Our MissionThe mission of Hospice of

San Joaquin, a not-for-profit organization, is to provide comprehensive medical and compassionate care, counsel-ing and support to terminally ill patients and their families, regardless of ability to pay, and to educate and collabo-rate with health care providers and the public in promoting quality end-of-life care.

A nonprofit agency serving the community since 1982

Hospice is governed by a community Board of Directors and is recognized as a 501 (c) (3) organization. Hospice of San Joaquin is licensed by the State of California as a Hos-pice Agency and is certified by the Centers for MediCare and Medi-Cal Services to pro-vide the Hospice Medicare/Medi-Cal Benefit. The Joint Commission of Accredita-tion of Health Care Agen-cies (JCAHO) has accredited Hospice of San Joaquin, most recently in May 2008. For more information or referral, call (209) 957-3888.

Board of DirectorsOfficers: Mark Wallace, President D i r e c t o r o f H u m a n

Resources, Lodi Memorial Hospital

Edward Schroeder, Vice President

P r e s i d e n t & C E O , O’Connor Woods

Chris Olin, Secretary Community Volunteer

G a y l e R i l e y , R . N . Treasurer

N u r s e , H e a l t h c a r e Administrator, Retired

Members: Jacqueline Bagatta, R.N.,

M.S.N. Deputy Director, San Joaquin General Hospital

Scott Beattle, Esq. Calone Law GroupPhyllis Berger, Esq.

Professor Humphrey’s Law School Jack L. Gilliland, M.D. R e t i r e d , K a i s e r

Permanente PediatricianLynne Davis

Dav is & Assoc ia tes Insurance Brokers

Patricia Erardi, Community Volunteer

Richard Ghio, CPA Instructor, San Joaquin Delta College

Stephen Guasco, Director Managed Care Catholic Healthcare West

Gary Giannini Pr incipal , Schwartz, Giannini, Lantsberger & Adamson, CPA’s

P e t e G o r m s e n , C PA , DeGregori, Gormsen, Ringer, LLP

Deitra Kenoly Advertising Director, The Record

Chris McCaffrey Vice President, Morgan Stanley

Diane Park F u n d D e v e l o p m e n t Consultant

Danae Sharp, R.N. Nurs ing Superv isor,

Dameron Hospital

Barbara A. Tognoli Executive Director and

Member of the Board

Support PersonnelRobert T. Browne, M.D.

Medical DirectorJames Saffier, M.D. Staff PhysicianMobin Ghavami, M.D. Staff PhysicianGail E. Wigley, RN D i r e c t o r , C l i n i c a l

ServicesJo Paganini, MSW Director,

Social ServicesSteve Parsons Director, Operations /

FinanceBarbara A. Pombo Director, DevelopmentGene Acevedo

Director, Community Outreach and Public Relations

Audrey Wuerl, RN, BSN Education Coordinator

Becky Freeman Volunteer CoordinatorCarrie M. Vanderkar

B e r e a v e m e n t Coordinator

Patty A. Rieber H u m a n R e s o u r c e Manager

Leo Ronquillo Information Systems Manager

Carolyn Gomes Annual Gifts & Events Planner

Hospice of San Joaquin

3888 Pacific Avenue

Stockton, C

alifornia 95204-1953

NON-PROFIT ORG.U

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3888 Pacific Avenue • Stockton, California 95204-1953 • 24 hr. main-line: (209) 957-3888 • fax: (209) 957-3986 http://www.hospicesj.org

Para asistencia en español, vea anuncio en la contraportada

Quality You Can TrustJoint Commission Accredited

Reverend Dave Bennett, pas-tor, United Central Methodist Church, delivered the invoca-tion and a tribute to Charles and Carole Plumb, benefactors of both the Church and Hospice of San Joaquin.

The Circle of Care Pavilion honors Lean on Me Society or major donor commitments to all hospice programs: HospiceHouseEndowment:

permanent & future funding for the Hospice House

HospiceHouseCharitableFund: current patient care in the House

PatientCare:allhospicecare, at home and in nursing

The April afternoon seemed to embrace the friends of Hospice

of San Joaquinwho gatheredto dedicate the Circle of Care Donor Pavilion and honor the firstdonorstohavetheirnamesengraved there.

