28 Years 1983-2011

1. Hospice Greater Saint John owns and operates both “Bobby’s Hospice” and “The Hospice Shoppe” 28 Years 1983-2011

2. In the fall of 2005, facing her own end-of-life illness, Bobby Lawson, a 20-year Hospice volunteer, and her family made a significant donation to enable Hospice to purchase a home in the community suitable for a Residential Hospice.

3. The Business CaseCommunity Needs 800 people die annually of a palliative illness in the Greater Saint John area. Over half of the annual palliative deaths take place in the SJRH - 200 in the Palliative Care Unit - 200 in Acute Care Beds In the last month of life, 50% of palliative patients are hospitalized because they need 24-hour care that families are unable to provide. SJRH has some of the longest wait times for elective surgery & admissions from the ER Seniors account for 75% of palliative deaths. By the year 2025, the proportion of seniors in NB is projected to be 21% higher than the national average. Palliative deaths are set to rise significantly, particularly in Saint John, which has NB’s oldest population

4. The Business Case The Community Benefits • Dying Patients–130 dying patients who will otherwise face hospitalization annually in the last month of life receive individualized quality end-of-life comprehensive care in a home-like setting. • Hospital Wait Times–Residential Hospicefrees up over 2,500 acute care bed days at the SJRH annually and increases access for 500+ patients on surgical wait lists, etc. • Families–Hospice palliative care positively influences the quality of dying and the recovery of survivors. With the death of one person affecting an average of 5 other people, 650 families are positively affected by Residential Hospice care. • Tax Dollars–Government is spending $200/day to care for palliative patients in the Residential Hospicecompared to $1,000/day in an acute care hospital. Over $2 million dollars/year is being reallocated to acute care services.

5. Twinning & Sharing for Success Carpenter Place, Burlington, ON – www.thecarpenterhospice.com Hospice May Court, Ottawa, ON – www.hospicemaycourt.com Vernon & District Hospice, Vernon, BC – www.vernonhospice.ca Rosedale Hospice, Calgary, AB – www.hospice.calgary.com Red Deer Hospice, Red Deer, AB – www.reddeerhospice.com Hospice Niagara, St. Catherines, ON – www.hospiceniagara.ca Dr. Bob Kemp Hospice, Hamilton, ON – www.kemphospice.org Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association Janet Dunbrack, Healthcare Consultant and Former Executive Director, CHPCA Carolyn Tayler, RN, BN, MSA, Director, Hospice Palliative Care, Fraser Health, BC Ontario & Fraser Health Standards for Residential Hospices Thank You!

6. Our Greatest Challenges Challenging the status quo Selling the unwanted Developing a critical mass Staying the course

7. Our Attitude

8. Secrets of Success Fearless Leaders & Dedicated Teams More important than technical brilliance or political smarts is the need for leaders to be courageous, persistent and resilient. It requires tremendous commitment and many sacrifices by a lot of people to get the job done. Dedicated Board of Directors willing to take smart, calculated risks Strong Staff Team to lead the way and manage the current business units Medical Experts to add credibility and rally a community Political Champions to open doors and lobby internally Community Champions to believe, invest and support

9. Secrets of Success Master the art of “The Spin” People buy want they want, not what they need. Selling death services is not what people want. Package it differently - how your Residential Hospice will reduce hospital wait times, improve acute care services and support economic development. Tell compelling stories to back up your facts. Communicate, communicate, communicate. If you’re not sick of saying it, you haven’t communicated enough! On average, it takes hearing or reading a message 8 times for someone to grasp it.

10. Secrets of Success Engage the media and be media savvy Meet with your newspaper’s editorial board to sell your plan. If you have a solid business case that will benefit the community, they will give you thousands of dollars worth of free publicity that will help inform the public and encourage political action. Remember that the media do not exist to support you – give them newsworthy items to report on, both the good and the bad. Be honest, fair and smart with your comments. Everything you say is ON THE RECORD.

11. Secrets of Success Develop political champions Secure experienced politicians in all parties, at all levels of government to take up your cause. They will open doors to government, give you wise advice and lobby internally for your project. Invite them to your public functions. Give them an opportunity to speak. Give them recognition. Praise them publically and in the media.

12. Secrets of Success Lean on and learn from others Take smart, calculated risks Build relationships with others who have travelled this path. Let them be your coach and champion. Lean on them for support, hope, guidance and strength. Learn from their experiences – don’t reinvent the wheel. Do your research and have a solid business plan. Have the courage to move forward. People and resources will follow.

13. Secrets of Success Don’t give up This will be an amazing, frustrating, exhausting and exhilarating journey. Learn to live on the brink of disaster – it’s the norm. Keep moving forward. Hard times bring strength, solidarity, clarity, unity and success. Things outside of your control will come along to propel you forward when you need it the most. In retrospect, you wouldn’t have missed any of it – you cannot appreciate the highs without suffering the lows.

