Grace Mills knew very little about home health care coming out of nursing school. In her first nursing position, she worked in the hospital setting. Around that time, a friend who was working in home health spoke very highly of her experience with her employer, Enhabit Home Health & Hospice. 

Based on what Mills learned from her friend about home health and the company, she took what she calls a leap of faith and accepted a role in the Community Care Program at Enhabit. As a part of this program, home health agencies provide care in settings such as independent or assisted living communities, to help older adults age in place. 

“I loved seeing patients in the community and getting to build those relationships,” she shared.  

The role also gave her an opportunity to discover her true calling: hospice. 

Unlike some of her colleagues, Mills did not have a personal experience with hospice. As a home health nurse, however, she had the opportunity to work closely with the Enhabit hospice team.  

“A lot of my very close patients that I took care of transitioned to hospice,” she explained. “I got to see how incredible it was for our hospice team to take care of those patients at the end of life.” 

When Mills had the opportunity to move to hospice, she made the change. She is now a regional administrator for Enhabit, overseeing hospice services for several branches. 

“Hospice was definitely where my heart was,” Grace recalled.  

Getting to know patients on a deeper level 

Mills learned that home health care was much different than nursing had been in a hospital. When she was caring for a patient in a hospital, Mills didn’t feel like she was seeing the full picture.  

“When you get to go into the home setting to take care of patients, it’s a completely different ball game,” she observed.  

She found that she got to learn more about family dynamics and see what each patient’s living situation was really like. This really helped her get to know her patients and gave her the context to create strategies that patients would be more receptive to.  

Collaborative care 

Each hospice team is interdisciplinary and can be made up of social workers, chaplains, nurses, aides, therapists, doctors and nurse practitioners.  

The Enhabit hospice team often works closely with colleagues in home health to provide a continuum of care so that the focus remains on the patient, even during transitions from one care setting to another. 

Unlike some other types of health care, hospice provides support to both the patients and loved ones to address the emotional needs throughout the process as well. Together with the patient and their loved ones, the Enhabit team creates a circle of care to ensure the patient’s needs and goals are being met.  

Connecting with caregivers 

Throughout her time working in hospice, Mills has many experiences and memories that have stuck with her. She recalls one such patient who had been diagnosed with Alzheimer’s disease. Although his wife was a nurse, she was in labor and delivery, so geriatric care was foreign to her as she stepped into this new role as a caregiver. 

She considers herself lucky to have had the opportunity to care for this patient from the time he entered hospice until he passed away. During this time, Mills got to know both the patient and his wife. The patient was a little harder to get to know. He was stubborn, she recalls, and was reluctant to tell her what was going on.  

“He really didn’t want me to be in the home,” she said. 

Eventually, she succeeded in cracking through the patient’s rough exterior. As time went on, she also became close with his wife. She worked to teach her how to take care of her husband and also how to not take things personally, since his behavior was sometimes affected by Alzheimer’s. 

“We laughed together,” Mills remembered. “We cried together. I felt like I gained more from that experience than I can ever give. I feel that a lot.” 

She knew that she was able to make an impact on her patient’s life and make his final months more comfortable. In addition, she was able to be there for his wife. Even now, years later, she is still in touch with the patient’s family. 

Addressing misconceptions 

There are many things Mills wishes she could change about how people perceive hospice.  

“When we are ready to live the best life with whatever time we have left, whether that’s a month or six months, hospice is there,” she said.  

The sooner patients can begin hospice services, the better. Mills prefers having at least six months with a patient because it makes the experience and quality of the patient’s life so much better.  

“You’ve got people in the home getting to know you, getting to know your family dynamics, getting to know your specific disease process and how it’s affecting you.”  

While Mills acknowledges that there may always be people that don’t fully understand hospice, she already sees change happening.  

“By educating one person at a time who then shares what they have learned with the next person they meet, we can help more people take advantage of the benefits hospice offers,” she said. 

Caleb Harms has a warm, calming presence that has served him well in his decades of work as a hospice chaplain. While he is quick to share stories of his own, his first instinct is to find a connection with everyone he meets. After that, it is all about listening. What he likes most about his job is that he has no agenda.  

“I am there to be and do whatever they would like, whether it be for the patient or family members,” he said.  

Harms has been ordained for over thirty years and has worked for Enhabit Home Health & Hospice since 2020. 

