in a homelike environment with access to outdoors, a place for families to stay, be comfortable, and fed.” 

Hopewell House is addressing the crisis of caregiver breakdown at the end of life. “The Medicare hospice benefit was designed around care being provided by the family, but in light of changing demographics – younger generations living far away, people living longer, living alone – there’s less access to the kind of hospice care people want and need. 80% of people want to die in their own home, and 36% of Oregonians do,” Hearn said.  

The idea behind the new Hopewell House is that the people who have the greatest needs and the fewest options at the end of their lives can come to receive high quality care from a specially trained. 

The training part is key: “We’re hoping that this can be an educational center for residents and faculty who want to get additional training and expertise in end-of-life care,” says Friends of Hopewell House Board Member and OHSU Family Medicine Professor Emeritus Eric Walsh, M.D. “Beyond that, we want to educate community members and professionals about what's on the horizon for end-of-life care.” 

In preparation for reopening, Friends of Hopewell House has added a new Executive Director, Lesley Sacks, L.C.S.W.; a Volunteer Coordinator, Crystal Ashton, who has recruited more than 100 volunteers so far; and a Director of Nursing and experienced hospice nurse, Marci Donaldson, R.N.

With a new model for both patient care and provider and community education, Hopewell House aims to reduce disparities in access to quality, inclusive hospice care. 

Dr. Walsh and Assistant Professor of Family Medicine Eriko Onishi, M.D., are on the Board of Friends of Hopewell House. If you’re interested in learning more about how to engage, donate, or train, please reach out to them. 

Outdoor area of Hopewell House residential hospice facility
Photo courtesy of Friends of Hopewell House.