About the Award

The Circle of Life Award honors programs that strive to provide effective, patient- and family-centered, timely, safe, efficient and equitable palliative and end-of-life care; show innovation in approaches to critical needs and serve as sustainable, replicable models for the field; demonstrate significant impact on people with life-limiting illness and those around them; and actively work with other health care organizations, educational and training programs, and the community. The Circle of Life Awards are sponsored by the American Hospital Association, Catholic Health Association of the United States, National Hospice and Palliative Care Organization, and National Hospice Foundation. Major supporters include the California HealthCare Foundation and Cambia Health Foundation. For complete criteria and other information, visit www.aha.org/circleoflife.

Care Dimensions, the largest hospice in the Boston area, was providing excellent care to the children who needed palliative and end-of-life care. But it wanted to do better, and it wanted to build a robust and comprehensive program. So, two years ago, the hospice hired Tamara Vesel, M.D., a well-known, board-certified palliative care specialist who worked at Dana-Farber Cancer Institute and Boston Children’s Hospital.

Because caring for ill children and their families takes such an emotional toll on hospice staff, the organization introduced special training to better prepare caregivers for incidents like the time a 3-year-old child coded during an airplane flight to Philadelphia with his family.

The plane was turned back to Boston and cardiopulmonary resuscitation was performed by a doctor and nurse on the flight. Vesel and a nurse met the family in their driveway and proceeded to help them through the end of their child’s life. The family wanted the child’s death to occur at home so they could take him to their mosque and prepare him for a traditional Muslim funeral. Once the family was prepared, Vesel removed the child’s breathing tube.

“Removing advanced life support in a home setting is not something a lot of hospice programs would take on,” says Nate Lamkin, the social worker on the case. “As tragic and awful as it was, it went smoothly. The family felt so well-supported and the staff coped well with it.”

Building the new pediatric program had a profound effect on the whole organization, reminding everyone of the hospice’s compassionate mission, says Lamkin.

Care Dimensions has grown over 35 years from an all-volunteer hospice to become a leader in palliative and hospice care in a town that boasts some of the nation’s premier medical institutions.

Hospice leaders take that position seriously, and emphasize building bridges with a wide variety of partners. An 11-person provider relations team maintains those connections with hospitals, nursing homes, assisted living and physician practices.

“We have tailored our care to our customers … and we do things differently, depending on their preferences,” explains Rob Warren, M.D., medical director of palliative care. Details about those preferences are maintained in individual profiles in an online toolkit available to all staff members.

“We tell them we can help keep your patients out of the ER and out of the hospital,” explains Lyn Skarmeas, vice president of provider relations. “If you bring us in and let us help with the symptoms, there’s a good chance this patient with congestive heart failure won’t bounce in and out of the hospital.”

Key connections are with case managers at hospitals that are focused on reducing readmissions. “Most of these groups have fairly intensive case managers and we’re in close communication with them,” COO Judy Cranney says.

The hospice maintains local hospital representatives on its board to ensure that communication also is taking place at the higher strategic level, and at the table in conversations about regional risk-sharing arrangements, says President and CEO Diane Stringer. Care Dimensions recently signed onto the Cambridge Health Alliance ACO.

“We continue to be a strong partner with health systems as they are looking at having risk for the full continuum of care,” Stringer says. “That requires a level of sophistication around financial modeling that we are working to develop.”

The organization’s reputation for competence in both hospice and palliative care was affirmed when Boston’s Partners HealthCare suggested that Hospice of the North Shore take over its hospice program, which it did in 2011, expanding its geographic reach significantly to Boston and eastern Massachusetts. After some deep organizational soul searching, the hospice rebranded as Care Dimensions.

“There were two things our organization was known for — expertise in end-of-life care and compassion, and those two are inextricably linked,” Stringer says. “There is a science as well as an art to providing the best end-of-life care.”

The hospice also maintains a robust bereavement program open to both the families of those they care for and the rest of the community. This includes a wide variety of support groups specialized to type of loss, as well as a grief workshop focused on cooking and another on writing.


Hospice of Frederick County, Md., received a citation of honor in the 2015 Circle of Life Award. The rural hospice has grown from a small volunteer operation founded in 1979, and now provides a broad set of hospice and palliative care services across the care continuum as part of Frederick Regional Health System. It provides pain and palliative care services at home, in 300-bed Frederick Memorial Hospital, in long-term care facilities, and in its residential Kline Hospice House. Many referrals start at the hospital, and patients are followed by the same group of physicians, nurse practitioners, social workers and chaplains wherever they go in the community.