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Annual Report 2016

PRESIDENT’S MESSAGE In last year’s president’s report I used one word to sum up the year for Rockbridge Area Hospice (RAH) and the word was “change.” Well, that word still reflects what has occurred this year, but I think we need to add “constant” to the phrase. In the world of hospice care, as in all medical care, there is always change. We have a seemingly barrage of new rules and requirements that affect how we operate. These changes require RAH to revamp how we serve our community. I am pleased to say that RAH has been able to keep up and has continued to provide the quality of care that we are known for. One of the most positive changes this year was the arrival of Tasha Walsh as Executive Director. Under Tasha’s leadership RAH has set its sights on doing more for our patients and the community. RAH is truly blessed to have a person such as Tasha in this key leadership role. Earlier this year during a time of staff transition, I was honored to work closely with the staff and I can truly say that it was really a learning experience. I was able to experience on a daily basis all the work and effort that each member of the staff puts in to ensure that RAH functions in accordance with our mission, “Rockbridge Area Hospice will treat, comfort, and provide supportive care for terminally ill patients and their families to enable to live life fully,” abiding by all the federal regulation that we are governed by. It has been a team effort this year, and I want to thank all who wear the mantle of RAH, whether employee, volunteer or board member. We have had a successful year and the future, I believe, is only looking better. As this is my last report as president and board member, in reflecting over the past six years I can honestly say that I do not think that RAH has been in better hands to continue its growth and to meet the ever changing challenges that will be coming down the pike. Thank each and every one of you for your continued support, advice, hard work, loyalty and friendship. Rockbridge Area Hospice is your home town non-profit hospice founded by four community members in 1983 with the belief in the idea of “Neighbors Helping Neighbors.”

Bill Luton, President of the Board

EXECUTIVE DIRECTOR’S MESSAGE Shortly after I arrived in May, I shared the following story during a staff meeting: A little girl was at a family gathering and watched her mother prepare a roast for dinner. The mother cut off about 2 inches of the meat, put the rest in a pan with seasoning and put it in the oven. The little girl asked, “Mom, why did you get rid of some of the meat,” and her mother replied, “That’s how you cook roast beef, dear – my mother taught me that.” Curious, the little girl went to her grandmother, asked the same question and her grandmother gave the same reply, “That’s how you cook roast beef – my mother taught me that.” Still not satisfied with the answer, the little girl went to her great-grandmother and asked, “Grammie, why do you cut off some of the meat when you cook a roast beef?” Her great-grandmother said, “Well, honey, back in the days when I was cooking dinner for our family, I had a very small oven and one pan, and that’s the only way it would fit.” Tasha Walsh, Executive Director

Since then, we’ve been talking a lot about roast beef.

Throughout 2016, RAH has faced a number of challenges and changes. One thing is constant: the organization’s commitment to quality care for patients and families who entrust us during the most important and tender transition of their lives. We have been renewing our focus on patient and family needs driving decisions regarding care and operations. This has involved: • improving orientation and professional development for staff, • reassessing operational practices re: admissions, billing, scheduling, etc. and • engaging all staff and volunteers to affirm “why do we work here.” Some of these inquiries have had us asking ourselves, “Is this a roast beef pan issue?” as we work to create efficient and meaningful processes that put the needs of patients and families we are serving in the forefront, while meeting evolving regulatory requirements in a way that does not overburden our valuable employees and volunteers. A critical aspect for our success is to create an organizational culture that is attentive to supporting everyone on the team, while we support patients and families. Early on I asked the staff to complete a standardized assessment designed to measure employee engagement on a team. After focusing on creating a more intentional atmosphere of respectful direct communication and gratitude for four months, I asked them to retake the same survey. The results (with 5 being the highest) indicate that we are heading in the right direction. The 5/6/2016 result was 3.8; the 9/15/2016 was 4.3. When I first met the RAH team, I brought a basket of oranges and shared why I felt called to take the role of Executive Director. The oranges were a symbol of calm (science has identified that the scent of citrus has a calming effect on our brain), and my sharing was about holding space for connection and healing to happen, whether that be in a family while a loved one is at their end of life or in a group of people working together for a noble purpose. It is critical that all of those involved with RAH feel safe and supported. All of us, from direct care to support staff, from volunteers to colleagues at partner organizations, need to care for ourselves and each other in order to be in a position to be fully present in our work caring for others. A noble purpose, indeed.


