October 14, 2022
Sojourn Center Update: Taking a Temporary Pause
Dear Friends of Sojourn Center,
The board of Sojourn Center has made the decision to temporarily pause our community effort to fundraise and to build an inpatient hospice center, commonly called a hospice house, in the New River Valley. We plan to redirect our efforts, and we want to share the reasoning behind this decision and let you know our plans for the future. To be clear, we are not giving up.
Sojourn Center hired an experienced hospice consulting firm this summer to answer two questions: the feasibility of Warm Hearth becoming a hospice agency and then the feasibility of Warm Hearth, www.retire.org, becoming the operator of Sojourn Center. Warm Hearth also hired a consultant to study these same questions. We were optimistic that the reports would reinforce our plan to establish a hospice house in the New River Valley. However, both studies concluded that this is not currently feasible. Recently, factors impacting the long-term financial viability of hospice houses (especially Medicare policies) have changed. It is the opinion of the consultants that the federal payment and regulatory climate make it difficult, if not impossible, to proceed with our plans at this time.
To be sure that the national data were accurate and relevant to our regional hospice house markets, we asked the consultant to gather statistics on the current hospice house utilizations and occupancies in rural and midsize markets in VA, WV, NC and northern SC. The secondary data confirmed that hospice house utilization has fallen in our region, and the consultant reported that “none of the hospice leaders that operated free standing hospice facilities with whom I spoke would recommend building a freestanding inpatient facility in the current conditions.”
One of the most challenging factors since the Sojourn Center mission began over a decade ago has been the relatively low usage of hospice services in southwest Virginia. Most hospice centers serve 300-900 patients a day in order to have sufficient patients needing specialized, non-hospital care that a hospice house provides. The combined average daily census in the NRV for the two largest non-profit hospice agencies serving the NRV is below 300 patients. Even established hospices are finding it challenging to maintain reasonable occupancy levels in their hospice houses in the current regulatory environment.
The Commonwealth of Virginia regulations require that a hospice house be clinically operated by a licensed hospice agency. Sojourn Center has negotiated for years with area non-profit hospice agencies and most recently, had very productive discussions with Warm Hearth to partner and have them become licensed as a hospice agency. Not only have the results of the feasibility studies made it unlikely for Warm Hearth to become a hospice agency at this time but, like other hospice organizations with whom we could partner for the running of such a facility, they are grappling with the fallout from COVID-19, including workforce shortages. The impact of COVID-19 has been large and far-reaching.
Since we live in an area of relatively low hospice use, the need to inform the public about the benefits of hospice care is critical, and this will be our immediate focus. The heart of our mission remains the same: helping terminally ill people and families throughout southwest Virginia access end-of-life care that provides comfort, support and dignity.
While the outcomes of the consultants’ reports are disappointing, we are committed to responsibly, sustainably and, ultimately, successfully fulfilling our mission. Pushing forward in this current environment, as much as we wish to do so, we believe would prove detrimental to long-term viability. We will continue our work developing community awareness around hospice, closely monitoring Medicare regulations and additional dynamic elements that will inform when our vision of building a hospice house can be responsibly realized.
Thank you for your continuing support of our mission.
Sojourn Center Board of Directors
Anne J. Campbell, President
Rhonda Rogers, Corresponding Secretary
Ed Spencer, Vice President
Bob Sterrett, Recording Secretary
Samara McMillion Abplanalp, Treasurer
How long will the “temporary pause” last for Sojourn Center?
There’s no clear estimate for when hospice services will increase enough in our region to support a hospice house, but perhaps more importantly, Medicare regulation changes are needed, too. These will only come with input from the public and medical providers who understand the importance of both palliative and hospice care. Sojourn Center’s board will closely monitor what regulations both in Virginia and the U.S. may promote our efforts. The Board estimates that it will be a pause of several years before we will see the necessary changes in the local hospice usage and federal regulations.
What specifically will the Sojourn Center board be doing now?
The board is in the process of defining the ways in which we can best improve the understanding of hospice services, end-of-life care, and advanced planning to increase the usage of these essential services in our region.
What if Sojourn Center received a big donation? Would that make a difference? How much money is actually needed?
If Sojourn Center were to receive a significant donation or legacy gifts, we would still need more people in our area to use hospice care and a better Medicare regulatory environment. Building a hospice facility is like building a small hospital rather than building a large house. In addition to building costs, an additional reserve is needed to cover the operational costs expected in the first years. Our plans have been for a 6 – 8 bed facility, with an 8-bed facility being more cost effective and efficient for staffing. The current estimate to build an 8-bed 15,000 square foot inpatient hospice facility (with building costs of $350/square foot with a 10% architectural service fee including furniture, fixtures and equipment) is $5,250,000.
