Department Spotlight: Hospice & Palliative Care
September 27, 2024
The Hospice & Palliative Care department at Renown is the best of the best. Their efforts go far beyond simply addressing physical pain; they also bring emotional and spiritual solace to patients and family members navigating the complexities of serious illness and end-of-life. This team provides crucial guidance and expert knowledge, comfort and care when it is most needed.
Bringing Dignity to the Final Days
Contrary to popular belief, hospice and palliative care is not a “last resort” option for families. In fact, it’s quite the opposite. These caring professionals work hard to ensure a patient’s final days are free of pain and full of peace, rather than focused on the end. This type of care isn’t a death sentence – it's a living gift.Each patient is involved in his or her own end-of-life process. They have a huge role in deciding on their own and with their family members how they want to live out their remaining days.
“Every team member’s daily work focuses on how to facilitate a good death for each patient,” said Tanya Prosch, Hospice Supervisor. “Ultimately, it is up to each patient’s family to be involved in this process. Every day, there is a lot of communication among team members as we prioritize the needs of our patients. As patients decline and their symptoms change, we continuously assess what topics we will discuss. This creates a beautiful back-and-forth dynamic among the team, patients and families.”
“Together, we come as a team to provide what they need, ensuring individualized care for each patient and family based on their safety and specific needs,” added Rachel Schneider, Transitional Care Specialist. “Our care plans are not cookie-cutter; they are tailored to fit each unique situation.”
The hospice team provides comfort and support to those in the final stages of a terminal illness. Hospice is focused on one main goal, which is enhancing quality of life for patients and their families.
“In general, hospice staff conduct home visits to see our hospice patients,” said Amy Nieminen, Manager of Home Health & Hospice. “We have an interdisciplinary team that includes nurses, aides, chaplains, social workers and volunteers. Together, we address both the physical and emotional, spiritual and social needs of our patients and their families at the end of life, ensuring they have a meaningful and peaceful experience. We do a lot of work with families and loved ones, providing follow-up calls and support for the patient’s caregivers after their passing. Our support extends for up to a year, with grief specialists available to help families through their loss. Additionally, we have rotating on-call nurses every night and weekend, so patients are never left without care.”
While palliative care shares similar duties to hospice care, it differs slightly. Palliative care can be involved at any stage of a serious illness, even during treatments.
“During in-home palliative care, we work with patients who may be physically ready for hospice but who are not yet psychologically, emotionally or spiritually prepared to make that transition,” said April Lennon, APRN for In-Home Palliative Care. “They may still be exploring treatment options and working with their specialists. We provide a lot of support, helping them understand the consequences and benefits of various treatments. Additionally, we focus on symptom management for patients experiencing significant pain or nausea, assisting them in managing these symptoms effectively.”
On both sides of this department, the team has the opportunity to be especially involved in their patients’ lives and in the lives of their families. Giving loved ones more time with their relative facing end-of-life is a duty that these team members take seriously.
“My job is to educate families about what’s coming next and what is happening now, as there is a lot that occurs during the death process,” said Katie Adams, Hospice Nurse Case Manager. “Families will never regret the time and effort spent during this process. We have only one chance to get this right. This is not just a random hospitalization that people will forget; it is a significant moment that everyone around the patient will remember.”
“Being able to connect more deeply with patients’ and families’ stories and their narratives about life is essential, as it provides a broader understanding beyond just the medical picture of what is happening,” added Libby Krayk, APRN for Hospice. “We explore their expanded value and belief systems to assist with decision-making, helping them make choices together. When patients are no longer distracted by pain or nausea, they can focus on their long-term desires and goals and spend more time with their families."
“Crisis intervention, social work, education, family conferences, and placement issues are all part of what we do, and it’s quite exciting,” added Donald Kamka, Social Work Care Coordinator. “You become fully invested in the lives of those you help, which is what makes this job so rewarding. This is a remarkable time in their journey, and it’s evident that everyone involved has a vested interest in it."
Naturally, many questions, worries and fears arise during this time in a patient’s life. The Hospice & Palliative Care team members are expert communicators and know exactly how to relieve some of those anxieties, prompting a more peaceful end-of-life. According to this team, it’s all about transparency and compassion.
“Our role involves helping patients navigate the healthcare system as they face death,” said April Lennon. “Home visits can range from one hour to three hours, depending on the needs of the patient and their family. We engage with entire families, including those who are out of town, coordinating care and working with many providers in the area. Our hope and goal for every patient is to ensure they understand what they are doing and why they are doing it, empowering them to make their own choices.”