Tasha Walsh, LCSW, PCC Executive Director

Lisa Howard, RN, BSN Case Manager

William Sayre, MD Volunteer Medical Director

Christina Brizendine Social Worker

Pam Jennings, CNA, CHPNA Hospice Aide

Ralph Caldroney, MD Volunteer Hospice Physician

Sue Clark, RN, BSN, CHPN Case Manager

Michelle Jones Public Relations and Development Director

Sinclair Harcus, Jr., MD Volunteer Hospice Physician

Carrie Claytor, RN PRN On-call Nurse

Susie Ladd, RN After-Hours Primary Nurse

Elizabeth Kosmos, NP Volunteer Nurse Practitioner

Pat Cooper, RN, CHPN PRN On-Call Nurse

Katelyn Lunsford Donor Relations and Event Specialist

Donna Conner Finance Director

Carolyn Morris Clinical Services Coordinator

Kathy Conner, CNA, CHPNA Hospice Aid and QAPI Specialist

Liz Norman Social Worker

Ali Engleman After-Hours Primary Nurse

Mark Schroeder Chaplain

Kam Flynn, MSW Patient and Family Care Supervisor

Teresa Sorrells, RN Case Manager

Sherri Hartless, RN Case Manager

Terry Volant, RN, BSN Director of Nursing

Christine Hopkins, CNA Hospice Aid and Volunteer Coordinator

Hope Wilmore, CNA Hospice Aide

Jutta Hopkins, RN, PhD Compliance Consultant

Those seeking to improve the quality of life for people nearing the end of life must assume the responsibility of great trust. This responsibility goes beyond legal or business obligations. It is a crucial relationship that must be well tended and nourished. In fact, the patient and family are, and must be, the center around which every conversation, decision, and action of the organization revolves. (Statement from the NHPCO Ethical Principals)


“No one can do everything, but everyone can do something.” –Unknown Abdur Khan Adrian Gordon Amy Hayslette Angela Moore Angela Wheeler Angie Henson Angie Moore Ann Nay Ashley Ooms Austin Frank Bank of Botetourt Barbara Czekner Barbara Luton Barbara Roudabush Batsheva Honig Becky Edmondson Becky Sheets Bethany Fresh Betty McMichael Beulah Knick Bill Lowe Bill Luton Bill Sayre Bo Hughes Brianna Chappel Buddy Derrick Butch Irvine Cadence Tanner Caleigh Wells

Camryn Wimer Cara Brown Carol Grigsby Carol Wheeler Carole Judy Carolyn Worrell Catherine Honeycutt Chip Honsinger Chip Schram Christyl Lee Clarence Martin CornerStone Bank Connie Schmoll Dani Leon Danielle Tolley Dave VanOsten David Kauffman David Walsh Dawn Peck Deb Klein Derek Carter Diana Davis Dick Halseth Dick Rathmell Don Roll Donna Cochran Eileen Norris Elizabeth Kosmas Elsa Burrowes

Evvie Rudisil Farris Hotchkiss Fon Teawdatwan Gabriella Youngblood Gary Judy Genie Robinson George Jurand Gobind Moore Grace Fu Harvey Galloway Helen MacDermott Hope Bird Iman Messado Jack Geikler Jaclyn Hostetter Jacquelyn Labus James Sampson Jeannie Hite Jennifer Palmer Jerry Plante Jim Brown Jim Dick Jim Slack Joe Pagnam John Czekner John Mason John Murphy John Rafferty John Vita

Josh Jones Joyce Kominski Julia Grover Julie Tanner Karen Lyons Karin Cron Kathy Lamb Katie Letcher Lyle Katy Datz Kelcy Brewbaker Kendal of Lexington Kerri Stillwell Lexington Golf and Country Club Lexington Lions Club Lexington Rotary Club Linda Krantz Linda McGuire Lisa Grandel Louis Grandberry Lu Dooley Marla Rock Marquisha Brown Martha Irvine Mary Dugan Mary Harvey-Halseth Mary Honsinger Mary Wimer Matt Hayden

Matt Paxton II Max Snarr Meg Mason Megan Childs Melinda Mills Melissa Sayre Meredith Bedell Montrose Grandberry Morgan Rowsey Nancy Coleman Nancy Lowe Natalie Schroeder Nick Charles Pat Rafferty Patti Hammond Paul Barron Peter Fyfe Prakhar Naithani Ralph Caldroney Ray Leinbach RCHS Interact Club Robin Moore Rose Watts Ross Schmoll Rusty Brown Ruth Dick Sara Cunningham Scott Beebe Seth Moore

