Seven Questions for Carole Fisher

The Nathan Adelson Hospice chief on planning for the inevitable, industry competition and Brad Garrett’s friendship


Photo by Jon Estrada

You joined Nathan Adelson Hospice in 2005 and became CEO/president in 2006. What drew you to health care and, more specifically, hospice?

My background is in social work. I tried many different areas to see what I enjoyed. I worked in the behavioral health care field for eons, and I worked for mission-driven organizations and for-profit corporate organizations. At this stage in my life I wanted to get back to a mission-driven organization and really make sure that when I get up every day, I have purpose and I’m really helping people. It is an honor to work with people as they transition. I’m in awe of people when I have the opportunity to talk to them bedside; we touch their lives that way. It really fulfills my need [for a] sense of purpose.

What’s a good day for you?

When we make sure patients and their families have what they need during this journey. That’s making sure first and foremost that pain is under control. What’s wonderful about hospice is its interdisciplinary approach. We don’t just look at physical; we look at spiritual and emotional. We get involved all the way around.

What numbers about Nathan Adelson Hospice would surprise our readers?

We have 20 beds here [Swenson Street at Flamingo Road], we have 18 beds on the west side of town and we have anywhere from 250-300 patients on hospice care every day. We give away more than $1 million a year in uncompensated care. Last year we cared for more than 3,100 patients. We raised more $3 million last year through our separate 501(c)(3) foundation. … There are more than 30 for-profit hospices in more than 40 locations in Southern Nevada; we’re the only not-for-profit. That number startles me. When I first joined the organization, maybe there were 10 or 12 hospices.

Hospice is a $17 billion-a-year industry. How does a not-for-profit compete with so many for-profits in the Valley?

Every hospice wants a Medicare patient because Medicare pays 100 percent. Our competitors are much more strategic about the patients they are seeking. They’re looking for patients with less expensive illnesses and long lengths of stay. The longer you are on hospice the more funds you’ll bring in. …

The competition is an opportunity for us because we have to make sure the community understands what makes us different. I would ask the community to wonder what a for-profit hospice does with its money. Many of those for-profits accept donations, yet those same for-profit hospices call us at least once a week with a referral for an uncompensated case. … Anyone who works bedside, whether they’re in a mission-driven organization or in a for-profit, they’re angels and their work is unbelievable. It’s the organization I question the purpose and intent of.

What makes Nathan Adelson Hospice different than for-profits?

We invest all of our money back into patient care and back into our employees. We have programs and services that are not replicated at the for-profits. So in addition to taking people who are uncompensated, we have many unique programs. We have the Bonnie Schreck Memorial Complementary Therapies Program. Complimentary therapies are those extra things that aren’t traditional medicine. We do massage, we do healing touch, we do pet therapy, we do a lot of aromatherapy. We do Pet Peace of Mind; animals are so important in our lives and so what do people do at the end of their lives when maybe they don’t have family, they don’t have friends and they’ve had this dog forever? They want to make sure that dog’s cared for. We work to get those dogs adopted. We make sure while the patient is still alive that the dog has the food it needs, that it has veterinarian appointments kept. We also have a meal-delivery service for families and work in partnership with Three Square food bank.

How do volunteers help Nathan Adelson Hospice?

We’ve had more than 300 volunteers last year, and they contributed half a million dollars [in manpower]. They work with patients and are companions. Some are in the pet therapy program. Some are helping with events in our foundation. Some are answering phones and filing. We’re always looking for help.

Describe the hospice’s initiative, Deciding Tomorrow … Today, which you plan to kick off this year?

It’s our responsibility as leaders in end-of-life care to make sure you’re saying to your family, “Hey, if God forbid, I can’t speak for myself, here’s what I want to have happen.” We plan to get a website up and a dedicated phone line so people can ask questions. We will have a guide on how to have those conversations with your loved ones and continue to promote the use of Nevada’s Living Will Lockbox, a place where you can park your advanced directive so a physician and health care provider can go and see what you wanted.

What are the pitfalls of not having end-of-life care conversations?

The best way someone can die is to make sure their loved ones know how they feel about them and what they want. I hate pain and don’t want to experience pain at the end. Some people want to be more alert; I guarantee if I have that choice, please don’t let me be in a lot of pain. Those conversations are so important to have with your children so that when the time comes, they know what to do and they don’t have to worry about what did Mom want, what did Dad want.

What’s the biggest concern families of hospice patients have?

One has to do with hospice being perceived as a place to die. It’s so opposite from that. We really add quality to life. Research shows that having good hospice care will extend life because we address all those symptoms and so you’re able to spend more time with your loved ones. There’s a lot of hesitation to say, “Boy, I’m going to bring my loved one over to your unit or bring you into my home and sign on to hospice because you feel like you’re giving up.”  We live in a time when we have so many new discoveries and innovations in the medical field that it’s easier to keep people alive today—but it doesn’t mean they’re living a quality life.

Has any one patient stood out to you through the years?

A patient Cliff Kehoe and I became very close. He was an educator and worked with children in high-risk schools. On April Fools’ Day he was very weak, but he called the school. They put him on the intercom, he told the students that they were having pizza for lunch, and then he said, “April Fools.” He kept his sense of humor to the very end. It was so important to him that children in high-risk schools had what they needed, so I promised him that we would honor that, and Nathan Adelson adopted two classrooms (including one at where he worked, Robert Taylor Elementary in Henderson). He showed such courage. Knowing he wasn’t going to be alive much longer, he never wavered from helping others.

We also had a nurse Terri Gerevich who worked for us for about 15 years. She was an amazing woman. She was like my boss; she’d come in and tell me the way it was. She had a great sense of humor. She had bladder cancer, and she worked till the end. She would go into the inpatient unit once in awhile. We’d get her hydrated and feeling better and she’d go back and educate people about the end of life. She was a veteran in the Marines, and she said she wanted to watch over us for the rest of our years. So she wanted us to hang her flag that she got when she died, and so we have her flag on our flagpole.

Hospice neither hastens nor delays death, but some states have physician-assisted suicide. Where does hospice fit in that dynamic?

There are a couple of people in our state who would like to see that legislation happen, and I met with them recently. The reason they were pushing for that legislation had to do with a young woman who had a painful death, and I asked if that person had been on hospice. She hadn’t, so what an opportunity for me at that point to educate about the value of hospice, because we relieve pain and suffering. I don’t see today a role for Nathan Adelson Hospice with that legislation because we know our good work makes a difference at the end of life. We touch on all those issues—the physical, the emotional and the spiritual. I see hospice as being value-added to the end of life; it doesn’t take away.

Comedian Brad Garrett does commercials for you. How did he become involved?

He has become a great friend to our organization and to me the last five years. He had a dear friend who needed to go to an inpatient facility. This man was in his early 50s and had a wife and young children, and he didn’t want to die at home. His friend came in, and we took care of him. Brad wanted to make sure he gave back and wanted to spruce up the facility. I asked him to be a spokesman. He did a television commercial for us [and his contributions grew]. He helps educate that hospice is OK. Here’s this man who’s known to be so funny, he personalizes the subject and he makes it OK to ask for help at the end of life.

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