“This permanent recogni-tion of our Lean On Me Society and Legacy League Members highlights the agency’s growthsincelocatinghereatourPacificAvenue site in 2004”, stated Nick Aninag, Past President and Fund Development Chair. Introducing the unique, outdoor recognition piece, Aninag gave it context: “In the early days of this decade, whenHospice of San Joaquinsetout tobuildoneof thefirstHospice Houses in the state, a CommunityBuildingFundwasinitiated and successfully com-pleted. Both modest and larger contributions came together to make possible our beautiful hospiceresidencethathasnowserved over 770 patients.”

“Big projects call for big investments from the donor & volunteercommunity,”acknowl-edged Aninag. The Board and management, led by Barbara Tognoli, understood that Hospice House is a unique service that requires a much larger operating budget. In order to provide the Hospice House 24-hour nursing care, regardless of ability to pay, the agency relies on the kindness of our community.”

ExecutiveDirectorBarbaraTognoli delivered a message of gratitude for the support of the

community. “We built and opened the only hospice residence in the regionwithconfidencebecauseofthe incredible commitment in this community to compassionate care for the terminally ill and support for grieving family and friends. We have not been disappointed. We are here today to honor lead-ersamongthosewhomakethisworkpossible. Everygift isaninvestment in community-based, compassionate hospice care and eachcontributionisreceivedwithour deep appreciation. In turn, Hospice of San Joaquin pledges to continue to deliver the very best in compassionate medical care.”

facilitiesBereavement:adults,chil-

dren & teens, both hospice families and the community

EducationPrograms:hos-pice care education for the public and medical commu-nity

LegacyLeague:bequestsorother estate gifts, completed or intended.The Board Officers Mark

Wallace,President,EdSchroed-er, Vice President and Gayle Riley, Treasurer joined Aninag in presenting sculpture replicas to Lean On Me honorees and Labyrinth replicas to Legacy League members.

SPRING GARDEN PARTY AT HOSPICE SAN JOAQUÍNGathering of Donors

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Anticipating the im-pending death of a loved one may be one

of the most challenging experi-enceswe face. Familieswhohave children in the home face a unique challenge in deciding howtoincludethechildinthisprocess. Naturally, families wanttoshieldchildrenfromthehurt that comesalongwithan-ticipatingadeath.However,weknowthatchildrenwhoareac-tively and thoughtfully involved in the anticipation, death, and grieving process, are better off in the long run. These children willlearntoadapttothelossina healthier and fasterway andwill be able to draw from thatexperience to help them cope withfuturelosses.

If you have children in your family and are anticipating the death of a loved one, consider these suggestions:Do not try to hide what is happening

Children are very perceptive and may already sense something iswrong even before you tellthem.Explainwhatishappeninginwords that theywill under-stand. For example, “Grandma is very sick and the doctors can’t help her anymore. We don’t knowwhen, butwe do knowthat she is going to die.” Avoid euphemisms such as “she is going to sleep or pass-on.’ Depending on the age of your child, you may needtoexplainwhat‘die’means.Olderchildrenmaywanttoknowmore about the physical changes thatlieaheadandwhatthedyingprocessmaylooklike. Answeryour child’s questions honestly in an age-appropriate manner.

This is an excellent time to share your family’s religious be-liefswithyourchild.Howeverbe careful discussing concepts of“God’swill”aschildrenmaythen perceive God in a nega-tivewayfor‘takingaway’theirloved one. Explain medical words and concepts

Explaindiseasesandsymp-toms honestly to your child. If

your loved one is connected to medical equipment, be sure to explain to thechild(beforehandifpossible)what theywillsee. Simple,matter-of-factstatementswillgoalongwaytoassuaginganyfearsyour child may have.

Create memoriesEncourageyourchildtospendtimewiththeirlovedone.Ifpos-

sible, take a small trip together. Take pictures together. Continue longstanding traditions as long as you can (such as family dinners, watchingfireworksonthe4thofJuly,etc….).Makenewtraditionsor routines as an illness progresses such as sharing a milkshake each afternoonorwatchingatelevisionshowtogether.Importantmemo-riesoftimespentwithalovedoneareinvaluabletoachildastheyfacethegrievingprocessandwillbetreasureddearlylaterinlife.

