Change is in the air for Davis, Calif.-based YoloCares, formerly Yolo Hospice, The nonprofit has completed a rebrand to reflect its growing scope of services while also launching a new adult day program.
The program is housed in a new adult day center, Galileo Place, following a $1.6 million renovation on Yolo’s existing campus.
Last Fall, Yolo also affiliated with the California Hospice Network, a collaborative of nonprofit hospices seeking to leverage their collective scale and resources in value-based payment programs and expand access to care.
Hospice News caught up with YoloCares CEO Craig Dresang to discuss the provider’s trajectory and his outlook for the hospice and palliative care space.
First, I wanted to ask about your rebrand. Can you tell me about the impetus for the change and the intended message for patients and families?
The rebrand has been really a long time coming for us. The first issue we’ve been mulling over for the past several years is that the word “hospice” is a barrier for people to access care. Our whole philosophy in our agency revolves around removing barriers to care. It’s also an important part of health care equity. We decided to take the “H-word” out of our name.
We were the first organization in Northern California to be accredited by The Joint Commission in the field of community-based palliative care, and our palliative care program grew pretty quickly. In fact, it surpassed the size of our hospice program for a while. Then we realized that the word “hospice” was not fully descriptive of what we do either.
Three years ago, we had another legacy nonprofit merge into our organization, called Citizens Who Care. Historically their mission is to support the frail elderly, and they did that through a number of programs.
One was a volunteer program, where volunteers would go into somebody’s home and provide respite. This was not respite in the medical sense. This is in the sense that there would be a professionally trained volunteer to go and be with your loved one if the caregiver needed to be away to go shopping or other things they had to do.
That was an additional program that folded into the organization, and they had a vision, as we have for many years, to create an adult day program. Coming together afforded us the opportunity to do that, because we had shared donor pools and really great synergy between our missions. By coming together, we were able to make a nonprofit adult day program a reality.
That was really the impetus for making that happen.
You just mentioned Citizens Who Care. Can you add some color about that organization and how the integration enhanced your business?
One of the reasons we were so interested in having that organization merge into us was because the work they do is so focused around the caregiver and caregiver support. We thought this was an opportunity to merge into our own palliative care program an organization that has a decades-old history of being professional supporters of caregivers in the home.
It really makes our program more robust than any palliative care program out there. I have not yet seen an organization that is as committed to caregiver support and making it part of the palliative approach.
What led you to prioritize caregiver support in this way?
I’ve been a caregiver in my life. The story of how I became interested in hospice goes back 25 years, when I was the caregiver for both my mom and my first partner who were both dying of terminal cancer. Living through that experience, both with and without hospice — and knowing the toll that it took on me — it’s challenging.
There’s a lot of research that’s been done that shows the death and the suicide rate of caregivers go up after they lose their loved one, especially if they’ve been ill for a period of time.
Our support of caregivers is just so congruent with the philosophy of hospice, because the care is for the patient and the family. That’s the whole unit. We need to support the family and friends in that work if we’re going to be successful. So it was a natural fit for us to think about Citizens Who Care becoming part of what we do.
YoloCares recently opened the adult day facility Galileo Place. Can you provide some details on the center and the work you’re doing there?
It’s a new business line on our current campus in Davis [Calif.]. We spent about $1.6 million renovating the north end of our building and converting a back parking lot that adjoins the building into a therapy garden.
For the adult day program, we have not been able to open because of COVID and trying to keep our community safe. But we are having a soft opening at the end of this month, and there is light at the end of the tunnel. We’re hoping to be fully operational by the summer.
It’s a 10,000-square-foot facility unlike any other day program in our market. Attention has been given to every detail from the furnishings and the artwork on the walls, to the floor plan to the amount of light that’s coming into the facility.
The floor plan even creates a sense of journey for the participants so that folks with maybe a little more advanced dementia can have a sense of exploration as they’re walking around the facility and moving from the indoors to the outdoors and back inside.
Can you say more about some of the community needs that the center is there to address?
We have an advisory board of community professionals and leaders who worked on envisioning what an adult day program should look like here. That committee met regularly for two years to really create the vision for this facility.
One of the programs that’s going to make this really unique is the commitment to caregivers. We have a teaching lab built into the facility that will be used for caregivers to come in and sign up for classes and learn how to change a bandage, how to maybe adjust the position or help a loved one out of their bed.
We’re going to run a regular slate of classes for community caregivers. They’ll be free of charge. We’ve actually gotten funding from a number of sources to pay for this. There’s a lot of support right now for caregiver programs, and it’s really helping us to kick the program off in a way we would not be able to otherwise.
Could you say more about how linking an adult day service with a hospice benefits your organization from a business perspective?
The decision to have an adult day program here was much more of a mission decision than it was a business decision. We had to make sure it makes sense from a financial perspective, so that we can afford to do it. We developed the structure to support financially.
For both our palliative care and our adult day programs, in addition to fee-for-service contracts, we also get support from the hospital systems for this work and the doctors in our communities often refer patients to these programs. They see the value in it, and the systems respond in kind with financial support.
That kind of flows right into my next question. You have invested a lot of effort in building out your palliative care program. Can you add some color around the kinds of payment arrangements that you’ve developed to support it?
We have contracts with payers like Partnership Health and Blue Shield. In addition to that Dignity Health and Sutter Health have both been backers of the palliative care program as well.
Our focus is quality. We believe that if quality comes first, your finances will take care of themselves. That is a fundamental principle that I think we lose sight of in health care, sometimes. That’s proven true here, and it’s been proven true in my 20 years of working in hospice and palliative care.
Whenever you lose sight of that mission and your commitment to quality, you’ll begin to struggle financially.
Everybody’s heard this phrase: No margin, no mission. I heard that a lot around the dinner table growing up. My favorite aunt was a Franciscan nun who was an administrator for a community hospital. This idea that we do have to operate with sharp business acumen was ingrained in me with my own family members, because I grew up in the industry.
If you have that commitment to the mission and you’re focused on quality, that financial piece will take care of itself. I see that play out over and over.
I’d like to get your take on the long-term outlook for palliative care. There’s been a lot of discussion and advocacy about creating a dedicated payment model within Medicare. How could a program like that change the game?
The reimbursements for hospice are just shy of $300 a day per patient. For hospice care that’s the average reimbursement in our market. That gets you a certified hospice nurse, a nursing aide who comes to your house as frequently as you need, a CNA, a social worker and a chaplain if you need one.
We pay for all of the medications related to your diagnosis, all the [durable medical equipment] all covered for about $300 a day. If you imagine that the hospice benefit somehow morphed into a palliative care benefit instead, the reimbursements could be similar or even less than what they are for for hospice services. Instead of looking at a six-month prognosis you might have an 18-month prognosis.
You would see nationally the quality of care, patient satisfaction, people’s sense of well being all going up, and it will save our health care system billions of dollars. But there has to be the will on a national level to do that.
Aside from the possibility of such a benefit, what else do you see on the horizon in the palliative care space?
I think more insurance payers are looking seriously at palliative care from their perspective, because of the cost savings.
It’s much better to care for somebody in the place where they want to receive that care, and to build trusting relationships with their care provider. When we can spend time with patients we can have more of a surround strategy in how we approach their care, looking at mind, body and spirit.
I think the case for palliative care to become much more mainstream and integrated into the national health care system is definitely there. I think it’s just going to take time.
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