When he reflected on how he ended up working in hospice, Harms recalled that the seed was planted many years ago. When he graduated from seminary, Harms had a friend who was a hospice chaplain. As his friend shared stories about his experience, he began to consider whether working in hospice might be in his future.  

As Harms moved to a new city years later, he asked the same friend for help finding a job.  

“It just all fell into place,” he said.  

He has been working with hospice patients and their loved ones ever since. 

Setting a strong foundation 

The hospice environment can sometimes be in stark contrast to today’s fast-paced world. For Harms especially, it’s important not to be in a hurry with patients and their loved ones.  

Harms makes sure he takes his time, focuses on listening and doesn’t make any assumptions about his patients or their loved ones.  

“For those of us who have worked in hospice for a long time, it’s hard to not go into the ‘this is what you do’ mode,” he admitted.  

Harms always reminds himself that this may be the first time a family has experienced hospice. To meet patients and families where they are, his philosophy is to approach each patient’s hospice journey as if they are experiencing it for the very first time. 

Working with families 

“I’m always trying to remember that this is an opportunity for a family to get as prepared as one can, as best as one can,” Harms said.  

If there’s one thing Harms has learned as a hospice chaplain, it’s that although we all know the end of life is coming, we can never be truly ready.  

When a person enters hospice care, the grieving process typically begins. Anticipatory grief usually starts while the patient is still alive.  

“Then, when they die, they are at peace,” he said. “It’s not that there’s not pain, but the family is more at peace.” 

Harms remembered the first visit he made to a specific patient’s home. He remembers this patient greeting him by his first name and saying, “I’m so glad you’re here!”  

That’s not the reception Harms is accustomed to receiving from working in hospice, but he was happy to get such a warm welcome.  

Harms recalled that the patient’s husband and three daughters were sitting together at a table. Before he had the chance to introduce himself, the patient expressed her gratitude for his situation.    

“I’m so glad to be in hospice care because now I have the opportunity, because I know I am going to die, to tell everybody what I need to tell them,” the patient shared.  

This experience taught Harms about the hospice journey. He has found that hospice provides patients with the opportunity to tell people they love them. It also provides an opportunity for forgiveness — whether the patient needs to be forgiven or they need to forgive someone else. 

In Harms’s experience, a person coming into hospice care usually knows they are dying. While patients may never say it out loud, he feels that they know their bodies better than anyone else. And while hospice is a positive experience for many families, at times it can be incredibly difficult for a patient’s loved ones. Harms tries to address this directly during his visits.  

“It’s important to name it,” he mentioned. “There’s nothing good about cancer. There’s nothing good about Alzheimer’s. There’s nothing good about temporal dementia. This is just a terrible time.” 

An amazing opportunity  

During Harms’s time as a chaplain, he has worked with patients and their loved ones representing all belief systems. Just as there are misconceptions about hospice, there are also misconceptions about what a chaplain does. 

Harms finds patients and their loved ones can sometimes be angry at God, angry at their church or feel as though God has abandoned them. Or, in some cases, Harms feels as if he represents every bad preacher, pastor, rabbi or imam they have ever had.  

To counter these feelings, Harms works to make sure patients and their families realize that he is there with them, wherever they are in their struggles. When he meets patients for the first time, he makes it clear that they are in the driver’s seat.  

“I don’t want to say, ‘This is what I’m going to do,’” he shared. Instead, he leads with, “It’s up to you. What would you like?”  

For some patients, Harms comes to the home every week. For others, it’s every other week or even once a month.  

He finds that almost every family, at some point, shares the same sentiment: “Oh, your work must be so depressing.”   

Each and every time, Harms responds the same way: “No, actually, it’s wonderful because I get to meet amazing people like you.”

Lisa Baethge has been a nurse for 25 years, 18 of which have been in home health. For the past five years, she has worked at Enhabit Home Health & Hospice. In her current role, she is a branch director, which means she oversees patient care, finances and clinicians.  

Patients are referred to home health for many reasons — maybe it’s to drive again or to get out of a wheelchair and walk a few feet. No matter what the patient needs, the Enhabit team is there to help them meet their goals. 

“The care we deliver is exceptional,” she said. “It all boils down to what’s best for the patient.” 

Empowering patients to manage their care 

Baethge and her team start caring for patients right when discharge planning begins. The intent is to strengthen patients’ abilities to manage their health and well-being on their own.  

“Our goal is to educate them to know how to manage their disease process,” she said. 

