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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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August is National Make-a-Will Month. We talked to Abbey Stephenson, Planned Giving Officer at Renown Health Foundation, to learn more about wills, trusts and estate plans and why you should feel motivated this month to get started. Why Make a Will There are so many reasons why it is difficult to make a will or put an estate plan in place. These include: Lack of time or money to prepare a plan The misperception that “only rich people need an ‘estate plan’” How intimidating legal documents can be General discomfort with planning for the future Given the barriers to making a plan, it’s not surprising that only 32% of Americans have a will or trust in place. But having a will or trust matters because these are the documents where you can say who will inherit your assets, who will manage your assets and estate, and who should be guardian of a minor or a child with a disability. Where to Begin If you have been thinking about putting together a will and don’t know where to begin, here are some next steps you can take. 1.  Learn the terms. If you have never created a will, trust, or an estate plan, the language can be hard to get used to. A few important terms to know include: Last will and testament (also known as a will): a legal document that describes how you would like your property and other assets to be distributed after your death. This is also the document where you can nominate a guardian for a minor or disabled child. Personal representative (also known as an executor): a person named in a will responsible for collecting your assets, paying your debts and final taxes, and distributing the remaining assets to those stated in your will. Personal representatives must be formally appointed by a judge and report certain information to the judge for review and approval. Living trust (also known as a revocable or family trust): a legal arrangement set up through a document called a trust instrument or a declaration of trust that gives someone called the trustee power to make decisions about the trust creator’s money or property held in the trust. Estate plan: a collection of documents that help organize what happens to you and your assets upon your disability and death. Your estate plan is comprised of documents such as a will, trust, and advance health care directive. If you want to learn more about these terms and estate planning in general, you are invited to attend a free one-hour estate planning education session on Aug. 22, 2024, at 10 a.m. or Oct. 21, 2024, at 11 a.m., hosted by Renown Health Foundation. Click here for more information and to register. 2.  Create a list of assets. Start by creating a list of your assets including real estate, investments, bank accounts, retirement accounts, business ownership interests, vehicles, life insurance, valuable personal property like jewelry or artwork, and any other significant assets. Click here and read our free estate planning guide. 3.  Put together a list of 2-3 people you trust. When you create your will, you need to name a personal representative who will collect all your assets, pay your debts, and work with the probate court to distribute the balance to the people and charities you name in your will. If you create a trust, you need to name a trustee to manage the trust assets under the terms of the trust document. It is a good idea to include at least two people who can take on these roles in case the first person becomes unavailable. If you do not have anyone you would trust as a personal representative or trustee, there are trust companies, banks, and other professionals and institutions who may be able to assist you. If you are the parent of a child who is under 18 or has a disability, you will also nominate a guardian in your will to care for that child if you and the other parent are gone.  4.  Start a list of who you would like to inherit your assets. Which people and organizations would you like to inherit the assets you own at the time of your passing? And which assets or how much would you like them to receive? You might want to consider who relies on you for support such as family members or charities, individuals and organizations that have made a difference in your life, or those you have a special fondness for. It is important to use the legal names of individuals you include as beneficiaries and the Tax ID number for any charity you include.  If you decide to make a gift to Renown as part of your will or estate plan and notify us, you will be included in the Renown Legacy Society. Legacy Society members enjoy invitations to exclusive events, special acknowledgments, and other unique benefits. Click here to learn more about the Renown Legacy Society. 5.  Put together a list of your professional advisors and enlist their help. Write down the names and contact details for any professional advisors you work with such as your accountant, financial advisor, investment manager, attorney, insurance agent, and planned giving officer.  You may want to seek their advice on how best to proceed and which assets are best gifted to which individuals and organizations from a tax standpoint. Collaboration among the professionals with whom you work can help your plan to run more smoothly when it is needed. Depending on your circumstances, it may make sense for you to introduce your trusted individuals to these professionals. 6.  Start drafting. Once you have these items in place, you will be in a good position to begin the drafting process. There are many capable estate planning attorneys in our community who can help you with drafting. There are other drafting resources available as well, but only a licensed attorney can provide you with legal advice. Click here to attend the free Family Estate Planning Series sponsored by Renown and presented by PBS Reno and the Community Foundation of Northern Nevada.

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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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August is National Make-a-Will month. We talked to Renown Health Foundation Planned Giving Officer, Abbey Stephenson, to learn more about wills, trusts, and estate plans and why you should feel motivated this month to get started. Did you know that 2/3 of Americans don't have a will or trust? If this is you, don’t worry, you’re not alone. Although there are laws in place to determine who inherits your assets if you die without a will or trust, having a will or trust ensures your assets go where you want them to go after you are gone. They can also help minimize disputes between family members and heirs about who gets what. In Nevada, the laws that govern who gets what if you die without a will or trust can be found in Chapter 134 of the Nevada Revised Statutes. There are other documents that people often prepare at the same time as their will or trust – like an advance health care directive and durable power of attorney for assets. These documents all together are called an estate plan. Although they have other purposes too (like nominating a guardian for a child, planning for disability or avoiding probate, which is a court process), wills and trusts are documents that say who will receive your assets after you are gone. The most common type of trust is often called a revocable living trust or a family trust. People who have a trust usually still have a will, although it is a shorter form of will called a pour-over will. It’s a good idea to talk to an estate planning attorney about whether or not a trust makes sense for your family or circumstances.  Now that you’re ready to get started, here are some mistakes to avoid: 1. Failing to plan Not setting aside the time to plan may be the biggest mistake. Failing to prioritize preparing or updating your estate plan means your last wishes and desires may not be fulfilled. The right documents memorialize what you would like to happen upon your disability and death so that other people can know and follow your wishes with respect to your care and your assets.  2. Failing to coordinate beneficiary designations Certain types of assets like life insurance and retirement accounts are not covered by your will or trust and need to be addressed separately. These types of assets are referred to as non-probate assets because they transfer under contract principles and don’t require court supervision or probate to be distributed to the named beneficiaries. By completing beneficiary designation forms provided by the retirement account custodian, insurance company or financial institution, you can direct your assets to one or more beneficiaries. 3. Failing to title your assets properly Asset titling refers to how you own your asset – such as in your individual name, jointly with someone else, or in a trust or entity. For example, assets titled for two people with a “right of survivorship” will automatically go to the surviving owner. Review your asset titling and make changes, if needed, to ensure your property and assets are passed down the way you intend. 4. Failing to include charities meaningful to you In addition to providing for family members and other important people in your life, you many also choose to give to charities meaningful to you in your estate plan. When you include a charity in your estate plan, that gift is called a planned gift and many charitable organizations, including Renown, recognize such donations through their legacy giving societies. As you prepare to make your own will or a more comprehensive estate plan, we recommend you consult with a lawyer. Here are some free resources that may be helpful too:  Renown Health Foundation is proud to sponsor the Family Estate Planning Series put on by PBS Reno and the Community Foundation of Northern Nevada. The free, 8-week course of 90-minute, in-depth workshops is a great place to learn much more and to help you get started in the planning process. The next course begins on September 7, 2022. More information can be found here. Renown Health offers periodic advance health care directive workshops where attendees can learn about, complete, and sign their directive. The next workshop is scheduled for September 14th. More information can be found here. The American College of Trust and Estate Counsel provides information on a number of commonly asked estate planning questions here. If you are interested in including a charitable gift to Renown in your estate plan, we would be happy to talk to you about how your gift will make a difference for our mission. Please contact Abbey Stephenson at abbey.stephenson@renown.org or visit renown.org/LegacyGiving to learn about Renown Health Foundation’s Legacy Giving Society and ways to give.

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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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