CLEVELAND _ It is 7:30 on a summer morning in a chapel-like room overlooking the slate-gray, lapping waters of Lake Erie. Ten or so people, some just arriving at work, some finishing a night shift, sit silently in pewlike benches and armchairs below stained-glass windows. A plump Golden Retriever named Linus, a hospice therapy dog, wanders from one person to another, gratefully accepting their caresses.
Dr. Kevin Dieter, a hospice care physician with graying mustache and goatee, gently suggests they get started. A hospice nurse sitting in a bench opposite him begins reading names. In the pause after she pronounces each, Dieter strikes together two palm-sized Buddhist meditation chimes, producing a tinkling peal that quickly evaporates. The names go on and on. Evonne and Molly and Andre and Jerry. Twelve in all.
Twelve patients who were alive in this hospice house three days ago when this ceremony was last held. Twelve who have died since, each in one of the bedrooms lining the quiet hallways, each having hoped for a death free of pain or distress and, for the lucky ones, bitterness or resentment.
Providing the possibility of that wished-for death is the professional mission of all in this room, of all the 935 employees and 3,000 volunteers who work for the 40-year-old nonprofit Hospice of the Western Reserve. Each day they serve 1,200 hospice patients, most of them in hospitals, nursing homes, or their homes, and as many as 88 in one of three inpatient hospice houses in the Cleveland area, like this one off Lakeshore Boulevard.
By Medicare's criteria, to receive hospice services, each of those patients is deemed to have six months or less to live. In most cases, they also must agree to forgo curative treatments.
All the employees will say they've gotten used to hearing The Questions, from family and friends, even from the loved ones of patients they care for. "We get asked that all the time," said Tammy Wright, 43, a nurse's assistant with hospice certification, now in her ninth year doing hospice work. "Why did you ever choose to work there? Why would anyone elect to spend their workdays so entwined with death and grief? And how can you possibly get up the next morning to do it all over again?"
It is hard to think of another profession with such constant exposure to dying. Yet, as intense and exhausting as hospice care is, you seldom hear any of the doctors, nurses, aides, social workers and bereavement counselors at the Hospice of the Western Reserve describe the job as grim, sad or dispiriting. Instead, they tend to portray the work as deeply fulfilling, gratifying and, perhaps most counterintuitively, life-affirming. And in working in the presence of imminent death, they all say they have witnessed sights that defy expectation or explanation.
"We see God working here all the time," said Dee Metzger, 68, a hospice nurse in the Medina Inpatient Hospice Care Center southwest of Cleveland. "All the time."
The turnover rate among employees at Western Reserve is a surprisingly low 12 percent, according to Judy Bartel, Western Reserve's chief clinical officer. (Nationally the turnover rate for hospice registered nurses is almost 19 percent.) To retain its employees, the hospice offers them many outlets to combat burnout and "compassion fatigue."
As more Americans opt for hospice care, keeping hospice workers dedicated, replenished and content is a growing concern. The number of hospice patients grew 167 percent between 2000 and 2016, to more than 1.4 million, according to a March 2018 report from the Medicare Payment Advisory Commission, which provides Congress with analyses regarding Medicare. Nearly half of Medicare beneficiaries who died in 2015 had received hospice services.
At Western Reserve, those who quit the job are the ones who can't leave the work behind when they head home.
"It's sacred work," says Lisa Scotese Gallagher, one of whose jobs at Western Reserve is to provide programming to help the staff deal with the stress and emotional intensity of their jobs. "But the expectation that we can be immersed in suffering and loss and not be touched by it is unrealistic."
