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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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It is no secret that looking for a new job can be stressful and overwhelming. Yet a record number of Americans are quitting their jobs to look for new opportunities, a trend also known as the “Great Resignation.” While there are many reasons why someone might be on the hunt for new work, it’s important for all job hunters to check in with their mental health regardless of their job hunting circumstances. To learn more about maintaining your mental health while looking for a new job, we spoke to Dr. Mavis Major, a Licensed Clinical Social Worker and Behavioral Health Therapist at Renown Health. 1. Identify Goals When beginning your job-hunting journey, your first step should be to make a plan that focuses on quality over quantity. Make lists of companies you would like to work for and, if you’re looking to change fields or industries, make a list of careers that interest you. At this stage in the process, it’s also important to determine what salary range you’re looking for, what type of work environment you want (in-person, remote or hybrid) and understand what benefits are important to you. Identifying goals makes it easier to narrow down the list of jobs you apply for so you can produce quality applications rather than frantically applying for jobs without putting thought into the process. 2. Set Boundaries It does not matter if you are working full-time while applying for jobs or if applying is your job right now; it can be easy to get lost in the stress of it all. For that reason, it is essential to set intentional boundaries throughout the process. This can look like scheduling days that you fully take off from the job search or going for a walk before a big interview to clear your head. Setting boundaries will make you more productive overall and hopefully help you get your mind off the process. 3. Ask For Help Do not try and tackle this undertaking on your own. Once you have identified goals (see tip #1) make lists of people you know within those industries, and do not be afraid to reach out. Of course, never be afraid to reach out to a mental health professional to talk through why this process might be making you feel anxious. Talking to someone who is not your friend or family can give you a different perspective.

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Cost-saving isn’t the only reason to enroll in a Medicare Advantage Plan. One of the main reasons Medicare beneficiaries in Nevada join a Senior Care Plus Medicare Advantage Plan is for the care coordination services. The Senior Care Plus Care Coordination team helps members navigate what can be a complex healthcare system. Care coordination is a popular and extremely important service for members because keeping members healthy is the number one goal. One way they help reach this goal is to encourage members to participate in a no-cost, comprehensive health assessment. At this Quick Start Health Assessment, members meet with a geriatric specialist – a provider who specializes in the care of seniors – to discuss the 4 Ms: Mentation – Thinking, memory and mental health Medications – Understanding your medication Mobility – Staying physically active What Matters to You – Let your provider know what is important to you – examples could be family, health and independence The results of this detailed visit are then shared with the member’s primary care provider, so a customized care plan can be developed. This is a free service for Senior Care Plus members, along with an annual wellness visit and an annual physical exam. Care Team Approach – Laying the Foundation to Improve Health Health assessments and annual visits are offered so Renown Health providers can build relationships to improve care. This approach, also known as the Building Relationships to Improve Care or BRIC Model, is the care model used across Renown Health. “What’s special about this care model is that it really puts our patients at the center of their care,” says Savannah Gonsalves, a registered nurse with Senior Care Plus. “Members have their providers and nurses, Senior Care Plus personal assistants, case managers, and within the BRIC Model, they’re all talking to one another and putting the focus on the patient to meet needs.” Personal Assistants – A Unique Connection to Each Member A team of personal assistants is available to help members coordinate care by: Scheduling a member’s appointments Answering a member’s benefits questions Helping navigate care – these are experts in both health insurance and healthcare Answering questions about medications Working with providers to coordinate a member’s care The Senior Care Plus personal assistants are one of the most popular services that the Medicare Advantage plan offers. Each personal assistant has a direct phone line so members can call them to ask questions. “After my hip surgery my personal assistant, Megan checked in on me every day,” recalls Janelle, a Senior Care Plus member. “She made sure that I was doing alright and that I didn’t need anything. She just let me know that she was there for me.” To Learn More Senior Care Plus is the largest Medicare Advantage Plan in northern Nevada. They offer $0 plans with low co-pays with access to Renown Health and Teladoc Virtual Visits that cover you nationwide. To learn more about Medicare Advantage plans and to see if you qualify, visit SeniorCarePlus.com or call 775-982-3158 to speak to an enrollment specialist.

