Every patient has different conditions that bring them to hospice care, whether for a few days or many months.
For 25 years, the Ames community leaned on the Israel Family Hospice House (IFHH) to guide families through the process of dying. Hospice caregivers help the patients in their transition from active health-care treatments to their end-of-life care while also helping the family cope with the loss of their loved ones.
Everyone grieves in different ways, but there’s a common goal for patients, families and caregivers: to make the end of life as peaceful as possible.
“Death is a certainty, but a peaceful death should be our goal every time,” said Laura Knowles, who worked as a nurse at IFHH. “Within the walls of this house is simply love. We have loved these patients like our own family. We’ve held hands, we’ve cried, we’ve laughed, we sang and danced and we’ve been peacefully silent. While we are terribly sad the house is closing — it has been our pleasure to provide care to our patients, and to have served our patients within these walls.”
Knowles, who has been a registered nurse for 36 years — six at IFHH and at home hospice visits — is grappling with the closing of the well-loved home.
“Working at the hospice house has been some of the most rewarding times of my career as a nurse,” Knowles said. “I truly believe that the end of life experience is one of the most sacred for anyone. It’s an honor to walk alongside someone during this journey, maybe even more important than when someone enters this world.”
The last day IFHH accepted new hospice patients was Dec. 15 and the remaining patients left on Dec. 17. The final two weeks at the house have been for cleaning up and moving out. It officially closes Dec. 31.
Hospice services began in ’80s
Mary Greeley Medical Center (MGMC) began providing hospice services in the 1980s and became Medicare certified in 1987, including home care, and later added respite care and bereavement counseling.
In 1999, MGMC opened the Israel Family Hospice House and there have been hundreds of patients treated at the house over the years.
The facility, the fourth of its kind in Iowa, operated for 25 years with the philanthropic help of many donors, including the Israel family and the endowment of the MGMC hospice program through the Mary Greeley Foundation, which coordinates fundraising. However, due to lower Medicare reimbursements and increasing operating costs over the years, the hospital determined running the facility was not sustainable.
Additionally, demand for the house has declined for years, which isn’t unique to Ames. Rather, it’s part of a national trend. While there were 10 rooms in the house, on average there were four patients there and often there were none, according to Steve Sullivan, MGMC spokesperson.
“Today, there is simply more competition with for-profit hospital services,” Sullivan said in October.
IFHH couldn’t survive current health care economics
Both nationally and in Iowa, many inpatient hospice houses have closed, and the majority of hospice care is now provided at home.
“Mary Greeley began reviewing hospice house operations more than three years ago due to declining admissions and increasing costs,” said Karen Kiel Rosser, vice president and chief quality and strategy officer at MGMC. “Many who go to the hospice house do not have adequate resources for end-of-life care, so their ability to pay is limited. This puts a significant strain on the operations of the house. Staffing, like all areas of health care, was also becoming a challenge.”
The yearly loss at IFHH had risen to more than $1 million, and because MGMC has many other philanthropically funded programs, the hospital’s Board of Trustees concluded in October that the losses were unsustainable.
IFHH employed 17 people in a variety of positions, and some of the employees have transitioned into other MGMC hospice care.
Dr. Larry Otteman, former hospice medical director, became involved with Mary Greeley hospice in 1985, before the IFHH was established. He remained involved in the program until his retirement in 2019.
“Over the years, I witnessed firsthand how hospice care in the United States, much like other health care initiatives, was shaped by federal funding,” Otteman said. “The evolution of hospice services continues to be influenced by shifting federal financial priorities and economic pressures.”
IFHH was there to support its patients
Like all hospice nurses, Knowles not only gives medical care and pain-relieving treatments and assists with patients’ daily tasks, she addresses the emotional needs of patients and families.
“People have a multitude of emotions in hospice — grief, loss, anger and also happiness from memories and current time spent together,” Knowles said. “Our goal was always to give patients quality time, with the most comfort possible, and a death with dignity. It’s a highlight of my time as a caregiver to be able to provide comfort, education and peace during the dying process for our patients.”
IFHH served as a pillar of support for patients and their families. One IFHH patient’s family expressed thanks for the care received.
“On behalf of our entire family, we want to extend our deepest gratitude for the compassionate, meaningful care your team provided our mother during her final days,” stated a letter to the IFHH staff and volunteers. “Your kindness, patience and unwavering support brought comfort not only to her, but to all of us during a profoundly difficult time. Everyone treated her with dignity, tenderness and respect, helping her find peace and helping us to feel less alone.”
Cari Trudeau, a staff nurse who worked at IFHH the past four years, viewed her position as “more of a calling than a job.”
“I have seen firsthand the difference that the end-of-life care we give makes, for those whom we are privileged to serve,” Trudeau said. “I have told many exhausted spouses and family members when they come to IFHH, that they no longer need to be ‘everything’ for their loved one.”
End-of-life care must treat more than just the patient
Hospice nurses have had additional training for helping patients and families in end-of-life care, and most families realize how special that care is in MGMC’s hospice program.
“In allowing us to care for their family member’s physical needs and manage end-of-life symptoms, they can be ‘the spouse’ or ‘the daughter’ and not be stressed and wondering what they should be doing to make their loved one’s death peaceful,” Trudeau said. “That’s a heavy burden even for someone with some medical background.”
Trudeau, like most nurses working in hospice programs, finds that the care, while demanding, can be rewarding, too. It allows them to not only care for the patient but also family members.
“When a patient dies, often the family is surprised that the dying process isn’t as mysterious as they thought it would be,” Trudeau said. “In those moments, they are grateful that their loved one was able to transition peacefully, until their final breath. In the end, our reward is feeling like we have accomplished what we could as a team with all the different disciplines at our disposal, to make a person’s end-of-life journey what they desire it to be.”
Volunteers help provide critical help, support
Volunteers in hospice care programs such as MGMC’s have various roles, including providing companionship and emotional support to families and patients, assisting with various daily tasks for both the family and patients and carrying out administrative tasks. Volunteers with training are an integral part of the MGMC Hospice program, not only at IFHH, but with many other hospice services.
Jan Martin, an MGMC hospice volunteer, previously worked as a nurse in oncology. In 1997 she began volunteering with home hospice patients, and she has continued to volunteer over the years.
“I started out going to patients’ homes in the evenings, usually so the family could go out for a meal together, get out of the house or whatever,” Martin said. “I went to the hospice house twice a month on Wednesday evenings, and I occasionally take on a home patient. And right now, I have a very nice 93-year-old gentleman that I go to every Friday and just sit and visit with him. And I’ve enjoyed that immensely, and I think he does, too.”
Hospice care in Ames continues shift to home
The hospice program will continue, with patients given the options of staying at MGMC as a hospice patient until a suitable placement opens locally, going to the Bethany Life/MGMC hospice unit, or entering hospice home care — which for most patients, has always been preferred over hospice houses.
Knowles plans to transition to full-time MGMC Home Hospice care, and Trudeau will begin a new role with First Nurse, answering phone calls from the public and directing callers to the right care or provider.
“Mary Greeley will remain a strong hospice provider in the communities served through a robust home hospice program,” Kiel Rosser said. “We remain committed to serving our region with a comprehensive hospice program and are already seeing a growing number of patients choosing our services.”
As noted by another letter from the family of a previous hospice patient, the dedicated, specialized and compassionate caregivers are important to patients and families during this precious time of life.
“Your presence was a gift, and we will be forever grateful for the way you walked alongside us on this journey,” the family wrote. “Thank you for the work you do. It matters, more than words can ever express. God bless you all.”