Shane Gonsalves Sharon Sensabaugh Shay Peters Shelley Martin Sherri Wilcox Sherry Teague Sinclair Harcus Sue Van Leer Susan LeMert Tammy Shomo Tasha Humphries Taylor Gulotta Ted Burrowes Teresa Fainter Terrie Scholl Tiffany Jordan Tom Tait Tom Peck Topher Jones University Florist Valerie Johnson Vincent Buckman Virginia Military Institute W&L’s Alpha Phi Omega Service Organization

NOMINATING COMMITTEE This year the Nominating Committee had six Directors to recommend for the term beginning January 1, 2017. Fortunately three directors ending their terms volunteered to remain on the Board for another three-year term. The committee recommended three additional Directors to the Board, and they were all elected at September’s Board Meeting. The Directors elected for the 2017 – 2019 Term are: John Czekner Ernest Kennedy Elizabeth Moss Carol Grigsby Kathy Lamb Scott Shank The Committee also proposed the following slate of Officers for the year 2017, all of whom where duly elected at September’s meeting of the Board: President: Ross Schmoll Treasurer: Carol Wheeler Vice President: Jim Brown Secretary: Mary Dugan

Ross Schmoll, Chair

PERSONNEL COMMITTEE Another busy year has drawn to a close. The Personnel Committee has been an integral part of the many positive changes that were experienced at Rockbridge Area Hospice this past year. President Bill Luton, treasurer Carol Wheeler and myself, as a member of the personnel committee, assisted with day-to-day operations while the RAH conducted a nationwide search for a new executive director. We proudly welcomed Tasha Walsh to lead the hospice organization and continue its mission. Under Tasha’s leadership, we have assessed, and revised where necessary, the entirety of the organization’s job descriptions, Carol Grigsby, Chair salary ranges, and table of organization. Other than immediate staffing needs, she will be focusing next on a longrange strategic plan. Special thank you to Jutta Hopkins for temporarily coming out of retirement to assist with both the compliance position and the interim director of nursing position. We greatly appreciate your willingness to help and your dedication to our mission. The coverage for after-hours care has been adjusted to create a more effective delivery model to better serve our clients. RAH strives to employ the best and most qualified staff who provide compassionate care and embrace our core values. While there have been many personnel changes at RAH in the past twelve months (we are now fully staffed), our committed professionals throughout the organization stand ready to serve our community and fulfill or our mission of “Neighbors Helping Neighbors.”


Ross Schmoll, President

Jim Brown, Vice President

Carol Wheeler, Treasurer

Carol Grigsby

Julie Grover

Kathy Lamb

Tom Peck

Scott Shank

David VanOsten

Mary Dugan, Secretary

Ernest Kennedy

Gabriella Youngblood

John Czekner

Elizabeth Moss

“Alone we can do so little; together we can do so much.” — Helen Keller


TREASURER’S REPORT The 2016 fiscal year has been a challenging one for Rockbridge Area Hospice. During the previous two years RAH realized growth in the average daily census (ADC) which resulted in an increase in fee revenue and net operating gains in both FY 2015 and FY 2014. This growth has not been sustained, however. FY 2016 saw a 19% decline in ADC from the previous year (from 36 to 29) with a resulting 17% decline in fees contributing to a net operating loss of ($108,939). In other prime revenue areas, fund-raisers exceeded FY 2015 levels but contribution levels were lower, marking the second year of decline in private contributions. The decline in revenue is being addressed. A new, comprehensive public relations program is underway to reach out to all areas of the community through increased advertising, outreach to area organizations, and more intensive contact with the local medical community. ADC is already starting to grow. In addition, new management leadership has re-organized and energized the clinical and administrative staffs resulting in greater efficiencies, improved service, and enhanced programs. Expenses ended the year at budget and below FY 2015 levels. Management has been strategic and effective in eliminating unnecessary costs, in seeking cost-saving medical expense agreements, in building maintenance, and in improving technology infrastructure. Fortunately, the investment portfolio performed well, contributing nearly $215,000 to the year’s overall financial profile and resulting in an increase in net assets of more than $111,000. Funds in the $2.6 million portfolio are the result of substantial contributions from generous donors over the years, the prudent investment Carol Wheeler, Chair