Members of the Enhabit care team have access to a wealth of patient education materials that they can bring to a home visit and leave with patients. Each patient handbook covers a different topic, such as fall prevention or cardiovascular care, that’s specific to a patient’s health care journey. The information in the patient handbooks is simple and presented in a way that patients can easily understand. 

“At each visit, you can bring something different,” she explained. “This helps us stand out from any other agency.”

The importance of teamwork 

Depending on the plan of care, Enhabit patients can receive services from a nurse, physical therapist, occupational therapist, speech language pathologist, medical social worker and home health aide. Although a patient might see all of these clinicians throughout their week, Baethge says that one of the main things Enhabit emphasizes is continuity of care.  

“Among all of us, we communicate very well,” she said. “We keep each patient’s goal in mind and work toward that.” 

With the help of real-time updates made on hand-held devices, each member of the care team understands the plan for the next visit for each person, which Baethge thinks provides a level of comfort to her patients. 

 Medicare asks patients to rate home health providers and allows the public to review these ratings to help make decisions about care. Baethge’s branch has 5-star ratings in both patient satisfaction and patient outcomes. Lisa gives credit to the entire branch for the caliber of care being delivered.  

“It’s a team effort,” she said. “We care about our patients. Not just as a patient, but as an individual. We also care about each patient’s family members.” 

Making a difference 

Perhaps one of the best measures of success is when Enhabit gets repeat patients. When patients remember their experience and choose Enhabit again, Baethge feels especially grateful and proud of the difference she and her team are making. 

“Good things are happening here,” she said with a smile.  

For Leandra Sanchez, going into nursing was second nature.  

“My mother was a nurse,” she said. “Growing up, I remember hearing all the stories she would tell about touching people and making a difference. In my heart, I wanted to experience that as well.” 

Sanchez likes to think that she ended up in home health not by chance but rather through divine intervention. She had worked as a nurse in urology for 22 years and decided to take a break. During that time, Sanchez got a call that would change the direction of her career. It was about a job opening in home health. 

Sanchez wasn’t ready to go back to work yet. She asked the branch director to call her back in a month. During that time, she did her research. She looked at what people had to say about Enhabit Home Health & Hospice, and she liked what she saw. After her interview, Sanchez decided to give home health a shot. Now 10 years later, she is grateful that she made that choice. 

Making a difference, one day at a time 

One of the things Sanchez likes best about her job is getting to see patients in their own homes. When compared to a hospital or clinical setting, patients tend to be more honest at home, and Leandra can see the full picture of a patient’s day to day. For example, she can help educate patients on how their diet could be impacting their recovery by noticing the food that’s out on the counter.  

Sanchez considers it a privilege to see patients in their own environment and takes that responsibility seriously. Each night, she calls the patients she will see the following day to make sure they remember their appointment. As a nurse preceptor, she trains incoming Enhabit nurses to do the same.  

“We know patients have a life, even if they may be homebound,” Sanchez explained. “We honor the fact that they may have nap time or visitors.”  

She also makes sure to call if she will be late to an appointment. What she thinks of as common courtesy means a lot to her patients. 

Health care can be a stressful job. Working through the COVID-19 pandemic has made some days even more challenging. Each morning when she wakes up, Sanchez focuses on one goal: to make a difference in each patient’s day. In taking this approach of one patient at a time, day by day, she avoids burnout and keeps showing up for her patients and showing how much she cares. 

Seeing the impact 

Thinking back on the many patients Sanchez has cared for, she recalls one in particular. For two years, she saw this patient three times a week for a wound on her leg. “I was the nurse and she was my patient,” Sanchez explained. “But we became very close. We became friends.”    

The day finally came when the patient’s physician determined that no more visits were needed and she was discharged.  

“After dealing with this for a while, the wound on her leg was healed and she was so grateful,” Sanchez said. “Those are the cases where we see a good outcome.” 

Empowering patients 

Sanchez feels that empowering patients to be able to care for themselves is extremely important. In fact, on her first visit, she always tells patients that the goal at Enhabit is education.  

“One of these days, I’m going to be out of the home,” she said. “If they don’t understand the disease process or their medications, then I haven’t done my job.” 

Although Sanchez is often called upon because of her depth of knowledge in urology, she has found that working in home health has made her an all-around better nurse. Now, she feels confident working with patients with a variety of diagnoses — whether it’s diabetes, congenital heart failure, chronic obstructive pulmonary disease (COPD) or another chronic condition. 

