A Disparate Peace
Terminally ill patients and those who will recover coexist in the Hospice House.
Thursday, September 27, 2001
Comfort in a Crowd: Rehabilitation patients like Pat Del Piero now outnumber terminally ill patients in the Hospice House, which was originally built to house people being eased out of life.Tucked into the woods east of Highway 1 near Monterey is a serene, airy sanctuary built expressly for the dying. The Hospice House of the Central Coast is a 28-bed facility completed in 1993 so terminally ill locals can slip into the hereafter amid rustic tranquillity.
It''s also a great place to get better. In order to keep the beds full at Hospice House, the Community Hospital of the Monterey Peninsula (CHOMP) sends people there for rehabilitative therapy following surgery. These days, those recovering outnumber those receding.
Pat Del Piero of Watsonville is on her second trip through Hospice House. She''s just had her hip replaced.
"To me this is the Number One spot if you want to get rehabilitated," she says, smiling, sitting on her bed in the morning sun.
She has no problem whatsoever with the mixed use of the facility. Asked if having to tiptoe around the soon-to-die creates any kind of problem, she says, "Oh, no. No. No. Heavens, no. We''re all in here together for one purpose or another."
Down the hall from Del Piero, 56-year-old Ronnie Heuson of Salinas is in bed with the television on. A terminal cancer patient, he''s been receiving palliative care--the pain-relieving regimen of drugs and grief counseling for which Hospice is known--for a week. His daughter Nichole is there with him. Asked if he''s comfortable, he says, "[I''m] as comfortable as I''m gonna be."
Nichole has no problem with the fact that most of the people at Hospice House are healing. "I think it''s a good idea. If there''s extra space, why not?"
Heuson has since passed away.
There are indeed two types of patients at the Hospice House. People who go to there to die are called "benefit" patients. People who go there for rehabilitation are called SNIF (or "skilled nursing facility") patients. The building''s twin uses are evident throughout. A rehabilitation room features a special staircase to practice climbing stairs after surgery. Another room that serves as a library is full of books and pamphlets dedicated to death and dying. A "wig room" offers a range of wigs and hats to those who have lost hair due to cancer treatments. In a very quiet chamber known as the meditation room, families can join a cleric in a ring of chairs.
The problem at the center is that the facility has 28 beds, and not all of them can be used for true hospice care. Christina Butler, head of nursing at Hospice, says that of the 28 beds, maybe four or five at a time are occupied by people at the end of their lives. Benefit patients always get first priority for space.
However, Butler says that in order to stay open at all, the facility has been mixing uses since CHOMP bought the building in 1997. Keeping a base of rehabilitation patients in the facility at $650 to $750 per day covers costs.
"It''s a monetary issue. To use this facility with a lot of empty rooms doesn''t make any sense," she says.
Founding director of nursing Becky Allen says the mixed use stems from the lack of a state license for hospice facilities in California. When she and Dr. Jerry Rubin first converted a Carmel Valley home for hospice use in the early 1970s, it had to be closed because Medicare reimbursement funding was restricted. She says having the dual-role facility is hard on nurses, who have to provide very different care to someone who is at the end of life than to someone with a reconstructed limb.
Though it might seem that having people on such divergent paths in the same place might create some friction, Butler says no one complains.
"I think it works in the opposite way," she says. "[The families] enjoy seeing the Hospice used in a positive way."