14. $2M Renovation Project 2008 - 2010 • Sprinkler System • Elevator • Fire System • New Plumbing System • Furnace Upgrade • Window & Lighting Upgrades • Automatic Generator • Parking Expansion • New Flooring • Architectural Design • Nurse Call System • Security Upgrade • Patient Bedrooms & Bathrooms

15. Renovation Costs

16. Power of the DreamA Capital Campaign Strategy for Residential Hospice Build theDream–2006 - 2007 $300,000 raised to purchase our first Hospice House. Realize the Dream–2007 – 2010 $2M raised to renovate and ready for operations Live the Dream Legacy Fund–2012… Endowment fund for bequests, etc. with annual interest earnings supporting operations

17. Realize the Dream Capital Campaign

18. Annual budget of $1.6M Hospice – 55% NB Government – 45% No fee to patients !! Government & Hospice Contract

19. Partnership Principles Patient’s first Hospice governance & administration model Partnership evidenced by a contract End-of-life care Industry best practices –evidenced-based model- Canadian Residential Hospice standards. Quality control Stability & predictability Integrated with volunteer support No duplication – seamless care Full accountability and public reporting $870,000/year $730,000/year

20. Over-Arching PrinciplesPalliative Care Partners Patient and Family first (not about us) Seamless care through Triage process. Good communication and collaboration amongst partners Right Person, Right Place (Home, PCU, RH), Right Time Patient Preference is respected if possible All attempts should be made to avoid ER

21. 10-Bed Residential Hospice Opened November 2010

22. Residential Hospice Overview 22,000 sq. foot palliative care facility with 24-hour care delivered by certified and licensed professionals and trained volunteers. 10 private home-like bedrooms and bathrooms for end-of-life palliative care 24-hour physician coverage and nursing care with expert pain and symptom management 4 family bedrooms, living rooms, TV room, dining room, kitchen, warm fireplaces, communication room, etc. A playroom for children, a chapel for spiritual reflection and outdoor garden to connect with nature. The care at our facility exceeds the Canadian Standards for Residential Hospice care.

23. Hospice Care PhilosophyCompassionate Care that Celebrates Life Individualized, dignified, respectful and compassionate whole person quality care that includes physical, emotional, spiritual and social care for both patients and family members. This is their journey – their way. We focus on what is important to patients and families and let them guide the way. We help people to live fully until the end of life. We provide non-judgmental, respectful, dignified and compassionate care and support. A home-like, peaceful environment that respects patient and family wishes. This is their home away from home for the remainder of their life. We work hard to make people feel comfortable and at home. We are committed to keeping things as home-like and non-institutional as possible. We create an environment of peace and tranquility. We care for this home as if it were our own.

24. Hospice Care PhilosophyCompassionate Care that Celebrates Life Experienced and dedicated staff and volunteers who work together in full cooperation with each other and with community healthcare partners to serve patients and families and deliver excellent healthcare and comprehensive support. We are here to serve others, not ourselves. We are dedicated to excellence in our clinical practice and respectful teamwork. We go the extra mile to provide superior customer service and exceed people’s expectations. A supportive community that provides the funds needed to cover our share of the operational costs. We treat our community’s donations as if they were our own funds. We are cautious with our use of supplies and spending. We don’t waste. We contribute to Hospice fund raisers to the best of our ability.

25. Customer Service “The Pickle” Hospice is committed to quality customer service and “giving the pickle” which is about going the extra mile to make customers happy and fully satisfied. Our customers include patients, families, donors, shoppers, community partners and anyone outside the organization who interacts with the organization to receive or provide services and/or support.

26. Admission GuidelinesTerminal care with ongoing pain & symptom management Patient and family aware of diagnosis & prognosis End stage disease management & terminal care Ongoing pain & symptom management Limited diagnostics/disease specific treatment Expected length of stay 6 weeks or less Cannot stay at home and does not require hospital care No ventilators No wandering

27. Residential Hospice Admissions From community through Family Physicians, Extra Mural and the HPC Outreach Clinic From Hospital via consult to Palliative Care Unit or direct consult to Hospice

28. Medical CoverageFunded by Hospice 2 FTE Medical Director – two ½ days per week Dr. Chris O’Brien Two additional ½ days of palliative physician coverage – Dr. Julia Wildish and Dr. Jennifer Hannigan Family physicians encouraged/supported to admit and follow 24-hour call team with physicians from the PCU Leading the country in RH medical coverage

29. Nursing & Support Services Nurse Manager – Monday to Friday – Nicole Hamming 24-hour Nursing & Personal Care 1 Registered Nurse (RN) 1 Licensed Practical Nurse (LPN) 1 Personal Support Worker (PSW) Volunteers in 4-hour shifts 8:00 am – 8:00 pm Exceeding Ontario Standards

