VITAS Innovative Hospice Care: Tim O’Toole, CEO

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Quality, compassionate care at the end of life is the mission at VITAS Innovative Hospice Care®.  Although a relatively new concept in the US, hospice has taken the direct route to mainstream medicine. Among the now 4,850 hospice organizations, VITAS has been a pioneer, leading the way for 30 years.

The growth of hospice care organizations in the United States represents a growing change in attitudes about death and dying. Hospice is not a place a person goes to die, but rather a concept of providing care wherever the patient resides, be it at home, in an assisted living community, or skilled nursing or long term care facility.  The goal is to do everything possible to the make the journey to the end of life comfortable and dignified. Hospice care allows patients to celebrate this portion of one’s life and live it to the fullest extent possible.

This idea was in the heart of VITAS’ founders more than thirty years ago, and continues to drive the VITAS mission today.  The life work of a minister and a nurse, VITAS (from the Latin word for lives), was the result of their collaborative efforts to provide care for patients with life-limiting illness. Beginning with the care of one patient at a time in 1978, VITAS now cares for more than 12,000 patients each day.

With corporate headquarters in Miami, Florida, the organization operates 44 programs and 236 patient care teams in sixteen states. They have 29 inpatient hospice units and 9,600 employees. VITAS healthcare and bereavement professionals attend an average of 660 deaths per week.

“I think people are beginning to understand because they’ve had personal experiences with the death of loved ones—family and friends—and seen that hospice is a solution to what is, in many cases, a crisis environment near the end of life,” says VITAS Chief Executive Officer Tim O’Toole.. “Individuals have been battling what is, in many cases, a very difficult disease, and are to the point where curative treatments are no longer appropriate for them. Based on the decisions of that individual, with advice and consultation from experts such as physicians and counselors working within hospice, we provide a great service, supporting choices regarding the end of life.”

A Leader in End-of-Life Care

VITAS is among the largest hospice provider in the United States. The company’s founders were instrumental in urging the U.S. Congress to establish the Medicare Hospice Benefit which went into effect in 1982.  Now, virtually every major health insurance plan in the nation covers hospice care. Regardless of insurance coverage or ability to pay, however, VITAS provides hospice services to all patients who meet end-of-life criteria.

The hospice field has grown, but is still relatively small in proportion to the overall amount of money being spent on healthcare nationwide.

“Hospice has very much become part of mainstream medicine,” says VITAS President and Chief Financial Officer David Wester
. “It’s being practiced in many of medical teaching facilities and it’s more prevalent in the literature. People need to know they have the right to make this choice. It might not be the choice  everyone makes, but it’s important that people know they can have these services.”

As public investors have watched hospice grow, there’s been a big influx of capital. About 70% of hospices remain not-for-profits, with 30% having moved to for profit operations. VITAS began as an all-volunteer, not-for profit organization. The company was acquired in 2004 by the Cincinnati-based Chemed Corporation, which had been an active partner in the company since 1991.

“Being part of a large, public company with enormous resources—a lot of expertise in healthcare at the board level, all the capital necessary to support the highest quality of service, and the funds necessary to upgrade internal systems—it is beneficial to have the resources of a large corporation,” says O’Toole.

VITAS maintains positions on various boards and member organizations across a range of related entities “Everybody looks to the leader for certain things,” says Peggy Pettit, Executive Vice President and Chief Operating Officer. “Whether they need influence, council or recommendations, we are key in pretty much all areas of the business. We are involved not only with vendors, but with the trade organizations and the legislative processes, as well.”

Innovation for Assuring High Quality of Life

When a person with terminal illness is reaching the final stages of life, the traditional curative approach to care might simply no longer be effective. “It’s important that patients have a choice at end of life, so that they can choose to meet death with dignity,” says Wester.

There is a broad spectrum of issues to consider. Many people decide that quality of life and the opportunity to be cared for by people who make them comfortable, in most cases, in their own homes, is the best choice. A key issue for the majority of patients is the ability to remain pain free. “We are world-class experts in pain management and, generally speaking, all patients can be managed in a manner where they can remain comfortable and pain free,” says O’Toole.

The needs of the family are also critical aspects of hospice. VITAS provides a multitude of services, including those geared toward meeting the needs of family members who are coping with the loss of a loved one. Appropriate caregiver visits are important to ease the added stress a family feels when caring for a loved one in the home. Hospice is also involves in the psychosocial aspect of an individual’s care. Grief counseling, family relationships and education dealing with end of life situations are part of hospice’s holistic approach to care.

