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Northern Mich. hospice houses adapt as business models change

The Cheboygan Hospice House is located at 722 South Street. The facility is now open under new management and accepting patients and hiring staff.
Michael Livingston
The Cheboygan Hospice House is located at 722 South Street. The facility is now open under new managment and accepting patients and hiring staff.

Residential hospice built on community funding is getting harder to find — especially in rural regions. Experts say organizers need to think creatively to provide essential end-of-life care.

The sun sets over the Cheboygan Hospice House on a cool evening last October, as a group of residents gathers for a vigil.

The small building is across a bridge near a running river and surrounded by carefully maintained gardens.

There are bricks with names on them nearby — a "who's who of Cheboygan," one speaker calls them.

Audience members sings songs and tells stories to remember all those who died here and to celebrate the care they received before the end.

The vigil was held just after McLaren Northern Michigan made the decision to close the Hospice House in the fall of last year. A few months later, the health system closed another facility in Petoskey, called the Hiland Cottage.

Combined, these two facilities provided more than a dozen beds for hospice in the region. And both were cherished by residents because hospice can be a difficult service to provide as business models change.

A crowd gathers outside the Cheboygan Hospice House in October to commemorate the building after it was closed by McLaren Health System due to funding and staffing challenges.
A crowd gathers outside the Cheboygan Hospice House in October to commemorate the building after it was closed by McLaren Health System due to funding and staffing challenges.

What is residential hospice?

Hospice is for those who are nearing the end of their lives. They may have a terminal illness or are reaching a point where hospital visits are just not improving their health anymore.

It also provides support for grieving families. Sometimes counselors are available and hospice chaplains are on staff to provide religious services.

According to the National Hospice and Palliative Care Organization, 1.7 million Medicare beneficiaries used hospice care for at least a day in 2020.

Not all hospice care is done at a dedicated residential facility. Most of those facilities, like the ones in Cheboygan and Petoskey were built through community funding.

The Hiland Cottage in Petoskey was built overlooking the Little Traverse Bay in the early 2000s.

In the months before the closure, the Friends of Hiland Cottage tried to convince McLaren executives to stay open.

“Over the last 15 years, the community has become less and less involved… they're unaware of what's going on in the facility," said David McBride, who leads the group. "So it became more of a corporate operation and less of a community based.”

But the group’s efforts weren’t enough.

McLaren called the decision to close "difficult" but necessary due to staffing constraints.

In press releases, the health system said it would pivot to providing more outpatient hospice care, where a nurse looks after a patient in their home rather than admitting them to a facility.

"McLaren is unwaveringly committed to finding and maintaining a sustainable hospice care model to ensure the entire Northern Michigan community has access to dignified end-of-life services now and into the future," the health system said in a statement in October.

A wider trend

Dr. Maria Silveira, an associate professor of palliative medicine at the University of Michigan says this isn’t new.

Many large health systems are abandoning residential hospice, especially in rural communities. Silveira says old business models that rely on community funding are no longer sustainable.

“With what they're making it's very difficult to survive in this day and age," she said. "Even these giant hospice corporations, they're no longer operating hospice residences.”

In its press releases at the time, McLaren seemed to imply that more people are choosing to die at home rather than at a residential care facility.

Silveira says that may be what people are choosing, but someone’s condition may eventually require some sort of residential care.

She remembers watching over her father, who wished to die at home.

“I had made the mistake of promising, which I always tell my patients' families to never do. Because you don't really know what you're talking about until you're in that position.”

Dr. Maria Silveira
on caring for her father

At the time, Silveira was a single mom with two kids. She said she felt overwhelmed taking care of her dad without much help.

"It was impossible to get him back to bed and I had to drag him across the floor on a blanket to get him back into his hospital bed," she said. “I had made the mistake of promising, which I always tell my patients' families to never do. Because you don't really know what you're talking about until you're in that position.”

Silveira says it's becoming harder to find a place for someone to die that’s equipped with all the technology and staff they need. And the cost of operating a facility isn’t appealing to large health systems that may still be recovering from pandemic shortages.

But she said there are other ways of offering hospice care under different models. Over the past year the two northern Michigan facilities have pivoted.

Under new management

It’s been nearly nine months since the prayer vigil but as of June 1, the Cheboygan Hospice House is back open.

This time under new owner Meagan Charboneau, a local nurse-turned-administrator who recently started an adult foster service in the area.

She said the McLaren Northern Michigan Board of Directors approached her after they closed the doors and proposed she take over.

“I felt like it was what I was supposed to be doing for the community," she said. "I felt like I had the know-how and the can-do to make this building open and operate at its full capacity.”

The Cheboygan Hospice House is slowly taking on more patients for its 12-bed facility.

Charboneau said she's still hiring staff and trying to spread news of the reopening through a Facebook page. The building and its gardens haven't changed but the business model has.

It now operates under a private-pay model which means services are paid for out-of-pocket. That may be inaccessible to some residents. But she says it’s exciting to have the building open for those who have the means.

“From personal experience, you don't know what kind of things you're going to require in that moment when your loved one is passing," she said. "So I knew that I could provide that level of care, not only to the resident, but to the family members too.”

Meanwhile in Petoskey, the Friends of Hiland Cottage are trying something different.

Rather than reopening the Hospice House from scratch, they decided to take their funding and support to a skilled nursing facility called Bay Bluffs in Harbor Springs, just on the other side of the Little Traverse Bay.

As hospice facilities close, a new model has emerged that combines the residential care of nursing homes while outsourcing end-of-life care from other companies.

Dave McBride, who leads the Friends of the Hiland Cottage, Lisa Ashley, administrator for Bay Bluffs and Jeff Hall, whose family were large funders
Michael Livingston
Dave McBride, who leads the Friends of the Hiland Cottage, Lisa Ashley, administrator for Bay Bluffs and Jeff Hall, whose family were large funders of the Hiland Cottage Hospice partnered to renovate a wing of Bay Bluffs for Hospice Care, the project could be finished as soon as August.

Bay Bluffs is owned by the Emmet County Department of Health and Human Services, not a hospital corporation. It takes Medicare and Medicaid.

Dr. Silveira says this model seems to be where most residential hospice is going. And while it’s still being studied, she said the model has worked in other places such as Arbor Hospice in Ann Arbor which closed its residential facility in 2022.

Last month, Bay Bluffs announced a project to renovate a wing of the facility for hospice care. It will eventually have three shared suites with room to expand. The unit is scheduled to be operational by Aug. 1.

“We're providing the best, the best final journey we can provide as a community, for our elders,” said Lisa Ashley, the administrator for Bay Bluffs. "As a region, our aging population is going to increase dramatically. There will only be a greater need for this kind of support and service.”

Dave McBride, with the Friends of Hiland Cottage, called the partnership "a great fit."

He said the suites will fill the void in residential end-of-life care in the Mackinac Straits region. But as hospice continues to change, McBride said the people who understand its importance will need to continue to get creative.

“There are situations where dying at home is just not an option. It's not comfortable. It's not the caregivers aren't there. There are so many reasons that it requires a brick and mortar facility with 24/7 nursing care.”

Michael Livingston covers the area around the Straits of Mackinac - including Cheboygan, Charlevoix, Emmet and Otsego counties as a Report for America corps member.