I am writing regarding Estes Park Health’s October 2023 decision to eliminate in-home hospice and home health care in Estes Park. I think this was both a bad business decision and a terrible outcome for the Estes Park community.
My focus here is on my family’s personal experience with the repercussions of this decision. Of course there are also community-level issues in play, but I will leave those for others to discuss.
My father, Fred Nemacheck, died on September 8, 2024. After his terminal cancer diagnosis in July of this year, my family discussed my dad’s wishes in consultation with his oncologist and primary care doctor. Like so many of us, my dad decided that he would very much like to die at home, so that became our goal.
With very little notice due to a swift decline, we sought alternatives to hospice support beyond Estes Park Health’s discontinued home hospice care. We read newspaper articles and canvassed the medical options in the area, as did our doctors on our behalf.
Once we confirmed that the only hospice available in Estes was in-hospital hospice, we worked to build the infrastructure ourselves to be able to keep my dad at home.
Thankfully we had the financial resources to do so, and a lot of gumption.
We hired a private nurse and caregivers, relied on friends and family with hospice backgrounds, met with the Ft. Collins oncology palliative care team regularly, and had virtual appointments with my dad’s primary care doctor.
We had a good system worked out during business hours and we were able to have the basics prescribed by palliative care. However, our hastily built infrastructure did not allow for exposure to doctors and we had little to no hospice education besides what was guided by the private nurse, and dosage guidance from palliative care.
We were also unable to get the full set of “comfort kit” medications. That may not sound significant to those unfamiliar with end-of-life care, as we were prior to this experience, but those medications, and the medical consultations that accompany them, are essential components to helping your family member through his process as peacefully as possible for both the patient and their loved ones.
As so many families do, we took shifts as the primary care-taker for my dad. Dad’s final night was my shift. I consider myself quite a competent individual and had been with my grandfather when he died at his home under in-home hospice care. My mother is also a retired nurse and we have several other medical professionals in our family. But medical professionals are not hospice professionals. And this last night was absolutely terrifying.
My dad’s breathing became labored and sounded very uncomfortable. For hours, I was in tears as I tried to make him comfortable, loving him, singing songs, and reading bible verses – he’d been there for me my whole life, so I wanted to honor him in the way he’d asked.
The materials that I had been given did not include information about a death rattle and what that meant, which I later learned was the labored breathing. I did not have that basic information, I had no one I could call for an explanation, and I had no way to get the information I sorely needed – that this is an expected part of the dying process. The trauma I experienced at the time also triggered anger — how was I to know that this was expected?
As we struggled through the night and into the morning, my dad became more uncomfortable and without a “comfort kit,” we had very basic medication. To help get him through what turned out to be his last hours, we called the oncology on-call doctor who prescribed a different medication for his comfort.
Of course, to use that prescription, one of us had to leave my dying father to go and pick it up in a typical 30-minute Safeway pharmacy line. So, there I was, during my dad’s last hour, at the Safeway on a Sunday, waiting for medication.
Once my dad died, five paramedics and two police officers came to the house, with one officer staying a few hours. I had to dig through paperwork to find my dad’s do not resuscitate order as required by law.
The police officer had to interview me about the medicine, including the dosage and times of administration, that I’d dispensed during hospice period. Obviously, having a house full of uniforms was a less-than-ideal situation for us and for them, as we grieved.
I feel fortunate for the friends and family that helped us through this. As I said above, my family and I are actually particularly well-suited to provide the care we did, and it was devastating for us.
How must it be for those without sufficient financial resources and even less medical knowledge than we had available?
I hate that this healthy and natural at-home death was made very difficult, and for me traumatic, in my dad’s last days.
Hospice helps the family. By dismantling hospice, Estes Park Health has off-loaded the end-of-life burden solely on the family, during one of the most difficult and totally predictable life events.
We received no help at all from Estes Park Health. When I spoke to an EPH medical social worker she gave me the “option” of in-hospital hospice. The concept of “in-hospital hospice” has significance for insurance and billing, but it is not the “hospice” that my father, or many of us, want to ease our way out of this life and to help our families honor our wishes.
