January, who lived near Brandermill, spent her last three months giving away her possessions, holding conversations with her family and getting right with God, Wilson says. She saw the arrival of a new grandchild, watched her granddaughter climb out of a long depression and saw another relative escape an imprisoning drug dependency. "She had more of a life in three months than in her entire life," Wilson says.
When the end came four weeks ago, "she got exactly what she wanted. She said she was just going to close her eyes and go to sleep."
Peaceful, comfortable and expected, she had a good death, says Wilson, who spent three months with January. But in the Richmond metro area, she says, not enough people get that experience.
Hospice organizations seek to erase fear and pain from the dying process by sending nurses, counselors and social workers to work with patients who have been diagnosed with an illness that is terminal in six months. They also help their families deal with emotional and financial strain. The service has existed for 25 years, but hospice advocates say that the number of people in the Richmond area who use the service has been astronomically low. They say residents have long been unusually resistant to the idea of dying under hospice care, at home.
Andrew Parker wants to change that. Parker is a partner in American Hospice Management, the nation's first hospice administration company, which oversees Hospice of Central Virginia and four others in different states.
Now, for the first time for any of the hospices he oversees, Parker says, his company is "spending a great deal of resources" on advertising Hospice of Central Virginia. The goal, he says, is simply to get people to notice and talk about hospice. "Access is the key."
It seems as if advertising a way to die would be a delicate task. But it's easy, he says, "You've got to give them an image and you've got to let them know help is here."
That idea resulted in the series of ads soon to be launched in newspapers, the phone book and on billboards in the Richmond area. They depict simple portraits of hospice clients with the messages, "If there's anything you need, just ask," and "If there's anything we can do, just call."
Hospice is not a luxury but "a universal right that people in Virginia have," Parker says. State law mandates that all major insurers, including Medicare and Medicaid, cover hospice services. That means "we pay for everything. We never send a family a bill," he says. The average cost is $130 to $140 per day, which includes medicine, equipment and nurse visits.
Virginia's policy on hospice insurance, shared by only four other states, is "so progressive," Parker says. But in Richmond, he says, it's not widely used "We have a better batting record in Farmville."
Parker's Florida-based company also runs four other hospices in Arizona, Oklahoma, New Jersey and New York. Hospice of Central Virginia, the largest in the area, serves an average of 200 clients at any given time. But in Oklahoma City, Okla., he says, a city of comparable size, the hospice serves 4,000 to 5,000 patients a day. In Jacksonville, Fla., also comparable in population, the number of patients served is 2,500 to 3,500.
Nowhere has the struggle to publicize hospice been as difficult as in Richmond, Parker says.
"My reading is, it's a denial problem with physicians," Parker says. Doctors are perhaps hesitant to inform their patients because planning for one's death is a difficult subject to broach. Or, he says, it could be the abundance of doctors and teaching hospitals here that makes it hard to see the need for hospice. Wilson, on the other hand, says it's Richmond's conservatism that makes people reluctant to die at home when a hospital has become the customary place to meet the end of one's life.
Rachel Schmidt, provider relations coordinator for Hospice of Central Virginia, says the first challenge of marketing hospice is overcoming the stigma of the word. "Hospice is 'a resting place for a traveler on a difficult journey,'" she says. "Nowhere did I say anything about, 'You're going to be dead next Tuesday.' "
When Scmidt talks about hospice to groups, she says, "I start off by saying, 'Let me tell you about a program where, if your grandfather had emphysema, he could receive all the medicines for his emphysema free.'" Not only that, Schmidt says, but he could receive visits from a nurse, help with bathing and errands, equipment, clergy and counseling again, all without cost.
"If you hold off [on] using the word hospice until you get the information out, the audience is much more receptive," she confides.
When Nadine Blackford's father told her in August that he dreaded dying in the hospital, she called Hospice of Central Virginia. She did it unwillingly at first her father was 77, weakened by a stroke and pneumonia, but nowhere close to dying, Blackford thought.
As it turned out, her father lived only a week in hospice care. But the nurse who rushed out to the family's home at 2 a.m. and stayed with him helped reassure the family tremendously, Blackford says. Hospice, she learned, is about "allowing you to do it your way. For the natural course to take place, but on your terms."
Hospice workers assist a grieving family for up to 13 months after the death of a patient, Parker says. In addition to alleviating the pain of a patient's terminal illness, "we deal with the bureaucratic and financial pain."
Being available around the clock can be a heavy burden for Wilson, who for three months has been handling a double caseload 52 patients while Hospice of Central Virginia sought another social worker. She often works 10- to 11-hour days before coming home to her husband and two children.
Yet despite long lunchless days and the piles of paperwork, despite the family members who order Wilson to leave or yell at her in their grief, despite the sorrow that inevitably follows when a patient dear to her dies, the work is worth it, she says. Especially when she becomes close to people like Miss January, whose death affected her profoundly.
"Her very last words to me were, 'I will always be with you wherever you go,'" Wilson recalls. "I kissed her and she kissed me and she left." Miss January, with a smile on her face, was gone. S