Long-needed hospice services arrive in Alpine, with goal to expand to entire region

Nurse Karen Ramirez assists Jo Reesing in drinking water during a home visit to the Reesings’ residence in Alpine earlier this week. Jo and her husband Ernest are in home hospice care with Angels Care and receive visits twice weekly from Ramirez, who helps with everything from checking their blood pressure to medication management and emotional support. Photo by Maisie Crow.

ALPINE — When diagnosed last May with heart failure, Dr. Ernest Reesing wasn’t ready to leave his home in Alpine for a far-away nursing home. He and his family have deep ties to Alpine. His daughter, Susan Carroll, lives nearby. He had spent decades as a professor of veterinary technology at Sul Ross and served as the fire chief at the Alpine Fire Department. His wife, Jo, had been a second grade teacher at Alpine Elementary School — when she was diagnosed with dementia, Ernest became her caretaker, a role he struggled to fulfill as his own condition declined. 

Until very recently, Ernest would have had little choice but to uproot and leave his hometown. Now, Angels Care Hospice, a palliative care provider with offices in Midland, is offering end-of-life care for Brewster County residents, who have been without access to crucial hospice services for over a decade. 

Ernest and Jo are now both tended to by Nurse Karen Ramirez, also an Alpine local, in the comfort of their home. “It’s been a godsend,” said Ernest.

Ramirez visits Ernest twice a week, and the couple receives bi-monthly visits from a chaplain provided by Angels Care. Ramirez said it’s important that locals like the Reesings are able to receive the care they need. “For people who have served their community, they shouldn’t have to leave their home,” she said.

For the couple’s daughter, the guidance Angels Care provides on legal matters has been a source of comfort. “The social worker helps by making sure you have all of your legal paperwork –– your will and power of attorney. They went through all of it to help me understand, really putting my mind at ease with everything else going on,” said Carroll.

The entire tri-county area has lacked hospice care since previous provider Big Bend Hospice shuttered around 2010, citing financial difficulties. The region also lacks assisted living facilities. Without hospice, Big Bend residents in need of end-of-life care have relied solely on the support of their families, have been forced to leave their homes in order to receive care in cities like El Paso or Midland or have passed away in the hospital. 

Alpine Mayor Catherine Eaves, in a statement to The Big Bend Sentinel, expressed relief and gratitude at the return of such an essential service.

“It is an incredible feeling to have hospice here once again. Now we no longer have to leave our beloved city, many of us with family and friends here, to receive palliative or end-of-life care,” said Eaves. “This greatly improves the quality of life, not only for the patient, but also for friends and family.”

Hospice is generally referred to as medical and emotional end-of-life care for terminally ill patients who may be suffering from cancer, heart failure, Alzheimer’s or other diseases, but needs vary among patients, said Dr. Adrian Billings, chief medical officer of Preventative Care Health Services. Hospice care can extend for weeks, months or even years in some cases. 

“When you think of hospice, you think of the days before death, but in reality, it can be anyone with a terminal disease that is in the process of passing away,” said Billings, who estimates around 10 to 30 patients in the Big Bend region might be candidates for hospice at any given time. 

Billings, who began practicing medicine in the region in 2007 when previous provider Big Bend Hospice was still in operation, said terminally ill patients often preferred to pass away in a familiar setting at home, but since local hospice care has gone by the wayside, individuals were left with fewer options for how to spend their final days. And grieving family members were left with fewer resources.

“Patients had to make difficult decisions of: ‘Do I want to pass away in a hospital setting with comfort measures in place provided? Not at [my] home, but in an artificial hospital setting, in a foreign setting?’” said Billings. “There were none of the wraparound hospice services like pastoral care and respite care for the family members that are so important.” 

With new hospice provider Angels Care, Billings said patients will have more options available to them, and physicians will be less strained without the necessity of as many home visits.  The long-needed shift is indicative of a much larger problem facing the region — that of limited access to healthcare.

“​​Having hospice again is an example of the expansion of the many healthcare services that are needed in rural communities like the Big Bend,” said Billings. 

Angels Care, which has locations in four states and is managed by AngMar Medical Holdings, Inc., is branching out to Alpine from their Midland office that also serves nearby Reeves and Pecos counties. Angels Care representatives said they have been active in Brewster County since November, taking on a handful of patients, and are currently working to grow their staff. 

Tiffni Bird, an account executive with Angels Care acting as Brewster County’s point person, and Lanae Lopez, executive director, said they saw a need for hospice care services in Alpine through their work with Midland-based doctors who have patients traveling from Alpine for healthcare. 

“There’s a major need for it there in Alpine,” said Bird. “We’re slowly building up our staff out there and providing hospice care.” 

The company has been posting on social media to recruit new hires and said it is interested in hiring locals. Angels has already recruited two registered nurses, including Alpine resident Ramirez. In addition to local employees, Angels sends certified nursing assistants from Midland to Alpine two times a week, with the goal of expanding to three days a week. 

