The nonprofit Partners in Care offers hospice and palliative care in Central Oregon. Its Transitions team recently received an award from Deschutes County for its work helping clients navigate resources for care. We learn more about the organization and how it aims to give Oregonians from all walks of life a chance to die with dignity. Joining us are Maureen Dooley, the marketing and communications manager, and Bethany Benefield, the Transitions Program Lead for Partners in Care.
Note: The following transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. The nonprofit Partners in Care offers hospice, palliative and home care over a huge swath of Central Oregon. It’s done so for 40 years. In 2004, it started a new program called Transitions to help people who otherwise might fall through the cracks of healthcare, a healthcare system that is full of cracks. Earlier this month, the Transitions team was honored for its work at a ceremony at the Deschutes County Health Services. Bethany Benefield leads the Transitions team, Maureen Dooley is a marketing and communications manager for the larger nonprofit, and they both join me now. It’s great to have you both on the show.
Maureen, can you give us a sense for the range of services that you provide at Partners in Care?
Maureen Dooley: Absolutely. And thanks again for having us on your show, Dave. As you said in the intro, Partners in Care is a nonprofit, and for over 40 years, we’ve been providing what we like to call post-acute care. You can think of that, you know, if someone is in the hospital, or they have a serious illness, or they’re diagnosed with cancer, we can provide the care here at Partners in Care to support them as they navigate that serious illness, as well as through end of life.
A lot of people think of Partners in Care, and they think that we are just a hospice care organization, but we are so much more than that. We really support people as they experience these changes in life and they are diagnosed with serious illness; where we can step in, and we can work with them, and we can work with their primary care or specialty physicians and we support them through that process, [by] navigating resources, getting that medical care with palliative care, with home health care, then with hospice care, and our inpatient hospice unit here in Bend as well. So, we provide a variety of services to the community, and we give back to the community. One of those programs that we do is our Transitions program.
Miller: Bethany Benefield, you run that. What is the Transitions program?
Bethany Benefield: Yeah. The Partners in Care Transitions program is a no-cost, non-medical program with five full-time coordinators. We’re helping medically fragile individuals – they tend to be medically fragile seniors. We help them navigate available resources in the Central Oregon community and what also is available in the state of Oregon. We can be involved with our clients years before an individual enrolls into hospice for end of life care, so we really get to establish relationships further upstream, and be a source of continuity for them, and help them navigate their options.
Miller: Can you give us a sense for the story of, maybe the average – maybe there’s no such thing as an average patient, but just a representative one – what your clients are dealing with, and how you approach their needs?
Benefield: Yeah. You’re right, there’s not an average. We have so many different individuals that I’ve been able to meet throughout my years as a Transitions coordinator. We have individuals who sometimes don’t have anyone else checking in on them. They aren’t able to figure out how to set up rides to get to medical appointments, or they don’t know that they can get Meals on Wheels delivered to their home. They don’t have anybody advocating for them or saying, ‘This is what’s available,’ or, ‘Let’s figure out if you can have financial assistance for XYZ.’
And then other times, we have individuals who have a wealth of support, from their family, from the community. They have the means to pay for additional caregiving support, but they really just want to have the connection to the Transitions coordinator as they become more medically fragile, as there are changes in their health - maybe they’re in and out of the hospital, and it’s just really overwhelming, and they want to have somebody within the healthcare system to help clarify who does what, who pays for what, what should I expect, when should we have hospice come in. I say, I like to try to take the guessing out of the game for all of the people that I’m meeting with.
Miller: Maureen Dooley, how big an area do you serve?
Dooley: Partners in Care covers about a 10,000-square-mile area. It’s pretty large, and if you think about Central Oregon, we cover Madras, Prineville, out through Sisters, down through Redmond, Bend, La Pine, Gilchrist, and way out to Christmas Valley in Fort Rock. So we have over 200 staff members across all of those service lines that are driving across the 10,000-square-mile area that we cover in Central Oregon every day. And we also have about 150 volunteers who also support our team all over Central Oregon, and our team, providing that medical care, providing that resource navigation as well, with the Transitions coordinators.
And so it’s a pretty big area. Central Oregon is obviously pretty rural in most of it. So we’re covering a large area, and we are working with people from all walks of life, people from all backgrounds, different housing situations. But it’s important for us to be there because a lot of times these people in these rural areas may not have someone to turn to. And so, for our Transitions team, they may be the only people that they’re interacting with, providing that really critical support during a difficult time.
Miller: Bethany, it almost sounds like what you’re responding to isn’t just a breakdown of a social safety net, but in some cases a breakdown of social connections. I mean, if you’re the only person that’s there to talk to people, to help them, that’s evidence that something in society has really failed.
Benefield: Did somebody tell you that was my passion, Dave? [laughs]
Miller: No. [laughing]. No, but I’m just imagining because we’re not just talking about diabetes medication, we’re talking about somebody who doesn’t have anybody in their world. Right?
Benefield: Right. This is my personal opinion, we live in an increasingly individualized society. And maybe that works for the majority of our lives, but there comes a point, there are certain things that you just can’t do alone. The mentality of, ‘it takes a village,’ it still takes a village at the end of life.
