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In the book of life, everyone eventually reaches the final chapter. End-of-life isn’t often something a patient or loved one wants to think about. The end of someone’s life isn’t a final option – it's a privilege. At Renown Health, we have a compassionate team prepared to approach this privilege with kindness and care.    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.

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Becoming a caregiver or playing a more active role in another’s healthcare is a big responsibility. At some point, almost all adults will support an aging parent or a loved one in need. Keeping track of their needs and wellbeing, while also prioritizing your own can become overwhelming. It’s important to know: you are not alone, and help is available. Read on for 11 tips to help you manage your time, your own wellbeing and your loved one’s care. Self-care comes first. When your main priority is the person in your life who needs care, it’s easy for your own needs to take the backseat. Give yourself time each day to focus on your personal wellbeing. It’s hard to give a loved one the care they need if your own needs are not met. Prioritize the Activities of Daily Living (ADL). Make a note of what ADLs your loved one can do alone, what they need help with and what activities require the most help. This will help you work through the day with them, as well as plan out how the day’s activities will go. Do a home safety audit. Do showers, bathtubs and steps have safety grab bars? Look around the house for additional tripping hazards, like rugs or electrical cords. If your loved one struggles with day-to-day navigation of the home, consider scheduling an occupational therapy appointment. This type of therapy helps a person develop or maintain the motions required to accomplish daily tasks. You might also qualify for a referral to in-home healthcare, such as Home Care. Have the hard conversation. The best time to discuss views about end of life care and to learn what choices are available is before a life-limiting illness or crisis occurs. With advance care planning, you can help reduce the doubt and anxiety related to decision making at the end of life. Completing an Advance Directive is a great tool to sort out all these decisions before they’re needed. Attend a free workshop to learn more and complete this important document. Identify when you need respite. Respite care involves receiving a short-term break from caregiving. Organizing in-home care for your loved one will allow you to step away and tend to your needs. By identifying what kind of respite care you are seeking, you can find the right person to provide you with that much-needed break. Don’t wait until you feel overwhelmed, plan ahead. Write down insurance contact information. Have a direct connection to the right insurance professional for support and advice. If your loved one is eligible Medicare, this is a good opportunity to review their current selections and if they would benefit from a Medicare Advantage Plan or Medicare Supplement Insurance. Seeking out expert advice or information on Medicare options is a great way to navigate this. Consider calling a broker, or attend a free educational seminar with Senior Care Plus. Gather legal and financial information. Make a list of all existing legal documents and financial accounts that your loved one has. These might include a will, advance directive, power of attorney, bank accounts or investment accounts. If you have questions about how to manage them, or need assistance in setting up additional framework, reach out to a lawyer, legal service, financial adviser or bank representative. Create an inventory of medical information. Identify where all of your loved one’s medical records are, as well as a list of providers or healthcare practices where they have received care. Consider if you should have your loved one give you Proxy Access in MyChart, which allows you to access all the features in MyChart on their behalf, including viewing upcoming appointments, viewing test results and emailing a doctor on their behalf. Make a list of what others can do. Think about all the little (and big) things that need to happen, and write down tasks that others could take care of you. When someone says “let me know what I can do” you’ll be ready with a pre-written list of items they may be able to assist with. Tasks could include tackling around-the-house repairs, scheduling lawn work, helping to walk the dog, taking a car for an oil change and cleaning. Find programs and events for social enjoyment. If and when possible, seek an activity outside of the home. Look for community centers that have programs for seniors, recreational activities or meals that you can patriciate in together. If leaving the home is not an option, arrange for visits or in-home activities, such as movie nights, card games or time to visit with family. Research long-term options. If you will be considering a nursing home or assisted living, make a list of amenities that you and the person you are caring for would like. Take this list with you when visiting potential locations to make sure you don’t forget to ask about each item.

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We plan for the birth of a child, weddings and retirement, but rarely do we discuss how we want to be cared for at the end of our lives. Getting through this challenging conversation and completing an Advance Directive can give you peace of mind that your loved ones will not have to make difficult choices on your behalf. The best time to complete an Advance Directive is now – don’t wait until a life-limiting illness or crisis occurs to discuss your views about end-of-life care and to learn what choices are available. By preparing in advance, you can help reduce the doubt and anxiety related to decision-making for your family if you cannot speak for yourself. What are Advance Directives? An Advance Directive is a document that states your choices about medical treatment and names another person to make medical decisions on your behalf if you are unable to. This document allows you to make legally valid decisions about future medical care.  “Completing your Advance Directive is a gift you give your family,” says Director of Palliative Care, Mary-Ann Brown RN, MSN. “The stress associated with these difficult decisions is decreased if everyone knows what is important to you and what you want at the end of life.”

