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Evolution of a Hospice: Hope HealthCare Services

Samira Beckwith
Hope HealthCare Services CEO Samira K. Beckwith was one of the first in her industry to start a pharmacy. She proposed starting a funeral home five years ago but later withdrew those plans. [Photo: Brian Tietz]

In the 1970s, as a graduate student working on her master's degree in social work at Ohio State University, Samira K. Beckwith learned she had Hodgkin's disease.

As she endured multiple surgeries, rounds of radiation and chemotherapy, Beckwith experienced a lack of compassion for patients from within the healthcare system. She eventually beat the Hodgkin's. Later, on her first job as a mental health counselor, she worked with a dying young mother who left the hospital in intense pain to be home with her three kids. That experience led Beckwith to devote her future to a new field: Hospice. "It hit me that this is what I needed to do with my life," she says, "because I was the lucky one."

After helping found the first hospice in North Dakota and becoming its director, she moved to southwest Florida to lead a young program that cared for about 50 patients a day and was operating in the red.

Today, Beckwith is in her 20th year as president and CEO of that program, Hope HealthCare Services of Fort Myers. The non-profit organization now cares for more than 2,400 patients a day and draws in $140 million in annual revenue. One of the top employers in Lee County, Hope operates 16 offices in nine counties, with 1,100 employees and 1,200 volunteers.

Local leaders and business people say that in the competitive environment, Beckwith has succeeded by taking an entrepreneur's approach to running her non-profit. "She runs it like a major corporation, no different than if she were CEO of an 80-bed hospital and on call 24/7," says Charles Idleson, president and CEO of Investors' Security Trust of Fort Myers and a longtime Hope board member. "I'm a workaholic, and I could never work her hours."

Beckwith made Hope one of the first hospices to start its own pharmacy, now more common in the industry, leading to speedier drug deliveries. Likewise, she led the organization to employ its own physicians and contract with its own medical-equipment and supply companies, which also means greater cost and quality controls. "When someone needs a bed or oxygen, they need it now," she says. "If we can control more pieces of the process, we can do a better job."

Hope's reach and level of service has grown so broad that regulators have not declared a need for a new hospice in the Lee County service area since Hope was established in 1979. Beckwith has even withstood attempts by for-profit firms to end-run the certificate of need process with a legal maneuver that asks the state to declare a "special circumstance" that would open the door for them to operate.

But as she's protected her own turf, Beckwith has stepped on some others'. In 2006, when state regulators declared a need in neighboring Collier County, Hope competed along with four for-profit companies — Miami-based Vitas Healthcare, Texas-based Odyssey, United Hospice of Georgia and Ohio-based HCR — to enter territory covered by fellow non-profit Hospice of Naples. In its certificate of need application for Collier County, Hope argued it would take better care of cancer patients, citing statistics showing it spent more on chemotherapy and radiation for cancer patients than Hospice of Naples.

Hope and Vitas had the strongest applications, according to regulators. But Vitas' bid got some surprising extra support — from Hospice of Naples. The smaller non-profit worried that Beckwith and Hope would steamroll its fundraising ability in Collier County. Vitas, on the other hand, promised as part of its proposal to donate $20,000 to Hospice of Naples Foundation and to give its patients literature for donating to the foundation. Vitas won the certificate of need.

Beckwith, who has recently battled breast cancer, tends to grow indignant at any suggestion that her hard-charging ways are motivated by anything other than concern for her patients. The bid for expansion into Collier County, she says, was "all about people."

Nothing Beckwith has done generated more outcry than her proposal five years ago for Hope to enter the funeral-services business. Beckwith had long observed the high cost and stress that funerals impose on families, says Idleson, and believed a Hope-run funeral operator would enable families to work with a familiar and trusted organization while saving them half the typical cost of a funeral.

Hope's entire board supported the move. But after funeral directors and fellow hospice providers went ballistic, Beckwith pulled her application for licensure as a funeral services provider on the eve of a state hearing.

Beckwith makes no apologies for competing against Hospice of Naples or taking on the funeral industry. In both cases, she says, she exposed problems and raised awareness. Meanwhile, Beckwith began employing a former funeral director to help families navigate funeral options. It is among extensive bereavement services — offered at no cost — including a grief camp for children, that Beckwith says sets Hope apart from for-profits whose offerings cannot stretch as far beyond what is reimbursable by Medicare.

Beckwith's latest proposal is for a 47-acre master development in Fort Myers. The health complex will include traditional elements of hospice but also some new ideas, including an educational campus to train hospice professionals from around the world.

Beckwith won't be ready to release details until later this year. She will say that a funeral home is not among them.