Providing hospice and palliative care to patients in remote regions can come with significant challenges alongside innovative opportunities to improve quality, according to Cathy Stauffer Wozniak, executive director at Hospice & Palliative Care of Martha’s Vineyard (HPCMV).
Established in 1981, the nonprofit provides care across Martha’s Vineyard island in Dukes County, Massachusetts. Approximately 7 miles off the state’s coast in the Atlantic Ocean, the island is a popular vacation and retirement destination.
Aging populations in the area, like many regions nationwide, are seeing swelling demand for hospice and palliative care. Seniors 65 and older represent roughly one-third of the estimated 20,000 annual resident population in Martha’s Vineyard, a Tufts University study found.
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Rising demand comes at a time when labor and financial pressures are bearing down on providers amid soaring care delivery costs. These were the driving factors that fueled HPCMV to seek out Medicare certification after nearly four decades of thriving on philanthropic support, according to Stauffer Wozniak.
Walk me through the scope of your services and how these have grown since Hospice & Palliative Care of Martha’s Vineyard was established.
We actually started in 1981 as a nonprofit organization in a rented trailer. Back then it was just Hospice of Martha’s Vineyard Inc. It was founded by a group of passionate and committed citizens and some community professionals who supported bringing hospice care to Martha’s Vineyard.
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After more than 20 years of operating out of the trailer, Katharine Graham, former owner of The Washington Post, bequeathed us an endowment upon her death. This allowed us to move from the trailer and purchase a location.
Up until we became Medicare certified in September 2022, we were licensed as a hospice but all of our hospice services delivered were supported through philanthropy and fundraising. We were growing, and it became clear to the board of directors that we needed Medicare funding and we also wanted to strengthen our services with Medicare and accreditation standards.
We began offering palliative care, and strengthened our community grief counseling services, which we provide to anyone on the island in addition to individual bereavement support. We have a school-based grief program at the elementary and high schools, individualized bereavement for children and youth and a family grief camp called Camp at the Sea.
Today our programs include hospice, a palliative care clinic and massage therapy for patients, caregivers and interdisciplinary staff. We also just applied for a grant to expand support for caregivers of patients who have dementia or Alzheimer’s.
Can you elaborate on what led to the Medicare certification process nearly 40 years after the organization’s establishment and some of the nuances involved?
Around 2018, the board of directors voted that it was time to expand into becoming a Medicare-certified hospice so that we could fully fulfill our mission of serving all islanders. Additionally, we were growing and needed Medicare funding.
It was a big decision, as it was a major investment for the organization but one that everyone knew had to be done to ensure long-term access to quality hospice care for the community and sustainability. It costs a bundle to become Medicare certified and we’re still working to break even. We do a lot through philanthropy and grants, but it’s more support for staff, patients and families out there.
We did enter a feasibility study with a consulting group, which reinforced the decision. The preparation took almost three years. We have really grown as a result of not only the Medicare certification, but also having staff that really understand the high standards.
With the Medicare funding we’ve added staffing to meet demand for our services, and we’ve had some pretty critical needs among kids that have lost their parents or grandparents to sudden and unexpected deaths related to opioid use, suicides and accidents on the island. Our grief counseling has flowed into crisis interventions in the community, at the school and the hospital for families with terrible losses in their family.
How would you describe your geographic service region on the island of Martha’s Vineyard off the coast of Massachusetts?
Martha’s Vineyard has six total towns across more than 100 square miles and a year-round population is about 20,000 residents. It is a rural area and is dependent upon resources from the mainland that can reach us. Martha’s Vineyard experiences coastal-like weather year-round, which can be unpredictable.
Last year was really tough, because we lost some staff who couldn’t afford to live on the island and we had to hire more traveling nurses. That’s a real challenge when you have to try and find temporary and affordable housing. Today we are well-staffed, but there’s still a shortage of nurses in the United States to contend with.
What happens here in the summer is that our population goes up to roughly 150,000 people coming to visit, so it explodes during good weather. Rent and other expenses increase dramatically during the season, so housing for our staff is limited and costly.
We try very diligently to retain staff through offering competitive salaries, excellent health benefits, providing self-care gift certificates and staff massage. We have a self-care employee committee internally. We provide assistive technologies to increase staff efficiencies. Our leadership team is very engaged with one-on-one dialogue with staff and lots of ongoing education for clinicians and administrative staff and opportunities for [continued] education.
We’re doing whatever we can to retain our staff. The cost of living in this rural area is ridiculously high compared to the mainland, which impacts the ability to retain staff while offering competitive salaries. It’s a double whammy. It’s a misconception that rich people live here. We have a lot of seniors on our service that have challenges affording housing, food, transportation and care.
What are some of the unique needs that serious and terminally ill patients and their families have in your area compared to those in other regions? What are some of the strategies that help address these needs?
Compounding a serious illness or terminal illness, many patients and their caregivers faced challenges with mobility and being able to get transport for medical care both on the island or the mainland.
[Among the] top health issues on the island was lack of available clinicians and access to quality care. Many patients need medical care or treatment off the island and getting to other providers or for specialty care on the mainland can be very challenging. The median income for seniors is $64,325 and tax bills have grown recently by 57%.
Our social workers play a particularly big role for our palliative care support, because there is such fragmentation in the health care system. We’re really the only palliative presence on the island, and a lot of these patients haven’t had good coordination of care because it’s hard to transport them to the mainland. We’re here to help them navigate and coordinate their health care and set them up with the resources they need.
Examples of some strategies to help address these needs include:
- We have a strong palliative care presence on the island and a palliative care clinic at the local hospital. Our aim is to help patients and family navigate the healthcare system and coordinate care to prevent fragmentation of services.
- We have connections with other island nonprofits who provide transportation and food bank support. We coordinate closely with the roughly 300 nonprofits on the island.
- We provide referrals to various resources such as caregiver support groups and an adult day center on the island
What do you think are some of the greatest opportunities in the future outlook of hospice and palliative care services? What should providers be prioritizing now to prepare for what lies ahead?
I think hospice care needs to be advocated for within our legislative system. Given cost of living and reimbursem*nt challenges for hospices that want to provide more innovative services, we don’t want to see our funding decrease as it has over the last two years in rural communities especially.
Organizations need to remember why the benefit was created and what hospice care really means to provide. Hospices should not be cutting service — and there are some out there that are putting margin before mission. For nonprofit hospices, philanthropy support is essential. For all hospices, seeking grant support, donors, bequests, etc. for innovative service is important. To help our organization be sustainable we sponsor several special events every year and provide community-wide education.
I would [also] recommend contracting with third-party insurers, providers, and hospitals are key. Additionally, outreaching and partnering with local community agencies and hospitals to share resources and collaborate on programs and the like.
