A Heritage of Compassion: How the WNC Community Started the First Hospice in the North Carolina Mountains

Pioneers in Hospice Care

Four Seasons Hospice began at Jean Moulthrop Hoogstra’s kitchen table, with a conversation about how starting an organization that provides dignity and comfort at the end of life would be a good outreach mission for her church. She had learned of the work of Dame Cicely Saunders who started the first hospice in London in 1967 and began a hospice movement. In 1979, with the help of Dr. John Esse and other community members, Jean organized a group representing medical, legal, religious, and other professions to explore the concept of developing a hospice facility for western North Carolina.

“Hospice looks upon death as realizing it is a part of the cycle of life,” said Hoogstra in 2005. “It is time to be treasured. The remaining period should be as comfortable, as loving, as peaceful as possible, and any desire of the patient forms the guideline of the day.”

Initial financial support was given by Immaculate Conception Church, St John of the Wilderness Church, the Episcopal Diocese, and donations from generous community members. The Hospice was incorporated as a nonprofit in December 1979 and named Hospice of Henderson County (HHC). HHC was the third hospice organization established in the state of North Carolina and the first in the North Carolina mountains.

In 2015, North Carolina House of Representatives passed House Resolution 852 to honor the memory of Jean Moulthrop Hoogstra, who died in April 2012, and to recognize the valuable services of Four Seasons Hospice.

 

Elizabeth House

Hospice of Henderson County served its first patient in 1981, and as the organization grew, the need for an inpatient unit became apparent. In 1999, local physician and philanthropist Dr. Kathleen “Kay” McGrady, was instrumental in establishing Elizabeth House, the 19-bed inpatient unit in Flat Rock, NC. Elizabeth House is named for Kathleen’s mother, an RN and early pioneer in comfort care for dying soldiers in World War II.

 

Pioneers in Palliative Care

As a result of innovative leaders and a progressive board of directors, a Palliative Care program was launched in 2003. Under the leadership of then President and CEO Chris Comeaux, leaders including Janet Bull, MD, MBA, FAAHPM, Chief Medical Officer Emerita, and John Morris, MD, FAAHPM were instrumental in bringing this care to western North Carolina. Four Seasons was awarded the Kate B. Reynolds Grant to start a palliative care

program at Pardee Hospital with Dr. Morris as the part-time medical director. It was important that from the beginning, a team not only consisting of providers but also social workers, chaplains, and nurses, be the foundation of this program.

“Palliative care is for patients with chronic illnesses, particularly with pain, who need help and care, but don’t have a definite end date to their illness,” said Dr. Morris in 2005, he further stated that the program had grown to be one of the largest in the country.

Since its beginning, the Palliative Care program has continued to expand care to those living with serious illness in multiple settings of care across western North Carolina and remains one of the largest national programs today.

In addition to developing the Palliative Care Program, Dr. Bull is also a pioneer in establishing best practices in hospice and palliative care. In 2005, she started a nationally recognized clinical

research department, which led to further innovation and enhancements in care. She served as principal investigator on more than 30 clinical trials and designed a training program which provided

guidance to clinicians throughout the country.

In 2009, Hospice of Henderson County became Four Seasons Compassion for Life and received the prestigious Circle of Life Award for its innovative Palliative Care program.

 

“The honors Four Seasons has received recognize the spirit of innovation interwoven into the fabric of Four Seasons and our approach to excellent care delivery,” said Dr. Bull in 2022.

(above) Employees have always been the Heart of Hospice
(right) Bill Lapsley, former President & CEO Chris Comeaux, and Jean Moulthrop Hoogstra break ground on the Greatrex Administrative Building, beside Elizabeth House, in 2006.

Continued Community Support

Over the years, the community has continued to support Four Seasons with donations from businesses, churches, and individuals.

The first Hospice Home Store started in 2006 in Hendersonville to assist in supporting the Palliative Care program, which is not fully covered by reimbursements for services. Today, Four Seasons Hospice Home Stores have expanded to also include stores in Arden and Brevard as well as a warehouse which holds monthly sales. 

Four Seasons Foundation was started in 2015 to ensure access to care is available for all. The Foundation holds fundraising events including Tree of Lights and Resale Runway, and helps to fund the Palliative Care program, Grief Services, Home Care, Care Navigation, and to provide additional services including Music Therapy. The Foundation also allows Four Seasons to provide care to those in need through their Angel Fund.

