Hospice away from home

Hospice care demands much of the caregivers. Their patients have a terminal diagnosis, and all endure discomfort and pain. Nurses and aides don’t get the sense of fulfillment that comes from curing a disease or saving a life; rather, they know the person they’re helping rest more comfortably will soon—often within weeks or months—rest in peace.

It would seem a depressing vocation. Yet, at Paradise Hospice House, Butte County’s lone residential facility for end-of-life—or palliative—care, the mood is anything but depressing.

Hospice House inhabits a property set back off Bille Road in the town of Paradise, a half-block from Clark Road, a major thoroughfare. Most who drive by simply see a white plaster archway; only after heading a few hundred feet down the driveway does the complex come into view.

It’s a soothing place. The building resembles a one-story home, albeit with direction signs. Behind it rests a tranquil garden featuring a trellis-covered patio and a waterfall. Each of the six patient rooms is bright and comfortable, with a recliner and a hide-a-bed sofa for visiting relatives. Down the hall, by the nurses’ station, is a kitchen, dining room and lounge.

Hospice House boasts a staff of 15, but if you include the support from home health-care agency Paradise Hospice and Feather River Hospital, that number rises significantly. The work is intensive—and expensive. Medicare and private insurers do not reimburse Hospice House sufficiently to cover round-the-clock care. According to Sandy Galka, a registered nurse who manages Paradise Hospice, the house stays open only because the hospital (which oversees Paradise Hospice and Hospice House) is willing to subsidize its operation and community members—“Hospice Angels”—are willing to donate time and money.

Still, amid so many challenges, smiles abound. Hospice isn’t somber, Galka insists—it’s stimulating.

“I know what I’m here for: It’s not to save a life, it’s to enable a person to go through death naturally, and as comfortably and peacefully as they can,” Galka said. “So the fact that people die here isn’t hard; we know that’s going to happen when they come through the door. Only when we’re not able to manage somebody’s symptoms is it depressing. When it’s a peaceful, natural death, I’m thinking, ‘What more can you ask for?’”

Yes, the work is physically and emotionally draining. That’s why nurses at Hospice House have eight-hour shifts, rather than the 12-hour shifts common to inpatient nursing. Even so, they derive deep satisfaction from their labor of love.

“Hospice is not a punch-in, punch-out job; you have to love what you do to do this work, and I would say everybody here loves what they do,” Galka said. “It’s a calling for some, a mission for others, and a passion for some others. There’s something burning inside them. If you’re just punching a clock and waiting for the minutes to pass, you won’t be able to hang; not only won’t you have the energy, but you won’t have the heart that’s necessary to really provide the patient and the family with what they need.”

Feather River Hospital established Hospice House in 2006 as part of its overarching hospice program, Paradise Hospice. Few communities have hospice houses; the closest ones to Butte County are Grass Valley, Yreka and Stockton.

Michelle Nye, community outreach specialist for Paradise Hospice, describes Hospice House as part hospital, part hotel. It can accommodate patients so severely ill that they need more care than can be provided in private residences and convalescent homes. The facility also offers “respite care” when home caregivers need time off. “We provide five days [to hospice patients], at no cost to them,” Nye said.

In some cases, Hospice House serves as a bridge between hospitalization and in-home hospice care. Patients whose insurance won’t cover room and board can elect to pay for their stay until they are ready for in-home care from field nurses.

“Most patients want to get home,” Nye said. “Here, they’re getting really close, personal medical care and attention, but once we get their condition managed, we’ll usually take them home.”

Just as lengths of stay vary, vacancy rates vary. A six-bed hospice house may seem small for an area as large as the North State, but as Nye explains, “People just don’t know about it or understand it. A lot of people have the misconception that they have to have cancer to come in here. That’s not the case; it’s anyone who is on hospice and is declining.”

Another misperception is that patients come to Hospice House only for their final days. “We discharge patients all the time,” Nye said. “Sometimes it looks like there’s nothing more that the doctors can do and they’re going to decline following the course they’re currently on, but we get them on hospice and they actually start to improve.

“I love to share that with new patients and families when I first meet with them, because I never want them losing that hope. Miracles happen, and things change.”

Uplifting moments happen all the time. Not only is Hospice House what Galka affectionately calls “the bed and breakfast,” it’s also a small-scale equivalent of the Make-A-Wish Foundation.

Staff members cater to dietary desires. If a patient wants a pear, a pear is what he or she will get. Same with a slice of lemon meringue pie, an Izzy’s cheeseburger or McDonald’s fries. “We have an incredible food program through Meals on Wheels,” Galka said, “but we have the ability to run out and get something that they’re craving.”

Other wish-granting is more extensive.

Galka shared the story of a patient who loved motorcycles and wanted to take one last ride. “That was his love,” she said, “the wind in his hair and that freedom. He wasn’t strong enough to get on a bike, even with someone else, but a friend brought a convertible. We helped this man get in the car—bundled him up, buckled him in—and they drove all the way up to Table Mountain. He had a smile on his face, and it was very touching to see that. He passed away the next day.

“Some of this stuff is outside traditional nursing, but those are some of the blessings that we get working here—to see those kinds of things happen and meet needs, unusual needs,” said Galka. “That’s the cool part of being a hospice nurse.”