By Viviane Gilbert Stein

Twenty-fi ve years ago, when a team of volun-teers sparked the idea of a fi reworks show

to benefi t Kaua‘i Hospice, they probably had no idea how big the fl ame would grow. “I don’t think they realized, way back when, that it would be our signature event,” Kaua‘i Hospice Operations Director Tricia Yamashita said with a laugh. “And that 25 years later, we would still be doing it.”

And doing it with a bang — if you can pardon the inevitable pun.

The 25th celebration of the Concert in the Sky was as spectacular as the sunset that painted the sky beforehand.

This year’s show was a unique 3-D produc-tion, with “layering effects” created by the fi reworks being set off from the stadium stands, on top of the announcer’s box, and the baseball fi eld. “It was really coming in different layers,” Yamashita said afterward. “It was amazing. There were a lot of fi reworks and low effects we’ve not had before.”

More than 6,000 people poured into Vidinha Soccer Field on the Fourth of July. Families spread out blankets, kupuna settled on benches, teenagers cruised, keiki ran underfoot.

They were all there to enjoy the annual cel-ebration, what Kaua‘i Hospice Executive Director Lori Miller dubbed a “friend-raiser.”

“While it does bring in money for Kaua‘i Hospice — and we’re grateful for that — what we value most is the awareness it brings to the community, for what we do,” Miller explained.

Raising awareness while having a good time — that’s the goal.

“We really want to stress the importance of experiences that create memories. That’s what this is: to create a family experience,” Miller said. As Karen Davis, vice president of the Board of

Directors, told the crowd during the opening cer-emony, “This Concert in the Sky is a celebration for our nation’s birthday, but it’s also a celebra-tion of all of you, and all your wonderful support, both now and in the future.”

That community support is key, echoed Kaua‘i Mayor Bernard Carvalho Jr.

“Kaua‘i Hospice is an important part of our island,” Carvalho said after stepping offstage, shortly after leading the crowd in a moving rendition of “Hawai‘i Pono‘i.”

“We gotta make sure it continues.”The Mayor praised the service that has

helped members of his family and so many others in the community. He lauded the “special people” who “support our families going through their diffi cult times.”

“We need to continue to provide the sup-port to those who go right into the living rooms of people who are suffering, and help them and their families,” Carvalho said. Volunteers are key to Kaua‘i Hospice, and that is even more evident at the Concert in the Sky.

Miller was effusive in her praise for the sheer amount of work done by the event’scommittee, the fi refi ghters, the many hun-dreds of volunteers.

“We harness energy from a wide swath of the community, with support com-ing from churches, community groups and businesses,” Miller said. Those volunteers staff the many food booths, general store, token booths, the keiki fun zone — which featured eight bounce houses and two huge water slides. Six musical groups entertained the crowd while waiting for the grand fi nale, which was followed by more music.

“Here’s the amazing part, to me:

our little organization, we’re also in the event production business!” Miller said.

Some of the volunteers have been helping since the very beginning, Miller was proud to point out. The most visible may be emcee Ron Wiley, who has been the voice of the program for each of its 25 years, but he is not the only one.

“It’s astonishing — it’s just astonishing, how the community supports us,” said Kaua‘i Hospice Administrative Assistant Trishana Star, who was colorfully attired as “Auntie Sam,” resplendently patriotic from head to foot. “It’s almost unbeliev-able, how we’re supported.”

”

(Continued on next page)

FALL 2014 Bringing forth the news of caring

others in the community. He lauded the “special

port to those who go right into the living rooms

(Continued on next page)

committee, the fi refi ghters, the many hun-

“We harness energy from a wide swath of the community, with support com-

Six musical groups entertained the crowd while waiting

was followed by

Concert in the Sky celebrates 25th year

2

It’s astonishing — it’s just astonishing, how the community supports us.