“We often find ourselves addressing the most difficult information, which can sometimes be seen as the ‘elephant in the room’ that people tend to avoid,” added Libby Krayk. “I ask patients for their permission regarding what they want to know and who they would like involved in the conversation. This approach can help alleviate some of the challenges and stress they may be experiencing. Being honest and discussing matters in a way that they can understand is essential. I take the time to sit down with my patients and connect with them on a human level, rather than just a medical level.”
As a not-for-profit health system, volunteers are at the core of our mission delivery. They graciously dedicate hours out of their week to be a friendly source of help for patients. Renown’s Hospice Volunteers exude this level of kindness and more. Our employed team members attribute their volunteers as a major source of success for Renown’s hospice program.
“I believe that being a volunteer provides a role that patients perceive as non-threatening,” said Linda Derry, Hospice Volunteer. “As volunteers, patients feel more comfortable talking to us and sharing things. This dynamic allows them the freedom to express not only how they are feeling but also their fears and any other concerns they may have. It is in these moments that we can truly connect with them, as we are volunteering out of a genuine desire to sit and visit with the patients.
“When I see a patient, the focus depends on their specific needs,” added Luanne Geissler, Hospice Volunteer. “I often give family members some time to themselves to do whatever they need to do while I visit with the patient. Many of them are very talkative and eager to share their stories. For instance, one patient told me how to make a baked potato while out in the wilderness, which has become one of my favorite stories. Another patient shared her experiences about coming to America from Asia, discussing her church, her religion and her passion for baking. She would even bring bread to her doctor.”
“I have one patient whose main desire is to play chess; he has been playing for over 80 years and is still able to play very well,” added Hervey Ibarra, Hospice Volunteer. “When I visit another patient at his home, we engage in conversations about a variety of topics. Additionally, some patients ask me questions about the military and law enforcement. Whatever they want to do and discuss, that is what I focus on during our time together.”
Regardless of whether they are a provider, supporting team member or a volunteer, every person on the Hospice & Palliative Care team shares a primary focus: helping patients live their remaining days, no matter how long that may be, with dignity and comfort, surrounded by their loved ones.
Renown Hospice
The “Why” Behind the Passion
For many people entering the healthcare field, hospice and palliative care often isn’t a field they immediately think of embracing when starting their career. After all, this line of work has a death-focused stigma attached to it. So, what is the story behind their passion for this field?Personal experience with hospice and palliative care is a main motivation for several of these team members.
“Hospice has always been a part of my life as far back as I can remember,” said April Lennon. “My grandmother passed away while on hospice when I was just five years old, so I was always aware of the process. When I later learned about hospice in nursing school, I was struck by how amazing it was that people could receive care at home while going through end-of-life. I initially worked as a nurse in the pediatric ICU, but once I transitioned to hospice and palliative care, I never looked back. I have found that this line of work is healing for the soul. With extensive experience in end-of-life care across various capacities, it is one of the most rewarding aspects of my career.”
"As a teenager, my grandfather was in hospice with us in Colorado, and the hospice nurse who cared for him made a huge impact on our family,” added Tanya Prosch, Hospice Supervisor. “This nurse helped us think beyond ourselves, and I held this person in high regard. Although I was initially scared of nursing, once I was in nursing school, I knew that hospice care was the only field I wanted to pursue.”
For others, growing up in an area without access to this type of care proved to be difficult for their ailing relatives. Bringing hospice and palliative care to those in our extended communities is a large reason for choosing this career.
“I lost my dad in 2006 while he was on hospice. At that time, we were living in rural Nevada, where there weren’t many healthcare options,” said Rachel Schneider. “When my dad needed hospice care, there was a company that was able to come out that far and provide the necessary services. I began my career in home health with the same company in that rural area. They were fantastic with my dad and my mom. They didn’t just take care of the patient and leave; they offered support and guidance to the loved ones going through the process while ensuring the patient’s comfort and a good quality of end-of-life care.”
Much of this team wanted to give back in this way directly in honor of a late family member, especially after going through the grieving process themselves.
"I began taking care of my father when I was just 12 years old, as he was diagnosed with Alzheimer’s,” said Jennifer Hendrickson, CNA. “He was the youngest Alzheimer's case in Washoe County at the time. I kept him at home until he passed away. This experience made me realize that the struggles I faced were similar to those others endured. I am now dedicated to helping people remain at home as long as possible, preserving their independence and comfort. Many people with dementia experience a rapid decline when their environment changes, which is why I am committed to working in this field—to support patients in staying home and maintaining independence for as long as they can.”
