A new study estimated that under 200 patients have been admitted to a new palliative care facility at Dartmouth-Hitchcock Medical Center since it opened about eight months ago. They are helping to reshape how end-of-life care is delivered in the Upper Valley.

If you look around the brand new Jack Byrne Center for Palliative and Hospice Care, it feels a lot like home. There are a kitchen and dining room, a library and a living room, and a big patio to enjoy the flowers.

"I would say it is a privilege," said Melissa Garland, a nurse manager at the facility. But, the people who are admitted here are all struggling with serious illness. Nurses prep for new patients every day. And while some will go home, many will take their last breaths in these beds. The average stay is three days.

Hospice Care

"I wouldn't say it is depressing. I would say it's sad, and sad is ok. And on a daily basis, we acknowledge that with each other," Garland said. Hospice care typically takes place at home, where doctors say most people want to die. But if a person in this region is too sick, in the past, they would be admitted to Dartmouth-Hitchcock's main facility just across the street.

"Maybe their symptoms of pain or nausea or delirium are out of control," said Dr. Kathy Kirkland, the DHMC's section chief for palliative medicine. This $22 million center, $10 million of which came from the Jack and Dorothy Byrne Foundation, fills a gap. It allows the seriously sick to get the comforts of home with acute care.

Treatment Management

So what this does it provides a choice that wasn't there before. To have both a home-like environment and the intensive symptom treatment management. There's also another important component to what happens here besides patient care education and research. To better understand and eventually teach how patient care is delivered.

Treatment For End-Of-Life Care

They have lost some of the skills of being with dying. And with an aging population and new medicine, treatment for end-of-life care is evolving.

More complicated deaths with multiple illnesses and with options for sometimes it seems like we can keep a body alive almost endlessly, so there is a lot more choice involved in how to do this well.


Input from patients and family members is a part of the new shared decision-making approach to caring for the dying. It's something these nurses do every day. So while we are really sad about the loss of life, we are dedicated to making a difference at this time.