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How can you ensure you’re giving your children safe doses of over-the-counter medications? The safest bet: Confirming dosages and recommendations with your doctor. With that in mind, here are a few answers to basic questions about OTC medications and children. It’s cold and flu season in Northern Nevada. This means you’ll find parents in the aisles of practically every drug store, wondering what will and will not work for their sick children. Over-the-counter (OTC) medications — and their dosages, side effects, interactions and more — can inspire abundant anxiety for parents. At the outset, the U.S. Food and Drug Administration offers the following warning about use of medicines for cough and colds in children:   The FDA doesn’t recommend over-the-counter medicines for cough and cold symptoms in children younger than 2 years old. Prescription cough medicines containing codeine or hydrocodone are not indicated for use in children younger than 18 years old. Codeine and hydrocodone are opioids that are available in combination with other medicines, such as antihistamines and decongestants, in prescription medicines to treat cough and symptoms associated with allergies or the common cold for adults. Caregivers should also read labels on OTC cough and cold products, because some might contain codeine. So how can you feel comfortable administering any OTC medication to your children? The short answer is: Check with a doctor first. And with that in mind, here are a few common questions and answers from Kristin L. Wilson, MD, of Renown Pediatrics about children and OTC medications. Please talk about the importance of correct dosage of pediatric medications. Pediatric dosing is weight-based and unique to each medicine (and sometimes even the circumstance you are treating.) Therefore, there are no standardizations of “safe” amounts that apply to all medications. What are signs of an overdose of pediatric medications? Signs of intoxication/overdose are also unique to each medication and supplement. And to make it more confusing, mixing current prescriptions with various supplements or over-the-counter medications can cause significant adverse effects as well. Is there an age at which children take adult over-the-counter medications? Infants through adolescents can take medications that are also prescribed to adults, but only under a healthcare provider’s careful guidance. Dosing is determined by various factors dependent on child’s age and also medical history, as above. What is the takeaway about administering medications to children? When in doubt, ask a healthcare professional whether a medication or supplement is safe for your child based on his/her age and medical history as well as recommended dosing based on recent weights and other vital signs.

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The kids are back in school and the holidays are all but a distant memory: Now what? Karen Wagner, APRN, offers specific tips about getting kids back to their routines in the post-holiday-hustle-and-bustle. Are you finding the kids struggling with bedtime routines? Having trouble getting them to tackle homework? There’s a simple reason: The holidays messed with their mojo! Here, we talk with Nurse Practitioner Karen Wagner about what to do to get them back on the straight and narrow.  Why Routines Are Important “Holidays are a fantastic time to get together with family and friends, so our routines are usually off — and this is understandable, “Wagner says. “While the holidays are exciting, they are chaotic and can put our kids out of the routines.” So how do you get kids back into those routines they crave?  “Consistency/routines are crucial for our kids,” she says. “Most people — kids and adults —  experience a let-down feeling after the holidays, and post-holiday adjustment takes time.” So what can we do, specifically? Wagner recommends the following:  Re-establish family routines, including before- and after-school programs or child care routines. Once kids are back on the regular schedule, they’ll find that sense of familiarity as the old routine returns. But keep in mind, this won’t happen overnight.  Encourage healthy eating, as the upheaval of their schedule can be offset by a balanced diet.  Make sleep time a priority: Keep in mind that it might take up to three nights of strict bedtime to get them back on track. But enforcing normal bedtime will get their bodies back on a normal schedule.  Return to usual chores and expectations. Nothing encourages a return to routine like reminding them of the basics.  Incorporate indoor and outdoor time. They likely spent lots of time outdoors during our unseasonably warm winter break — and they even had a snow day or two! So encouraging both indoor and outdoor time will help them return to a circadian rhythm and tire them out from exposure to fresh air.  “It is never too early to encourage a love for physical activity in kids by exposing them to fun fitness activities and sports,” Wagner says. “Physical activity improves bone health, cardiorespiratory and muscular fitness, decreases levels of body fat, reduces symptoms of depression, and improves cognitive skills and the ability to concentrate.”

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Health insurance might be one of the most complicated purchases you will make throughout your life, so it is important to understand the terms and definitions insurance companies use. Keep these in mind as you are comparing health insurance plan options to choose the right plan for you and make the most of your health insurance benefits. One area of health insurance that can cause confusion is the difference between a plan's deductible and out-of-pocket maximum. They both represent points at which the insurance company starts paying for covered services, but what are they and how do they work? What is a deductible? A deductible is the dollar amount you pay to healthcare providers for covered services each year before insurance pays for services, other than preventive care. After you pay your deductible, you usually pay only a copayment (copay) or coinsurance for covered services. Your insurance company pays the rest. Generally, plans with lower monthly premiums have higher deductibles. Plans with higher monthly premiums usually have lower deductibles. What is the out-of-pocket maximum? An out-of-pocket maximum is the most you or your family will pay for covered services in a calendar year. It combines deductibles and cost-sharing costs (coinsurance and copays). The out-of-pocket maximum does not include costs you paid for insurance premiums, costs for not-covered services or services received out-of-network.  Here's an example: You get into an accident and go to the emergency room. Your insurance policy has a $1,000 deductible and an out-of-pocket maximum of $4,500. You pay the $1,000 deductible to the hospital before your insurance company will pay for any of the covered services you need. If you received services at the hospital that exceed $1,000, the insurance company will pay the covered charges because you have met your deductible for the year. The $1,000 you paid goes toward your out-of-pocket maximum, leaving you with $3,500 left to pay on copays and coinsurance for the rest of the calendar year. If you need services at the emergency room or any other covered services in the future, you will still have to pay the copay or coinsurance amount included in your policy, which goes toward your out-of-pocket maximum. If you reach your out-of-pocket maximum, you will no longer pay copays or coinsurance and your insurance will pay for all of the covered services you require for the rest of the calendar year.

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