Star, who has worked at Kaua‘i Hospice for 14 “wonderful” years, praised of the “650-700 volunteers, that support the work of Hospice, and actually volunteer their Fourth of July and work hard to make this happen.”

After all, she said, “We’re a small organiza-tion, and how on earth we pull this off, every Fourth of July, I’m amazed.”

A crucial element to the event’s success is the logistical support provided by Kaua‘i fi refi ghters, said Yamashita, who serves as the event coordinator. A massive team of fi refi ghters from across the island volunteer their brains as well as brawn for the event.

Beginning on the Monday before the Friday holiday, fi refi ghters were hard at work setting up tents, marking the fi elds, installing sinks and pipes, putting up signs — basically, “all of the labor,” Yamashita said.

And then, right after the show ended at 9:30 p.m., as the smoke and the people were still dispersing, the fi refi ghters began breaking it all down. They returned the next day to fi nish clean-ing up the vast fi eld.

“There’s absolutely no way we could do this event without their participation,” Yamashita said. “It’s a huge undertaking, and they are a

huge gift to us. I have immense gratitude for them — they are amazing.”

Lead logistics coordinator Steven Doi has volunteered all of the event’s 25 years, and Bo Domingcil has been shadowing him for the past fi ve and will eventually take over the reins, Yamashita said.

Another volunteer who “is critical” to the event’s success is Tony Pajela and his family, Yamashita said. The owner of Garden Island Security provides 24-hour security for the pyro-technics used in the show.

“From the moment the fi reworks touch Kaua‘i, he is at the fi eld with them, 24 hours a

day,” Yamashita explained. Members of the Pajela family set up a tent

and camp there to guard the explosives. This year, that meant being on-site from the Friday before the Fourth of July, and staying until the Monday afterward, Yamashita said.

The elaborate pyrotechnic display was produced by J&M West Displays and sponsored by King Auto Center.

Charlie King, a volunteer with Kaua‘i Hospice since its early years, was a member of that original planning team that cre-

ated the Concert in the Sky, Yamashita said, and his auto dealership has sponsored the fi reworks every year since.

It’s an incredible outpouring of support, and requires an immense amount of work, much of it is invisible to the thousands of residents and visitors who enjoy the annual celebration.

And yet, for those who labor behind the scenes, it’s all worth it.

Standing outside the craft tent on the big night, Star surveyed the fi eld, fast fi lling up with people. “What’s meaningful for me, is about 7 o’clock, when it’s wall-to-wall people, and you look around, and it’s family fun,” Star said. “It’s so clean. It’s so fun. It’s wonderful.”

That moment of joy, that sense of ac-complishment, makes all the months of work worthwhile, Star said.

She’s not alone. Even while they’re busy dealing with the details of the day itself, staffers are already making notes on how to make the next year’s event even better, Yamashita said with a chuckle. “People will ask, ‘Is this the last one?’” Yamashita said. “I can defi nitely say, we’re already planning for next year — and looking forward to it.”

huge gift to us. I have immense gratitude for ated the Concert in the Sky, Yamashita said, and

The elaborate pyrotechnic display was produced by J&M West Displays and sponsored

we’re already planning for next year — and looking forward to it.”

Executive Director Message

Me ke aloha pumehana,Lori J. Miller

Aloha dear friends of Kaua‘i Hospice. Recently, one of my favorite philosopher

authors died. A statement from the family of ‘Phenomenal Woman’ Dr. Maya Angelou was posted on her Facebook page, Wednesday morning, May 28th, “Dr. Maya Angelou passed quietly in her home before 8:00 a.m. EST. Her family is extremely grateful that her ascen-sion was not belabored by a loss of acuity or comprehension. She lived a life as a teacher, activist, artist and human being. She was a war-rior for equality, tolerance and peace. The family is extremely appreciative of the time we had with her and we know that she is looking down upon us with love.”

