Calvary Hospital’s newly appointed president Michael Fosina is embarking on a deeper journey to improve quality and access to hospice care amid rising demand. Research and workforce growth will play large roles in the future of palliative and end-of-life care delivery, according to Fosina.

New York City-based Calvary is the only hospital in the United States that’s specifically dedicated to providing hospice and palliative care. The hospital system has provided palliative and hospice care across the New York City area for about 125 years and was founded by the faith-based organization Women of Calvary.

Fosina recently ascended to the hospitals’ helm after serving as COO of Calvary since March 2024, overseeing its integrated services with parent organization ArchCare, the health care ministry of the Archdiocese of New York.

The hospital’s unique focus on end-of-life and serious illness care has made it well-poised for expansion into other health care settings – including the home, Fosina told Hospice News in a recent interview. Developing strong staffing resources and education initiatives are two core parts of Calvary’s strategic growth plans in the hospice and palliative care arenas, he said.

Photo courtesy of Calvary Hospital

Can you share what drew you to initially join Calvary Hospital’s leadership team, as well as some of your past experiences in the health care realm?

I have had a long term in health care. I’ve been running hospitals for 25 years or so, and I’ve been on the acute care side of health care and in medical centers. We always deal with end-of-life in health care. But for the academic centers and the community hospitals, we have a different role in the continuum of care.

Everybody in the New York metropolitan area knows about Calvary. Quite frankly, I know health care leaders all over the country who are aware of the Calvary brand and its mission. Coming to Calvary was an honor for me, because it’s an organization with a distinguished history and reputation in what it does.

It wasn’t until I got here that I truly understood how special it is. We do a very unique part of the continuum of care — the end-of-life component of it. We are built and designed to manage that end-of-life stage and to make it as pain-free and as comfortable as possible for not only the patients, but also their families. The end of life is a very, very emotional time for people, so you have to handle the quality of care of the patients, you have to engage the family members.

The support that Calvary has with the staff onsite — whether it’s the nurses or the clinicians, the social workers, the chaplains — everybody is sensitive to what patients and families are going through. They do their best to make sure that they’re providing the care that’s best for the patients and the emotional support for the family. That is what built Calvary over the last 125 years, and that is what’s going to help us continue to thrive over the next 125 years. 

What are some of your main priorities and top-of-mind challenges to address as the new president of Calvary Hospital?

Some of the top concerns and some of the things that we are doing right now is coming out of the COVID-19 pandemic. Like every hospital in the country, Calvary was dealing with challenges: financial challenges, workforce challenges and the number of people that have retired in health care were all things that COVID impacted dramatically. We are rebuilding that workforce, and we are rebuilding the finances of the hospital through a variety of different mechanisms. But the first thing you have to do is get the staff in place to be able to do anything.

The workforce is one of the biggest things that we are rebuilding. It’s a special type of person that we’re looking for to work here. We want someone who’s committed and aligned with the mission of end-of-life care, and not everybody is. Some people struggle with that. Some people come because Calvary has such a strong reputation and a strong brand that they want to work here. But at the end of the day, they may realize this is not for me because this is hard emotionally.

The dedication that our staff shows every day is nothing short of remarkable. You see it in how they manage your patient. It’s all the little things that they do that you can’t teach, that they just innately know what to do and how to make a patient and or a family member get comfortable during a very emotional time.

As we’re in the process of getting that workforce in place, the demand for our services is high. So it’s looking at expansion, putting more patient beds in different locations, because we’ve got to bring the care to where the patient and family are. We don’t want families to have to travel an hour or two every day to visit their loved one in a hospital. We’re going to expand our services into different locations.

In addition, we are working with the academic centers to really reinvigorate the research and education component to end-of-life care. Our goal is to be the premier end-of-life research and education facility in the country.

Calvary is the only hospital in the United States that’s specifically dedicated to providing hospice and palliative care. What drove this focus, and how have your services evolved over time 125 year history?

How did we get to be one of the only, if not the only, hospital in the country dedicated to the end of life? It’s the forethought and vision of the previous leaders handed down to where we are.

The Women of Calvary started the program 125 years ago. They saw a need for patients dying of cancer with nowhere to go, and they started to create a program in a house. Then they built it into a hospital and built it into a facility, and it was just dedicated to providing care at the end of life by preserving dignity, providing comfort and preparing emotionally and spiritually for death.

We started off with an eight-bed facility in 1899 that grew over the next 20 years or so. In the early 1900s we opened up a 100-bed facility, but it wasn’t a hospital. It was a home for men and women who were dying of cancer, and they were cared for by that time by a religious order who had taken over the administration of the facility. In the mid 1960s Calvary’s care really became medicalized when a team of doctors joined the institution and worked to convert Calvary from home-based services to a hospital.