“Our western North Carolina community continues to be passionate about the care we provide,” said Paige Wheeler, CLE, Foundation Executive Director. “Not only do so many support our care through donations, endowments, and planned giving, but others support us by donating furniture and goods as well as making purchases at the Hospice Home Stores. We hear their stories and steward their items to ensure that we can provide care for all.”

 

Expanding to Serve WNC

In 2010, Four Seasons expanded its service area to include Buncombe, Transylvania, Macon, Jackson, Clay, Graham, and Cherokee counties. In 2014, care was expanded to serve Haywood County, and in 2016, Polk County was added to the service area. In 2022, Rutherford and Madison counties were added and in 2025, Four Seasons expanded to include McDowell County, bringing the total number of counties to 14.

Honoring Our Veterans

In 2014, Four Seasons added the We Honor Veterans program, which provides training and resources on the specialized care that veterans may require during Hospice. In addition, the program recognizes veterans in our care through a “Pinning Ceremony” which brings together the veteran, their family and friends to honor them. Four Seasons collaborates with the Military Officers’ Association of America – WNC Chapter to celebrate those veterans whom we are honored to care for. We have currently held over 1,200 pinning ceremonies recognizing veterans throughout western North Carolina.

 

Leading the Way

Four Seasons has never been an organization to “think small.” In 2017, Four Seasons continued to innovate care through collaborating with other hospices to create Teleios Collaborative Network (TCN). This organization, led by former Four Seasons President & CEO Chris Comeaux, MLAS, CPA, empowers, educates, and guides member nonprofit hospices to thrive. In 2017, as Comeaux transitioned to lead TCN, Dr. Millicent Burke-Sinclair, Ed.D, MBA, MLAS, SPHR®, SHRM-SCP was named President and CEO of Four Seasons.

Also, during the 2016-2017 period, Four Seasons added Care Navigation and Home Care services to its continuum of care.

More recently, Four Seasons collaborated with multiple nonprofit organizations to begin the development of Caring Seasons Health, a new hospice organization, expanding care into South Carolina. Today, patients and families in multiple SC counties receive compassionate, quality care.

Creating a Culture of Caring

Under the leadership of Dr. Burke-Sinclair, the organization has consistently remained a national Best Place to Work by Modern Healthcare, which has supported Four Seasons in expanding services to 14 counties. Four Seasons now provides quality care to over 3,400 hospice patients and over 5,400 palliative patients each year.

Innovating Care for All

Four Seasons not only offers care to everyone, regardless of the ability to pay, but also provides care to people of all ages. Our Pediatric Hospice and Palliative Care program, which is called Riversong, recognizes the unique needs of children and adolescents and provides these specialized services in all counties.

“Our goal is to support families through each chapter, preparing them for the next chapter in the life of their child, no matter how short or long that might be. Being invited to be a part of that journey is a privilege, and we are grateful that we can offer this expanded care to families across Western North Carolina,” said Chief Clinical Operations Officer Rikki Hooper, MBA, MLAS, MSN, FNP, ACHPN, NE-BC, FPCN.

The organization continues to innovate quality care with community support. Programs like Grief Services provide grief support to adults and also to children and adolescents through our Compass program. These services are provided free of charge to everyone in our 14-county region, regardless of whether they were served by Four Seasons. It’s part of our commitment to our community.

Another innovative approach to care supported by the community is Music Therapy. This program provides evidence-based therapy that recognizes not all symptoms respond best to medications, using music interventions to provide comfort and address physical, emotional, and social needs.

Our Heritage & Our Future: Co-creating the Best Care

Over the years, Four Seasons has won numerous awards, including Hospice Honors in 2025, which is based on CAHPS scores from patient satisfaction surveys, as well as placing 4th in the nation in the Home Care Pulse survey where we were named Best of Home Care Leader of Excellence in 2026, among others. Four Seasons doesn’t rest on it’s laurels, as our motivation continues to be to provide the best care to our community. This means that we are always looking to the future to think about what our community needs. Please click here to meet our Senior Leadership team, who continues to innovate and co-create the best care experience for our community.

“Reflecting on the impact of hospice and palliative care for families throughout the 14 counties served, we are inspired to look to the future on how we can continue to provide quality, prompt, and trusted care,” said Dr. Burke-Sinclair. We are a nonprofit always focused on genuinely caring for our community; we are always improving, always looking for the best ways to provide care. We realize that every individual we are honored to serve deserves compassion, respect, and quality care, so we love learning about what is most important to them and prioritizing that.“

 

 

“We are so very grateful to our community for being a significant part of this heritage of compassion and look forward to co-creating the best care in the future.”

– Dr. Millicent Burke-Sinclair