Tears began to fl ow as I absorbed the news, it sounded as if Dr. Angelou had a ‘good death’ a ‘peaceful passing’ and I wondered if she had ‘Hospice’ caring for her. After all, the family’s statement seemed to suggest peace and gratitude in the midst of sadness and loss. I also began to refl ect on some of her words, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” And another quote which resonates so deeply, “Try to be a rainbow in someone’s cloud.”

One thing I know for sure is all who are Kaua‘i Hospice strive to deliver our mission while trying “. . . to be a rainbow in someone’s cloud.” In this Newsletter you will read about our organizational growth in depth and breadth of service to individuals and families facing serious life-threatening and life-limiting illness, dying,

death and the grief that accompanies all loss. All that we are pursuing is rooted in the impenetrable foundation of the Hospice philosophy of care.

You will also read of our celebrations of milestones and all the good news that accompanies our work which has at its core - to keep people from suffering. Another ‘Phenomenal Woman,’ Dame Cicely Saunders created the foundational statement for hospice and its continuing movement: “You mat-ter because you are you, and you matter to the end of your life. We will do all we can, not only to help you die peacefully, but also to live until you die.” Therein lies the truthful irony. Hospice is about LIVING.

I do not know whether or not Dr. Angelou had an organization delivering Hospice care to her and her family. What I do know is that she LIVED until she died. And from where I sit and what I witness every day at Kaua‘i Hospice is that makes all the difference in the world.

Thank you for your loving support and Aloha throughout the years. Our commitment remains. We know we are making a difference on Kaua‘i and that is because people like you continue to recognize the value of our special kind of caring.

death and the grief that accompanies all loss. All that we are

in the impenetrable

Hospice philosophy

celebrations of milestones and all the

Try to be a rainbow in someone’s cloud.

OFFICERSWalter “Kamika” Smith III, PresidentKaren Davis, RN, Vice PresidentKeith Yap, TreasurerMark S. Hubbard, Secretary

DIRECTORSThomas LodicoCandy McCaslin, MSWAnthony “Tony” PajelaJim SaylorMarynel Palalay ValenzuelaRoberta L. Weil, PhD

DIRECTORS - EMERITUSGale LeeValerie Rekward

Board of Directors

Lori Miller, Executive DirectorNeil Clendeninn, MD, PHDLinda Crocker, LCSWJuliana Grigorova, RN, CHPNJennifer Glorioso, RNJessica Haynes, RNJo Ann Kawaguchi, RN Leslie Kilcoyne, RNPatricia Kocher, CNABeverly Lavens, CNAYvonne Lawrence, RN, CHPNSharon LeslieAnnie Meredith-Mitchell, RNReverend Caroline Miura, BCCMarion Morita

Darla Myers, RN, CHPNMyra NiauJeffrey Pears, MAMelanie Rindon, CNAKathy Reams, RN, CHPNVicki RequilmanSu Smith, RDTrishana StarCrystal Stoner, LMSWKayla Uptmor, CNARobert Weiner, MDKristi Weiss, RN, CHPNHoward Wilson II, RNTricia Yamashita

Meet the Staff

3

Our MissionTo ensure the highestquality of life possiblefor individuals andtheir families facinga life-threatening illness;to provide bereavementsupport to individuals;and to promote anunderstanding ofHospice services.

By: Dr. Robert S. Weiner, Medical Director

For many years it has been known that hospice and palliative care increased

comfort and quality of life for patients and families dealing with progressive illnesses, but it was thought that this came at the cost of a shorter life expec-tancy. More recently several research

reports have come out indicating that hospice and palliative care patients may actually live longer!

In August of 2010 Dr. Jennifer Temel of Harvard Medical School and Massachusetts General Hospital published in the New England Journal of Medicine that on average 151 patients with the most common type of lung cancer lived 30 percent longer with palliative care than matched patients not receiving palliative care. The following month Keyes, Reed and Lowery reported in the journal Gynecologic Oncology that the choice to use hospice in female cancers was associated with an 89 percent longer survival.