One thing VITAS has done that helps differentiate them from other hospice providers is to create a company within their company for providing home health medical equipment to their patients. They’ve taken the time to source and evaluate the items that would be most beneficial to patients living their final days at home. Whether a patient needs a specialized hospital bed, a wheelchair, a walker, or oxygen equipment, VITAS HME Solutions provides the item, the delivery and the setup.

When a patient does pass away, the company works to efficiently remove such items from the home with as little distraction to family members as possible. Hospice services continue until the needs of the family are met. VITAS bereavement experts continue to be available to loved ones after the death, offering support groups and counseling to help them move into the next stages of their own lives. This is a unique, holistic approach to medicine that extends beyond the patient in question.

VITAS also actively pursues and implements innovative therapy programs that, not so long ago, were unheard of in medicine. Paw Pals®, a pet therapy program, has proven to be extremely beneficial for many patients. “We have volunteers who actually bring pets into a facility to interact with our patients and their families,” says Wester. “For many people this is a strong and powerful connection to make.”

One television advertisement for VITAS shows a woman talking about her mother, who suffers from Alzheimer’s disease. A visit from a Paw Pals® therapy dog brought out stories of her mother’s experiences and memories from her childhood. “VITAS gave me a little more time with the mother I once knew,” the woman says. Though a dramatization, the story illustrates the difference in focus for end-of-life care. It’s no longer about repairing the body, it’s about giving people that little extra something that helps bring a smile to their face and gives them the ability to enjoy each day that is left to the greatest extent possible.

“We also offer music therapy to our patients,” says Wester. “Our music experts come in and sit with a patient and work through different aspects of music, whether they play it or whether they just listen. It’s very interesting stuff. I think the competition [in hospice care] has helped force us to keep reinventing ourselves to make sure that our services get better.”

The Work Place of Choice

“We’ve essentially positioned ourselves as an employer of choice in a deliberate way over the last five years. We’ve really tried to pay attention, so that we are able to recruit the best, but also retain them. We want to be able to grow the company because of the expertise and skill sets of our employees,” says Wester

VITAS provides a strong array of competitive benefits. The company also provides training and internal continuing education support. Eight of 10 employees are clinicians of some kind and VITAS maintains a strong emphasis on the advancement of knowledge and skills.

“In the last year, we’ve seen a better pool of available talent in all areas. We’ve also seen a reduction in our internal turnover. This is a great positive for our company. It’s a wonderful thing when our caregivers are assigned to a patient and return to that patient while they are with us. Longevity of the caregiver improves the quality of care and service to the patient, which is great,” says O’Toole.

“We are big enough we can provide mobility for our employees as well,” says Wester. “There are a lot of two income families these days, and if employees are forced to move because of an opportunity or job change for a spouse, we can often accommodate relocation, because we have programs in 15 states and the District of Columbia. In many cases, our employees can transfer and maintain their employment status and benefits seamlessly.”

“Obviously, hiring to replace workers is a high cost area, especially because of the high level of training and orientation that we provide. We believe that the key issues are to provide fair compensation, a good level of benefits and an environment that recognizes and rewards employees for their success,” says O’Toole. “We also like to see internal advancements from scholarships that we provide. We like to see someone become a nurse who was not, to see someone progress to the next higher level of caregiver. That benefits the organization and builds a culture and retains good people and, at the end of the day, helps us provide the highest level of service that we can.”

Death and the Future of Healthcare

Overall, it makes sense on both a personal and a financial level to have people electing to spend their last days at home versus an institution. Keeping patients comfortable in their own homes for fewer dollars—once the option of curing a terminal disease has run its course, hospice should be a choice the patient and family can make.

“We, as a company, are on a mission to serve these individuals at this period of critical need,” says O’Toole. “Most of our patients are only with us a couple of weeks, but we believe that in that period of time, we make a positive impact on lives. We believe that every day has value for all of our patients and that’s our goal—to provide great care and quality service to our patients and their families at every contact we have with them.”

by Tracy Million Simmons

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{ 1 comment… read it below or add one }

Heather Carrington September 24, 2012 at 1:23 pm

Dear Mr. Toole, CEO

I received a letter and form sign by you requesting a complete the “Evaludation of Hospice Care”. I evidently wanted to say more than I thought and now the form is illegble. I could not located a telephone number to request another form, so I am emailing my request. If it helps any, Vitas Innovative Hospice Care, PO Box 8239, Louisville, Ky, 40257, is listed on the letterhead dated August 15, 2012. To the right of the form these are some letters and numbers: HOS-FEHC-VITAS-1a. I would appreciate another hard copy of the form mailed to me at: Heather Carrington, 4784 San Carlo Court, Naples, Fl, 34109. I will complete the form and return it by mail. Thank you for your assistance.
Heather Carrington


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