Officials of Holy Cross Hospital, which already operates a major home care program for terminally ill patients, have applied to the Maryland State Health Planning Commission for permission to build the first inpatient hospice in suburban Maryland.
The eight-bed, $1.5-million facility, planned for the grounds of Holy Cross Academy in Garrett Park, would provide care for up to five days for patients who have already moved home to die but who need temporary medical assistance. Most patients who seek hospice care are suffering from cancer.
Many of those terminal patients "dread going back into the hospital," said Rockville cancer specialist Dr. James A. Brown, who is helping plan for the hospice. "They fear -- and rightly so -- that they may never come out again. At home, if you need help going to the bathroom at night, somebody is there in a few minutes. At a hospital, you ring the buzzer and wait. It's a very dehumanizing process.
"The inpatient hospice would have beds so family members can sleep with the patient, kitchen areas where they can prepare food to his taste rather than to a hospital menu, and a big all-purpose space for family celebrations," Brown said.
The hospice could serve up to 200 patients in a year, he said. Holy Cross's outpatient program last year enrolled 135.
The hospice movement, popular for many years in Europe, has also grown in the United States, which has more than 1,350 hospice centers serving 100,000 patients a year.
In this area, the hospice inpatient facilities include the Washington Home Hospice in the District and the Hospice of Northern Virginia in Arlington.
"Traditional medicine is based on the concept of curing a patient," Brown said. "But there comes a time when medical treatment with all the fancy gizmos we have in a hospital just isn't effective.
"These patients are fully aware that they are beyond help," Brown continued. "This is cards-out-on-the-table medicine limited to their most immediate needs -- pain . . . and getting out of the hospital."
But until recently here, home care programs were not covered by Medicare, Medicaid, Blue Cross/Blue Shield and other medical plans. As health costs have soared, however, insurers have begun to encourage home therapy, which is less expensive than hospitalization.
Because the hospice would not generate much income, Holy Cross administrators say they expect to lose as much as $250,000 a year operating the facility. They said they plan to conduct fund-raising drives to make up the losses.
"We've asked for an expedited review of our application" by state health authorities, Holy Cross spokesman Jann Paul said, "and we hope to break ground this fall and open in the fall of 1987."
Proponents of the hospice concept, which emphasizes counseling of family members as well as patients, say the program has broad emotional implications that traditional hospitalization does not. Brown calls it "conciliatory, social" therapy; Harold Ross, director of the preventive health program at Holy Cross, calls it a "reorientation of people's concept of death" that encourages crucial communication and mutual support.
Ross became a supporter of hospice care last year, when his father, who lived in Fort Lauderdale, Fla., was diagnosed with terminal pancreatic cancer.
Because Ross was an employe of a hospital who knew the "ins and outs," he was able to bribe the security guards so he could see his father after visiting hours, he recalled.
"One night after my father had had surgery . . . I went back to the hospital about 11:30 or 12 p.m., and between 1 and 3 a.m., we had probably the most profound conversation of our lives -- that conversation we all want to have with our parents when they're dying.
"But most people aren't available at that hour," he observed. "People who are dying need to be with their families when they want to, when they have the energy."