These studies confi rmed the fi ndings of Stephen Conner ofAlexandria, Virginia who showed in two studies done on thousands of cancer patients that those who chose hospice survived signifi cantly longer than those who declined hospice. The longest difference was in patients with congestive heart failure who lived 81 days longer than the non-hospice patients.

There are many theories as to why patients on palliative care or hospice may live longer but the major conclusion from all reports so far is that patients with terminal illnesses can be more comfortable and expect a longer prognosis if they choose hospice and supportive or pal-liative care. For questions regarding the Kaua‘i Insight column, contact rweiner@kauaihospice.org.

Kaua¥ i Insight:Studies Show Survival Benefi t with Hospice

By: Rev. Caroline C. Miura,Spiritual & Bereavement Care Coordinator

In, The Book of Awakening: Having the Life You Want By Being Present to the Life You

Have, by Mark Nepo, he describes the origi-nal meaning of the word, random.

Random is the instant a horse at full speed has all four hooves off the ground. He says it refers to the mystery of unbridled passion, to the lift that results from total immersion and surrender.

Most of us use the word to refer to something that has no purpose or occurs by

utter chance. Nepo says this helps us dismiss whatever appears beyond our control. Nepo, a cancer survivor, argues that our lives are full of unexpected surges of kindness that seem to come from nowhere. He points out that we can learn from the horse at random by considering how all of its energy and desire mounts for the brief moment it inhabits itself fully, and in that moment, it fl ies.

For us, he suggests the moment at random is the moment of hold-ing nothing back, of giving our all to whatever situation is before us. In that charged moment, we come as close to fl ying as human beings can. This is when the healing happens. For people living with life –threaten-ing illnesses, and for those who love them and care for them, these ran-dom moments are the times grace carries us across all that threatens to swallow us whole. In the fl ying our true wholeness is revealed.

My hope & prayer is that each of us will experience many random moments which will allow us to accept, embrace, and truly enjoy this one life we all are gifted with, to learn to grow in ways that allow love to be what propels us forward.

Spiritual Corner

Fcomfort and quality of life for patients and families dealing with progressive illnesses, but it was thought that this

reports have come out indicating that hospice and palliative

Studies Show Survival Benefi t with Hospice

how all of its energy and desire mounts for the brief moment it inhabits itself fully, and in that moment, it fl ies. how all of its energy and desire mounts for the brief moment it inhabits

For us, he suggests the moment at random is the moment of hold-For us, he suggests the moment at random is the moment of hold-

Random is the instant a horse at full speed has all four hooves off the ground.

4

By: Rev. Caroline C. Miura,

In, You Want By Being Present to the Life You

Havenal meaning of the word, random.

speed has all four hooves off the ground. He says it refers to the mystery of unbridled passion, to the lift that results from total immersion and surrender.

something that has no purpose or occurs by utter chance. Nepo says this helps us dismiss whatever appears beyond

Supportive care, through the eyes of clientsBy Viviane Gilbert Stein

While some palliative care patients eventu-ally go into hospice, others like Jessie

Sam-Fong “graduate” from the 90-day HMSA pilot Supportive Care program offered by Kaua‘i Hospice’s Palliative Medicine Partners — and even wish it lasted longer.

At fi rst, Sam-Fong didn’t even want to get involved in the Supportive Care program. But after visiting with Palliative Care Coordinator Juliana Grigorova, Sam-Fong realized, “I’m being selfi sh, by not wanting the help and the care,” she recounts in a video made by Grigorova. So she signed up — and never looked back.

“It was very positive — very positive!”

Sam-Fong said. “They helped keep me positive, get rid of anxiety. Overall, they did a great job to get me to where I am today. I enjoyed the yoga. I enjoyed everything that they had to offer.