Collaborative care 

In addition to field nurses like Sanchez, Enhabit home health patients have access to an interdisciplinary team that works together to deliver an individualized plan of care for each patient. A patient might see different clinicians for physical therapy, occupational therapy, speech therapy or other needs, based on each patient’s goals. The care team decides which services the patient needs at different stages of their recovery. That way, the patients aren’t overwhelmed, and they get the right care at the right time. 

Sanchez’s heart guided her into the field of nursing and a lifetime of caring for others. Just like her mom, she now has countless stories about touching people and making a difference. It’s compassionate and patient-focused clinicians like Sanchez who make Enhabit special. 

After Lynn Kerr’s father died 20 years ago, her mom moved in with her and her brother so they could care for her. All three family members were living together again under the same roof. One January day, Kerr and her brother noticed that their 97-year-old mom was eating less and less. This was the first sign of their mom’s rapid physical decline.   

Kerr is a social worker by profession and was familiar with the signs that someone was nearing the end of their lives. She knew what she had to do: begin hospice care for her mom.  

Kerr chose to pursue hospice care because she wanted her mom to pass away in a personal place as opposed to the impersonal setting of a hospital. Admittedly, she was happy to have support navigating the difficult tasks — like calling a coroner — as well. 

As her mom’s primary caregiver, Kerr talked to her physician, who made the referral to Enhabit Home Health & Hospice.   

“The person who did the assessment was amazing,” she said.  

Kerr’s mom was approved for hospice and a nurse came for the first visit the following day. From there on, there were visits from a chaplain, a physical therapist and an occupational therapist, among others.   

“People need to know that it’s going to be incredibly overwhelming that first day or two,” she said. “After that, things calm down.”   

In Kerr’s case, visits from the hospice team began to fall into the household’s regular routine.  

They met me where I was 

“My overall experience with Enhabit was amazing,” Kerr added. “I felt really supported. The nurse and chaplain were caring. I realized the nurse was there for me as much as she was there for Mom. We would sit and talk. They were there and met me wherever I was.” 

Kerr remembers the day that her mom died. It was in August, about five months after starting hospice services. The nurse who was assisting her mom requested that Kerr let her know if her mom passed whenever she wasn’t there.  

Kerr made the call in the early hours of the morning and the nurse arrived within an hour to be with Kerr as she processed her mother’s death — and stayed with her all day.  

Kerr was astounded by the kindness and partnership of the whole Enhabit team. Both the nurse and the chaplain also had experiences with losing loved ones. They shared a little bit about those experiences without implying that her pain was any different than theirs had been.  

“I remember what that felt like,” she recalled them saying to her, in a gentle and comforting way.  

Kerr now calls her mom’s nurse a friend and they are still in contact.  

“It was a good experience,” she reflected. 

Learning about hospice 

Kerr understands that a lot of people don’t realize that they have a choice to begin hospice services at home. She recognizes that many people don’t think about their wishes for the end of life and what they want it to be like. Kerr is grateful for the care plan the hospice team made for her mom and believes that it was the best choice for their family. She encourages anyone considering hospice care to think it through carefully and ask questions.   

As a social worker, Kerr knew that hospice wasn’t about her mom getting better. But she still found herself wondering why staff weren’t at her home as often as she might have imagined. At one point, Kerr had a realization — this wasn’t a situation where someone would simply take care of her mom so she could go about her life as normal.  

“This is your life right now,” she recalled thinking. “That was big.” 

Kerr never anticipated the level of support she would receive in hospice. In her line of work, everything is family-driven. She recognized that the hospice staff allowed her mom’s journey to be family-driven as well by following her family’s wishes for her care.  

Kerr remembers a time when her mother was having a rough day and she was close to calling an ambulance. Instead, she called her mom’s nurse, who reassured her that in hospice, you can begin the process of letting go and start to resist those urges. Kerr understands why someone would call a hospital and set steps in motion to prolong a person’s life. But she remembered that hospice is all about allowing that person to pass peacefully and comfortably. 

While her mom was in hospice, Kerr found that it was helpful to have someone to talk to. She reached out to a therapist colleague and asked if she would be willing to meet weekly. It helped her to have a support system outside of her brother and the Enhabit team as she, her mom and her brother navigated the end-of-life process together.  

Having difficult conversations 

Kerr watched her mom’s level of awareness and cognition improve and decline throughout her time in hospice. At first, her mom asked her why a nurse was coming.  

“Mom, you’re getting close to the end of your life,” she explained. “And you’re going to need the help later. So, we’re going to start now. She’s just checking to see how you are doing.”  

