Esther Colliflower munches toast in her new home high on a hill in Flat Rock, North Carolina. Shes been retired for two years, since publicly-traded Chemed merged with her beloved VITAS Innovative Hospice Care® 26 years after she took care of its first terminally ill patient. She ponders a question: What makes you tick?
“Im very goal-oriented,” she answers. “Im never happy unless Im looking forward to something.” Thats why, in 1972, when the youngest of her eight children began school, Colliflower did too, deciding to get a masters degree and teach. Incensed to learn her 25-year-old credentials were considered worthless, that shed have to start school as a freshman, this registered nurse turned her ire to energy, helping to develop the Life Lab curriculum at Miami-Dade Community College that allowed adults to use life experiences toward college credits. The Life Lab was wildly successful, becoming a magnet for interesting people and new ideas in the vibrant melting pot of South Florida. For Colliflower, it is where Elisabeth Kubler-Ross theory on death and dying, Cicely Saunders experiment in hospice care, and a young Methodist minister named Hugh Westbrook all came togetherand received her undivided attention.
Westbrook and Colliflower shared the conviction that America was doing an appallingly bad job of attending to the dying. They developed courses in death education and counseling and attracted some like-minded people. In 1978 Colliflower resigned from her community college post “to volunteer in this crazy organization.” Incorporated as the non-profit Hospice of Miami, they soon admitted their first patient and family. “There was no licensing,” she remembers, “no hospice organization, no rules. There was just a lot of fun, a lot of hard work, a lot of exciting people. It was a real high; we were creating something.”
What they created were things like patient-centered care and interdisciplinary teams, both evolutionary/revolutionary concepts in the 70s. Colliflower tweaked the Cicely Saunders hospice model to make it more democratic.
“I made the doctor part of the team, but not the leader of the team,” she says. “I thought each member, including the patient and family, had important information to add to the plan of care.”
There were other challenges. How to find the clinical staff committed to caring for the terminally ill? How to find doctors and hospitals willing to take a holistic approach to the patient? How to license and regulate hospice care? How to raise the capital necessary to take the Hospice of Miami model to the national level?
“What was unique about the organization we pulled together is that we were always in a leadership roleand we were sometimes unpopular, if not controversial,” Colliflower reflects. “Hospices were small, local, mom-and-pop organizations that were certain they couldnt meet state regulations. The biggest challenge was getting hospice added to the Medicare benefit; a lot of people didnt want the government telling hospices what to do, even in exchange for a dedicated payor source. And then there were those who insisted that the only true hospices were all-volunteer hospices.”
Westbrook and Colliflower had other ideas. In 1979 Florida became the first state to have a hospice licensure law; in 1982 hospice became a Medicare benefit. A few years later Hospice of Miami became Hospice Care, Inc. (It would become VITAS Innovative Hospice Care® in 1992.)
“We knew we couldnt be an all-volunteer organization that ran itself by whim,” says Colliflower. “We had a responsibility to the patient, the staff, the payors, the community to manage our funds responsibly. The downfall of many hospices is that they think if you are concerned about the budget you are not concerned about the patient. Thats just not true. You have to be fiscally responsiblein every segment of healthcare.
“We also knew it had to be a fluid team,” she continues. “We had to take care of patients and provide opportunity for the people who worked in the organization. Thats what creates a vibrant, healthy business. And we did that. Peggy [Executive Vice President and Chief Operating Officer Peggy Pettit] was a night nurse in Broward County 20-plus years ago. We had home health aides who are now team managers; chaplains and social workers who are now corporate executives.”
And VITAS had founders with the good sense to know what they didnt know. “Hugh and I knew we didnt have all the knowledge we needed to run the business side of end-of-life care,” says Colliflower. “So we surrounded ourselves with people like [President] David Wester and [Vice President of Communications] Mark Cohen. We found people who had the moxie to go into new communities and identify hospices that can grow with the company.”
Colliflower stops, reflecting on the company that began with one patient in Miami and now cares for more than 10,000 every day nationwide. “Its dynamic,” she says of VITAS today. “I dont know whats next. But Im sure if I were there Id think of something.”
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