“I looked forward to their visits,” Sam-Fong continued. “Juliana is very, very well-versed, informed and compassionate. I just love her be-cause she would come here and we’d talk story, and I would feel so much better, just being able to talk! And by that I got rid of the anxiety.”

Before receiving supportive care, Sam-Fong said, “I wouldn’t go nowhere. I was in such depression because I was in the hospital for so long.” But that’s no longer the case. “Today, the only thing I don’t do is drive — because my judgment might not be the greatest,” she admit-

ted with a laugh.While she is receiving chemotherapy and

being monitored, she is “a lot better, stronger” as a result of palliative care. “I only wish I could continue,” Sam-Fong said. And she has an important message for anyone who might get a similar diagnosis. “I just want everybody to know that palliative care is not the end of the world,” Sam-Fong said. “It’s not the end of your life. It’s the beginning of accepting life — quality life — and making the best of it.”

For other patients, palliative care can serve as valuable preparation, smoothing the way for an easy transition to hospice.

Bob Self was the caregiver for his brother, Thomas Self, who was referred to Supportive

(Story continued on page 6)

Kaua¥ i Hospice, Humane Society team up for pet therapyBy Viviane Gilbert Stein

The therapeutic benefi ts of the relation-ship between pets and people have been

well documented, both in scientifi c journals andby anyone who has ever relaxed with afurry companion.

Now, Kaua‘i Hospice clients are able to enjoy some of those benefi ts too, thanks to a collaborative effort with the Kaua‘i Humane Society. “It has shown to have a lot of benefi ts to patients, and for end-of-life patients in particu-lar,” said Kaua‘i Hospice Medical Director Dr. Robert Weiner. “People love it.”

Pet therapy is very big in the hospice fi eld nationally, said Weiner, but he’s not sure anyone else in Hawaii is doing it yet. The Kaua‘i program only started a few months ago, but so far “it’s going very well,” said Weiner. “The patients really like it.”

“The people who bring their dogs love it, too,” he added. “And the families of patients report that the patients have less suffering, and are happier afterward.”

The response from Kaua‘i Humane Society (KHS) was equally positive.

“What I’m hearing is that it’s wonderful, both for the clients and the volunteers,” said Janis Benn, volunteer coordinator at KHS. “What

a wonderful experience for them to be a part of!”The Pets Are Loving Support (P.A.L.S.) Pro-

gram was started years ago at Kaua‘i Humane Society, Benn said, and P.A.L.S. volunteers regularly take dogs and cats into nursing homes and long-term care facilities around the island. So Benn was thrilled when Dr. Weiner ap-proached KHS about extending the service to

Kaua‘i Hospice. “It seems to be going very well,”

said Benn. “The families have been very excited.”

P.A.L.S. volunteers were already familiar with facility visits, wherethe interactions with clients range from structured to casual. But taking their animals for solo visits with apatient in their home, where “they can go out in the fresh air,” is a new and positive experience for the volunteers,Benn reported.

“Hospice visits are really one-on-one,” and the volunteers are really enjoying that opportunity, Benn said.

“I think it’s a wonderful program,” she said.

Two P.A.L.S. volunteers and three Hospice patients have participated in the program’s fi rst few months, but in order for it to expand, more volunteers arebeing sought.

Volunteers with special dogs, that is. “It obviously has to be an animal that trusts and loves people,” Weiner said.The Kaua‘i Humane Society holds volunteer

orientations on the second Saturday of every month, Benn said. After the orientation, training and evaluation sessions are scheduled.

For animals in the visitation program, there are slight modifi cations to the “Canine Good Citizen” test normally administered to volunteer animals. For example, dogs are screened to make sure they can handle “clumsy petting,” or loud noises, and won’t be startled by a person moving around them on crutches or in a wheel-chair, Benn explained.

“We want the dogs and the clients to be comfortable, so it can be an enjoyable experi-ence,” Benn said.