I don’t know that it’s the most glamorous thing in society to wonder, ‘Gee, who can seniors turn to? Who’s helping them figure out what might be the best fit for their needs?’ It’s not the campaigns that you see around, but they’re often the forgotten members of our society. I just feel really strongly that they still have a right to dignity, and to services, and to information that isn’t a sales pitch, to someone listening to a voicemail and saying, ‘Oh, that sounds like a scam. Maybe you don’t call them back.’ And just meeting them where they’re at, and helping them feel less isolated, and giving them the information to be empowered, to still be in charge of their own care decisions, their own life, because oftentimes people are like, ‘Well, they just need to do this, this, this,’ but that’s not what they want to do for themselves, and they still have the right to determine what’s important to them, what gives them quality of life, what’s meaningful.
Miller: Bethany, has the housing crisis affected your work?
Benefield: It absolutely has. Like I said, we meet with a wide variety of individuals, and sometimes it’s in a gated community and sometimes it’s in an affordable housing complex. Sometimes it’s down a dirt road off the grid, and they don’t have access to electricity or running water. It becomes increasingly more difficult to get services to them because stable housing is often kind of the base of what is required for at least medical services to be provided; for wound care and home health, there needs to be access to running water. Especially if they don’t want to participate in programs that are supposed to help them because they’ve had poor experiences with them before, it’s still very difficult to figure out what we can plug in, how we can best support them while still honoring their wishes.
And then the resources sometimes just aren’t there. Like Maureen was saying, resources that are in Sisters are gonna be different than what’s in Fort Rock and Gilchrist and Prineville. And so sometimes it’s like we try not to be Bend-centric because there’s a wealth of resources in Bend itself, but you can drive 30 minutes and then there may not be any other options for those people living in the more rural areas of Central Oregon.
Miller: How much do you feel like you have to try to convince people who did have negative experiences with health care in the past to trust you?
Benefield: I try to listen a lot. I try to build a relationship, a trust relationship with those individuals. It may not be within weeks or months that we have any forward motion on them being comfortable with medical interventions or just establishing with a primary care provider. Oftentimes, when it’s explained, the barriers to their care always loop back to their resistance to following through on medical support. But just having somebody there with no agenda, other than supporting them with accurate information and unbiased guidance. I can meet with people for a long time before there’s any forward motion, but that’s part of it because you’re meeting them where they’re at, in whatever season and whatever mindset they have and you have to be comfortable with being in uncomfortable situations and being present with those individuals, and helping them feel seen and heard and validated. That’s a big part of it.
Miller: Maureen, Bethany mentioned earlier that she and other people who work for the Transitions team can be there to help clients realize what’s a sales pitch – what’s real, what’s not. It reminded me that last year, The New Yorker and ProPublica reported that hospice, which began in their words as a visionary notion that patients could die with dignity at home, has now become a $22 billion industry that they say is plagued by exploitation and Medicaid fraud. How different do you think your operations or the services that you offer would be if you were a for-profit entity?
Benefield: Oh, I wouldn’t have a job. [laughter]
Miller: Bethany, you said you wouldn’t have a job?
Benefield: Yeah. The Transitions program doesn’t generate any direct profit. This is supported by our donors, and we’re not charging for these services. The money isn’t there. It doesn’t actually make profitable sense. And so it wouldn’t exist in a for-profit setting.
Dooley: Yeah, it’s an interesting question. Like Bethany said, we offer services at Partners in Care that aren’t necessarily profitable, but we do them because we were started in this community. We are a nonprofit organization and so a lot of the services and a lot of the things that we do, we do them because it is the right thing to do and because we recognize a gap in the community, and we are trying to fill that gap and fill that need, and Transitions is one of those programs. As Bethany said, we’re paying five transitions coordinators right now, and this program does not bring in a cent for our organization. We are grateful for all the people who donate so that we can continue to provide this necessary service. But if we were a for-profit organization, we may not have the ability to do programs like this because they are not earning money for us.
Miller: And so you can’t even get Medicaid reimbursement?
Benefield: No, not for Transitions.
Miller: Okay. Bethany – maybe this question is too big, but I’m gonna ask it anyway – has this job given you insights into what a better version of an American healthcare system would look like?
Benefield: Oh, yeah, that’s not a heavy loaded question at all. [laughter] Absolutely. I do think, kind of tagging off of what Maureen said, people have to make money and they have to pay their own bills and have their own housing and feed themselves. But the focus on profit in the American healthcare system is, I think, taking away from the patients and community needs. I don’t think that it’s evil, but there’s just a better way, like the Partners in Care board continually seeing that the right thing to do is support the Transitions program that brings in no money whatsoever. But we’re supporting people in their overall experience, the last months to years of their lives are just so greatly improved, they feel cared for. And that’s the goal, right, for health care, is to help people feel cared for? And so when it’s a bottom dollar – I might get scolded by finance for talking about this – but when the focus is on the money and not the people, when it’s a system created to serve people in really vulnerable situations, the disconnect is obvious.
Dooley: The hospice was originally founded through volunteers, and hospice was founded originally with the notion to really care for people and give them dignity at the end of their life. And that’s what Partners in Care does every day, and programs like Transitions provide that dignity upstream for people. And like Bethany said, they feel listened to, they feel cared for, and it may give them the ability to trust an organization to provide that medical care for them during the critical times at the end of their life.
Miller: Maureen Dooley and Bethany Benefield, thanks very much.
Benefield: Thanks so much, Dave.
Dooley: Thank you, Dave.
Miller: Maureen Dooley is marketing communications manager at the nonprofit Partners in Care, Bethany Benefield leads the Transitions team there.
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