Fee Revenue Medicaid Nursing Home R&B Ordinary Contributions & Grants Investment Income TOTAL INCOME

2016 Income 1,450,769 230,949 220,787 78,692 1,981,197

2015 Income 1,743,935 228,918 242,901 94,234 2,309,988

Salaries, Taxes & Benefits Direct Patient Services Medicaid Nursing Home R&B Management & General Fundraising & Public Relations Building, Upkeep & Depreciation Insurance Other TOTAL EXPENSES

2016 Expenses 1,218,497 242,032 234,907 221,537 64,620 55,930 29,301 23,312 2,090,136

2015 Expenses 1,225,948 284,695 243,749 185,203 49,648 65,961 25,219 40,195 2,120,618




Other Income/Gains (Losses)/Bequests CHANGE IN NET ASSETS

220,484 111,545

(48,311) 141,059

Cash and Cash Equivalents Investments, CD’s, Endowment & Misc Accounts Receivable Pledges Receivable Property & Equipment TOTAL ASSETS Less Liabilities TOTAL NET ASSETS

2016 2015 167,734 289,043 2,607,457 2,442,713 180,380 157,760 0 1,050 544,398 556,560 3,499,969 3,447,126 (125,468) (184,171) 3,374,501 3,262,955

BUDGET Fee Revenue Medicaid Nursing Home R&B Contributions & Grants Investment Income TOTAL OPERATING INCOME

2017 Income 1,567,204 242,621 232,300 106,468 2,148,593

2016 Revised Income 1,568,955 217,415 248,678 47,634 2,082,682

Salaries, Taxes & Benefits Direct Patient Services Medicaid Nursing Home R&B Building, Upkeep & Depreciation Insurance Office, Fundraising, Prof fees & Other TOTAL OPERATING EXPENSES

2017 Expenses 1,331,382 237,141 225,000 58,574 29,878 318,966 2,200,941

2016 Revised Expenses 1,218,234 262,377 237,985 54,747 31,123 284,093 2,088,559





(continued on the following page) (continued from previous page) of those funds, and the resulting growth. The strength of the portfolio helps cushion the impact of unprofitable years and underscores the critical need for community support to maintain the financial well-being of the organization. RAH continues to be free of long-term liabilities and enjoys an assets to liabilities ratio of 28-1. The budget for the new fiscal year, begun October 1, 2016, is based on a projection of patient days, a more accurate base for estimating fee revenue than ADC, and is roughly equivalent to an ADC of 29. The FY 2017 budget includes a spending rate draw of 4.5% on the investment portfolio, fee projections based on a revised government rate system for Medicare and Medicaid billing, a revised salary structure, funds for professional development, and a new donor database. RAH faces a forecasted budget deficit of ($52,348) which we hope to see made up by an increase in patient days. Unaudited financial statements for FY 2016 are provided here. Following the annual audit in December, the FY 2016 audit report and IRS form 990 will be available early in 2017. The Finance Committee has worked diligently throughout the year and provided expertise in accounting, banking, and business management. Sincere thanks to Butch Irvine, Bill Luton, Ross Schmoll, David VanOsten, Director of Finance Donna Conner, and Executive Director Tasha Walsh, as well as to our Financial Advisor, David Dugan.

DEVELOPMENT COMMITTEE The Development Committee has had a very busy and productive year. We have helped run, staff and plan five events to raise money for Rockbridge Area Hospice. Our team of board members, staff and volunteers assisted with the Kenney’s Classic Cruise-In presented and organized by Goads Body Shop, which raised more than $23,000; the holiday fund-raiser and community memorial, Light Up a Life, brought in just over $15,000; the annual Golf Classic was a great success bringing more than $22, 000, and our summer music event, BBQ, Bands and Brews made almost $7,000. RAH’s annual Hospice Hustle was very successful both financially and in attendance, grossing nearly $23,000 with 246 runners and walkers. The committee is excited to announce the 20th anniversary of the Hospice Hustle for 2017, which will take place in Buena Vista. These events are necessary for two reasons: one, to raise funds for our hospice mission, and two, to raise community awareness about RAH. The committee and staff are working on a development plan to help continue our neighbors helping neighbors philosophy, and to raise more funds in our community to help those in our local hospice community.

