Louie B. Nunn Center for Oral History

Interview with Gretchen M. Brown, September 12, 2014

Louie B. Nunn Center for Oral History, University of Kentucky Libraries
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00:00:01 - Training in social work

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Partial Transcript: Alright, this is Turner West and I'm talking with Gretchen Brown.

Segment Synopsis: Brown recalls her schooling and training before working in hospice care, and how her education came at a time when the field of social work was expanding in higher education.

Keywords: Community health; Graduate school; Social work; University of Kentucky

Subjects: Hospitals; Social work & counseling; Universities and colleges

00:06:07 - The mission of hospice care

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Partial Transcript: So, you said you started on January 1st, 1982?

Segment Synopsis: Brown discusses how her training in social work reversed the philosophical trends in hospice care and treating the death process.

Keywords: Community organizing; Death process; Hospital expense; Lamaze technique; Social work

Subjects: Hospice care; Social work administration; Social work and counseling

00:11:00 - First year of the organization and early patients

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Partial Transcript: So Community Hospice of Lexington in 1982, what, what sort of support system were you creating for patients, and what kind of patients were you taking care of?

Segment Synopsis: Brown discusses the difficulties in the organization's first year, from struggling to maintain a non-profit organization to earning the recognition from area oncologists in the early years of organized hospice care.

Keywords: American Cancer Society; Cancer patients; Meals on Wheels; Oncologists; Primary caregivers; Social work; UK Healthcare, Markey Cancer Center

Subjects: Grants-in-aid; Medical personnel-caregiver relationships; Social work administration

00:22:10 - Medicare hospice benefit

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Partial Transcript: So the Medicare hospice benefit, do you want to talk about how important and critical that was for the expansion of--

Segment Synopsis: Brown discusses the addition of hospice benefits to Medicare in Kentucky, and how the state's support for hospice care stabilized the fledgling organization.

Keywords: Kentucky legislature; Medical ethics; Sunset provision; Volunteer care

Subjects: Medicare; Nonprofit organizations; Volunteer

00:30:01 - National hospice movement

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Partial Transcript: Can you talk a little bit about hospice nationally at that time?

Segment Synopsis: Brown discusses her program within the context of the larger national hospice movement, specifically how the Lexington economy relies on healthcare more than other cities.

Keywords: Alternative healthcare; Cicely Saunders; Hospice movement

Subjects: Physicians; Rural hospitals; University hospitals; Urban hospitals

00:37:05 - Expanding beyond Lexington

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Partial Transcript: So talk about the decision to expand outside of Lexington.

Segment Synopsis: Brown describes the growth of her organization, both outside of the Lexington area, as well as beyond serving primarily cancer patients and primarily outpatient procedures.

Keywords: Assisted suicide; Central Kentucky; Community education; Eastern Kentucky; For-profit hospice; Frankfort (Ky.); Lexington (Ky.); Satellite locations; Urban Studies Institute, University of Louisville

Subjects: Catholic hospitals; Health education; Health promotion; Rural hospitals; Urban hospitals

00:54:58 - Hospice care in rural Kentucky

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Partial Transcript: Well, and your entire professional experience had been in this urban setting with, um, hospitals in town.

Segment Synopsis: Brown discusses the difficulty of providing hospice care in rural areas of Kentucky, particularly mountainous regions with poor infrastructure.

Keywords: Eastern Kentucky; Hazard (Ky.); Roads

Subjects: Appalachian Region; Rural hospitals

GPS: Appalachian Regional Healthcare hospital in Hazard (Ky.).
Map Coordinates: 37.277581, -83.2298037
01:00:16 - For profit versus nonprofit

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Partial Transcript: So you mentioned for-profit, again, the for-profit/nonprofit, uh, hospice care, has there always been tension...

Segment Synopsis: Brown discusses the tension between for-profit and nonprofit hospice organizations, particularly amid national media scandals regarding the industry and health concerns of the 1990s like the AIDS crisis.

Keywords: Scandal; VITAS healthcare; Washington Post

Subjects: AIDS (Disease)--Patients; AIDS phobia; Health facilities, Proprietary; Malpractice; Nonprofit organizations

01:04:28 - Daniel's Care program / palliative care

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Partial Transcript: Well you mentioned children, which kind of takes us, it's a nice segue to sort of, the late '90s, uh, when we created Daniel's Care program, we get involved in palliative care.

Segment Synopsis: Brown discusses the creation of Daniel's Care, a hospice care program for children, and Hospice of the Bluegrass's entry into palliative care programs. Brown also comments on the consistent support she's received from her board of directors.

Keywords: AIDS; Daniel Pitino Foundation; Daniel's Care program; Kentucky Children's Hospital; Medicaid; Medicare; Robert Wood Johnson Foundation

Subjects: Charity organization; Endowments; Palliative treatment; Pediatrics

01:17:37 - Hospice of the Bluegrass in the 2000s

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Partial Transcript: So in the 2000s, Hospice of the Bluegrass really, kind of unprecedented growth, expanded to 32 counties...

Segment Synopsis: Brown recalls the growth of Hospice of the Bluegrass in the 2000s, specifically the organization's growth and national/international recognition, as well as the lingering challenges facing the hospice movement.

Keywords: Hospice agencies; Hospice movement; Malpractice; National leadership; Palliative care; Payment structure; Revenue

Subjects: Health care reform; Health counseling; Health education; Recessions; Rural hospitals; Urban hospitals

01:34:16 - Reflections / looking forward

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Partial Transcript: So as you look back, is there--we've got two kind of retrospective questions.

Segment Synopsis: Brown concludes with a general retrospective on her time with Hospice of the Bluegrass, as well as her recommendations for the organization's future.

Keywords: Bereavement service; Kentucky Appalachian Transition Services (KATS); Palliative Care; Veterans program

Subjects: Hospice care; Rural hospitals