DEATH OF A DREAM 

San Diego was fortunate to have two dedicated women who had the vision and the determination to provide end-of-life care and comfort, San Diego Hospice was their goal that took time and persistence to achieve. A practicing medic at UCSD and a generous donor teamed up to overcome bureaucratic obstacles and launch the most innovative hospice facility in America.

The woman with the vision was Doris Howell M.D., and Joan Kroc provided the principal funding. Both had personal experience with end-of-life care and wanted San Diego to have the best.

Hospice provides home care for a patient who has six months or less to live. The traditional treatment was to end life in a hospital or nursing home. Most patients prefer to die at home with family and friends, Hospice makes that possible in its home-care system. It is even better if the there is a hospice facility for the most critical patients.

San Diego was lucky to have a state-of-the-art facility on the bluff overlooking Mission Valley in Hillcrest. Designed and landscaped by prominent architect Homer Delawie and landscape designer Joe Yamada, the 25-bed  center was deigned to allow family members to stay with he patient in a home-like suite that had cooking capability. Other amenities were a park-like garden and a children’s play ground where families could share time together.

Major funding for the hospice center was provided by Joan Kroc while Doris Howell gathered the medical team trained for the special care procedures to treat end-of-life needs. The large staff was headquartered at the center but most worked at the patients’ home. At its peak in 2010, San Diego Hospice served over 1000 patients.

What could go wrong with medical funding from Medicare and other welfare programs? Patients paid what they could to cover what insurance did not. Fundraising was a major task, but they did well accepting memorial tributes by naming rights for every room and special decorative installation in the Hospice Center. It was not a profitable operation, but the staff was able to obtain grants and promote the naming rights.

Sometime in 2012 there was signal that maybe San Diego Hospice had a problem with the funding from Medicare. An investigation disclosed that the hospice care was extended beyond the six months covered by the government.

Here is the rub. A patient near death is enrolled and gets better with proper care. What was Hospice supposed to when the six months are up and the patient is still alive? They are still at end-of-life and need hospice care. So the staff stepped outside the rules to continue to assist their patient with a comfortable death.

When the government auditors finished their investigation for Medicare fraud, Hospice was assessed $112 million for reimbursement of improper billings. There was no way it could raise that amount of money, so they choose bankruptcy in 2013. The dream of the founders and thousands of dedicated supporters had ended.

Scripps Health stepped in to take over 500 patients into its small hospice unit, then won the courthouse auction for the four acre site intending to reactivate the care center for the more distressed patients.

As time went by Scripps found the care center needed deferred maintenance and upgrades to be functional. The case load for hospice home care declined, In September Scripps’ management announced it was terminating hospice care and selling the Hillcrest property to a developer of condos. There were only 114 hospice patients who are being assisted in transferring to another care agency under the same hospice plan.

This was a blow to those hospice advocates that had put so much effort of volunteer service and financial support into San Diego Hospice. Not only are thousands of terminal patients denied the critical care they need, but the renowned model care center and all the donor tributes will be bulldozed.

The closure of Scripps Hospice provides for 111 employees and the doctors on staff to join Elizabeth Hospice, an established home-care group founded in 1978 currently serving 500 patients in San Diego and Riverside counties.

Scripps announcement of hospice closure blamed the on-going losses from operations. No one would expect a hospice operation to make money. Fund raising is necessary because of the high cost of care verses the amount funded by Medicare and Medicaid. I would expect a healthcare organization as big as Scripps could raise funds for hospice care.

Of course, such a small patient census limits the funding opportunities. Besides private foundations and some government grants, support comes from family and friends who appreciate the end-of-life care that hospice provides.

The dream of the founders, thousands of volunteers and the hospice patients’ families for 40 years came to an end, At least there is some consolation for the donors of memorial tributes. The larger memorials in the San Diego Hospice Center landscape area will be removed to a garden setting at a Scripps facility. The interior dedication plaques can be retrieved by the donor from Scripps upon request.