SUMMER 2012

Hospice Care: Making a DifferenceA hospice nurse was recently asked, “How can you work in hospice – it must be so sad!”

She answered, “I love providing highly-skilled, compassionate care because I know I make a huge difference in the quality of a person’s life. Hospice isn’t about dying, but is about living as fully as possible despite a life-limiting illness. I love that I can use my training as a nurse to bring comfort and dignity to my patients, and seeing the relief on their faces and on the faces of those who care for them. I love being a part of a professional hospice team that works together to offer individualized, holistic care to families when it is critically needed. I love that I can offer practical solutions to patients and families at one of life’s most challenging moments.”

What is Hospice Care?Hospice care provides pain management, symptom control, psychosocial support, and spiritual care to patients and their families when a cure is not possible. The nation’s hospices serve more than 1.5 million people every year – and their family caregivers, too.

Hospice care is fully covered by Medicare, Medicaid, and most private insurance plans and HMOs.

Many people only consider hospice care in the final days of life, but hospice is ideally suited to care for patients and family caregivers for the final months of life.

brookingshealth.org

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Home Health Staff

Achieves Top 25 Percent

Performance Rating

Jan Olson

Jan Olson has worked for Brookings Health System for 28 years, first as a Certified Nursing Assistant at the hospital, and in the home care department since 1988. In her role as a nursing assistant, she helps patients with bathing, dressing, ambulation and other personal cares.

When asked what she enjoys most about working with hospice, Jan said, “I think of my job as a ministry and am pleased when I can give comfort and aid to the people I care for, whether it’s by giving them a bed bath or if they are strong enough, a nice warm shower and shampoo. I know that sometimes this is the only time that the family can relax just for a few moments. My time taking care of their loved one is so much appreciated. I know that

Brookings Health System’s home health services staff have consistently performed in the top 25 percent of home health services nationwide for the past nine months as surveyed by auditing firm NRC Picker.

Ninety-two percent of patients surveyed in the past nine months rated overall care by home health at a nine or a 10 on scale of zero to 10.

“Home health’s consistent, high quality rating signals that our staff and care providers continually exceed the expectations of our

sometimes it is hard for the family to cope with what’s going on with the patient, so I try to listen and suggest ways of helping.”

Jan and her husband, Dale, have been married for 44 years. They have a son, Dale, who lives with his family in North Carolina, and a daughter, Michelle, who lives with her family in Nebraska. They have seven grandchildren.

In her spare time, Jan enjoys photographing family and places she has visited, as well as scrapbooking those photos. She is an active member of the local VFW Auxiliary and has held the positions of Auxiliary President and Auxiliary Treasurer. She also enjoys sewing, knitting and counted cross-stitch.

patients and deliver compassionate care that allows patients to remain living at home,” said CEO and President Jason Merkley.

Home health provides customized care plans to patients who are recovering from an illness, undergoing treatment, disabled, chronically ill, or terminally ill. They provide skilled nursing care, home health aides for personal care, rehabilitation therapy, social services, patient and family education, and medication monitoring seven days a week.

Hospice Team Spotlight

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In my previous article, I discussed the topic of suffering and identified some of the common emotions associated with it. Fear, anger, sorrow, guilt, and grief are just a few. I also commented that it is human nature to question the purpose and meaning of suffering. The biblical character Job wondered why he became the object of suffering when he had done nothing to deserve it. He wondered why and he wasn’t afraid give voice to his complaint. Looking to God he asked,

“Why did I not die at birth? I am not at ease, nor am I quiet.” In reality Job was boldly telling God that if suffering is the lot of the innocent, then they’d be better off dead. He expected answers. And he wasn’t about to let God off the hook.

I wonder how you feel about Job’s protest. When I read the book of Job for the first time, I remember feeling shocked by his brashness. I remember thinking that he had a lot of nerve talking to God like that. After all, he was just a man and God was, well, God. I was disappointed with Job. If I’d been there, I would have told him so. As for his questions, I would have answered them all. What he needed was right there in the Bible plain as day: “God works all things together for good...”

That’s what I would have said. If only I’d been there. I could have really helped Job.

Isn’t that the way it is? The minute bad things start happening, a sickness, a death, a difficult divorce, or a wayward child, our “friends” start showing up from all over to tell us how to feel and what to do. People we don’t even know start giving advice, telling us what’s wrong with us, even judging us. They really believe they have the answers to our problems. I call them

“Fixers.” Someone said, “Sufferers attract fixers the way roadkill attracts vultures.” For the most part though, fixers mean well, bless their hearts. They really do want to help. If only they could wave their magic wands and make everything better, life would be great. But magic wands belong to fairy tales. Illness, death, and suffering are real life.

