Bridget Cotton still gets lonely sometimes, and she still watches for her husband to walk through the door.But it’s been two years since colon cancer claimed the life of 44-year-old Ray Cotton.

“They told me what to expect,” she says. And after Ray’s death, “Hospice helped me keep things in perspective.”

Few knew what Hospice was
Hospice has been caring for local patients and families for 25 years now. Originally called Sandhills Hospice, the organization accepted its first patient in August 1980.

Two years earlier, David Allen, M.D., a medical oncologist with Pinehurst Medical Clinic, had brought together a small group of local residents to start laying the groundwork. Because most people at that time were unfamiliar with the Hospice concept—the first Hospice in this country opened in 1974—one of the local organizing group’s first challenges was educating the community. Ursula Hebert, who at 92 is still an active Hospice volunteer, was among those who began spreading the word.

“She went through the phone book and called people to get them involved,” says Charlotte Patterson, director of FirstHealth Hospice & Palliative Care. “They started sending out mailings to tell the public what Hospice was all about and that one was starting here.”

They also began raising money. For the first few years, Hospice depended entirely on community support because neither Medicare nor private insurance covered Hospice care.

“Hospice was driven purely by community generosity and volunteers,” Patterson says.

When Sandhills Hospice opened, the only paid staff was a part-time patient care coordinator. Dr. Allen served as the volunteer medical director. Patterson was one of several nurses at Moore Regional Hospital who volunteered to spend some of their off-duty hours caring for Hospice patients in their homes.

“It’s a passion,” she says, explaining the motivation to work or volunteer for Hospice. “It’s a passion to give excellent end-of-life care. You’re part of a family’s life at such an incredibly important time, which makes it the most rewarding work I have ever done.”

As Hospice began to grow, the board hired a part-time administrator and a few paid nurses. Moore Regional Hospital donated the use of a couple of small rooms in the old nurses’ residence, as well as a closet.

“That was a very important closet,” Patterson says. “It was the lending closet where we kept supplies and equipment that people would donate for us to take out to patients.”

After renting office space in the community for several years, Hospice constructed a building of its own on Aviemore Drive in 1990. That original building and a later addition were both paid for entirely with community donations.

In 1996, Sandhills Hospice joined FirstHealth of the Carolinas and became FirstHealth Hospice.

“The hospital really wanted to provide cradle-to-grave services, so it was a very good move,” Patterson says.

In the first year or two after Hospice began serving Moore County, between 10 and 15 patients were being cared for at any given time. Today, that number is about 100 in Moore and Montgomery counties.

Expert care for patients and families
FirstHealth Hospice & Palliative Care offers a variety of services for terminally ill patients and their families—starting soon after the patient receives the diagnosis and continuing for as long as the family needs help coping with its loss. The Hospice staff of 43 includes nurses, nurses’ aides, social workers, grief counselors, a chaplain and administrative personnel. About 100 volunteers serve in various roles.

Members of the interdisciplinary Hospice team are available around the clock to deal with the physical, spiritual and psychosocial needs of patients and their families.

“Each of these pieces affects the others, and every piece must receive equal attention,” Patterson says. “We want to get the symptoms under control and, at the same time, help the patient and family deal with all of the other issues.”

Hospice nurses evaluate patients’ conditions, administer medications and teach family members to provide daily care. They alert a physician if a patient’s pain or other symptoms are not being adequately controlled, and they let other Hospice team members know if they feel the family needs counseling or other assistance.

Seven of 10 FirstHealth Hospice nurses are nationally certified in hospice and palliative care.

“Things can change rapidly for patients and their families, and the nurses help them understand what’s happening and help them adjust,” says Ellen Willard, M.D., medical director of FirstHealth Hospice & Palliative Care.

Dr. Willard, a hematologist and medical oncologist with Pinehurst Medical Clinic, was the first physician in North Carolina to be certified
in hospice and palliative care.

Although patients keep their own doctors during Hospice care, Dr. Willard serves as a resource if those physicians aren’t available. She also meets with Hospice team members weekly to discuss their patients.

Most Hospice visits are to patients’ homes, but the Hospice staff and volunteers also see patients in nursing homes and assisted living facilities.

FirstHealth plans to build a residential facility for end-of-life care called Hospice House. It will be part of the FirstVillage complex across Memorial Drive from Moore Regional Hospital. Construction of Hospice House is expected to begin next fall, with the opening tentatively set for summer 2007.

Many of the patients in Hospice care have been diagnosed with some form of terminal cancer, but Hospice serves anyone with a life-limiting illness including heart disease, stroke, ALS (Lou Gehrig’s disease), Parkinson’s disease, Alzheimer’s and failure to thrive.

In the 1980s, Congress mandated Medicare coverage for Hospice care. Today, Medicare reimbursements provide about 88 percent of FirstHealth Hospice’s income. Private insurance and Medicaid also cover Hospice care, and the FirstHealth Hospice Foundation provides additional funding to cover the deficit each year, mainly by way of funds raised at the Annual Pottery Plus Auction. No one seeking the services of FirstHealth Hospice & Palliative Care is ever turned away, regardless of the ability to pay.

A part of FirstHealth Hospice & Palliative Care that is free and available to anyone in the community is the Grief Resource and Counseling Center. The Center’s professional staff provides individual and group counseling and facilitates support groups for people who are struggling to cope with the loss of a loved one.

Youth programs are geared to specific age groups, and a summer program called Camp Lost and Found draws children ages 5 to 17 who have been affected by death.

“This may be their first group experience,” says Family Services Coordinator Tina Markoff. “It’s not a fix-all. It’s a tool to complement individual counseling.”

Hospice also offers support groups for caregivers who may be experiencing burnout from tending to the needs of their loved one. And Hospice staff or volunteers sometimes make home visits to give family members a break from caregiving.

“There are a lot of retired people in this area, so often it’s an elderly caregiver dealing with an elderly patient,” Patterson says.

Always there to help
Alexandra Lawson, who works as a FirstHealth nurse, took on the role of caregiver at home when her 65-year-old mother faced cancer for the second time. She turned to Hospice to help her children deal with their grandmother’s death.

“They were close to my mom,” she says about her children, ages 4, 7 and 12. “She helped raise them while I went to nursing school and worked. I needed help explaining things to the children.”

Instead, she became a volunteer at the hospital. When the hospital chaplain suggested she might like to work with Hospice, she didn’t even know what the word meant. That changed as she and her husband became involved with Dr. Allen and the other community members who started the program.

Through the years, Hebert has known people who found it difficult to accept the Hospice philosophy of helping people live their final weeks or months with dignity, autonomy and a better quality of life. They couldn’t get past Hospice’s association with death.

“Once they did understand it,” Hebert says, “they didn’t know how they could get along without it.”She says her volunteer work with Hospice became an important part of her life and introduced her to families who eventually became good friends.

“It’s not all sadness,” she says about the patient’s final months and days. “You enjoy the good things with them, and you work through the sad times.”