Once all the training is complete, the volunteering can be done completely at the convenience of those involved, Weiner said. Volunteers can arrange to bring their freshly groomed dogs for vis-its whenever it is convenient

for them, and whenever it is mutually agreeable for the patient, who tends to be homebound.

After that, it’s all up to the healing benefi ts of a warm set of paws, a furry grin and the unconditional acceptance of a comfort critter.

“People are very comforted by animals,” Weiner said. “It’s something we can’t calibrate.”

Although there have been plenty of stud-ies showing the benefi cial effects of pets on humans, that’s not really the point here, Weiner said. “We’re not trying to do any research or measure anything. But if it seems like it helps, we’ll try it.”

To volunteer for Kaua‘i Hospice, call245-7277 or email info@Kauaihospice.org.

To volunteer for the P.A.L.S. Program, con-tact Janis Benn at the Kaua‘i Humane Society at 632-0610, ext. 111, or via email at volunteers@Kauaihumane.org.

We want the dogs and the clients to be comfortable, so it can be an enjoyable experience.

Kaua‘i Hospice.

very excited.”

familiar with facility visits, wherethe interactions with clients range from structured to casual. But taking their animals for solo visits with apatient in their home, where “they can go out in the fresh air,” is a new and positive experience for the volunteers,Benn reported.

on-one,” and the volunteers are really enjoying that opportunity, Benn said.

she said. Two P.A.L.S. volunteers and three

Hospice patients have participated in the program’s fi rst few months, but in order for it to expand, more volunteers arebeing sought.

Volunteers with special dogs, that is. “It obviously has to be an animal that trusts

6

Kaua‘i Hospice is part of Foodland’s Give Aloha Program. During September, Maika‘i members are invited to make donations up

to $249 to their favorite participating Hawaii non-profi t organiza-tions at checkout. Donations to each organization are tracked, and Foodland’s matching gift is divided proportionately among all participating organizations based on customer donations to the organizations.

Please tell the cashier that you’d like to supportKaua‘i Hospice, Inc. organization code 78137.

Give Aloha aua‘i Hospice is part of Foodland’s Give Aloha Program. During September, Maika‘i members are invited to make donations up

By: TriciaYamashita, Opera-tions Director

Since 1983, Kaua‘i

Hospice has been providing expert end-of-life care to patients and families in need on our

Kaua‘i island community. Today, Kaua‘i Hospice remains the island’s only not-for-profi t, community-based provider of hospice care.

Today, we care for patients living with any life-limiting illness, including heart disease, cancer, ALS (Lou Gehrig’s disease), AIDS, liver

disease, emphysema and Alzheimer’s demen-tia. In 2013, Kaua‘i Hospice’s patient census reached a record high – serving nearly 40% of all deaths in Kaua‘i County, a long way from the 10 patients served the entire year in our humble beginnings. No matter how sick or how old (or young), from newborns to centenarians, we’re ready to be of service.

The need for hospice care will continue to expand due to an aging population, the increas-ing concern about end-of-life care, rising health care costs and cuts to state and federal funding streams. Both medical professionals and the general public are choosing hospice care over other forms of health care delivery because of its holistic, patient-family and in-home-centered philosophy. A National Institutes of Health study showed that more Americans now die at home

or in hospice care than in hospitals.Charitable gifts to Kaua‘i Hospice help

underwrite nearly 16 percent of patient care costs. We count on your support to make end-of-life care available to everyone, regardless of their ability to pay, and to provide excellent comprehensive care, bereavement support, and other services.

A little planning can result in big tax savings and provide a lasting tribute to your support of Kaua‘i Hospice. Our trained professionals will work with you and your fi nancial advisors in strictest confi dence to help meet your charitable and fi nancial goals. To learn more about giving to Kaua‘i Hospice, please contact the Develop-ment Department at 808-245-7277 or email: development@kauaihospice.org.

