Blue Monarch CEO: Hospice Startup Seeks to Raise Bar on Quality

Nurse practitioner Raphael and registered nurse Britt Akobundu, a married couple, launched San Diego-based Blue Monarch Hospice this past March, with the intent of improving the quality of life for not only patients and families, but also health care workers. 

CEO Raphael Akobundu recently sat down with Hospice News to discuss the couple’s experience of opening a startup hospice company in the competitive California market. They’ve found their clinical backgrounds gave them valuable perspective as they worked to strike a balance between their patients and their workforce.

As a nurse practitioner, what led you to begin a hospice program?

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I became a registered nurse in 2012 and received my nurse practitioner degree in 2017. I practiced in men’s and women’s health before deciding to start Blue Monarch Hospice. My parents are both nurses and my wife is a nurse as well, so I’ve been around clinical care my entire life before we decided to branch out into hospice.

Years ago, I thought the customer service side of things in the hospice industry could use some improvement. That, coupled with the increasing age of the [nation’s] population, led me and my wife to start Blue Monarch Hospice. 

I began taking care of hospice patients back in 2015 after moving to San Diego and working in a hospital setting for a while. I often saw slow response times as patients waited sometimes days for nurses to provide care.

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But a hospice situation is very delicate and you don’t really get a second chance to get it right. I thought the customer service needed to be better at being very communicative with a patient’s care team and their family, and that lack gave the idea to start a hospice.

When did you begin offering hospice services, and what is your scope of care thus far?

We’re fairly new and still in the early stages. We started in March 2022 and are very much still in the startup phase. Right now, we’re a community-based provider, and we also work with a hospital system to provide general inpatient hospice care. 

There’s a lot of good hospices established in San Diego, so we’re hitting the ground running and trying to reach out to as many people and referrals as we can to build relationships and gain trust in the community. It’s a very difficult time to gather those referral sources, but I’m confident that we’re gaining traction slowly. Being newer to the industry with so many hospice companies around, it can be challenging to stand out.

What is the demand for end-of-life care in your service area, and how do you anticipate this evolving in coming years?

San Diego is a very big county with a growing aging population, and we’re already seeing a growing need for more hospice providers. The demand is high, and I believe it will increase with time in roughly 8 to 10 years when every baby boomer will be at least 65 years old.

It’s just a matter of time before the need for hospice rises. There’s potentially going to be a huge gap in care with even less qualified hospice care providers to fill it, causing stress on the overall health care infrastructure. We can close that gap.

The health care system is strained. With the labor shortage, there’s just not enough doctors, nurses or caregivers, and just not a lot of just health care providers in general. There is an extreme shortage of nurses and it’s anticipated to worsen.

How will you evolve service offerings along with changing needs of an aging population?

Telehealth and innovative technology will be imperative in regards to keeping up with the demand.

Being able to have telehealth services has allowed providers to call or video [chat] with a patient or family member and still provide optimal care. As time goes on, there will be more room for services and technologies that come out to help us bridge gaps in care even more.

Technology will play a huge role in making things very seamless operationally. Moving forward, it’s going to be even more imperative in the next decade or so. From your electronic medical records to your patient and staff charting systems and referral databases.

All of those aspects of care can be collaborated and everything can be intertwined into one system so that staff doesn’t have to find and enter patient data across multiple places. Technology can also ensure a line of communication between staff, which is extremely important.

Are there any specific populations or services you’ll be focused on expanding?

Being an African American, I understand how most African Americans do not quite understand hospice services and many are not very receptive to it. Our plan is to be able to go into these communities to educate them on the importance of hospice care.

That is probably our main group of focus, to target African American populations in San Diego and educate them on hospice care through a personal touch, a face-to-face conversation,, and reach into churches, community groups and seniors.

What are some of the challenges you’ve experienced thus far and what strategies are you employing to alleviate these?

The labor shortage certainly made hiring tough, because we can only offer so much in regards to pay. Luckily, we have been able to stay fully staffed.

Our staff right now has three nurses — including myself. We also have a home health aide, a chaplain, a social worker, a patient intake coordinator and a medical director. We’re starting small to be able to manage patients coming to us. I get into the field right alongside our staff to provide hospice care.

When we hire people it’s letting them know that we’re with them every step of the way. As an owner and practitioner, it’s being in the grind with them and being hands on. I think that helps us stand out from others, being so involved and having a deep understanding of what burnout feels like as nurses ourselves. We don’t ever want our staff to be burnt out and we try to help avoid that in any way we can.

When staff don’t feel appreciated for their hard work, they’re going to look for another job elsewhere. It’s being a team player and leading by example with an open door policy. Staff have my number to text or call me directly every day.

How are you navigating challenges of the hospice regulatory environment in California as the state faces increasing scrutiny?

Providing great patient care is the top priority. The increased scrutiny and regulations should help remove the providers who are not in it for the right reasons.

When it comes to regulatory and hospice services, it’s a team effort. The very beginning of that process is where trouble can start, because hospice is highly regulated. The most important thing is just being on the same page with your team, the patient and their family to first make sure the patient qualifies for hospice. That’s really where it starts, with a team collaborating together and deciding whether a patient is appropriate to come onboard in hospice.

It’s difficult to navigate a patient’s prognosis and meet that six months or less to live requirement. It’s keeping in touch with referral sources, staff and patients as their condition changes or their health declines and knowing when they are eligible. It all comes down to being very honest and transparent.

What are your hospice’s growth plans on the horizon?

We would like to remain small because it will allow us to provide optimal care and excellent customer service. We want to be known as one of the best hospices in San Diego, and we plan on [offering] services only within that county.

We have a plan in place to want to grow very slowly, because when you grow too fast then you’re just unable to manage that growth with staff. We don’t want to be scrambling to find staff to look after patients and then have our referral customer service drop as well. We’ll continue to hire as we bring on more patients and make sure there’s no slippage in quality or level of care.

We don’t want to be short-staffed and cause strain that can decrease morale. It’s hard enough to compete for resources and offer competitive pay for employees right now. The biggest thing will be making sure we have enough leverage where we can manage patient care efficiently without having to burn people out. It’s okay to tell people we can’t accept a patient and be transparent as opposed to bringing them on to services and having to stop without enough staff. That’s definitely not ideal for anyone. We want to be able to have people trust us to take care of patients well.

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