Program for dying to end at Franciscan

Tacoma’s Franciscan Health System is phasing out an award-winning program for dying patients that drew national acclaim when it was started 12 years ago.

The free program, which typically served 500 to 800 patients a year at 11 South Sound clinics, was designed for people with less than two years to live.

A staff of 14, including seven registered nurses and three chaplains, essentially adopted the patients, offering help with pain relief, emotional and spiritual stress, and help negotiating the medical system.

The palliative care program is separate from the Franciscan Hospice program, which accepts patients with six months or less to live and who have declined curative treatment.

To replace the current system, Franciscan will offer a fee-based service in which terminal patients will be billed for home visits by one of five advanced registered nurse practitioners.

“Throughout the country, palliative care programs are facing a sustainability question,” said Dr. Mark Rake-Marona, regional director of Franciscan’s palliative care and hospice programs. “Everybody intuitively recognizes that it’s valuable work. The problem has been figuring out how to pay for it.”

Nurse practitioners will be used in the new program, Rake-Marona said, because insurers cover their visits. Current services generally are not billable, he said.

The 14 staffers have been given notice that their jobs will end next month, but at least five will take positions in the new program, Rake-Marona said.

Efforts are being made to find positions elsewhere in the company for the others who are being laid off, said Gayle Robinette, a Franciscan spokesman.

Current employees regret the loss of a system they say seemed nearly too good to be true.

“The program was a safety net for people who are out there really struggling on their own,” said one laid-off employee who asked not to be identified for fear of jeopardizing chances of a different Franciscan job.

“I know it didn’t generate revenue,” she said, “but it provided lots of services to people who are the poorest and most vulnerable in this community.

Rake-Marona disagreed with that assessment. He said he expects that, in time, more people will be better served by the new system than the old one, which he helped create.

The new service will be available not only to Franciscan patients but also to all patients throughout the South Sound, he said.

“The new components we’re adding really, in a lot of ways, are an improvement,” he said. “This is something we have thought long and hard about: How do we not only change it to make it sustainable, but how do we improve it and address the gaps?”

The biggest gap, Rake-Marona said, is people dying without any intentional end-of-life care.

Generally speaking, he said, physicians are too busy or too uncomfortable for in-depth talks with patients about dying and the various support systems that are available.

“Having these conversations early and moving them upstream is what we hope to do,” he said. “With the new model, we hope to do that with more patients.”

Those conversations will not include the option offered by Washington’s Death with Dignity law, which allows doctors to prescribe lethal medications to terminal patients so they can take their own lives.

The Franciscan Health system is affiliated with the Catholic Church, which rejects all forms of physician-assisted death.

The only advice Franciscan employees are allowed to give on that subject, Rake-Marona said, is to tell patients to call the state Department of Health for information.

Rob Carson: 253-597-8693

rob.carson@thenewstribune.com