What is the admission requirement?
To be considered eligible for Porta Caeli House, a person must be terminally ill and within thirty days of end of life. The guest must not require skilled nursing procedures or services, must be under contract with a hospice, and must have a DNR order in place. There will be an understanding that a guest will be required to find other accommodations if taken off hospice care or if skilled nursing care becomes required.
Porta Caeli House reserves the right to filter all admissions for these criteria: actual need, potential for disruption of house by the guest, family and/or their guests, behavior, weight or physical limitations, uncontrolled mental illness, or other factors, in order to maintain the well-being of all guests of the house. Indigent and isolated members of the community will receive priority.
Why only 12 guest rooms?
This size, along with the fact that we will neither charge for our services nor provide skilled nursing care, will allow us to provide a home for our guests without incurring the cost and administrative burden of complying with nursing home or hospital regulations.
What is the relationship between St. Joseph Residence and Porta Caeli House, and what is Catholic Charities’ role?
The need for St. Joseph Residence declined due to medical advances in treatment of HIV/AIDS and it was closed in 2011. The St. Joseph Residence facility was evaluated for use as Porta Caeli House and deemed unsuitable. The building was sold and proceeds dedicated to construction of Porta Caeli House. The St. Joseph Residence Board of Governors voted to transfer its endowment to Porta Caeli House to support its operations. With the aging of the U.S. population, the need for end-of-life care facilities is increasing at a fast rate. The mission of Porta Caeli House is broader than that of St. Joseph Residence.
Catholic Charities and Porta Caeli House are separate legal entities and have separate boards of governors. There is some overlapping membership on the boards. The Executive Director of Catholic Charities is also Executive Director of Porta Caeli House. Catholic Charities will donate the land to Porta Caeli House for the facility. Catholic Charities will provide some support services to Porta Caeli House under a services agreement, e.g., facilities maintenance, accounting, phone and computer systems, and other administrative support.
What are the practical implications of implementing the Ethical and Religious Directives (“Catholic teaching”) at Porta Caeli House?
Our purpose is neither to hasten death nor cause patients to linger unnecessarily when they are terminally ill. If a person can be fed, AND can benefit from feeding, it is morally obligatory to feed him/her. This moral obligation takes precedence over the person’s advance directive that might otherwise refuse beneficial and life-sustaining feedings. Determination of benefit varies from case to case, and includes medical, personal, and spiritual benefit.
Withholding nutrition and hydration must never be the cause of death. For people within hours or days of unavoidable death, it is often true that they may not benefit from feeding, and the withholding of nutrition and hydration would not be the cause of death.
Neither do caregivers want to be perceived (by family members) as over-medicating, but want to provide all possible pain relief within the bounds of the hospice doctor’s medical prescriptions. Caregivers and families need to understand that medication to relieve pain is morally acceptable even if it may risk hastening death, so long as the intent is to relieve pain, not to hasten death, and no more medicine is given than necessary for relief of pain. ~ G. Kevin Donovan, MD, MA | Director, Pellegrino Center for Clinical Bioethics | Professor, Georgetown University Medical Center