Affirm children’s feelings about the upcoming loss

Childrenwillhaveavarietyof feelingsas theyanticipate thedeathofalovedone.Encouragehimorhertoexpressallofthosefeelings,eventheoneswemighttypicallylabelas‘negative.’Yourchildmay respondbetter tocreativewaysofexpressing feelingsthroughart,music, journaling,orevenpretend-play. Youmayalsowanttovisityourlocallibraryorbookstore.Therearemanywonderfulbooksforchildrenthatdiscussdeath,dying,andgriefandcanhelpyoudiscusswhatishappening.

Be aware of your own words and fearsChildrenaremoreawareandattunedtoourwordsandactions

thanweoftengivethemcreditfor.Don’thideyouremotionsfromyourchildrenbutexpresstheminappropriateways. Bemindfulthatsomeconversationsneedtowaituntilachildisoutofearshot.Perhapsmostimportantly,remembertoreachoutandfindsupportforyourownself.Youcannoteffectivelyhelpyourchildthroughthe anticipation and later the loss of their loved one if you are not caring for yourself.

Reassure child that they will be cared for and loved

Yourchildmayfearthattheirparent(s) or primary caregiver maybenexttodieandtheywillbe alone. Reassure him or her that theywill be cared for andlovedandwhattheplanforthisis. Set aside time each day to spendjustwithyourchild.Reada book, play a game, or go on a bike ride. Itwill begood forboth of you!

Preparing for the death of a lovedonewill not be easy foryou or your child. However,keep in mind that children are indeed resilient. Talking to them and including them in this part ofyour family’s storywillhelpthem tobetter copewith lossestheywill inevitably face in thefuture. While it is the family’s responsibility to guide the child through this time, there are other individuals and organizations that can support you. Do not hesitate to reach out for extra support.

For more information about the Adult or Children’s Bereave-ment programs at Hospice of San Joaquin, please call 209-957-3888 and ask for the Bereave-ment Coordinator.

Preparing Children for Loss

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Marissa Torres (right) shares memories about loved ones with volunteer Lois Altnow during Kids Korner 2008.

From theDirector

Dear Readers,

In April of 1982 a small group of hospice staff and volunteerspresentedareportonthefirstthreemonthsof hospice care in San Joaquin County. We had served eight patients and families since initiating hospice services on January lst of that year.

This pilot project set the course for our future. We, through our hospice care, had changed the living and the

dyingofthesefirstpatientsandtheirfamilies.WeknewHospicewasheretostay.Wedidnothaveanoffice.Wedidnothavemoneyinthebank.Butwehada passion to continue to provide this compassionate care called “hospice” and this vision carried us forward.

Twenty-twoyearslater,onanAprildayin2004,weheld

ourfirston-siteeventforthethenproposedHospiceHouseandCenter.Itwasabeam-signingceremony.Weinvitedeveryonetosigntheirnamesandtowriteapersonalmessageonthelarge,woodenbeamsthatwouldsupport the interior framing of the Hospice House and offices.Themessageswerevaried:therewerewordsofhope,wordsoflove,tenderwordsinmemoryoflovedonesandwordstoencourageustocontinuetofollowour vision to provide hospice care for more and more patients. These foundation beams became the physical support for the hospice buildings, but the community whoralliedaroundthisnewventurebecametherealsupport and remains at the heart of our hospice care today.

NowhereitisAprilagain.Howmeaningfulitisforus to thank you our community today for helping us toreachthisbenchmarkinourhistory.Everybladeofgrass, every pebble under our feet, every beam and solid piece of foundation is due to your generosity. But more importantly, every nurse’s intervention, every comforting wordofasocialworker,everygentlekindnessofahospice volunteer has continued for 27 years because of the thousands of gifts, small and great, of individuals, familiesandlocalorganizations,manyofwhomareheretoday.

This agency and its assets are yours; the community’s.Thiscommunityfirsthadthevisionandhasalwayssteppedup,nomatterwhatthecost,tocarefor the most fragile among us.

