Colorado-based Emmaus Catholic Hospice has seen both staffing and census volumes swell since launching nearly a year ago. This growth has come with recruitment and reimbursement challenges alongside significant opportunities to expand patient reach.

The organization began as a home health agency and added a hospice segment in 2022, according to Vicki Owens, CEO of Emmaus Catholic Hospice, DBA under the nonprofit Dominican Home Health Agency. The home health organization has provided care in Denver, Colorado, since 1923.

Becoming Medicare-certified in April 2023, the hospice served its first patient last June. Starting out as a global pandemic ended was a difficult feat, said CFO Carlos Quintanilla. But the hospice was driven by an aim to improve spiritual support for terminally-ill patients and their families, Quintanilla added.

Hospice News recently sat down with Owens and Quintanilla to discuss ways that new hospices can navigate the biggest hurdles around recruitment, retention and forthcoming payment evolutions.

Emmaus Catholic Hospice established services within the last year. Can you share some of your history and what led your organization to launch a hospice program?

Owens: The inception of pivoting from home health to hospice was in 2022. That was a really foundational year for us.

We changed our name and pivoted to provide home hospice care. Up to that point, the history of the Dominican Sisters was providing home health and spiritual care to the sickest, poorest individuals. They came to Denver from upstate New York in 1923. So, we really want to ensure we’re carrying that legacy forward in meeting people where they’re at and also sharing our faith.

We got our license in April 2023 and accepted our first patients on June 7, 2023. That was a process and a big learning experience for us all.

What really led to the launch was seeing so much suffering because of the COVID pandemic and seeing many beautiful, heroic moments in health care. Our board at the time really felt that God was calling them to pivot to home hospice and care for people through that lens. Relinquishing the home health license for hospice was a little scary to do something different.

It was heartbreaking to see family and friends dying without any spiritual support — whatever their faith background was. People were dying alone during such a sacred time in life. The spiritual piece for us is really important. Predominantly we have patients who are Catholic, but we care for patients of all faiths and all backgrounds and honor the faith that they bring with them.

What is the scope of the hospice services you provide? How has your organization grown since its inception?

Owens: We are a home hospice provider and take care of patients wherever they call home, whether it’s with family or in their own home or at a skilled nursing, memory care or assisted living facility. We have patients at roughly 15 different facilities in Denver and provide the full gamut of hospice care to people in their homes.

I was employee number five when I started at Emmaus Catholic Hospice. We’re now up to 24 or 25 employees over the course of the last year and half. We have a social worker, medical director, chaplain services, nursing care and nursing assistants, and bereavement and volunteer coordinators. Our volunteer program is particularly robust.

We just admitted our 50th patient. We have defined two different concentric circles for our patient service area. The first being 10 miles from our [Denver] office and the next being about 20 miles. We had a lot of requests to grow northwest to Boulder, Lafayette, Louisville and Westminster, Colorado. We really feel strongly that we are covering a lot of geography on the Front Range of Denver, and we would hate to start taking patients up before we have the staff.

Quintanilla: Education is another big part of our process as we’re building up the genesis into hospice. There’s a lot of resources out there to do things right.

Quality of care is a big emphasis on what we do and is part of our legacy, so that drives every decision we make as we grow. We have had options to grow faster than our current rate, but we’re very intentional to maintain that quality of care and grow more at a pace that allows us to bring the right people on board.

What are some of the largest challenges you see on the horizon?

Owens: The pandemic is over, but COVID is still thriving in many communities. My concern is still around the ability to recruit health care workers with the environment of nursing and doctor turnover and burnout. Clinicians are the hardest role for us to fill, and so are social workers.

My biggest fear is recruiting and ensuring that we have the right people joining our team who are committed to hospice care. We’ve partnered with a recruiting firm and prayed a lot. We are too small to suffer through high turnover.

Quintanilla: The public education piece is also a big challenge. People are very vulnerable at this time of life and looking for information as to how to form a decision. There’s a misconception on what hospice is.

In our community, we’re looking at growth in the Hispanic population, because hospice and talking about death is taboo in the community. The question is how we go about sharing what hospice is and does for the family. It’s bridging that gap in education at a time that is difficult. That’s probably one or our biggest hurdles.

What are some of Emmaus Catholic Hospice’s goals for end-of-life care delivery?

Owens: It’s keeping up and planning for the expansion of our patient census. We are small, but getting ready to grow pretty rapidly in the last few months. We’re preparing for what our census will be in the next three to six months from now, which is important from the patient perspective.

We haven’t saturated the community we’re in yet, there’s still a lot of people in need. So there’s a balance between the desire to serve when we get a referral and understanding the burnout if there’s a lot of windshield time for staff.

We are really focusing on that strategy for our growth. The biggest question we get asked is whether we admit patients on the weekends. So that’s what our strategy looks like, just seeing what resources we need to have in place for on-call and admission nurses.

We don’t have a brick and mortar building right now, but it’s a dream to have someday.

Quintanilla: Our initial development was in a metro area, but there’s a need that’s much larger than that. It’s making sure that we’re stable as an organization and can get out to those areas. We want to make sure that when we grow, it’s in a way that we can be methodical about and maintain the culture and quality approach of the organization.

What’s really important for us, for our culture, is how we come to meet and support our employees and develop their professional qualities. As we develop teams further away from headquarters, maintaining that quality as you put those systems in place becomes a new challenge. We want to make sure that the process is sustainable as our growth continues and we see opportunities throughout other communities.

What do you foresee as the biggest evolutions in hospice in coming years? How can providers prepare now to navigate these?

Owens: Being newer to the space, what we have seen is that there are many layers in hospice. One thing I didn’t anticipate was the proliferation of hospices. Denver doesn’t see the same rapid movement as some other states, but that challenges what it takes to become a recognized name. It’s a lot of meetings and miles on the car that you think might not bear fruit. We have the beauty of being able to communicate with parishes all over Denver, but we don’t take that for granted. It’s just harder, and probably an opportunity we have to really think about how to bring the conversation of hospice up a little sooner.

I also want to emphasize the regulatory changes with Medicare, Medicaid and Medicare Advantage that are going to be coming up toward the end of the year. Especially with the [value-based insurance design (VBID) demonstration ending. We’re learning along with everyone else about the impact.

Quintanilla: It’s a very challenging environment to start a hospice from scratch. We don’t have the advantage of a private equity group that gives tons of money to set things up. It’s really going through a learning process, especially in the regulatory environment and trying to do things right. It’s been very challenging for us to grow. But the type of service that we provide, the relief that we provide families and seeing those types of reconciliations makes it all worth it.