Based in Lockport, N.Y., Niagara Hospice has set plans in motion to expand its general inpatient hospice facility. The hospice expects the project to reduce its waiting list for patients seeking admission to the facility as demand rises for end-of-life and serious illness care. Construction will begin July 1 with completion anticipated in early 2022.

New York is a certificate of need state and allows hospice residences to have a maximum of 16 beds. Niagara Hospice is moving forward on plans to build a 5,000 square-foot addition onto its current 10-bed facility and cost roughly $2 million. The New York state Public Health and Health Planning Council approved the project on June 3, according to CEO John Lomeo.

“New York state is a little different than most of the country. Hospice is not permitted in assisted living facilities, therefore patients desiring hospice services must leave their assisted living facility,” said Lomeo. “We have a 10-bed general inpatient facility, and now we will complement that with a 16-bed residential facility. With a current waiting list for admissions to Niagara Hospice House, the demand for six additional beds was clear and convincing.”

Patients are eligible for Niagara’s hospice residence program when they lack caregiver support in the home, when their home is not safe or appropriate, or when they are denied hospice care in skilled nursing homes and assisted living facilities, stated Lomeo.

The nonprofit organization has cared for 27,000 terminally ill patients since 1988 and operates the only hospice residence within its service region.

Photo courtesy of Niagara Hospice

Demand for hospice services is rising in the organization’s Niagara County service area as demographic tailwinds fuel the need for hospice. Seniors aged 65 and older make up 19.5% of the Niagara County population, according to the U.S. Census Bureau. Hospice utilization reached a rate of 30% among Medicare decedents during 2018 in New York state, according to the National Hospice & Palliative Care Organization. The Census Bureau expected this aging demographic to increase by 25% between 2015 and 2040, according to projections from Cornell University.

Niagara had an average daily census of 180 patients as of June 2020, according to local news coverage, which reported that the hospice would see an increase in its patient load by up to 1,500 in the first year of opening the facility’s expansion and 1,800 by the third year.

The anticipated increase in patient admissions is due to several factors, according to Lomeo. In New York State, inpatient hospice beds are not “swingable” to residential. Niagara’s services have been in high demand, in part because their facility is the only one in their region to have four negative pressure rooms, which allows them to admit infectious patients. The organization has five physicians and two nurse practitioners on staff, allowing them to serve as the patients’ primary clinicians.

“Our community physicians have indicated to us that when a patient needs hospice, they would rather transfer care to us,” Lomeo said. “This sentiment has escalated since [primary care providers] in the community are reluctant to write orders for opiates. Lastly, we have proven to the acute care community that a referral and admission to Niagara Hospice is the best option for the patient and will result in no 30 day readmissions.”

The hospice provider began a dementia program in 2019 to help them reach those patients earlier in their illness trajectory. They expect the program to generate cost savings through reduced hospitalizations and emergency department visits, as well as increased patient volume as rates of dementia continue to rise.