When Tom Hottman’s father was dying of cancer, he said that his mother vehemently opposed the idea of bringing in hospice care — a service she called “death watch.”

Hospice care is supportive care, focused on providing comfort and quality of life — rather than treatment or a cure — for people in the last days, weeks or months of a terminal illnesses. It can be provided in a home, a hospice facility, a nursing home or hospital.

Once misconceptions about end-of-life care are put aside, patients in rural Oregon find that it’s difficult to find providers, whether in home or in a facility, and that services are more expensive than they would be in more heavily populated areas.

“(Patients) can’t access hospice or they don’t know what it is and what it can do for them,” Hottman, public information officer at Sky Lakes Medical Center in Klamath Falls, explained. “They don’t get to have the service that can bring them comfort. It wouldn’t change the outcome, but it might have made the days more comfortable for everyone.”

Barb Hansen, chief executive officer of Oregon Hospice and Palliative Care Association, said the availability and use of hospice services varies throughout the state.

“Oregon overall has high utilization statistics, usually we’re in the top 10,” she said, “but then within our own state we have counties that are high utilization and other counties that are lower.”

Rachel Throne, executive director of Klamath Hospice, added that a big part of the problem is economic.

She said people in rural areas are generally lower income and can’t pay for additional support services. To make matters worse, hospice care in rural areas is more expensive than in the city.

Geography drives costs. Those providing in-home services in rural areas have to drive farther, so they can see fewer patients in a day than they could in urban areas. 

“A nurse may be able to provide four to five visits per day in town, but only two to three in rural areas,” she said. “Klamath Hospice covers 3,600 square miles requiring travel time as much as one hour one way.”

At the same time, Medicare reimbursements for services in rural are less than for urban providers even though operational costs are higher.

Those economics also are forcing hospitals to end or limit their hospice services. In 2018, Pendleton’s St. Anthony Hospital closed its hospice center and transitioned it to home hospice care.

To counteract these challenges, four non-profit provides merged to form the Oregon Non-Profit Alliance to provide better service and compete against for-profit hospice providers that have a larger economy of scale that a smaller non-profit won’t have.

Kelly Beard, the chief executive officer of the Alliance, has worked in hospice care for 16 years. Her goal is to make sure that non-profit hospices survive and that clients have a choice. 

“That’s our main thing,” Beard said. “We want to not just survive, but thrive, and providing the highest quality care and the best care possible to all the communities that we serve.”