Angels Care Nurse Karen Ramirez checks Dr. Ernest Reesing’s leg during a recent visit to his home in Alpine. Reesing and his wife have been in hospice care with Angels Care since last year, allowing them to stay in their own home. Photo by Maisie Crow.

For now, Angels is focusing on getting established in Brewster County and is still seeking a part-time social worker and a chaplain to add to their new Alpine team. However, they would like to expand services to Presidio and Jeff Davis Counties eventually, said Bird. Individuals 65 and older make up 37% of the population of Jeff Davis County, 23% of the population in Brewster County and 21.4% of the population in Presidio County, according to U.S. Census data from 2021. While they are currently working as a satellite operation out of their Midland office, the possibility of creating an Alpine hospice office is being explored, she said. 

“We decided to run with it and see how many patients we will generate out there in that area,” said Bird. “We are fixin’ to try to request to service Fort Davis and Presidio because I know some of those towns aren’t very far from Alpine even though they may be in another county, so we will eventually try to venture out into those counties too. Once we do that, I’m sure it’ll just blow up even more.” 

In the absence of local hospice care, some Big Bend residents take on the role of caretakers for their loved ones. Marfa residents Lionel Hernandez and Jimmy Maywald have been acting as full time caregivers for Hernandez’s 86-year-old uncle Ruben Vasquez, a Marfa native, since 2019, and said they hoped to see the expansion of hospice care services to Marfa.

“It’s almost an inherent right for you to be able to die in a home, in the city where you were born. It is probably a very common wish, amongst those facing the end of life,” said Hernandez. 

In addition to taking care of Vasquez, Hernandez and Maywald check in on an elderly friend in Fort Davis and see the need for hospice care and caregiver support in that area as well. Hernandez said those who wish to die in their homes should be able to do so with company and without pain. “These situations are present in our community on a smaller scale, but they’re still there, and we should address them because nobody should ever die alone,” said Hernandez. 

Hernandez and Maywald — who expressed gratitude that their demanding roles as caregivers were at least shared by each other — said they are exploring the possibility of establishing a caregiver support group in the area. “There comes a time when we really need to go out there and talk to somebody about something we’re struggling with at home with our loved one,” said Hernandez. 

The couple also sees a need for more social activities for local seniors in order to get them out of their homes and into the community. “[Hospice] is generally for people facing the last six months of their lives, right? But even those months should be special,” said Hernandez. 

In addition to providing financial assistance for medications and personal care supplies, hospice care seeks to provide emotional and spiritual support for families and patients while they are experiencing loss. Helping full-time in-home caregivers, which are often family members, by giving them a break to run to the store or take a nap, for example, are important aspects of hospice, said Bird. 

“There’s so much more to it than just nursing care and aid care. It’s really a whole family taking care of a family,” said Bird. 

Marvie Burton, a retired hospice nurse living in Alpine who worked with Big Bend Hospice while it was still in operation, said the return of hospice services to the Big Bend was sorely needed. Now 81, she recalled how Big Bend Hospice, which operated with the help of both nurses and volunteers, struggled to recruit enough volunteers and failed to keep afloat financially. 

As with the area’s emergency medical services, providing hospice care to such a vast, isolated region is complicated by the driving time it takes to get to patients. Burton said they worked to have a few trained volunteers in each town, but traveled great distances to reach patients. 

“Sometimes we’d have three or four patients here in Alpine and a couple in Fort Davis and maybe one or two over in Marfa,” said Burton. “Out in rural areas it’s a whole different ball game.” 

Bird said Angels Care will provide mileage assistance to their employees for their travel time, and the company may consider hosting educational community classes on hospice care in the area to help fill gaps in service. The company has been contacted by Sul Ross State University and may have the opportunity to get involved with the nursing school, allowing the students to complete clinical hours with them, said Lopez. 

To date, the company’s biggest challenge has been securing a reliable durable medical equipment (DME) provider to ensure they have the hospice supplies they need in Alpine, said Bird. 

“Oxygen, that’s definitely something that’s dire. We really haven’t run into too many options with that, it has been more like your other medical equipment that can take a week or two to even get it out there to them,” said Bird. 

Bird and Lopez said they are being clear with their patients about their current limitations and resources. They said they have been working with case managers at Big Bend Regional Medical Center to obtain referrals and have been contacted weekly by Alpine residents seeking hospice care. 

“We’ve even had families that just heard through the grapevine that Alpine now has hospice. They’ve called us themselves to let us know what was going on with their loved one,” said Lopez. 

Material challenges aside, there is an emotional element to hospice care that the specialty workers are uniquely equipped to handle, said Burton — and that is helping families, and communities, learn to confront death.

“Our society, for some reason, is afraid of dying people,” said Burton. “Not so much fear, but they don’t know what to say. My answer to them was, ‘Well, what did you talk to them about before you knew they were a hospice patient?’”  

To contact Angels Care Hospice services for a consultation, call the main office line at (432) 208-5530 or reach Tiffni Bird at (254) 631-7734.