The Importance of GivingBy: TriciaYamashita, Opera-tions Director

SHospice has been providing expert end-of-life care to patients

Kaua‘i island community. Today, Kaua‘i

The Importance of GivingThe Importance of Giving

Care after his second surgery. “Tom received excellent care,” Bob said in

the video made by Grigorova. “Dr. (Robert S.) Weiner and Juliana, they were always there for any questions that he had. They were there for the support and if he needed his prescriptions, his pain medications revised, updated, it’s like they already knew what he needed.”

Tom was optimistic about recovery, and throughout his three months of palliative care, there was no talk about dying.

“He was all very positive through the whole process and supported in what he was preparing for — it was wonderful,” Bob said.

But when it became clear that Tom’s health was declining, the foundation was laid for his transition to hospice care. “I didn’t know what really to expect, but it was so smooth and so easy and so stress-free. They just knew what to do,” Bob said of the team. “And they were caring for both of us, you know. It was a process that we were both going through.” Bob is certainthat the positive feedback Tom was getting,

“his positive feelings that he had, always for the positive end,” and supportive care staff “helped in that tremendously. Tremendously.”

Bob, who never considered hospitalizing his brother, said that “Juliana was supportive in helping keep him at home and feel comfortable at home, and made us feel comfortable with him being there.” The team also helped the family prepare emotionally for the end.

“I can’t imagine having gone through that and not having had the palliative care before, and the care that hospice gave after,” Bob mused. “I just don’t know what we would have done or how we would have felt. But it was real caring, and real supportive, and we felt good.”

In the end, Tom was able to die at home, not a hospital. And Bob was visibly moved when re-calling the support they received from Palliative Medicine Partners and Kaua‘i Hospice staff.

“Juliana was there the whole time. Dr. Weiner, the whole staff, was very supportive,” he said. “I have no idea how we would have done it (alone). I have no idea. This is the fi rst time I

have gone through being with a loved one and them passing. I don’t know what I would have done.” So would he recommend palliative care to anyone facing a similar situation?

“Oh boy, yes,” Bob responded emphatically. “There’s no doubt. If people are in that position, they really need to come to palliative care. The program is wonderful.” Sam-Fong agreed.

“I would like everybody to know: if they recommend palliative care or even hospice care, it’s not the death sentence,” Sam-Fong said. “It’s to help you to live a quality life. Quantity is one thing. I don’t wanna be alive and no quality. “So I guess my message is, out to everybody out there: if you get diagnosed with the Big C and they talk about palliative care, before you make a decision of saying no, fi nd out what the program is all about.”

(Continued from page 4)

Newly diagnosed patients with a serious illness are presented with many concerns:

not just alarming physical issues but economic, emotional and spiritual questions that often accompany such a diagnosis. Questions range from the prosaic and concrete (“What will insurance cover? Who is going to drive me to my treatments?”) to the profound and abstract (“Why did God give me cancer? What happens when we die?”)

Facing those questions alone can be daunt-ing. Kaua`i Hospice’s Palliative Medicine Partners provides a team of healthcare professionals who help the patient and their family navigate their new landscape.

“The whole emphasis of palliative care is to work with the patient to bring about comfort,” explained Dr. Neil Clendeninn, program director

for Palliative Medicine Partners. “With palliative care, they still are receiving curative intent thera-py or active therapy, but we’re helping them with the other issues.” And while palliative care can serve as a transition to hospice, it is aimed at assisting patients with any serious complex illness — not just those for whom deathappears imminent.

Kaua`i Hospice’s Medical Director Dr. Robert S. Wiener summed it up like this in a recent article: “All hospice care is palliative care. But not all palliative care is hospice care because palliative care also includes symptom-weighted care for patients who may completely recover from their serious illness.”