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Feelings of grief can take on many forms and can occur in reaction to many situations, including the death of a loved one or a medical diagnosis for yourself or someone close to you. It is important to remember that this reaction is entirely natural, and many people who experience grief find outside help to be a valuable part of the healing process. Below is a list of both local and national grief and bereavement resources for all ages and specificities. If you or someone you know is experiencing grief, the trained professionals below are here to help. Solace Tree Support groups for children and teens (ages 3 to 18), young adults and their family members. For more information visits solacetree.org/grief-programs or call 775-324-7723. Healing Minds Counseling services for those coping with the loss of a loved one or major life change. For more information visit healingminds.com/grief-counseling-reno-nv or call 775-448-9760. Circle of Life Hospice Support groups open to the community held the first and third Tuesday of every month. Fore more information visits colhospice.com/bereavement-and-spiritual-care or call 775-827-2298. Summit View Hospice Grief and bereavement support open to the community-groups, memorials and by mail. For more information visit summitviewhospice.com or call 775-636-9598. The Compassionate Friends Monthly support group on the second Monday of each month for families after a child dies. Fore more information visit facebook.com/TheCompassionateFriendsofReno, compassionatefriends.org or call 775-750-7005. Healing for Survivors of Suicide Links and resources for those who have lost a loved one to suicide. For more information visit survivingsuicide.com GriefShare Grief recovery support groups meeting weekly both in-person and online with options in Reno/Sparks, Carson City and rural cities. For more information www.griefshare.org National Alliance for Grieving Children Resources for parents and caregivers to help children navigate the challenges of bereavement and grow into healthy adults. For more information visit nacg.org/resources-and-support/ Mourning Hope Grief Center Grief support groups, counseling, resources and COVID-19 support for children, adults and families before and after a death loss. For more information visit mourninghope.org Crisis Support Services of Nevada 24/7, free, confidential and caring support to people in crisis across Nevada and the U.S. For more information visit cssnv.org, call 775-784-8090 or text CARE to 839863 National Alliance on Mental Illness-Warmline A stigma-free, non-crisis phone service you can call or text that is staffed by trained peers in recovery. For more information visit namiwesternnevada.org/resources/ or call 775-241-4212. Vitas Healthcare Grief and bereavement resources and support groups both virtual and phone-in. For more information visit vitas.com/family-and-caregiver-support or call 866-489-0583. St. Mary’s - Hospice We Promise Resources on grief for all groups including children to adults, trauma, caregivers and more. For more information visit hospicewepromise.com/topics/grief or call 775-525-6700. Mountain View Mortuary Grief support and tools available to assist you in your healing journey including “365 Days of Healing” email list for daily support and comfort. For more information visit mountainviewmortuary.net/resources/grief-support or call 775-788-2199 Sesame Street – Helping Kids Grieve Discover games, videos and more on topics important to you and your child. For more information visit sesamestreetincommunities.org/topics/grie Trauma Intervention Program-Northern NV A national non-profit organization of volunteers dedicated to ensuring those emotionally traumatized receive assistance. For more information visit tipnnv.org/about-tip/resources Pregnancy & Infant Loss Support Organization A non-profit organization dedicated to the support of families who have lost a baby through miscarriage, stillbirth or neonatal death. For more information visit pilsos.org Caring Info A program of the National Hospice & Palliative Care Organization providing free resources to help people make decisions about end-of-life. For more information visit nhpco.org/patients-and-caregivers/

