PeaceHealth eliminated its Advance Care Planning (ACP) program in recent layoffs, canceling scheduled patient appointments with only a few days’ notice. The free program helped patients complete and update advance directives and end-of-life care preferences with trained coordinators embedded in the healthcare system.
The program had four coordinator positions across the healthcare system, including Whatcom County, supported by social workers outside of the program. PeaceHealth clinicians flagged patients they believed would benefit from creating advance directive documents or having that paperwork updated. Coordinators would then meet with patients and their families, equipped to notarize documents and have difficult conversations that clinicians didn’t have the time for, program advocates said.
Former PeaceHealth employee Hilary Walker, who was the ACP program’s first coordinator, said the program provided a holistic approach to patient care.
“These are patient-facing programs that help a patient’s story be part of their medical plan,” Walker said.
The positions were among PeaceHealth’s layoffs announced Feb. 11 that eliminated 94 positions across the state, with 27 in Whatcom County. These layoffs trailed cuts last October, when 241 positions were eliminated across the state, 55 of those in Bellingham.
Walker, who spoke with former colleagues, said the coordinators only had a few days after the February layoffs to cancel as many appointments as they could with patients, leaving the remaining cancellations to other employees.
PeaceHealth spokesperson Amy Drury wrote in an email to The Northern Light that, as the healthcare landscape rapidly shifts, PeaceHealth is focused on keeping core services and resources helping the greatest community need. She added the decisions were not simple and were approached with “deep respect” for patients, caregivers and the community as PeaceHealth strengthened its ability to provide long-term compassionate care.
“PeaceHealth is in a period of transformation that calls for both courage and compassion,” Drury wrote.
While Walker and other advocates said the healthcare system viewed the program as unprofitable, they believe it saved long-term costs, especially when preventing emergency medical intervention and procedures.
“It saves our hospital-based teams a lot of time and effort,” Walker said. “It’s worth its weight in gold.”
Walker became the first ACP coordinator shortly after the program started in 2017. She then spent the next nine years building the program through the healthcare system in Washington, Oregon and Alaska. When Walker resigned last June, she said it was “writing on the wall” that her role wasn’t replaced.
Referrals to the program tripled in the last three years, signaling its success, Walker said.
“Values and preferences are not something that medical systems are used to talking about,” Walker said. “It matters deeply, and people want to be having these conversations.”
While some organizations provide ACP support, Walker said most are for-profit businesses unable to provide free services. Northwest Regional Council offers free resources, though they’re only available for people who meet income requirements. For profit or not, these groups aren’t embedded in the healthcare system, which Walker said created easy access to the patient’s health records and primary care doctors.
Bellingham resident Micki Jackson saw firsthand the importance of having end-of-life paperwork in place shortly before her husband died in 2013, inspiring her to organize an advanced medical intervention presentation series with healthcare providers across Whatcom County.
The presentations, which ended around 2020, made a couple of stops to the Blaine Senior Center that Kathy Sitker, former senior center director, said brought the center to full capacity.
As director, Sitker said a lot of her time outside of running the center was spent helping members navigate the paperwork and conversations.
“A lot of people are on their own,” Sitker said. “Their kids aren’t around.”
Jackson, who has been closely following the cuts, said embedded hospital programs provide an important community service.
“Without a dedicated program, I think a lot of people won’t have the capacity to complete an advance care directive,” Jackson said of the PeaceHealth cuts. “Just because it’s done, doesn’t mean they wouldn’t want to tweak it over time.”
Despite the ACP layoffs, Walker remains optimistic that with enough community support, the program could be reinstated, similar to how PeaceHealth’s outpatient palliative care program was brought back shortly after cuts in 2023.
“I want to stay hopeful. Nobody thought the palliative care program would be reinstated and it was,” Walker said. “We see the importance in community members rising up and using their voices.”
