Home Care Entrepreneur Builds Serenity First Hospice, Seeks to Educate Patients on End-of-Life Options

Debbie Johnston is a registered nurse who founded Virginia-based Serenity First Hospice in 2021, inspired by the care her father received as he reached the end of his life.

With the launch of Serenity First, Johnston transitioned from her career in home health and personal care. In those fields, she previously had founded the company Care Advantage, which telecommunications firm Bell South acquired in 2017. Today, Bell South is a subsidiary of AT&T (NYSE: T).

In addition, she has since established the care navigation service Ask Nurse Debbie, as well as Connecting Hearts, a nonprofit organization for adoption awareness. Johnston is the author of two books, including The Hospice Handbook, which published in June by Advantage Media Group.


Hospice News spoke with Johnston about her drive to establish a hospice startup and the organization’s multi-faceted approach to care, as well as the importance of education in helping patients recieve person- and family-centered care at the end of life.

What led you towards the decision of opening Serenity First Hospice in 2021?

My father was in hospice, and I used to own a large home health company. I had thought I knew what hospice was, because we referred many people to it. But it’s one of those things that you often don’t know until you see it.


When I started seeing the things they did for my dad, it made me want to do one. It was a very intense regulatory process. There are many hurdles, and nobody’s really in a hurry to get you started.

Can you give me a sense of Serenity’s growth since those early days in 2021 versus your current scale?

We’ve had very rapid growth, faster than I would have imagined. It’s definitely been a learning curve the whole way. It was something I’d never done before.

We’ve been very fortunate and blessed to get both patients and staff because staffing is an issue for everybody these days. But we’re one of the only local owned companies in our city, and I think people like to use locally owned businesses. We had a pretty good following from my last company. So I think that’s part of our success.

Are you able to share your current average daily census and how that compares to the number of patients you had in that first few months of 2021?

Our average census right now is running in the 50s. We started with zero, of course. Hospice is different in the beginning. They make you take a certain amount of patients free in the beginning. They want to know what you want, and then you get paid. So it’s capital intensive. 

You got to have staying power, because you’re paying to take care of patients and you’re not being paid. It’s the only service in the home that I know of that does that.

How did you go about capitalizing the business? Did you have investors or was personally funded? 

I went to my bank and got a line of credit.

Serenity’s website describes the services as “innovative hospice care.” Can you add some color on the the innovations that Serenity has implemented?

I like to think that we go above and beyond what the requirements are. We offer our patients massage therapy, music therapy, pet therapy. I watched my dad get that, and he loved it.

We’re very user friendly to the patients and their families. We’ve started a grief group, because we want to be there after it’s over and because people really need that help and follow up. I feel like I need help, because I just lost my dad. And it’s really hard.

I am sorry for your loss and really feel for you and your family. Looking ahead to 2023, what are some of your priorities and concerns that are on your radar?

To manage the growth and have enough employees to do it well while we’re growing. It’s kind of been a particular kind of thing. We’ll get 10 referrals in a week, and we’ve got to make sure that we have enough help. So we’re constantly assessing how much help we need to come in. That’s a constant.

Can you tell me about your book, The Hospice Handbook? Who were the readers you hope to reach and what do you hope they’ll take away from it?

Making the decision to enter hospice is scary. It took me a while to do it with my dad, even though I had the ER doctor and his own personal doctor say it’s time for your dad to go to hospice. 

It was an inner fight with myself and my siblings, because you think  this is the end and all sorts of things that are really not correct. My dad actually graduated from his stay in the first hospice. Once he stopped having four doctor appointments a week and all kinds of stuff, he actually got better. 

That’s a message I try to give people. It’s not always that they’re going to die immediately. That’s not true. It’s a shame that so many people wait too long in the game to put somebody in hospice, because they lose out on a lot of good services. Our team works to prepare the patient and the family for the transition and everything that goes through the dying process. 

Regarding the problem of patients coming into hospice too late to really reap the benefits, what are some of the ways that you think that issue can be addressed?

We do everything we can to educate, and I thought my book would be for people that were like I used to be. Because you really don’t understand hospice until you go through it. So in my book, I’m trying to tell you exactly what it is, what’s offered and encourage people to go in that direction rather than wait. 

With my mom, I took a totally different approach. My mom was only in hospice for 24 hours. The medical system put her through a lot, and I promised myself I was not going to do that with my dad. 

There were unnecessary tasks, hospitalizations. She hated to be stuck with needles. She really went through a lot that could have been avoided. Her last days could have been a lot easier had we not been so headstrong to just keep going with treatment for her.

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