“I joined the hospice volunteer program after my brother passed away; I was going through a very difficult time and decided that I needed to give back,” added Linda Derry. “At that time, the Reno Gazette-Journal had a section titled ‘Help Wanted/Volunteers Needed,’ and I happened to see an ad for hospice volunteers. I thought to myself, ‘Well, I can do that!’ I became involved in honor of my brother's memory.”
The passion for end-of-life and critical illness care has helped these team members develop a fulfilling career with a focus on continuous improvement. In fact, when an opportunity arises to improve any processes or implement new programs that would benefit patients and families, individuals on this team will always find a way to take action.
“I recognized an opportunity to improve end-of-life care for families, which motivated me to create an end-of-life packet during my time at another hospital,” said Katie Adams. “I trialed and rolled this packet out to our unit, which included grief resources, mortuary information and legacy-giving options, such as providing families with a lock of hair or a handprint on a poem. For anyone who was dying in our unit, we would implement this program. I felt a strong urge to act on this and make a difference. The program was successful and was eventually accepted throughout the entire health system, including in the NICU and other areas.”
Renown has a longstanding role in the community, which makes a strong impact on several hospice and palliative care team members. Bringing their passions to our health system was a no-brainer for them.
“Eight years ago, my sister passed away from pancreatic cancer, and we were at Renown when we signed her onto hospice care,” said Luanne Geissler. “The quality of care provided by the nurses and staff was truly exceptional. When she passed away, I expressed to the doctor my desire to be involved with the team that had cared for her.”
“I believe the palliative care team at Renown is the best team around,” added Jessica Elmore. “Here at Renown, it’s all about doing what’s right. From the moment I joined, it felt like I had been a part of this team forever. The emotional intensity in palliative care is huge. I truly feel that there is no other place I could be; it aligns perfectly with my personal philosophy and my role as a social worker.”
“I knew Fianna – whom Fianna’s Healing Garden at Renown Regional Medical Center was named after – and was involved in her complex care,” added Libby Krayk. “I realized that palliative care is a special level of nursing, and I knew I’d learn so much here.”
“I remember being a little kid seeing the Renown buildings and telling my dad, ‘I’m going to work there one day,’” added Jennifer Hendrickson. “Over the years, I have worked with different agencies and facilities in home care. Knowing that Renown is a nonprofit organization that treats everyone regardless of their income or insurance, I felt that this was the place where I could truly give back. I enjoy helping my patients all over Reno-Sparks, Carson City and Fallon with personal hygiene and tidying up their environment to make them feel more refreshed. I call this their ‘spa day.’”
While there are several reasons why these team members chose hospice and palliative care as their career path, there are also several reasons why they have decided to stay at Renown. Now that we all know why members of this team entered this career and came to Renown to practice their craft, let’s learn about the many reasons why they decided to stay.
“The reason I stay here is because the hospice care Renown provides is top tier; it truly is the best of the best,” said Adam Barkley, Chaplain. “There is no better place to work. I have never encountered a higher quality of colleagues, both in terms of their professional disciplines and in administration. The entire team consists of the finest individuals I have ever worked with, both in their dedication to their unique disciplines and in their commitment to teamwork and to our patients.”
“I have been with Renown for 13 years,” added Amy Nieminen. “I chose to come to Renown after graduating from nursing school because I felt it was the best option among all the places I considered, and I knew I would have more opportunities here. I truly appreciate my coworkers, as well as Renown’s commitment to improvement and to providing the best possible care.”
A patient’s legacy doesn’t just surround their death – it lasts forever, and the Hospice & Palliative Care team make sure of it.
“In 2022, a patient’s family nominated me for a Northern Nevada Nurses of Achievement award, and I cannot say enough about that whole experience; I remain very committed and just love what I do,” said Katie Adams. “Seeing things like a handprint or a poem up in a patient’s loved one’s home has reignited my passion for legacy work. I am going to develop a new legacy program within this department to honor patients before and after they die.”
“I get to take home a little piece of each patient every time I visit them,” added Jessica Elmore.
It’s An Honor
Every team member in the Hospice & Palliative Care department echoes the same sentiment – it's an honor to be a part of this delicate process. After all, death is all a part of the trek.“Hospice is part of a journey for both patients and families,” said Hervey Ibarra. “I gain so much from the patients themselves; it is truly an honor and a blessing to be there with them. Sharing life with these individuals brings me a profound sense of fulfillment and joy.”
“What I take the most pride in is my ability to make a difference in the lives of patients and their families,” added Donald Kamka. “While we celebrate births, we often do not embrace death, as we are not taught to do so. I strive to help families gain reassurance and find balance. Knowing in my heart that I’ve made a difference is something I will carry with me for the rest of my life.”