Kathy Lamb, Chair

STATISTICS Top Referral Sources:



2. Hospital 3. Nursing Home 4. Facilities

Percentage of RAH patients with Alzheimer’s diagnosis



have heart disease diagnosis Average number of patients cared for per day:


of all deaths occurring in Rockbridge County (including the cities of Buena Vista and Lexington) were under the care of Rockbridge Area Hospice. Average length of stay (days enrolled) per patient:


Total Referrals:



164 Total patients admitted into hospice care

When looking for graphics for this page, we googled ‘wheelchair.’ The image below of a snorkeler in a wheelchair was one of the clipart results that popped up. The first thought was, this picture doesn’t relate to hospice. The next search was, ‘hospital bed.’ It occurred to us that the image of the snorkeler in the wheelchair is more about Hospice than the hospital bed is. With our focus on life, patient options and choices, the snorkeler is a far better representation of Rockbridge Area Hospice services than the hospital bed. We work everyday to create more meaningful moments for patients and their family.

Patients enrolled in RAHs Connections pre-hospice program:



Percentage of RAH patients have non-cancer related hospice diagnosis.








As Rockbridge Area Hospice reflects on 2016, we are grateful for each opportunity that each of us has had to care for our friends and neighbors in this community. Our commitment is to create more moments, to focus on living, provide the best hospice care possible and to continue to strive to be solid, strong, and always best equipped to serve our community. Here is a glance at “Hospice by the Numbers.�









RAH family and community members receiving bereavement touches (phone call, letter, visits).

269 40 166

RAH family and community members receiving bereavement services. Number of Reiki Therapy hours provided to RAH patients.




As the local hospice, RAH is able to provide the best access to care, more local programs, sustained by local volunteers, such as our RAHConnections pre-hospice program and our We Honor Veterans program. Additional goals for a music and pet therapy program are in development.


Active RAH volunteers. Patient care, front desk, brawn patrol, board member, special event, vigil, special therapy services, veteran, bereavement.

18 3000+ 24

Patients enrolled in our pre-hospice bridge program, RAHConnections. Hours of service provided by volunteers throughout the year. Hours of direct volunteer training.



In the summer of 1998, Katie, along with

Other notable accomplishments were her efforts to support a cookie basket brigade (an effort to thank individuals and businesses that were actively supporting RAH), her contributions to the Founders Day celebration in

Just four years after becoming a volunteer, she hosted “Breakfast at Katie’s,” a spring fund-raiser. Katie described the breakfast’s purpose to continue to support RAH and to invite those who have been supportive, to give voice to the needs of the community that RAH might fulfill in the future. She would later host another “Breakfast at Katie’s” in May of 2003.

Katie graciously donated twenty years of faithful volunteer service to RAH, joining as a patient care volunteer in 1996. She subsequently was appointed to the board of directors the following year. In the 1998 annual report Katie was quoted as saying, “We must work hard to ensure RAH’s future. Every family we serve believes in the benefits of hospice. Our service is indisputably excellent.” Over the course of the next eighteen years she worked tirelessly to support our patients, their families, advocate for our mission, and raise funds to ensure the organization’s future.

her daughter Jennie, began designing and printing notecards titled “Jennie’s Cats,” as a hospice fund-raiser. The cards were sold at community festivals, church bazaars and at the hospice office. All proceeds were donated to RAH, and current staff continue to use the cards as a gift to patients and families.

The 2016 Rockbridge Area Hospice annual report is dedicated in memory of Katie Letcher Lyle. Katie was a longtime volunteer, and her commitment to RAH was a source of deep meaning for her. We are grateful for the impact that she has had on our lives and the lives of so many over the years.

A Neighbor Helping A Neighbor


315 Myers Street Lexington, VA 24450 540.463.1848 (P) 540.463.3175 (F)

2016 Annual Report

These are just a few of the many gifts Katie gave to Rockbridge Area Hospice. She leaves a legacy and an example of stewardship that we all should follow. We will forever be grateful.

April of 2005, her efforts to support the capital campaign to secure a fully renovated, debt-free permanent home for RAH in 2007, hosting a westernthemed volunteer “round-up”, being voted hospice hero of the year by the staff in 2010 and her attendance and support of the 30th anniversary Gala in 2014.

RAH 2016 Annual Report  

Annual report for Rockbridge Area Hospice. Included are reports from various committees, the board president and the executive director. Als...