Kaua`i Hospice has been operating an HMSA Supportive Care pilot program that provides up

to 90 days of palliative care to patients with late-stage cancer and patients with advanced heart and lung disease. “We provide intensive palliative care services, consisting of physi-cian support, nursing support, social work and spiritual care.” Palliative care not only eases suffering and improves quality of life; it makes sense from a fi nancial standpoint. Studies are proving that offering palliative care can save in-surance companies money — “a lot of money,” Clendeninn said.

That’s especially important as the impacts of the Affordable Care Act are realized, Clen-deninn pointed out. “The insurance companies are looking at how they can best maximize their dealings and profi ts, under a changing health care system.”

“Not only does palliative care save money, the patient feels better, and their quality of life is better, and in many cases they actually live longer!”

Team of SupportDr. Weiner and Dr. Clendeninn

provide medical support, while working with the patient’s primary care physician. Patients may re-quest the service, or be referred by their oncologists and cardi-ologists. It’s a collaborative, not a competitive relationship, Wiener and Clendeninn emphasized.

That, in turn, helps the primary care physicians, who may not be able to spend as much time as they would like with patients as palliative care professionals can. “A huge benefi t of palliative care

is the 24/7 nursing support service it provides,” Clendeninn pointed out.

Six of Kauai Hospice’s RNs are certifi ed in hospice and palliative care, Wiener said.

Palliative Care Coordinator Juliana Grig-orova’s favorite anecdote to illustrate the benefi t of palliative care concerns a patient with heart disease who was a “frequent fl ier” at the emergency room. This patient was enrolled in the HMSA Supportive Care program. When Grigorova went to the house and visited with the patient and caregiver, she requested they phone the 24 hour nursing support the next time a crisis arose.

Soon enough, Grigorova got a call from the frantic caregiver, who wanted to take the patient to the ER right away. While they were speaking,

Grigorova was able to reach Dr. Wiener, who was in the area, and directed him to the house.

“When I put the phone down, Dr. Wiener was already in the house. That was even faster

than the ER response would have been, “Grig-orova recounted.

The Palliative Medicine Partners team also includes two certifi ed palliative medicine social workers Linda Crocker, LCSW and Crystal Stoner, LMSW, who address psychosocial issues as well as provide social services support.

“Spiritual care is provided by Board Certifi ed Chaplain Rev. Caroline Miura, who supports patients and works to address spiritual and emotional issues, Wiener said.

“The whole purpose of palliative care is to reduce suffering,” Wiener explained.

“And the fear, confusion, anger and ’an-ticipatory grief’ that follow a serious medical diagnosis all can cause suffering.

‘The work of the spiritual caregivers is often misunderstood,’ Weiner said. ‘They don’t aim to convert patients, or make them pray. They won’t even force patients to talk about their feel-ings — but they’re there to listen,” Wiener said. “There is a spiritual aspect to people that they may not have thought of before, but at the end of life such issues often arise.” Bereavement counseling is also very important. With all those benefi ts, one wonders why palliative care isn’t covered by all insurance companies.

“This seems like such a logical thing to do, why can’t it happen, like, yesterday?” Clen-deninn mused. He recounted a recent conversa-tion with insurance company representatives, who said, “This is great! But we don’t know if we can do it yet.”

His response? “But you have to do it! It’s important to do it! It’s not expensive — look at the benefi ts you would get! And they see that, but it’s just changing the paradigm.”

The efforts of Palliative Medicine Partners are seeking to bring about that change.

Palliative care supportspatients, families ‹ and even saves money

7

Palliative care supportsPalliative care supports

Photo by Viviane Gilbert SteinPalliative Medicine Program Director Dr. Neil Clen-deninn, Palliative Care Coordinator Juliana Grigorova and Kaua‘i Hospice Medical Director Dr. Robert S. Weiner are key members of the Palliative Medicine Part-ners team at Kaua‘i Hospice.

was already in the house. That was even faster was already in the house. That was even faster

than the ER response would have been, “Grig-

A huge benefi t of palliative care is the 24/7 nursing service it provides.

Photo by Viviane Gilbert Stein

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