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A wedding is a big day for the wedding couple, but it’s also special for loved ones. A patient at Renown, Ken, got to take part in his daughter’s special day as her wedding plans changed to accommodate his medical condition. Grab some tissues and read how Renown’s team of compassionate caregivers and chaplains planned a wedding in Fianna’s Healing Garden. Ken was hospitalized at Renown Regional Medical Center where he was battling a lung problem – which was unrelated to COVID-19 – and his condition worsened rapidly on Wednesday, Aug. 12. His family made the decision to transition him to palliative care, which helps patients near the end of their lives remain comfortable, while supporting their dignity and quality of life.  Ken’s medical condition altered wedding plans for his daughter, Chandra, and her fiancé, Tyler, who were planning to tie the knot later in 2020. Chandra wanted her father there, but knew he could not leave the hospital. That’s why Chandra’s sister, Heather, approached Ken’s care team with a request to have a small wedding ceremony at the hospital.  Planning the Wedding A member of Ken’s care team, Amy Heston, registered nurse (RN), began planning how the wedding could be held outdoors in Fianna's Healing Garden in the E. L. Wiegand Pavilion, which was donated by the E. L. Wiegand Foundation.   In 24 hours, Amy planned a wedding ceremony with the help of her colleague, Breyanna Aufiero, RN; the Renown Spiritual Care team; and nursing leaders on the coronary intensive care unit (ICU). Together, they decorated the aisle in the garden with flowers and battery-operated candles. They also made a sign for Ken’s hospital bed, which read, “Father of the Bride,” and crafted a bow tie for him to wear for the special occasion.  With visitor restrictions in place at the hospital due to coronavirus (COVID-19), having the wedding outside in the Healing Garden allowed for more members of Ken’s family to attend including his wife, Charlotte, and his dog, Bella.   Every step in planning the wedding required thoughtful and thorough care coordination so Ken could participate. His breathing was supported by oxygen and special arrangements were made to transport the oxygen tanks he needed to take part in his daughter’s wedding. Amy worked with respiratory technician, Kasey Benfield, and critical care technician, Ruben Duckworth, to ensure Ken’s oxygen needs were met using portable machines.  Celebrating Love and Life Together Ken’s team of caregivers bathed him and shaved his face so he could look and feel his best for the ceremony. They put on his bow tie, covered his bed in decorations and his favorite blue, flannel blanket, and wheeled his bed outside for the ceremony.  Renown associate chaplains Terri Domitrovich and Susan Palwick coordinated music and performed the ceremony for Chandra and Tyler on Thursday, Aug. 13, 2020. The bride and groom shared their first dance in the garden and Ken’s care team provided water and treats to give the family a full wedding experience.   Shortly after the ceremony, Ken passed away. This wedding provided Ken and his family meaningful memories for their big life-changing moments as they celebrated and said goodbye.  “Seeing Ken surrounded by family he never would have gotten to see again while in the hospital, watching him get to share a father-daughter dance with Chandra on her wedding day, and having him tell me that this day meant more to them than we would ever know were some of the most moving moments I’ve witnessed as a nurse,” Amy said. “I am so thankful for the team we have here. I know that this beautiful day wouldn’t have happened without the help of every single person who gave their time, money, creativity and passion to make it a day to remember.”

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National Healthcare Decision Day is forthcoming. Here’s an easy and free way to commemorate the occasion: openly discussing how we want to be cared for at the end of our lives. Join Renown Health’s experts at a workshop about making decisions about an advance directive. Among the random national holidays, this one has significance: April 16 is National Healthcare Decision Day. And experts agree that the best time to discuss your views about end-of-life care and to learn what choices are available is before a life-limiting illness or crisis occurs. By preparing in advance, you can help reduce the doubt and anxiety related to decision making for your family if you cannot speak for yourself. “Completing your advance directive is a gift you give your family,” says Mary-Ann Brown, RN, MSN, director of Palliative Care. “The stress associated with these difficult decisions is decreased if everyone knows what is important to you and what you want the end of life.” What Are Advance Directives? An advance directive is a document that states your choices about medical treatment and names another person to make medical decisions on your behalf if you are unable to. This document allows you to make legally valid decisions about future medical care. Find more information about advance directives and the form online. The Conversation The first step in completing an Advance Directive is to think about what’s important to you and talk to your loved ones. The Conversation Project provides helpful tools to guide you and your family through this challenging topic. Getting this information together will help you fill out and complete your advance directives. Some things to consider and discuss with your family include: When you think about the last phase of your life, what’s most important to you? Who do you want involved in your care? Who should make decisions on your behalf if you’re not able to? Where do you want or not want to receive care? Are there specific treatments you would or would not want? Complete Your Advance Directive Planning In order to complete an advance directive, you will need either two witnesses or a notary to sign the form. Be sure to note restrictions on the witness process. When an advance directive is complete, you should keep the original. Copies should be given to your agent named in the form, your family, your doctor(s) and the location that you receive care. Renown Health offers four advance directive workshops every month to cover the details of filling out this document. A healthcare team is available to answer questions and work through the process with you. A notary is also present to finalize the process, which means you can complete your advanced directives during this workshop. Find the workshop by calling 775-982-RSVP for more information. Advance Care Planning Workshop April 17, 1-2:30 p.m. | Free Join Renown Health’s experts for a workshop about making decisions regarding end-of-life care. You will learn how to fill out an advance directive, receive one-on-one assistance and have your documents signed by a notary. Workshops are typically held several times each month. To RSVP, call 775-982-7787

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