Hospice by the Bay provides a wide range of end-of-life services

As Margaret Caulfield approached the final weeks of her life, her husband, Bob, wanted her to be free of pain and suffering. Equally important, he wanted her to maintain her dignity.

He considered Margaret, an interior designer from England, an elegant woman who “always presented herself very beautifully whether going to a formal ball or taking a walk around the block. She was a very classy lady.”

Caulfield, 78, was grateful and relieved to discover a local nonprofit agency that provided a wide range of end-of-life services. Hospice by the Bay helped the couple in numerous ways, from overseeing pain management to helping him grieve for his wife of 15 years.

Caulfield initially became concerned when Margaret began to forget items at the grocery store and then stopped completing her sentences.

Margaret’s doctor initially thought she had early-onset dementia. A biopsy instead ?discovered inoperable brain cancer. She died in 2015 at 74, just three months after being diagnosed.

The only treatment, confirmed by a second opinion, was aggressive radiation along with chemotherapy. When Margaret failed to respond to the five-times-a-week radiation, her oncologist suggested hospice.

“Without it, I don’t think I could have kept Margaret at home, and I didn’t want to hospitalize her,” Caulfield said. “I wanted her home with me.”

Having Margaret at home also was reassuring to the couple’s blended family of four children and seven grandchildren.

Dr. Molly Bourne, Hospice by the Bay’s chief medical officer, said the agency’s interdisciplinary team is in place to enhance quality of life for the terminally ill, although people sometimes hesitate to contact them.

“So often people don’t want to come on hospice because of the meaning behind it,” she said. “When they do come on, they wish they’d come on earlier.”

Rather than losing hope, Bourne said, reaching out to hospice is an opportunity to take charge, find support and assistance and provide solace for loved ones during an emotionally charged time. And sometimes, patients improve while on hospice care and are discharged from services until needed again.

Hospice by the Bay CEO Kitty Whitaker says the hospice mission has been steadfast since its founding in 1975 as California’s first hospice, the second in the country.

“In the early days when there weren’t even regulations around hospice, our mission was to serve the terminally ill and alleviate their suffering and pain and improve the quality of life at the end of life,” she said.

The team approach includes nurses, physicians, social workers, spiritual support counselors, hospice aides and direct-care volunteers, all offering compassion through regular visits. Nurses are on call 24 hours a day; providers offer referrals for outside services like round-the-clock caregiver support and other needs. No two care plans are identical.

Each year serving about 2,600 patients and one to four of their loved ones, the organization cares for those living on the streets, in hospitals and long-term care and convalescent centers as well as in private homes.

“People die how they live,” Bourne said. “We try to help them be safe and comfortable.”

Headquartered in Larkspur, Hospice by the Bay serves Sonoma, Marin, San Francisco and San Mateo counties and the cities of Napa, Vallejo and American Canyon; it is one of several North Bay hospice programs.

The Caulfields lived in Sonoma when they received services, although Bob Caulfield has since moved to San Francisco’s Noe Valley, where he works in advertising sales.

“They were so helpful from the get-go,” he said. “Anything we needed, they saw that we got it, and quickly. I can’t say enough about the care and attention they gave us.”

Whitaker said caregivers also are moved by the depth, trust and appreciation of their clients.

“There isn’t any way that it can’t touch you personally and emotionally,” she said.

Hospice care teams offer pain and symptom management; help with bathing and dressing; support and respite for caregivers; pediatric and palliative care; and grief services that include bereavement support groups.

Hospice by the Bay also offers community workshops and presentations on end-of-life topics and on-site crisis, and grief support when a death impacts a school, workplace or community.

Most costs are covered by Medicare, Medi-Cal and private insurance, with hospice services also available to the uninsured for minimal expense. Although typically recommended for patients with a life expectancy of six months, duration of services may extend for a year or two.

While Caulfield was grateful hospice could assist his wife, he also is thankful for the help he received after her death.

He at first declined bereavement support, figuring he could work through the loss on his own. With encouragement from a social worker, he changed his mind.

“I think I was initially reluctant to talk about my feelings,” he said. “I was afraid of my own feelings, but I’m glad I did it.”

Today, almost two years after his wife’s death, Caulfield cherishes a palm-sized stone he personalized with a drawing of a teacup, part of a final grief-support session for those who had lost spouses to cancer.

“Margaret being very English, we had tea almost every day of the week around 4 o’clock,” he said. “Whenever I have tea, I inevitably think of Margaret.”