By Todd Cohen
RALEIGH, N.C. — The number of patients and families served each year by Transitions LifeCare, formerly Hospice of Wake County, has roughly doubled in the last five years to between 5,000 and 6,000.
That increase tracks with a surge in the hospice marketplace: According to a recent report in The Huffington Post, the U.S. hospice industry has quadrupled since 2000 and, among all Medicare patients who die, nearly half now are hospice patients — twice as many as in 2000.
To cope with rising demand for services, growing competition from for-profit hospice providers, sweeping changes in health-care regulation, broad misunderstanding about hospice, and a reluctance among Americans to acknowledge their mortality, Transitions LifeCare is undergoing big changes of its own.
In addition to changing its name, the Raleigh nonprofit has developed partnerships to better educate health professionals and care providers, and raise awareness, about end-of-life care.
It also has launched the quiet phase of a capital campaign to raise $6 million to add 10 private single-rooms to its 20-room hospice home, install a Veterans Garden, and create a building maintenance fund for its eight-acre campus.
“We have a unique expertise in managing a period of a patient’s life that is emotionally exhausting, medically intense, and financially can be extremely expensive,” says Cooper Linton, vice president of marketing and business development at Transitions LifeCare.
That approach, he says, is in sync with a marketplace and regulatory climate that increasingly are “moving more toward paying for outcomes than paying for process.”
Founded in 1979 by volunteers and operating with an annual budget of $24 million, a staff of 330 people and 450 volunteers, Transitions LifeCare provides services in the areas of home-health care, palliative care, hospice care, and grief care.
It provides home-health services, including nursing, social work and home-health aid, to 300 patients a year, with 50 percent to 60 percent of those patients ending up in hospice care.
Its palliative care services, which focus “on comfort and not cure,” Linton says, provide physician consultations to 1,500 to 1,800 patients a year in the areas of pain and symptom management, setting goals for care, and assisting with end-of-life decision-making. It serves patients in four hospitals in two counties and 25 nursing facilities in five counties.
Its traditional hospice care serves 2,800 to 3,000 patients a year in six counties, with patients staying an average of 55 days.
And it provide grief care for over 1,000 adults a year and 127 young people.
But Transitions LifeCare faces big challenges, including increased operating costs, growing competition, declining insurance reimbursements, rising demand from uninsured patients and “the denial by both our lay society and the health care profession” that mortality is “the natural last phase of human life,” Linton says.
“We have an unrealistic and irrational sense that we can eliminate death as a reality,” he says.
To address those challenges, Transitions LifeCare has worked to improve efficiencies, including a merger four years ago with Hospice of Harnett County, and to increase economies of scale in its operations and the use of its medical and clinical staff.
It is working to treat patients sooner through palliative and home-health care, working more closely with its medical partners and referral sources to find the best way to treat patients collaboratively.
It is providing nurse education, and offering classes for lay and professional caregivers and for civic groups, faith communities and employers.
And it has changed its name to reflect its geographic reach and its focus.
“We are more than hospice, serving more than Wake County,” Linton says. “There is a misconception and misperception that hospice is about death, as opposed to maximizing life until you die.”