We became an accredited hospital in 1965 and changed our name from the House of Calvary to Calvary Hospital in 1969. In 1978, we moved into a 200-bed hospital in the Bronx, where our main campus is currently located. During this time, we transitioned to a hospital that was specifically designed to be an acute palliative and end-of-life care facility. Since then, we have been perfecting that model of end-of-life care.

During the 1960s we transitioned from The American House of Calvary, the care for people who were dying, to a hospital that was specifically set out to be an acute palliative and end-of-life care facility. We’ve kind of been perfecting that model of end-of-life care.

What are some of Calvary Hospital’s future goals in hospice and palliative care? Can you share any details about some of the new initiatives, projects or programs on the horizon?

We can only expand into areas in which we are licensed, which is in four of the five boroughs of New York City We are licensed in Nassau, Westchester and Rockland counties, which are north of New York City. Those seven geographies are where we’re going to expand into while the state figures out its next steps. We have low use of hospice in New York. We’ve put together a committee on the future of health care in New York, which is looking to advise our governor on the next steps for health care, and lower hospice utilization is a component of that.

One of our biggest facilities is in the Bronx. We have a small number of beds in Manhattan and also in Brooklyn. The demand for care in Brooklyn and Manhattan is so strong that we have to continue adding beds into those boroughs. Part of the expansion as part of Arch Care, one of the largest nonprofit health systems in New York, is that we have nursing home programs, a [Program of All-Inclusive Care for the Elderly (PACE)] program, a [Guiding an Improved Dementia Experience (GUIDE)] program, a home health agency and an end-of-life hospital. Nobody else has all of those components. We have the full continuum of post-acute care, and we can put all those different components together in our service areas.

In addition, it’s working with different communities and all the academic health care systems, community physicians that ties this together. The academic systems are incredibly good at what they do in healing people. But that’s not what we’re built to do. Our mission is to help a patient live a dignified end-of-life experience, to be comfortable and prepare their families emotionally. Our unique subset is not to compete but to partner with all the health care systems in the New York metropolitan area. They’re helping us and we help the patients.

We’re the only hospital that has acute end-of-life beds, which makes us different. So when a patient is on our hospice program and needs to be admitted to the hospital, they are directly admitted to Calvary. It’s not like that in other organizations. They have to admit them, and that patient goes into the emergency room, which is never ideal for any patient at the end of life. Our value is having both components of hospital and hospice at home, and that’s what makes us unique.

Can you expound upon Calvary Hospital’s strategic approach to growth in hospice? What does your growth strategy look like on the palliative care side?

One of the things that Calvary has been historically known for is research of palliative and end-of-life care. Over the last 10 years or so with some of the financial situations in New York’s economy and then with COVID, that focus split a little bit.

Our academic partners are interested in working with us to reinvigorate that. We have a significant amount of grants that we’ve just received to help expand and reinvigorate research and education components of end-of-life care. We’re excited about that opportunity, and we’re in the process of recruiting more physicians to be academic-based clinicians helping to continue to lead end-of-life research.

Can you expound upon Calvary Hospital’s strategic approach to growth in hospice? What does your growth strategy look like on the palliative care side?

The strategy is three-fold:

1. Enhance our relationships with partners such as nursing homes and other community-based health providers to raise awareness of quality in palliative care and hospice. Working with (not competing with) other organizations enables us to provide better services to patients, increasing the quality of care that their patient receives. A Calvary Hospice nurse practitioner, for example, could provide dedicated service to a nursing home. This is one way of scaling care [and] addressing the needs of more patients in one place.
2. Skilled professionals are scarce. We are aggressively building the palliative and end-of-life capacity of health care professionals in all fields. This includes educating nurses with a palliative care residency program. More staff with these skills can service more people; the demand for care is there.
3. Building community awareness of hospice through education and outreach programs.

What do you foresee as the largest obstacles facing hospice and palliative care providers today? How is Calvary Hospital navigating these challenges?

Access to care is a challenge, especially as care managed by insurance programs, such as [Medicare] Advantage plans, tend to limit timely access to hospice. Our experience is that patients need to access hospice far earlier in the trajectory of their illness. They’re missing out on all the benefits quality palliative and hospice care can deliver to patients and families.

Finances and reimbursement rates are always obstacles. Payers such as Medicaid, Medicare (in all forms) and insurance companies need to be more timely and responsive to the real needs and cost of care provided by nonprofit organizations like Calvary, which provide a depth and breadth of quality services that other businesses may not.

Calvary will continue to advocate for access to quality nonprofit palliative and end-of-life care. We will continue to educate our stakeholders, clinical partners, community associates and others. Challenges such as increased demand, workforce shortages, financial pressures and more complex patient needs are shared by the entire health care sector.

Better clinical integration, smarter economic modeling, expanded education and more innovative models of care focused on home-based care — all of these will help Calvary navigate as the aging population grows and lives longer with chronic illness.