35 years of palliative care | News, Sports, Jobs


SARANAC LAKE — Last Friday, Ann Merkel and other original High Peaks Hospice founders gathered at Saranac Village in Will Rogers, where filmmaker Jim Griebsch began creating a video to document the early history of High Peaks Hospice .

The High Peaks Hospice 35th Anniversary Celebration will be held Thursday, June 2 from 5-8 p.m. at the Saranac Waterfront Lodge in Saranac Lake.

The new video will be released and Ann Merkel and other founders will be there.

Start of end-of-life care

Merkel grew up in New Haven, Connecticut, where the first hospice in the United States opened in 1974.

In 1986, Ann and her husband, the late Dr. C. David Merkel, were living in Saranac Lake. That year, Medicare determined that death was no longer a diagnosis warranting hospitalization.

Families struggled to deal with the death of their loved ones without support at home. The Merkels felt keenly about the lack of compassionate care options for the dying. So Ann and David decided to do what they could to start palliative care services locally.

“This is a very exciting event for a group of people who have started hospice,” said Ann Merkel.

“It’s helped many, many people in the North Country here.”

From the ground

In 1982, Medicare authorized reimbursement for palliative care. The program was unique, offering comprehensive family-focused services that included medical, nursing, social, spiritual care, volunteer support, bereavement services as well as the availability of specialist care by physiotherapists, nutritionists and speech therapists.

It would cover all medications related to comfort and symptom management as well as durable medical equipment and oxygen. There are no co-pays or deductibles, no bills to deal with. Care could be provided anywhere, at home or in institutions, and accessible to anyone, regardless of diagnosis, with a prognosis of six months or less.

In 1986, the Merkels got to work. Their first step was to contact Katrine Krester, director of the Franklin County Department of Public Health.

As a public health agency, it had the authority to provide hospice services, but the Tri-Lakes spanned several cities and two counties, so an independent hospice would have to be formed.

Katrine worked hand-in-hand with the Merkels to learn more about the hospice and understand the regulations. They contacted the New York Department of Health to begin the process of becoming a certified palliative care program. The message they received from the DOH was that it would be impossible to hold such a comprehensive program in such a small community. It was too complicated and required so many services. It was out of reach for such a rural area.

Ann and David Merkel were not discouraged. They began the process by filling out a certificate of need providing statistics on the number of deaths and the lack of care options available for the dying.

Merkel hand-delivered 27 copies of the certificates to the Albany Department of Health, delivering each to the appropriate office.

The Merkels then rekindled the health care spark of Saranac Lake’s legacy as a tuberculosis care haven. With that spark and the extraordinary volunteer spirit of Tupper Lake, Lake Placid and Saranac Lake, a local palliative care movement was underway.

team building

Ann and David have formed a team.

Merkel has signed on with her partner Robert Kasulke to lead the medical care.

Kasulke became the first Medical Director of High Peaks Hospice, and today he continues to serve as Medical Director of Jefferson County Hospice.

“When we initially founded the hospice, the organization was obviously in its formative phase, from day one,” he said.

“Our service area was the Tri-Lakes region. Of course, now it has turned into something much bigger and the coverage is much bigger. At that time, the federal government, Medicare in particular, decided that, unlike in previous years, hospitals were not going to be reimbursed by Medicare for patients who went there to die. It is as plain and simple as that. They kind of cut the funding for that particular event, and they stopped paying for it. Well, most people in those days had no idea what hospice was, patients and families didn’t. It was a drastic change for them, and they’re not comfortable caring for someone who was dying, not at home, not in a medical situation.

One by one, professional and lay volunteers stepped up to dedicate their time and expertise to provide all the services needed to receive palliative care certification.

Jimmy Bevilacqua was the required prep pharmacist available 24 hours a day.

Sr. Camille, director of the Uihlein Mercy nursing home in Lake Placid, worked to ensure that palliative care services would be available for residents of the nursing home. It also provided an opportunity for new hospice volunteers to be introduced to working with the disabled. Alice Scollin, endowed with a keen sense of organization, recruited and coordinated volunteers for family support or office work.

Funeral director Andy Fortune launched the bereavement program, supporting families for 13 months after the death.

Father Rick Dennis provided spiritual care and coordinated with other ministers to provide end-of-life comfort in patients’ homes.

Prof. Dennis’ wife, Connie Dennis, who was executive secretary of the Saranac Lake Voluntary Health Association, facilitated the loan of medical equipment from SLVHA to the hospice.

home office

The original Hospice office was a den in the Merkel household. But the community helped here too, and the first office spaces were provided free of charge by the Trudeau Institute and the American Management Association. Madden’s Storage donated office furniture.

“It all started in a small office on the second floor of our house on Park Avenue”, said Ann Merkel.

Most projects of this magnitude take years to come to fruition, but in less than a year, High Peaks Hospice opened its doors on a strictly volunteer basis, providing home care in the Tri-Lakes. In 1988, they received their license from the state Department of Health and became eligible for Medicare reimbursement.

Two years later a small hospice support group in Elizabethtown asked if High Peaks Hospice could expand its reach and soon all of Essex County was added.

In the early 1990s, the Hospice of Warren County joined us. What started as a two-person mission quickly became a triumph of volunteerism and community spirit.

“What was our initial impact, of course, was when we started admitting patients and treating them in our hospice,” said Kasulke.

“We took the place of the hospital. Patients were allowed to stay at home. They had comfort care. We had specially trained hospice nurses, volunteers specially trained to volunteer for patients who were more likely than not to be a typical hospice patient, and social workers who would care for families who are in hospice . Because the families have been somehow thrown off balance by this terminal diagnosis of their loved one. You don’t really want to fill out paperwork for Medicaid, Medicare, etc., etc. They helped with all of this. and if they had spiritual needs, of course, which many of them have, we had people who would help fill that need as well.

“We had it all from day one. The need was that, again, patients could not be admitted to the hospital. We took care of them at home. Gave them comfort and interacted with their personal doctors or other situations they had. This was the thrust of how we assigned our patients in the Tri-Lakes area.

High Peaks Hospice provides dignity, comfort and peace at the end of life. It serves 5,400 square miles, including all of Essex and Warren counties, southern Franklin County, and parts of Washington, Hamilton, and St. Lawrence counties.

“When we first started, the Hospice movement was pretty much mature in England and Canada,” said Kasulke.

“It wasn’t really a well-known entity in the United States in the early ’80s. Of course, over time it became kind of a household word, hospice, and the whole movement, if you will. to call a movement, has matured into the modern realm.

Hospice movement

Dr David Merkel served as the Hospice’s medical director until his death in 2012.

For many years, Ann Merkel remained very active at High Peaks Hospice, serving as the initial Executive Director and then Chair of the Board.

She was also past president of the Hospice and Palliative Care Association of New York, where she worked to expand access to hospice palliative care in rural areas of the state.

“It was wonderful in two areas,” she says.

“First, all the volunteers who came from all over to help start a hospice in the North Country. Secondly, for all the health professionals who wanted to give their time as volunteers for free to help us start the hospice. It was just extremely exciting for me. It was something I had never experienced or seen before in the various places I had lived.

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