Without basic compassionate services, I do not believe that Estes Park is a viable place for retirees to and live. The burden of medical care on the family is too great. The lack of hospice and home health care is a critical loss to the community.
I believe there are ways Estes Park Health could have improved our experience without significant cost increases and have offered suggestions.
I urge Estes Park Health to reconsider the decision to eliminate in-home hospice care. No family whose loved ones choose to die at home should suffer the trauma that we did, trauma that could have been so easily mitigated.
Until then, I recommend that all retirees reconsider living in Estes Park.
Elizabeth Nemacheck lives in Richmond, Va. Walter Nemacheck’s obituary can be read here.
My heartfelt condolences and sincere empathy for your loss and enduring trauma. While EPH may have fallen short in their support, I believe there is potential for growth and healing.
The former hospice nurses and the previous director of HH and hospice, though not in current hospice roles, possess valuable experience that could be harnessed with creative and compassionate thinking.
By providing essential reading materials, resources, and connecting families with local end-of-life doulas, they could have made a meaningful difference.
Many families in Estes Park have faced similar challenges due to EPH’s closure of home health care and hospice services. The lack of awareness about these vital services, coupled with limited local marketing, has left a void that our community felt deeply.
It’s disheartening that local news outlets, influenced by EPH’s advertising, overlooked the importance of the closure, missing the opportunity for transparency and truth.
While EPH reported only a fraction of the affected staff, the reality included 23 displaced employees, highlighting a significant impact. Additionally, at the time of the closure announcement, approximately 30 patients were receiving care, contrary to EPH’s claims of fewer patients. The well-run organization previously provided essential services, such as housekeeping and in-home visits by doctors, to support hospice onboarding. I am not sure, and I believe EPH is required to contract or employ spiritual services as long as they accept medicare. They were blatantly, careless to not retain the one they had on payroll.
This narrative serves as a catalyst for change and awareness, paving the way for better support for families in need.
Thank you for sharing your difficult time losing a loved one. I too experienced this in Denver where we did have excellent in-home hospice help. This type of service is definitely needed in Estes, where our population consists mostly of old retirees. The EPH hospital (it is supposed to be a “hospital”) needs to include this in its future plans.
Thank you for sharing your story, Elizabeth. Your words vividly convey the pain and frustration you’re experiencing, and my heart goes out to you and your family during this challenging time. Your story resonates deeply with so many in our community, reflecting the struggles that others have faced. You’ve done an incredible job capturing those shared experiences.
What makes this even more upsetting is that it didn’t have to be this way. Estes Park Health’s (EPH) continued mismanagement has harmed countless families, and your story is yet another example of this ongoing failure.
Think back to 2022 when EPH closed inpatient pediatric care, the Birth Center, and other critical services. At the time, they assured us that hospice care, though facing challenges, was indispensable and would either be maintained or transitioned to a capable local provider. Fast forward to October 2023, and they announced the closure of outpatient hospice care along with other services, once again leaving vulnerable populations without the support they desperately need. For more on this history of missteps, I encourage you to read Dr. Tom Leigh’s recent article in the *Estes Valley Voice.*
While it’s tempting to vent our frustrations, complaints alone have led us nowhere. It’s time for meaningful action. In less than six months—May 2025—we have an opportunity to create change with the upcoming hospital board election. Fortunately, term limits prevent David Batey from running again, which guarantees at least one new board member. However, we also need to replace Drew Webb, as both he and Batey have been instrumental in the decisions that have caused significant harm to our hospital. Real change requires new leadership on the board, which in turn can ensure a qualified and effective administrative team to run EPH.
Some are hopeful that UCHealth’s potential involvement will resolve these issues. While UCHealth could bring some relief, we must remember that the hospital board will still exist, and we need competent members who will represent our community’s best interests. Additionally, hospital mergers often fall through, and the letter of intent between UCHealth and EPH is non-binding. We cannot afford to rely solely on external solutions.
The power to create change lies with us. Let’s vote for new leadership in May and encourage others to do the same. Together, we can begin to rebuild and secure a better future for our hospital and our community.