It will be the only one of its kind in the far western counties, yet the champions of a hospice house in Franklin were faced with seemingly endless setbacks and hurdles — political, financial and logistical.
Initially a crucial health care partner, Angel Medical Center pulled out of the project, preferring instead to continue serving hospice patients in the hospital setting. Soon after, the state rejected a necessary “certificate of need,” essentially stopping it cold.
The obstacles facing the Hospice House Foundation of Western North Carolina to open a center in Franklin seemed insurmountable.
“I didn’t know anything about what to do,” Michele Alderson, president of the foundation, said of navigating the many bureaucratic hurdles that kept getting in her way.
The small group of hospice volunteers and medical professionals persevered, however, to finally realize the vision of offering what is considered a crucial service — especially in a region with a relatively large elderly population.
Asked if she or others behind the effort ever considered giving up amid the adversity, Alderson answered quickly.
“Never. It only made us stronger,” she said.”
The foundation will need every bit of that resolve as it enters perhaps its biggest challenge yet: a capital campaign to raise $4 million.
It now has a site, a permit from the state, a managing partner to run the facility, and a base of supporters.
But the fundraising effort could prove challenging amid a competitive nonprofit sector vying for donations.
Last week, the foundation kicked off its capital campaign with a ceremony celebrating a $1 million grant from the N.C. State Employees’ Credit Union. The challenge grant comes with a condition: that the foundation raise a $1 million match within the community by next fall.
A home in Franklin
The location for the inpatient center is the former house of a prominent figure in Franklin, Merle Dryman. Her involvement in the town ranged from working as a secondary school teacher for more than 30 years to starting an enduring garden club and serving as an alderman, her name eventually given to a section of U.S. 64. She died in 2010, after which her two sons put the house on the market.
The center is expected to open in 2016, though construction of a new space designed to house six patient rooms and medical supplies could be finished as early as late 2015, Alderson said. She added that the existing part of the house will include a chapel and a space for visiting family members.
Four Seasons Compassion for Life, an independent hospice and palliative care nonprofit based in Henderson County, will operate the center, which will include a group of certified nurses and aides and a physician, along with bereavement counselors and a chaplain. Four Seasons, made up of some 400 volunteers across the region, has several hospice operations in the region, including at the Highlands-Cashiers Hospital.
The idea for a Franklin hospice center was hatched in The Dillsboro Smokehouse, where a handful of home health aides and medical professionals from across the region gathered to discuss ways to extend hospice services to the far western part of the state. The foundation later formed in 2005, growing to what now is now more than a dozen members on its board of directors.
The lengths to which the group would eventually go to pursue such an ambition, however, were likely unforeseen.
The hospice house was initially going to be a joint venture with Angel Medical Center in Franklin. But Angel Medical pulled out in 2009, preferring instead to provide hospice care within the hospital itself as it always had, rather than in a stand-alone facility.
The foundation found a new partner in Four Seasons, but was then unable to get its so-called “certificate of need” from the N.C. Department of Health and Human Services. The permit is required for any medical facility in the state in an attempt to align hospital-type services with demand. It essentially limits competition to keep start-up medical facilities from undermining the strength of existing ones.
The Health and Human Services Department denied its request, citing objections from Angel Medical that the foundation was unable to demonstrate a substantive need for the center, let alone raise enough money for it.
Despite these travails, the foundation and Four Seasons appealed the decision by the state, eventually regaining certification in 2012. Initially seeking to build an inpatient center on Old Murphy Road, also in Franklin, the foundation later bought the current house for $250,000 as a way to reduce costs.
“It’s been a long road,” said Ron Fisher, the director of hospice care with MedWest Health Systems in Sylva, who is among the founding members of the foundation. He was referring to what he described as the “frustratingly slow” process of earning the state certification, though he added that the adversity did not appear to discourage what he and others have dubbed the “tenacity board” of foundation members.
Hospice is not a remedial form of health care. Usually staffed by volunteers, it is seen as a source of respite, whether physical or emotional, for the terminally ill and their families.
While many facing such circumstances tend to remain at home, some are recommended by family members to inpatient facilities to help alleviate symptoms, like pain and nausea, that can surface as a result of complications from their condition. Reimbursements for inpatient services, known as respite care, are offered under Medicare and Medicaid.
The reach of the planned hospice center in Franklin could stretch across the region. Whether the need for such services in Macon is greater than that of other parts of the region is unclear. About one-fourth of the county’s population is age 65 and older, according to the U.S. Census Bureau, among the highest in a region whose mountainous terrain is seen by home hospice care aides and families of patients as a logistical challenge. According to the county sherriff’s office, in 2011 at least 50 people died in their homes in Macon without adequate care from home health aides or family members.
A shortage in WNC
Of the nearly 60 inpatient hospice centers operating across North Carolina, only one has a service area extending west of Asheville — Haywood Hospice and Palliative Care, which opened last year as part of MedWest Health Systems.
“It’s taken a long time,” said Beverly Murray, director of the hospice center, called the Homestead, in Clyde. She was referring to a fundraising effort that spanned about eight years to raise the $4 million she said was needed to open the center, which relies largely on donations.
Made up of six beds, the center has served about 300 patients, Murray said. Among them was her mother, whose death there last year led her to recognize hospice care as significant not only to patients but also their family members.
“It’s different when you’re on the other side,” she said of tending to her mother. “It’s life-changing.”
It is a kind of care that Evie Byrnes, a retiree who has volunteered as a hospice aide, uses to spread compassion.
She recalled a hospice patient whom she regularly visited in a Highlands nursing home in the mid-2000s. Suffering from cancer, the man, whose wife had Alzheimer’s and whose son struggled to care for him while working full-time and raising a family, did not immediately appear to welcome Byrnes’ presence.
“When I entered the room” in the nursing home for the first time, she said, “he wouldn’t even look at me.”
But that changed eventually as he grew to expect such visits, sometimes calling the Byrnes from down the hallway at the sight of her silhouette.
The started talking family, politics — “whatever he wanted,” she said.
“It’s my favorite thing to do,” said Byrnes, who also is among the founding members of the foundation. “I love making a difference in someone’s day.”
For Alderson, who has volunteered as a home hospice aide since retiring as a real estate broker in the early 2000s, the thought of tending to the terminally ill is less evocative of despair than commemoration.
“It’s a very special time in people’s lives,” she said. “We celebrate all these people being born into the world … it’s the end of life that should be celebrated.”
She spoke of the time she spent by the bed of her brother before he succumbed to cancer at age 52 in an inpatient hospice center in Florida. It was a period of relief after Alderson and her family — all of whom were either working full-time jobs or living elsewhere — had spent so much time struggling to arrange house visits.
“I never forgot,” she said of the six weeks she spent with him at the center in the mid-1990s. “We were so exhausted. It just took such a burden off our family.”
Beyond that, she added, the care likely offered her brother a sense of repose amid the uncertainty of his illness, which was the result of exposure to chemical weapons during his time as a soldier in the Vietnam War.
“We never know when anyone’s going to go to heaven,” she said.