In our compassion, we don’t like to see people suffer. When I ask patients how I can help them, some ask for physical healing. I wish it were that simple. If I could fix them, I would. But I can’t. So what does it mean to help? What does helping look like? Scores of books have been written on the topic of pastoral and spiritual care. I obviously don’t have

the space here and you don’t have the time (or perhaps the interest) for a full exposition. But I do have a few goals that I try to bring to every spiritual care visit. They’re simple, but they’re not always easy to accomplish.

My first goal is to be present. Being present means loving and accepting patients where they are spiritually and emotionally—good, bad, or ugly. It means giving them the freedom to be real, to express their thoughts and feelings without the fear of being judged. It’s amazing what “just being there” can do for a person. My second goal is to listen. Everyone has a story to tell. Listening means that instead of telling my story (which is really tempting), I focus my thoughts on the patient’s story. I find that when people are allowed to tell their story, they often find their own answers to questions. My third goal is to be empathetic. Because we’re all human, we share a fellowship of suffering. I have suffered, and I imagine you have, too. As a result, we can resonate with patients’ struggles and accompany them through their journeys. Job needed someone who cared. He suffered alone. No one needs to suffer alone.

Excerpts of this article were taken from Eugene H. Peterson, The Message: The Bible in Contemporary Language.

The Fellowship of Suffering

Hospice ChaplainBy Pastor Gregg TeBeest

Being present means loving and accepting patients where they are spiritually and emotionally—good, bad, or ugly.

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”—Pastor Gregg TeBeest

brookingshealth.org

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Brookings Health System Hospice would like to acknowledge with appreciation the following donations (received through 6/30/12):

We Extend Sympathy to the Families of Patients Lost through June 2012:

In Memory of Dale Svennes Bonnie Nielsen

In Memory of Irene Bolte Dolores Brage

In Memory of Bob Fenner SV Homemakers

Donation from local wine club

Connie Even 1/4/60-4/6/12

Lavon Harsh Hodson 5/8/35-4/8/12

Robert Martinell 4/14/21-4/12/12

Thomas Lucas 5/4/30-4/18/12

Gerald Houtman 2/21/32-4/24/12

Gertrude Mullinix 1/3/12-5/6/12

Dale Svennes 2/6/43-5/8/12

Irene Bolte 6/6/19-5/22/12

Lovern Hruska 1/26/31-5/25/12

Doris Olson 9/27/25-5/26/12

Marlene Westby 5/23/35-5/26/12

David Nilges 8/30/47-6/1/12

Helen Vessey 11/14/21-6/11/12

Douglas Andersen 5/21/56-6/19/12

Karen Hogie 8/30/43-6/19/12

David Swenson 2/6/43-6/22/12

David Hintz 12/25/47-6/25/12

George Rud 3/13/34-6/29/12

Gary Dekraai 2/23/42-6/29/12

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Are You Traveling Without a Map?A Layperson’s Guide to Advance Care Planning

Advance care planning is like planning a road trip to an unfamiliar destination. If you’re like many people, once you have your destination in mind you begin mapping the route you will take to get there. Some people consult AAA or Google Maps to help them chart their course. Other people talk tofriends and family members about their experiences regarding their previous trips.

While people approach mapping their route in differing ways, very few people would expect to arrive at their destination safely and comfortably without having a well-thought out map in hand before hitting the road. Yet only 30% of American’s have a living will, a map detailing where they want their health care to “go” in the future should they become unable to voice their wishes.

Map Your Journey

A living will charts the course for your health care, letting your family and health care providers know what procedures and treatments you would want provided to you — and under what conditions. If you’re one of the 70% of Americans without a living will, it’s best not to wait to chart the course for your future health care. Without a map, your health care journey is out of your hands and may not take you in a direction you’re comfortable with.

What if you have a sudden, serious illness or accident and you’re unable to breathe on your own, would you want a tube to be placed in your throat to push air into and out of your lungs? If you are diagnosed with an illness that your doctor thinks is incurable and likely to shorten your life significantly, do you want the focus of your care to be on keeping you comfortable and pain free? Or do you want a combination of life-extending care and comfort care? A living will, like a route marked on a map, indicates which direction you’d like to take at each fork in the road. It’s your journey — you decide which roads you want to take and when.

Choose a Back-up Driver

A health care power of attorney or health care proxy designation form, the second type of advance directive, allows you to choose someone you trust to “drive” (take charge of your health care decisions)in case you are unable to make those decisions yourself. You might want to pick a family member or friend who is comfortable talking to doctors.

If you don’t decide who can “drive” and you end up unconscious you might end up being taken on a health care journey that is contrary to your values, wishes, and choices. Choose someone you trust to be your back-up driver so that when unexpected road blocks appear

along your health care journey, your back-up driver is able to choose a detour that is in keeping with your values, wishes, and choices. Your health care journey may involve traveling long distances, so prepare your back-up driver by reviewing your map with and allowing them to ask questions so they are prepared when it is their turn to drive.