Although she took the time to explain, Kerr wasn’t sure her mom ever fully understood why the nurse came to check on her. 

She also recalled the times when her mom didn’t know who she was and how hard that was. It wasn’t unusual for Kerr’s mom to wake her up at night and ask who she was. Sometimes after explaining she was her daughter, her mom would say, “I have a daughter?” 

As Kerr spent more time with her mom, her mom shared stories she had never heard before, some which broke her heart and some which she couldn’t have anticipated.  

Even on hard days, there were special moments — like the time her mom said, “I’m going to miss my kids. I hope you have a good life.” Memories like that still pull on Kerr’s heartstrings.    

Cherishing the memories 

At first, Kerr’s mom had more questions about the chaplain than the nurse. She wasn’t sure if she should continue having the chaplain come for visits. However, the chaplain became one of her mom’s most treasured guests.  

“I heard the laughter,” she said. “They would talk, she would tell her stories, and there would be laughter for an hour. I thought that was a pretty precious thing to give her at that point in her life.”  

Kerr and her mom didn’t always have the best relationship, but they made up for lost time. There are a few memories that will have an everlasting place in her mind. During her mom’s final days, she remembered her mom telling her that she was lucky she was always there. 

She also remembers one special day when she woke up and noticed her mom was holding her hand. This wasn’t typical for her mom to do, so it meant that much more.  

“There isn’t a day that goes by that I don’t miss her,” Kerr said. “While the pain doesn’t go away, you get better at living with it. When you have a conversation and start thinking about it, you’re right back in the moment. And it’s OK.”  

Her mom expressed that she was lucky to have Kerr and her brother in her final days. And, as Kerr said, “We were lucky to have her.” 

Keri Gaytan joined Enhabit Home Health & Hospice as a branch director in 2020. In that role, she focused on patient experiences, quality outcomes and how to recruit and train staff to get those outcomes. Now, Gaytan is on the clinical excellence team as a quality and outcome specialist. In her position, she works with branches across the state of Florida to educate staff on how to use Enhabit’s resources to accurately score OASIS, a tool for Medicare-certified home health agencies to track and report on patient outcomes. 

Gaytan’s career in health care started after she graduated from nursing school. She first worked in a hospital and then moved into home health, where she has stayed ever since. 

“I fell in love with it immediately,” she said. “I fell in love with being able to go into the patient’s environment and help them get better. When you go into their home, you see what they need, or what they have, and how you can make them safe in their environment.”  

Outcomes and relationships 

One thing that Gaytan has learned during her time in home health is that clinicians often have to think outside the box.  

“You have to look at the community resources,” she explained. “You have to take in the family dynamics. You have to learn the patient’s health knowledge and what’s going on with them.”  

Although there is a lot of critical and innovative thinking involved, Gaytan appreciates being in a position that helps provide clinicians with appropriate tools to assist patients, no matter their circumstance. She believes that education is the foundation for working toward the best possible outcomes for each patient. 

From Gaytan’s perspective, Enhabit’s focus on patient education has made a huge difference in patient satisfaction and outcomes. She thinks making education a priority is something that sets the company apart. Materials provided during Enhabit home visits are disease-specific and printed in simple language that uses bigger fonts to make them easier to read and more accessible to a wide variety of patients. 

A coordinated approach 

While home health patients may see one clinician during a home visit, the entire team is collaborating on a plan of care that is individualized for that patient’s needs and goals.  

“We use all of our resources to provide that better way to care,” she explained.

In weekly case conference meetings, the entire team reviews the plan of care for each patient to develop a collaborative approach, making necessary adjustments and being proactive about any needed interventions to get each patient back to doing the things they love. 

“We really do treat our patients as if they were our family,” Gaytan said. “That’s the standard. When you do that, you’re going to go above and beyond.”  

Having a bigger impact 

In Gaytan’s position, she’s able to see the impact Enhabit is making on both an individual and a larger level.  

“What’s unique to me about Enhabit is when they identify anything that a patient or a community might need, they don’t stop there,” she added. “What I’ve really seen is how involved they are with the community — with the hospitals and with the referral sources — collaborating with them to get patients better. It’s truly ‘What can we do for this patient and this community?’” 

For Gaytan, working at Enhabit has brought enjoyment back to her nursing career and has given her hope about the future of health care.  

“It’s really made me feel like I can make a difference with patients. And it really makes me enjoy my job,” she said.