The sun inched towards the horizon setting the sky ablaze in ribbons of pink and orange above the waters of Hampton Roads before slowly slipping out of sight. As she soaked up the view from the fifth floor suite at The Chamberlin on Fort Monroe, Eva Francis let the breeze from the open window ruffle her hair. Since the end of July, Francis and her small staff at The Legacy Home for Hospice and Support have shared this awe-inspiring scene with 20 hospice patients and their families as they experience the end of life.
"It was the best fall day — pelicans flying, ships going by, the sun setting," said Mike Boyer, whose father, Terry Boyer, died on a Monday evening in November after spending just 24 hours under Legacy's care. Francis dragged his bed to the window and made finger foods for the family. "All he wanted was to feel the salty air. It was just a very serene, sweet moment," Francis said. For the Boyer family, it was an almost joyful experience. "It was the best last day ever," said Mike. "She made it like a celebration rather than a depressing thing."
Penny Jordan, whose mother, Marian Bradley, 82, spent a week in the fifth-floor unit, echoed Boyer's sentiments. Jordan spent hours watching the water, and marveled at the care her mother received. "It's heaven's waiting room," she said. "The atmosphere Eva creates there is so peaceful, so calm. She has such a pure, kind, compassionate heart. She's doing exactly what she was called to do."
Legacy is born
Francis had mulled the idea for the nonprofit, nonmedical hospice for a while, prompted by her family's experience. However, its launch was precipitous. A registered nurse and chaplain, Francis, 52, swung into action when an Alabama woman, stricken with a terminal stroke, had nowhere to go. She spoke with management at The Chamberlin, an historic hotel converted into senior independent living units, rented a two-bedroom suite, and ordered furniture delivered. The ailing woman moved in and passed away the next day. Since then Francis has tended to almost two dozen terminal patients and added a handful of staff. "It's just supportive care. There are so many gaps in the system," she said.
Francis hopes Legacy can become a model for end-of-life care in terms of both offering people the care they want and in being fiscally responsible. "Polls all show that 80 to 90 percent of people want to die at home or be in a place that's home-like," she said. "There just aren't enough dollars to go around and provide aggressive care to the very end."
Unfamiliar with hospice, Liz Tunstall, who works full time and whose husband Bill, 75, had Parkinson's, thought his choices were between a hospital or nursing home. "It was as close to home as you could get. It was just the most incredible experience," she said of the 26 hours the family spent at Legacy. "The beauty of the setting, the comfort, the peace and calm — all of these set the tone."
Tunstall detailed all the "little things" Francis added, from providing food to staying past midnight to accommodate her grandchildren's farewell calls to attending both the visitation and the funeral. "The family all firmly believes the process, the staff, Eva, the place got us on the right track for the grieving process," she said. "We hit the mother lode on this." Weeks later, suddenly feeling inconsolable, Tunstall brought "the only thing that was missing" — Bill's binoculars — for others to enjoy the panoramic vista. As she once again took in the view, she heard the church bells pealing. "God wanted me up here," she said.
What it costs
Studying for her doctorate in nursing, Francis is on a leave of absence from her job. She puts in about 80 hours weekly at Legacy, and is on call around the clock. Her husband, Albert Francis, a family physician with Sentara, supports her endeavor — both emotionally and financially. "She's a remarkable person," he said, shyly. "She's passionate about it." Eva estimates the costs for each patient at $400 a day. "We still have a little left in our 401K," she said, adding that she doesn't draw any pay and equivalent hospital care would cost $18,000.
Contributions are encouraged, but there is no charge to patients or their families, who currently learn about the service from local hospitals and their palliative care divisions, or through word of mouth. "We haven't received a single bill. This is her money. She's funding everything. She'll need some business support," said Tunstall, adding, "She shouldn't have her money on the line. We need this option."
To be at Legacy, patients must have a qualified hospice agency contracted to provide medical services through Medicare or a private insurance "hospice benefit." Neither, however, covers the residential round-the-clock care provided by Legacy, so its operation relies on donations — and the Francis' generosity. "Being generous is part of it. Life is more than just looking after yourself. You can't have real joy without giving. It's a legacy for our own children," said Eva, who shares five grown sons with Albert. Her son, Jacob Ross, 26, currently works as one of the carers.
The costs do not include medications, which are provided by professional hospice that also oversee their administration in daily visits. Legacy supplies all the necessary cleaning and hygiene supplies. It also accommodates patients' food requests, which have run from fried chicken to ice cream. "They're usually minimal," acknowledged Francis, just back from a run to BJ's wholesale club to stock up on snacks and drinks for patients and visitors.
Living to the end
A stay at Legacy, which can last from a day to two weeks, includes 24/7 staffing and an atmosphere dedicated to eking out the most from the last days and minutes of life. (Those who aren't ready for Legacy's end-stage care are directed elsewhere.) "It's about taking time to make those last minutes count; it's about living to the very last breath," said Francis. She aims to provide company for those with fractured families and peace of mind to all.
Brought up Southern Baptist and with a strong faith, Francis isn't afraid to ask those of different faiths, or no faith, to consider and discuss their beliefs at the end. Recently, she exchanged ideas with a follower of Islam with end-stage renal disease, left alone while his daughter was on a military deployment. "He felt he'd lived a good life," she said. "They're tough conversations. As a chaplain, I don't direct them but encourage them to explore." When there's family involved, she'll ask them specific questions to bring up good memories and get conversation flowing. Tunstall recalled with gratitude how her grown children curled up on the sofa together and shared memories.
"This isn't the end. It's part of life and living," said Francis. She described it as an honor, "a gift I've been given," to help families through the emotions — praying, singing, laughing and crying with them. Some say thank you and some don't. "It's a learning experience. We don't do it for the thanks," she said.
Francis is committed to raising community awareness about the needs of the upcoming wave of baby boomers. "We're all terminal but no-one's talking about it. It's very, very hard for families," she said, recounting how caregivers tend to panic near the end, their physical and emotional fatigue often resulting in a 911 call and the patient being taken to a hospital — at great expense and for inappropriate care. "There's the overwhelming sense that 'I can't do it' but there's nowhere else to go," she said.
Francis envisions similar hospices to Legacy in every facility to help take the burden off families.
"No one should die alone. It's about love, not the money," she concluded.
Salasky can be reached by phone at 757-247-4784.
The Legacy Home for Hospice and Support
What: Nonprofit, 501 ©(3), non-medical hospice for end-of-life care, providing round-the-clock staffing and support.
Where: 2, Fenwick Road, Fort Monroe, Hampton.
To donate: Call 757-870-3938.