Twenty-sevenyearshavepassedsincethatAprilreport in 1982. Over these past years Hospice of San Joaquin has provided care for thousands of patients and families in our community — Thanks to your generosity

Thank you

Barbara TognoliExecutiveDirector*These remarks were delivered at the Spring Garden Party on April 16, 2009

Hospice Awareness is a quarterly newsletter published by Hospice of San Joaquin Located at 3888 Pacific Avenue, Stockton, CA 95204 * (209) 957-3888.

Gene Acevedo, Director of Community Outreach: EditorBarbara Pombo, Director of Development: Co-EditorHospice Staff: Article ContributionsRoberto Radrigán, G. D., GráficaDesign: Design & Layout

Comments, questions, sponsorship opportunities or if you wish to be removed from our mailing list, please contact our office at (209) 957-3888

Local Volunteers and contributions in the early 1980’s, founded

Hospice of San Joaquin, a non-profitcommunityagency.

From the admission of the firstpatientsinJanuary1982,allhospice patient support, bereave-ment, and professional services; including attention by registered nurses,socialworkers,aprimaryphysician and pharmaceuticals, wereprovidedsolelythroughthecharity of San Joaquin County residents. In 1989, Medicare and Medi-Cal established the hospice benefittoeligiblepatients.Todayit is not much different, the ben-efitassignedtoHospiceofSanJoaquin covers only a portion of the cost of care for the terminally ill patient and support for the family. The Medicare and Medi-Calbenefit,assignedtoHospice

of San Joaquin did provide for expanded capacity to better serve the community.

TheMedicare benefit wasnot designed to cover all care of the terminally ill; nor does it

reimburse all mandated aspects (e.g., bereavement and educa-tion). In addition, approximately 17 percent of patients cared for by Hospice of San Joaquin are either too young or otherwisein-eligible for Medicare.

In the tradition of Hospice of San Joaquin’s founding and early history, community charity carries the balance. These chari-table dollars consistently supply between15percentto20percent

of Hospice of San Joaquin’s an-nual operating budget and 80 per-cent for direct patient care. Last year, the Federal Government approved a cut back in Medicare reimbursement rates triggering a lowerreimbursementforhospice

services. Hospice of San Joaquin is anticipating the need for stron-ger contributions.

Hospice of San Joaquin serves patients based upon terminal diagnosis, doctor’s referral and the patient’s choice of hospice care. Hospice of San Joaquin does not bill the patient or fam-ily for the hospice care, nor for bereavement services, nor for its education programs. This non-profitcommunityagencyrelieson the thoughtful consideration of individuals and families in planning annual contributions and designations inwills andtrusts to fund the Mission of Hospice of San Joaquin.

With your community part-nership, Hospice of San Joaquin, serving the terminally ill and their families since 1982, is the premier leader in hospice care.

Hospice of San Joaquin a nonprofit, community agency

Charitable Gifting and Volunteerism

Scott G. Beattie, Esq.CALONE LAW GROUP, LLP

Studies on philanthropy indicate that more than 80% of house-holds make charitable gifts during their lifetimes. Whether it is to schools and universities, churches, medical institutions, or other charitable organizations, Americans like to give some of their blessings back to the or-ganizations that are meaningful to them. While benefits underthe tax code are generally not the primary motivation for such gifts, the tax break doesn’t hurt either. The tax code encourages “Social Capital” so that people canchooseforthemselveswhichcauses they want to benefit,therebykeepingwealthlocalandreducing the money available bywayoftaxesforgovernmentchosen social programs. Sur-prisingly, only a small fraction of thosewhogive during theirlifetimes make legacy gifts (i.e.,

testamentary charitable gifts). Some may feel they have given enough during their lifetimes. Others just don’t think about it whendoingestateplanning.I’vemade some informal inquiries, and I believe only about 1 in 5 es-tate planning attorneys even ask the question, in their standard cli-entinterview,whethercharitablegifts are to be considered.

