DHMC Receives $10 Million Gift for End-of-Life Care Center

Lebanon — With an anonymous gift of $10 million, Dartmouth-Hitchcock Medical Center plans to expand its palliative and hospice care program with a 12-bed center near the hospital campus.

The run-up to the project, which officials expect to cost $20.5 million by the time the center opens in 2017, will bring the palliative-medicine program’s founder and former director back to the Upper Valley on a part-time basis to consult on the planning.

Ira Byock, a physician, writer and lecturer on end-of-life issues, has been living in Montana since retiring from his clinical work at DHMC last summer, after more than a decade of building and fine-tuning the medical center’s system of caring for patients too ill or in too much pain to live at home or in a nursing home.

“The idea is to create something that feels much more like home than your average hospital or (intensive-care unit) bed,” Byock said in a telephone interview from Montana on Thursday. “This is available in very few places in the country.”

Only a few social service agencies and community hospitals — among them Gifford Medical Center’s Garden Room, which Byock describes as “nicely developed” — offer palliative and hospice care in the region.

And nationally, only three Medicare-certified facilities in New Hampshire and one in Vermont are connected with academic medical centers that conduct research into such care and training practitioners, Byock said.

The Visiting Nurse Association of Chittenden and Grand Isle Counties cares for about 150 patients a year at the 13-room Vermont Respite House in Williston, which opened in 1991.

The facility specializes in patients with a life expectancy of six months or less who need more intensive management of symptoms than they can receive at home.

Typical stays range from three to six weeks, with an overall average of 30 days.

“The announcement today of a hospice residential center by Dartmouth-Hitchcock Medical Center will extend similar services and support to the southern Vermont and New Hampshire communities,” the VNA’s End-of-Life Director Angel Means said on Thursday. “This is exciting news for the advancement of high quality, end-of-life care to many more individuals, families, and practitioners.”

Means credited the success of Respite House to “the strong partnership and collaboration with Fletcher Allen Health Care, especially their Palliative Care Consult Service.” She added that Fletcher Allen’s “numerous nursing students, medical students, residents, and fellows (are) providing important end-of-life education. Our medical Director is also on staff at FAHC, further enhancing our ability to coordinate the best care for patients and their families.”

The DHMC program currently operates out of small offices near the radiology department. The staff of about a dozen professionals includes doctors, nurse practitioners, physical therapists, social workers, chaplains and volunteers who are on call at all times to each patient’s medical team and family.

The clinical staff helps the patient’s doctors and nurses alleviate pain and other discomforts, while social workers and chaplains help patients and families to work through decisions and goals for intensity of treatment. The program’s outpatient clinic provides evaluations, follow-up visits and care through checkups, where possible during regular visits to the specialist treating the patient.

“We developed it into one of the landmark models,” Byock said, “but we have a long way to go. There’s so much work to be done.”

Byock added that the new DHMC center, in addition to treating patients, training doctors, nurses, and other practitioners, and conducting research in hospice and palliative care, will serve as a resource to hospitals, doctors, and other providers in northern New England.

“There’s so much need that it just makes sense to work together,” Byock said. “The quality goes up when the transitions of care from one provider to the other are seamless. We have collaborations with Fletcher Allen, in Nashua and Manchester, the (New Hampshire) seacoast. We all collaborate actively now.”

According to a medical-center press release, officials are still looking for a location “close to the DHMC campus to make transitions of care easy for patients and their families.”

Byock, in his early 60s, said that he is not a candidate for the position of director of the program, now or once the new facility opens.

“I have plenty of work to do, in writing and speaking and policy work that I’m well-positioned to do,” he said. “There’s a deep need for a positive, coherent vision of how we can care for one another.”

David Corriveau can be reached at dacorriveau@gmail.com and at 603-727-3304