Could Sojourn Center build a smaller hospice house?
The feasibility studies found that even if 100% of the combined hospice patients needing such specialized care from all seven hospice agencies in the New River Valley were admitted to a Sojourn Center hospice house, a maximum of four beds could be filled. This falls short of our plans for a 6-8 bed facility.
So, why not build a 4-bed facility? With the huge fixed cost of constructing a building, a smaller occupancy hospice house makes the cost prohibitive. Knowing that staffing is the chief expense of operating a hospice inpatient facility, it is important to note that the staffing costs are virtually the same for a 4-bed and a 7-bed facility.
Has Sojourn Center conducted a capital campaign?
No. While Sojourn Center has selected a capital campaign firm (Capital Development from Winston-Salem, NC) to assist us with fundraising at the appropriate time, to date we have not conducted a capital campaign. The board decided it is imperative to partner with a committed hospice agency to operate the hospice house before initiating the campaign.
Why didn’t the Sojourn Center conduct a feasibility study sooner?
We did. In fact, Sojourn Center conducted several studies, including both internal research and external consulting firm studies, regarding the feasibility of building a hospice house through our many years of work. Unfortunately, these most recent studies reached different conclusions as a result of changed circumstances
Can you tell me more about how the number of patients and type of hospice patients affects the finances of a hospice house’s clinical operator?
It is well known that hospice inpatient facilities, such as a hospice house, are mission oriented and not money-making ventures. The expectation, especially with smaller facilities, is that there will be an operational loss each year that will require ongoing annual fundraising to offset. The amount of loss is dependent on both the occupancy rates in the facility and the level of hospice care for those occupants. It is essential for a hospice house to care for very ill patients who require more hospice services because Medicare pays more per day for these patients versus those requiring less hospice care.
It is notable that the number of national Medicare hospice days for General Inpatient Care has dropped from 1.6% in 2015 to 1.2% in 2018 to 1% in 2020
What will Sojourn Center do with the money it has raised?
The money that has already been donated to Sojourn Center will continue to support the goal of hospice education and utilization in the New River Valley and will be managed by the board’s finance committee. Our treasurer will continue to pay for Sojourn Center’s associated land costs such as insurance, land water expenses and land maintenance. We will continue to file appropriate State Corporation Commission and IRS forms. Financial support may be needed to conduct public education to broaden hospice awareness and use in our community. Some funding will be needed to monitor relevant Medicare regulations.
What about the land that Sojourn Center has?
27 acres of land were donated to Sojourn Center in 2017 by Roger Woody of Christiansburg. The land is located at 3000 Farmview Drive in Blacksburg, VA between LewisGale Hospital-Montgomery and Warm Hearth Village. Sojourn Center will continue to maintain the land and pay the necessary expenses which it incurs.
Who did the two recent studies to which you refer?
- Schramm Consulting
Sue Lyn Schramm, MA
Schramm Consulting LLC
41308 Lavender Breeze Cir
Aldie, VA 20105
- Senior Options
3181 Shore Drive
Virginia Beach, VA 23451
What will happen with the $695,000 ARPA money granted to Sojourn Center by the town of Blacksburg when Sojourn Center takes a temporary pause?
The American Rescue Plan Act grants are federal monies with strict qualification guidelines prescribed by both the federal and Town governments. Securing a committed clinical operator by a certain date was a requirement for Sojourn Center receiving the money. While the Town’s is not definite at this time, it is most likely that the funds will be re-allocated by the Town for other purposes.
How has Covid affected hospice care?
The statisticians and economists do not have a complete answer to this question yet. Due to the COVID pandemic, the number of Medicare patients who died in hospice fell in 2020 for the first time since the start of the hospice benefit in 1983 even though more patients received end-of-life care. Additionally, the location for hospice care shifted radically between 2019 and 2020 with more hospice care occurring in a person’s home versus a specialized hospice house. It is yet to be determined if this will be a short-term or long-term trend.
Can I still donate to Sojourn Center?
Yes. Those wishing to donate are invited to do so. Memorial, honorary, celebration, matching and other gifts remain tax deductible and help us improve the future of hospice care in the New River Valley. We still believe that everyone deserves exceptional end-of-life care in a facility that will honor, celebrate and lovingly support a person’s final passage – and we remain dedicated to that cause. You can donate through the www.sojourncenter.org website or by mailing checks to Sojourn Center, P.O. Box 295 Blacksburg, VA 24063.
I have further questions. How do I contact Sojourn Center?
Contact Sojourn Center at firstname.lastname@example.org.