At Hospice Center, Acceptance, Comfort, and the Space to Let Go

Rasheeda Laird, an aide at the Kanas Center, wheeled a bed onto a porch, demonstrating how the building's floor-to-ceiling sliding doors allow patients to take in fresh air and sunshine. Lindsay Morris Photos

Family members who visit terminally ill patients at the Kanas Center for Hospice Care on Quiogue are given a five-page document that lays out, in sometimes excruciating detail, the symptoms of approaching death.

The document offers some straightforward insights, for example, that a dying person’s hands may feel unusually cool because blood circulation is being reserved for vital organs. The document also contains gentle admonitions against intervening by, for example, urging food on a patient who shows no interest in eating

“Coming here is a whole acceptance that this is the end, and the worst-case scenario is when nobody talks to families about these things,” said Mary Crosby, an executive president at the Kanas Center who will become its president and C.E.O. on Tuesday.

“We say to them, ‘The hope now is that he or she passes peacefully and pain free, and with the space to really let go,’ ” Ms. Crosby said.

The Kanas Center, which opened in March 2016, is run in association with East End Hospice, which has provided home care since 1991. It was founded as an in-patient facility for those with life expectancies of less than six months and whose symptoms require extensive medical assistance.

On six acres of land adjacent to a nature preserve, the center takes advantage of serene surroundings. It is named for John and Elaine Kanas of East Moriches, whose philanthropic foundation donated $2 million toward its construction.

“The building allows as much of the natural world to come in as possible,” Ms. Crosby said. “What’s happening here is very spiritual. A lot of people are going through this letting-go process, and you don’t want the physical environment to intrude on that.”

Patients’ rooms contain floor-to-ceiling sliding glass doors, which open wide enough for beds to be wheeled onto patios overlooking a thicket of trees. “If you spend a month in a hospital, then come here and have the opportunity to get a little sun on your face, it’s a game changer for people,” Ms. Crosby said.

Medical equipment like oxygen tubing is in custom-built cabinetry, allowing rooms to retain the ambience of a boutique hotel rather than a hospital. Visitors are allowed at all hours and sleeper chairs are available for those who want to spend the night. Even pets are welcomed. “We’ve had a resident cat, and many dogs,” Ms. Crosby said.

Ms. Crosby, who was born and raised in Southampton, said she was drawn to hospice care after having seen end-of-life treatment she thought was wrong. Referring to her experience as an oncology nurse at Manhattan’s Memorial Sloan Kettering Cancer Center, she said, “You’re doing CPR on a 90-year-old woman who’s full of cancer, and you have to do it because no one talked to the patient and the family about what they wanted. It’s not the hospital’s fault, it’s our society. We don’t accept death.”

The Kanas Center offers the “preparing papers” to counteract cultural aversions. “Part of the natural dying process is that people don’t want to eat, people don’t want to drink, people talk less, they sleep more, and a lot of family members, with the best of intentions, keep pulling patients down into this world,” she said. “It is longstanding hospice philosophy that you have to give them permission to let go.”

Catherine Ecker, whose mother died at the center in August and whose aunt died there the previous year, called the hospice an “amazing, sacred place.”

“When you arrive you are interviewed about your loved one, their history and family,” she said. “The staff is always available to answer any questions and explain all processes. Every day, they’re letting you know what’s happening and what to expect.” Ms. Ecker also said she was impressed by the natural surroundings. “The first day my mother was there, there were three baby fawns running around outside,” she said.

The center has only eight rooms for patients, a number that Ms. Crosby said had been determined by the state, using a formula for the number of in-patient beds necessary for the geographic area the center serves, which reaches from Brookhaven to all of the North and South Forks.

Medicare and private insurance companies pay a per-diem rate of about $800 for each patient. “The cost is a lot more than that, so we rely very heavily on donors to make up that difference,” Ms. Crosby said.

According to Ms. Crosby, the biggest hurdle for patients entering the hospice is accepting that death is imminent. “When we do informational visits, people will say, “Well, am I going there to just die? But when they get here, they realize they’re still going to get the care, and pain medication, but in a totally different environment.”

Before being admitted, patients are asked to formally agree to forgo lifesaving measures such as resuscitation or feeding through tubes. “We’re always telling families, this is all about your father’s comfort now,” Ms. Crosby said. “A feeding tube has its own complications and it is, in a way, going against the natural process of a disease course.”

According to the center’s records, 42 percent of patients arrive with terminal cancer, which they had been attempting to treat with increasingly aggressive measures. “They’re told by a doctor ‘Your choices are stronger chemo or radiation,’ but, guess what, you have another choice, and that’s to do nothing,” Ms. Crosby said. “Spend whatever time you have left with your family, rather than going back and forth to Sloan Kettering or Stony Brook or whatever.”

Social workers and volunteers help provide emotional support for patients in addition to family members. They also reach out to clerics for counseling and spiritual care,

After a patient has died, the organization keeps in touch with families for a minimum of 13 months to ease them through bereavement with phone calls, by setting up group and individual therapy sessions, and with Camp Good Grief, a day camp for grieving children and teenagers.

“Even if it’s for a patient’s last couple days, we encourage people to go on hospice to get access to the bereavement services,” Ms. Crosby said. “That way, we’re going to make sure the families are doing okay.”

The Rev. Bob Griffin of the Shelter Island Presbyterian Church, the center’s resident chaplain, said patients often experience a sense of peace when they stop struggling to hold on to life. “They’re making a transition from doing to just being, and I let them know that they still have many gifts left to give just by being,” he said. 

"The building allows as much of the natural world to come in as possible," said Mary Crosby, the center's soon-to-be president and C.E.O.Lindsay Morris
Family members visiting the center receive a document that lays out the details of approaching death.Lindsay Morris
Farrah Etsch, the Kanas Center's nurse manager, spoke to a patient on Sunday.Lindsay Morris
RaSheeda Laird made a bed in one of the center's eight rooms.Lindsay Morris
The center sits on six acres adjacent to a nature preserve.Lindsay Morris
Kanas Center staff members help with the physical, emotional, and spiritual needs of patients and their families in the final days of life. Those on duty Sunday included, from left, Farrah Etsch, Hattie Dantes, Catherine Hart, and RaSheeda Laird.Lindsay Morris
A common area at the center has the feel of a peaceful living room.Lindsay Morris