Nestled into a residential neighborhood on the city’s Northeast side, Abode Contemplative Care for the Dying is a three-bedroom home that serves as a safe and comfortable space for people to die.
Abode is one of two non-medical end-of-life facilities in Texas – and one of 42 nationwide – that cater to those who have no other caretakers and no financial means to “live their ending in peace.”
“People come to this house who are in their last few moments of life, which can be anywhere from several hours to several months,” said Martha Jo Atkins, Abode’s executive director. “Everyone who comes into this home is experiencing poverty, and when we talk about poverty, it includes poverty of spirit.”
The 26 facilities make up the Omega Home Network, the nation’s only non-medical hospice facilities that do not charge for services. Aurora House, located in Weslaco, Texas, is the only other location in the state.
According to the Centers for Disease Control and Prevention, there are 4,300 licensed hospice care facilities in the nation, with more than 1.4 million people needing short and long-term care.
Patsy and Edwin Sasek were experienced in hospice care when they founded Abode five years ago with other hospice providers. Their model was based on hospice care in the Middle Ages, when convents and monasteries would help people reaching the end of their lives by providing physical and spiritual comfort. Abode provides what it calls “contemplative care,” which is rooted in meditation, mindfulness, and compassion.
Through individual and business donations, Abode has been able to care for more than 200 people since opening in December 2014. Its services include “end-of-life navigators” on site at all hours to aid a dying person with anything from sharing a meal to lending a friendly ear to simply sitting by their bedside, Atkins said.
When Jack Hall was referred to Abode, he was homeless. He had suffered a traumatic brain injury, and because he had no permanent residence, he lived in University Hospital for several months, moving from floor-to-floor to avoid being escorted out by security. Hall has stage 4 prostate cancer and made the decision to stop treatment for the disease, which has no cure.
“I stayed there because I really had nowhere to go. I was in pain, I needed sleep. I had been praying, saying ‘please just let me find someplace where I can go to die,’” Hall said. “A hospice worker referred me [to Abode] and when I got here, I knew there was something different about this place, something special.”
Hall, 64, is too young to qualify for Medicaid and falls into what Atkins calls a “categorical gap,” because federally funded programs do not pay for extended hospice care. Doctors told Hall he has several months to live before he’ll ultimately succumb to his disease.
“There are a significant number of people in the country who fall into this gap, and do not have insurance to pay for hospice,” Atkins said. They may have Medicaid applications pending, but often these people become a charity case for hospice providers, who try to find alternate arrangements when their facilities cannot provide long-term care.
Suzette O’Calliham, care coordinator supervisor and a registered nurse, is the liaison between hospice facilities and Abode, and screens each referral to make sure the person is a good fit for the non-medical home.
“If someone’s diagnosis causes them to have seizures, they wouldn’t be a good fit for our facility because we aren’t equipped to help them medically, so we would have to turn them away,” O’Calliham said, noting the need for full-scale hospice care is greater than available beds throughout the city.
Atkins said more Omega Home Network homes are being built throughout the nation to work toward meeting the needs of a growing population needing hospice care, but noted there are likely hundreds of people throughout San Antonio who soon will need this type of care with limited options available.
On Monday, the Omega Home Network began its annual three-day conference at the Marriott Rivercenter, held for the first time in San Antonio since its inception in 2012. The purpose of the conference is to share best practices, and have conversations about how each facility navigates the emotional, spiritual, social, and physical aspects of dying, Atkins said.
“Everyone who comes into one of these facilities is dying – there are no illusions,” Atkins said. “We are not experts on death; the person who is dying is the expert, and what we do here is consistently show up for that person and hold space for them. Our opportunity is to be present with the person who is dying when no one else can.”
The shortest stint at Abode lasted five hours, the longest was a little more than nine months, which O’Calliham said was due to extenuating circumstances. The average stay for someone at the Abode is about 14 days.
While many who come through the home are in the later stages of their life, it did treat a 28-year-old mother, the youngest-ever resident, whose 2-year-old and 8-month-old children would visit her during her time there.
“We try to help facilitate conversations about grief and loss with residents if they are interested, and include family members in anything that goes on in the home,” Atkins said. “If a grandparent wants their grandkid to stay the night, we make that happen for them. We work to honor what people need as they work toward accepting their situation and ultimately accepting the inevitability of death.”
Volunteer Edward Alderette spends at least five days a week at Abode, sitting with the residents and inviting them out for dinner, or spending time in the outdoor garden area. His wife, who suffered from Alzheimer’s disease, died at Abode in 2013 following four months at the home. As she continued to cognitively decline, Abode was able to provide her the around-the-clock care needed.
“In the last days she spent here at Abode, she was like a 2-year-old. Abode cradled her when she went down further and further into the disease and returned to childhood, and I wouldn’t have been able to do that for her on my own,” Alderette said.
Now 82, Alderette has spent more than 1,000 hours volunteering at Abode. On a recent visit to Abode, he was sitting in the room of a woman who had just arrived with several inoperable brain tumors.
“I had never met her before, but I spent about 45 minutes with her as she slept. I hope to make her feel a comfortableness in knowing she is not alone, that someone will be with her in her final moments, even if she is not completely aware,” Alderette said.
For Hall, having volunteers spend time with him as he inches toward his final days gives him a sense of peace and belonging that he previously never experienced.
“Jack is living his ending here,” Atkins said. “He is dying, and he is approaching this with consciousness and connection and letting people love him. He told us that he has not had a meal around a dinner table with family since he was 17. There is a beauty in that for him, and for all of us, as he nears his final days.”
Hall has seen three people die since arriving at Abode, and knows his time will come.
“We all have a destiny with death, it doesn’t bother me. It’s all about how you approach it. You don’t have to know everything. What I do know is that when I go, I will go knowing that what I get here [at Abode], a lot of people aren’t used to this. They aren’t used to a home. I know I wasn’t. But this is a home,” Hall said.