By Thea Jarvis

Jim O’Hara met Andreas Kun in the spring of 1983. Kun was a terminally ill leukemia patient at St. Joseph’s Hospital in Atlanta and O’Hara a volunteer with Hospice Atlanta. Their friendship lasted for seven months.

“At first he resisted me,” Jim O’Hara remembers. In his suffering, Kun was “a very difficult guy” to reach. “He was lonely. He had no family.”

On one occasion, O’Hara heard the story of Andreas Kun’s life. He had escaped from Hungary in a boxcar during the revolution of 1956, eventually picking his way through a minefield to freedom. An engineer by profession, he was also an accomplished photographer. His only known relative was an elderly uncle living in Paris. Kun was 49 years old.

Jim O’Hara visited his friend during his sporadic stays at St. Joseph’s during the last seven months of his life. When he was well enough, Kun remained in his own home. He frequently had dinner at the O’Hara’s house in north Atlanta and spent time with Jim and his wife Bonnie. Sharing his life with friends eased the loneliness, the loss of control felt by the dying.

In October of 1983, Andreas was admitted to the intensive care unit of St. Joseph’s Hospital for the last time. He died there surrounded by ice packings, life-giving tubes and life-sustaining machines.

“Andreas could have benefited from an in-patient hospice and there was no in-patient hospice there for him,” Jim O’Hara says plainly. It is for Andreas and those like him that O’Hara now labors. He is making a home for Hospice of the South, a planned 36-bed, in-patient facility offering round the clock, compassionate care for the terminally ill.

Elizabeth Kubler-Ross describes hospice as “A concept of care whose goal is to help a person live until he dies.” The notion of hospice dates back to the Middle Ages when the Alpine monks of St. Bernard assisted sick and weary travelers. Contemporary hospice care was pioneered by Dr. Cicely Saunders, who opened London’s St. Christopher’s Hospice in 1967.

Although some 1500 hospices of all shapes and sizes are currently operative in the U.S. – the first opened in Branford, Connecticut in 1974 – most deal in outpatient care. In metro Atlanta, five not-for-profit programs offer hospice support where a primary caregiver is available to supervise a patient in the home. The closest in-patient hospice facilities are located in Jacksonville, Florida and Daphne, Alabama, near Mobile.

“To my knowledge, there is no freestanding hospice in Georgia,” Jim O’Hara explains. He has done his homework, from detailed market research to hospice visitation as far west as Colorado and as far north as New England. Interviews with terminally ill persons, physicians, nurses and families have convinced him that hospice care is a necessary option.

“The way in which people die in this country is wrong,” O’Hara is certain. A tall, silver-haired Philadelphian whose ice-blue eyes and pin-striped shirt bespeak 27 years of corporate business experience, he remembers his own family’s approach to sickness and death.

“I come from a large, close family. I was raised in an environment where people took care of their sick and dying. Hospitals were not places people went to. And our family was not unique. This was what most families did.”

Because of a stepped-up federal funding program in the 1950’s, O’Hara contends, hospitals were built and expanded. Medicare and Medicaid monies permitted prolonged hospital stays and treatment. Today, however, federal cutbacks have made such care impossible. This cost is too great. In the area of care for the terminally ill, costs are out of reach for patients, hospitals and insurers.

“Terminally ill people are being discharged sooner and sicker than ever before,” O’Hara says. Many face death alone. In metro Atlanta, where the influx of out-of-staters is an economic asset, it is a medical liability. Often it becomes the sole responsibility of a spouse to care for a terminally ill patient. There is no relief from family members because the family is up north, out west or on the coast. Statistics confirm that in metro Atlanta, where cancer is expected to increase seven-and-a-half percent by 1990, 76 percent of all terminally ill persons have two or few people in their household. If those people hold jobs, are unable to be primary caretakers or are unwilling to undertake such care, even these small numbers become ciphers.

In 1983, only 13 percent of all terminally ill cancer patients in the metro Atlanta area became hospice patients. Even with expanded awareness of home care hospice programs, this percentage is unlikely to rise, according to Jim O’Hara, because of the limited number of primary caretakers.

The in-patient hospice facility is a rational, compassionate solution. Hospice of the South will offer 24-hour care with a ratio of one nurse to every five and a half patients. A staff of doctors, nurses, social workers, psychologists and volunteers will man the hospice, and treatment will be fine-tuned to satisfy the physical, emotional and psychological needs of the patient.

The first thing is to deal with the physical pain the terminally ill person is suffering,” O’Hara explains. This is usually done in concert with the patient’s primary physician, who is familiar with his medical history and current needs.

“In the hospice, each individual level of pain is treated,” he continues, as opposed to many hospital situations where pain medication is typically administered in standard dosages and full relief not always achieved. “Once the pain is under control you find many of the other anxieties experienced by the terminally ill decrease.”

People are there to talk when a patient wants to unload. Staff psychologists and social workers provide a strong support system for both the patient and his family, and because treatment always focuses on the family unit, bereavement care is available up to one year after a patient’s death. Along with in-patient care, outpatient services will be offered if a primary caregiver is present. Even respite care, during which families tending a terminally ill patient in the home use the in-patient facility for a few days to catch up on needed rest and relaxation, will be an option.

Hospice of the South rooms will be spacious and homey, two or three times the size of most hospital rooms, comfortably outfitted with a television, reading lamp, draperies and an easy chair. Sofa beds for family members wishing to stay the night will be a fixture in each room. Walls will be papered attractively, bed linens colorful and visiting hours ongoing.

“Visitors are not limited to specific hours. If you feel you want to come over at one o’clock in the morning to stay with your mother because you don’t think she’ll last the night, you’ll be welcome,” says O’Hara, adding that pets and children are included that open welcome as well.

Research indicates that 49 percent of terminally ill patients know of their condition more than six months before death. This is not an attitude of despair but a clear understanding of their situation. Those who enter hospice care do so willingly; their consent is pivotal. They and their family have faced the reality of death in terms of days, months or weeks. Such acceptance brings a measure of peace and the opportunity to prepare for death in an unpressured, pain-free environment. Palliative care, not a cure, is the goal; no artificial life-support systems will be found in hospice treatment. The quality of a patient’s life, not the quantity of his remaining days, is emphasized. In keeping with this philosophy, Hospice of the South will include a library, an art and music room, barbershop, styling salon and common room where patients can meet and talk together.

How much, you are wondering, will such streamlined, compassionate care cost? Surprisingly little, when compared to the escalating figures hospitals must charge to make ends meet. Blue Cross of Georgia estimates an average stay of 5.6 days in a hospital facility will run $490 a day. This average does not reflect off-the-chart costs of terminally ill care, which can rise to almost $2000 per day.

Hospice of the South, however, “can operate for under $200 per day per patient,” according to Jim O’Hara, whose research has been meticulous. “This includes,” he adds, “20 percent indigent patients.” Most insurers include hospice care in their coverage. In Georgia alone, Medicare pays up to $262 per day.

For the past two years, Jim O’Hara has been on leave from his job as program manager at IBM. His work with Hospice of the South comes with their blessing. “They’ve given me this time because they believe I’m doing the right thing,” he says.

It has not been easy, this business of hospice-building, but for O’Hara, Hospice of the South is a necessity whose time has come.

There’s no place for these people to go,” he says simply. “We’re trying to provide an alternative.”

For more information, contact Jim O’Hara or Hospice of the South, 5430 Peachtree Dunwoody Road, NE, Atlanta 30342 (404-252-1187).