30. Volunteers Adding Value Serving Meals Doing nails and hair Running errands Laundry Emotional and spiritual support Playing piano Baking and cooking Cleaning, mopping, dishes, changing beds Massage therapy

31. Oxygen and Respiratory Therapy Complex Wound Care and Help with Supplies Specialized air flow Mattresses Liaison Nurse - EMP Hospice Palliative Care Coordinator Continuity of care. Frequent visits to patients from their community EMP nurse ( “ they love to visit”) Payer of Last Resort (not had to utilize to date) OT /PT / SW

32. Medications Exclusive pharmacy for all patient prescriptions Delivery, supply MARS, Flips and holders Medication discard and Sharps disposal Back up supplier for medical supplies Staff promo medication discount card Future engagement for team rounds

33. Lives Lived at HospiceNovember 2010 – October 17, 2011 96 admissions 60% from hospital and 40% from home 82% are age 65 and older 85% cancer diagnosis Average PPS on admission – 41% 85 deaths; 4 discharges Average length of stay: 22 days (16 days outliers removed) Over 2,200 beds days saved at SJRH Occupancy Rate – 72% Projected to care for 130 patients/year

34. Community Feedback “How can we even begin to express our gratitude for all the excellent love and care that you gave to our Mom during our time with you. What started out as a dark and fearful time into the unknown became a place of joy and laughter and friendship that made her final journey a blessed time. She loved you all and told me so all the time. You are truly God’s Angels on earth.”

35. Updated Sept. 2011 Board of Directors Director of Medical Care Chief Executive Officer Shoppe Managers Marketing Manager Palliative Support & Food Services Manager Grief, Spiritual Care & Operations Manager Finance & Website Manager Nurse Manager Housekeeping Coordinator Food Services Coord(s) 24-hour RH Care Team RN’s, LPN’s PSW’s Shoppe Clerks Admin. Assistant Maintenance Coordinator Shoppe Vol’s Friends Of Hospice Vol’s Grief Vol’s PS & Kitchen Vol’s

36. John Carver’s Policy Governance Model Advanced Board Model - not involved in operations Board has two employees – CEO and Director of Medical Care - run operations and report to the Board on outcomes Board’s Role –Oversee the affairs of the organization on behalf of the community and be accountable that the org works and delivers on community needs Governance and Stewardship Confirm strategic direction, delegate authority and evaluate results. Review and authorize plans, policies and commitments. Ensure compliance with legal and contract requirements. Monitor performance outcomes and evaluate the organization work against quality standards and best practices. Ensure dedication to, and use of assets for public benefit. Leadership and Support Ensure the long-term financial health of the organization. Act as ambassadors to the community and attend special events Ensure the Board performs effectively.

37. Executive Committee Board of Directors Chief Executive Officer (CEO) Director of Medical Care Community HPC Network Medical Advisory Committee Management Team Community Triage & Care Team (IDT Rounds) Quality Care Operations Committee Health & Safety Committee

38. What Does It Cost To Run A Residential Hospice for One Year? Nursing Costs $800,000 General Operations & Management 150,000 Hospice Shoppe 135,000 Medical Supplies & Services 100,000 Events & Promotion 70,000 Food Services 70,000 Maintenance & Housekeeping 65,000 Supplies & Equipment 60,000 Heat, Lights, Water 40,000 Volunteer Services 40,000 Worker’s Compensation 18,000 Laundry & Supplies 15,000 Professional Fees (audit, legal, payroll) 12,000 Phone and Cable TV 8,000 Insurance 8,000 Grounds 6,000 Garbage & Compost 3,000 Total Costs $1,600,000

39. Where Does the Money Come From? Govt = 45% Shoppe = 20% Events = 15% Donations = 15% United Way = 3% Grants = 2% $730,000/year $360,000/year $48,911/year

40. Special Events December 8-17, 2011 $20,000 Saturday February 12, 2012 $110,000 Saturday May 12, 2012 $50,000 Wednesday June 13, 2012 $25,000

41. 77 Catherwood Street West Saint John Open Monday – Saturday 10:00 am – 5:00 pm Thurs & Fri Evenings until 8:00 pm 100% of proceeds fund care at the Residential Hospice

42. Leading Org. Change Tough-Minded Optimist Be Somewhat Naïve and Believe it is Possible Make Tremendous Sacrifices Doggedly Persistent & Very Resilient Surrounded by a Dedicated Team of Leaders & Champions Team’s Greatest Cheerleader Be Aware of “Founders’ Syndrome” Accept Not Everyone will Make the Journey No Matter What – The Journey will be Worth It!

43. The Tipping Point

44. We Made It!

45. “At some time, in some way, we must all face the end of life. And most of us share a common hope—that when death comes to us or to a loved one, it will be peaceful and free of pain. We hope to face death and grief surrounded by a circle of support, feeling safe, comfortable and cared for. This is the promise of Hospice Greater Saint John.”