As experts in Renown’s cultural commitment to “Collaboration,” these team members feel especially proud in their ability to bring new possibilities for patients with the help of everyone across their department and other departments throughout the health system.
“The collaboration between disciplines is top tier,” said Adam Barkley. “I am deeply interested in caring for the whole person, which encompasses various aspects of their well-being; my role involves supporting the entire person, whether it's addressing psychological, spiritual or faith-related needs. “Renown Hospice and the teams I work with have embraced this holistic view of care. Each discipline incorporates a spiritual element to provide comprehensive support for patients.”
“I am very proud to have played a role in building the in-home palliative care program and establishing a deep connection with the hospice team,” added April Lennon. “We work very well together, and being able to bring this type of care to the community has been a significant accomplishment for all of us. It represents a crucial step forward for our community to have access to these services."
When it comes to being a patient’s biggest advocate, those skills come naturally to this team. They are here to guide them through the process, which serves as a great source of pride.
"We are patient advocates,” said Donald Kamka. “Being on our patients' team and being invited to be a part of this significant process during such a critical time in their lives is incredibly meaningful. Many of our patients and their families reach out to us seeking support. It is a privilege to visit people in their homes and engage in these intimate conversations, guiding them through the experience. Choosing hospice care is a significant decision, and we have the opportunity to witness that process.”
“I have been in home health for a long time and have helped patients transition to hospice care. It is an honor to be a part of that process, as I can provide a little bit of love and support while advocating for them,” added Jessica Elmore.
This work brings an intrinsic sense of fulfillment for these compassionate team members, with many of them noting that this is a “surreal” experience.
“This is such a unique time in people's lives when we step in to support them,” said Adam Barkley. "They face tremendous end-of-life concerns, and being able to step into a stranger's life during such a vulnerable time is a tremendous privilege. Although we are all dying, we often project that reality into the future. To travel alongside someone who is processing their own mortality is truly an amazing experience.”
“I provide a shoulder for patients to cry on, as sometimes this support can make or break a situation, particularly for those who have no family,” added Jennifer Hendrickson. “We are there to remind patients that it’s okay to feel angry or frustrated, and we encourage them to be kind to themselves during this difficult time.”
Thanks to the dedication of compassionate caregivers just like those on our Hospice & Palliative Care team, there have been major strides in helping more individuals access much-needed end-of-life and critical illness care. Our state and federal governments have adopted several measures that have made the process easier for everyone.
“Medicare Part A and Medicaid Fee-for-Service cover hospice care 100%, regardless of the number of visits we make, which significantly alleviates stress for families,” said Rachel Schneider. “Most insurance plans also pay 100% once the deductible is met. While these plans typically do not cover in-home caregiving or the costs associated with higher care facilities, such as group homes or skilled nursing facilities, the coverage does include staff visits and necessary equipment, ensuring patients receive the support they need. We worked with the Joint Commission to exceed Medicare’s expectations.”
“In January 2024, the law regarding advanced directives in Nevada changed,” added Jessica Elmore. “I collaborated with a nursing student volunteer from the University of Nevada, Reno to revamp the advanced directive used by Renown. The new directive is aesthetically pleasing and very user-friendly, ensuring compliance with the updated law. Through the Nevada Revised Statute, we have changed some of the verbiage, specifically under AB 414. I hope to conduct training sessions for the entire health system, as I have big visions for this initiative.”
Don’t think of hospice and palliative care as a last-minute item. Instead, think of it as a part of your life, not your death. The other definition of hospice is “guest house” or “lodging,” which accurately describes the feeling our hospice and palliative care team members have with their patients: a comforting, peaceful place to be.
“A lot of people think that once you go on hospice, that’s it, you’re going to die,” said Linda Derry. “It’s important to realize that we’re not here to help you die – we’re here to help you live the best way possible until the end of your life. It’s an honor for any of us to be invited into someone’s end-of-life. It’s a tight team, and we support each other.”
If you’ve made it to the end of this piece, hopefully any stereotypes you previously may have held against hospice and palliative care have fizzled. Giving someone comfort for the rest of their days on this earth can be a beautiful privilege.
“It’s an amazing job to be able to enter people's homes, especially during their vulnerable and intimate moments at the end of life or when facing a new diagnosis. It is beautiful to witness how people manage these challenging times and to help them through it. Every single day, I find it truly inspiring. Not a day goes by that I am not inspired by our patients in some way, and that inspiration is what keeps many of us dedicated to this work,” reflects April Lennon.