Update Your Map and Make Sure Your Driver is Prepared

Just as your travel preferences might change as you age, so might your living will. Your first living will might state that you want all care focused on sustaining your life and at some point later in your life you might change your mind. Later on you might decide your priority is to try life-extending treatment for a period of time and then transition to a focus on comfort care. And at some point, you may or may not choose strictly comfort care, like hospice, to allow for a natural death in the setting of your choice with friends and family around you. Therefore, as your preferences change, it’s essential that you update your living will, and that you make sure your backup driver knows what you want.

In the end, the route you take and the driver you pick are your choices to make. And the care you receive and who talks to doctors on your behalf is also your choice, but only if you make a plan now.

Vice President, Consumer and Caregiver Services, National Hospice and Palliative Care Organization

By Katherine Brandt, MS

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Hospice Volunteer Spotlight

We in the Hospice Program are happy to have two new volunteers who have already been very involved in spending time with clients. Kris Rivas and Nancy Gries are compassionate people who are volunteering because they want to help others.

Kris works as a secretary for the Probation Department. She has been involved in volunteering at her church, for PTA and as a mentor.

Nancy was the Activities Director at Brookview Manor until her retirement. She plays the piano by ear and is bringing music to our clients with her keyboard.

We warmly welcome Kris and Nancy as our newest Hospice Volunteers.

Are you interested in becoming a Hospice Volunteer?

We would like to have you join us! Our hospice program utilizes volunteers in a variety of ways at all levels of skill, from providing companionship to a hospice patient and their family, to assisting with meals, to doing administrative work in our office. We are in need of more compassionate and caring men and women. If you’re interested in volunteering, call Mavis at (605) 696-7700 for more information.

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Yesterday’s message on the answering machine stunned me. A friend of many years had been diagnosed with Alzheimer’s disease. Joan had been a friend for more than 36 years. Her husband and mine were also friends. Joan had been living some three states away for the past four years and our contacts with each other had decreased. A visit 14 months ago revealed nothing unusual (in fact, more concern about her husband than about her).

Joan can no longer read, gets confused about names of people, and of course has difficulty with short-term memory. A phone call to her was encouraged. My thoughts about that were questions. What would I say? Would she remember me? What could I say that would be of any help to her? She had been depressed about her diagnosis and was now just frustrated.

Then I remembered a book I’d just read called The Four Things That Matter Most by Ira Byock, MD. Byock is a hospice and palliative care physician. His other writings had been interesting and enlightening, and this book was no exception. Byock talks about four things that

are important to say to family and friends, especially before one dies. I had begun to encourage this with hospice clients and family members.

His four things are simple: Forgive me. I forgive you. Thank you. I love you. The words are simple, but saying them may be difficult in some circumstances. Byock cites many anecdotes in which spouses, children, parents and friends have been challenged by these simple but powerful words. Saying them had also been immeasurably rewarding.

As Byock says and those working in the field of grief education also affirm, people live on within us. Consciously and unconsciously our memories of them and our interactions with them become part of who we are. Being able to say “forgive me” and “I forgive you,” though difficult, can heal years of pain. A woman, Carla, talked about spending hours talking with her father days before he died. He had not been emotionally available and was often physically absent to his family because of his drinking and deep depression. Though difficult for her, Carla was able to ask forgiveness for not being able to help him. Her father, though not directly asking forgiveness, apologized for the

difficulties he had caused. They also said a lot of “I love you’s.” Carla felt a good measure of peace following her father’s death because of these conversations. The memory of her father that would live on in her had shifted to include the man of his final days who apologized and said “I love you,” words Carla had longed to hear for years.

When saying thank you, Byock suggests being very specific. “Thank you for your love. Thank you for putting up with me,” can be ways to begin.

I have much for which to thank Joan. The list includes her faithfulness in remembering birthdays, and her personal support of me during a difficult time. I can ask her forgiveness for my not keeping in touch more often. It is hard to come up with something to forgive her about. Saying “I love you,” will not be difficult. I indeed love this friend of long standing.

Of course one does not need to wait until a crisis to say these things to family members or friends. Much may be gained by saying them now.

Forgive Me. I Forgive You. Thank You. I Love You.

Hospice Social WorkerBy Mavis Gehant

The words are simple, but saying them may be difficult in some circumstances.

“”

—Mavis Gehant

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Hospice News is published by Brookings Health System. This publication in no way seeks to serve as substitute for professional medical care. Consult your physician before undertaking any form of medical treatment or adopting any exercise program or dietary guidelines.

300 Twenty-Second AvenueBrookings, SD 57006

ADDRESS SERVICE REQUESTED

Hospice Volunteer Meeting…………………………Last Monday of each month

Grief Education Series………………………………5 weekly sessions to be offered in the Fall 2012. Call Mavis Gehant for details (605) 696-7700.

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