If youwant tomake a chari-table gift in yourwill or trust,one simpleway to do so is tomake a specificmonetary gift.For example, your Will might indicate “I hereby give to Hos-pice of San Joaquin a specificmonetary bequest in the amount of $10,000.” The residue of the estate may then be disbursed to family members. One impact, though, is that the specificgiftis paid first and, if there are insufficientfunds,theresiduarylegatees (your family) may be leftwithlessthanintended.This

could happen if the gift is a larger dollar amount (say $100,000) and the estate is depleted in the years before the donor’s passing. Anotherwaytohandlealegacygift is to make a percentage gift. For example, “I hereby give 10% of my estate (but not greater than $xx.xx) to ________ [charity’s fullname].”Suchagiftfluctu-ateswiththevalueofthedonor’sestate and puts an express cap on the amount to be given. The residue is then protected for heirs orotherdesignatedbeneficiaries(e.g., in equal shares to my is-suewhosurvivemebyrightofrepresentation”).

These are just a couple among agreatmanyways tostructurea charitable legacy gift. The ways to give are limited onlyby your imagination. Gifts can be made outright, or in trust, or even entrusted to a donor advised fund for management. Frequently,thedonorwillwant

to limit the gift for a specificpurpose. If so, the limitation should be clearly spelled out in the instrument (e.g., “to be used solely for the purpose of funding 24 hour nursing care at Hospice House”).Thetypeofgiftwilldepend on the size of the estate and the donor’s particular goals andinterests.Somepeoplewantto use charitable gifts to create anestatetaxreductionwhilestillpassing the maximum amount to family members (Jackie Onassis did this). A charitable lead trust (CLT)mightbeforthem.Youshould contact your estate plan-ning advisor before engaging in any legacy planning.

I hope this helps you give back to your community

For further, more detailed information on particular planning vehicles, please call Hospice of San Joaquin’s De-velopment Office (957-3888)

E S T A T E P L A N N I N G

Thoughts on Charitable Giving

The Native Daughters of the Golden West have selected Hos-

piceofSanJoaquin’sExecu-tive Director Barbara Tognoli to receive the 2009 Roll of Honoraward.

TheRollofHonorawardis given to individuals that are not born inCalifornia,whohaveperformedsomesignifi-cantand/ornoteworthyservicefortheState.AcknowledgingTognoli’s success in ensuring patientshaveanoptionwhen

Native Daughters of the Golden West honor Barbara Tognoli

cure is not, Patricia Sharratt, Senior Grand Trustee, NDGW stated, “Barbara Tognoli has helped many people… Shedeveloped and directs Hospice

of San Joaquin, an agency that offers an ongoing hospice pro-gram for adults and children and provides education to the community on issues of death and dying.”

On June 18, 2009, Barbara Tognoli received the award atthe Grand Parlor at the State Convention in San Jose.

“Iacceptthisawardonbehalfof Hospice of San Joaquin’s staff,” Tognoli said, recognizing theirhardworkanddedication.

The Order of the Native

Daughters of the West is a fraternal and patriotic organi-zation leading in preserving the history of the State of California.

Parlor No. 5, responsible forawardingBarbaraTognoliwiththeRollofHonoraward,represents San Joaquin County and neighboring communities since the mid 1800’s.

The NDGW invite the community to become mem-bers of the Order by calling (209) 859-0840.

Santa VisitedSan Joaquin in the Spring

Claudia Gamaza, receives a special hug from Santa (Harry Olson, volunteer and HSJ former Board member) in March 2009 — Spring Christmas.

At Hospice of San Joaquin, we knowthat the best quality

of life for patients is achieved through a multi-disciplinary care approach that encompasses all the patient needs. A critical component in our care is the non-medical support services provided by volunteers; as in the case of Claudia Gamaza and her family.

ClaudiaGamaza,knownforher energy and enjoyment of familyactivities,wasdiagnosedwith cancer in her late 40s.As her cancer progressed, her husband Robert decided to stay home full-time to care for his wife.“Ijustwantedtomakeherwish[tostayhomeuntiltheend]a reality,” shared Mr. Gamaza.

Mrs. Gamaza’s favorite seasonwaswinter followingthe family’s holiday gather-ings. Unfortunately, during theholidaysof2008shewashospitalized.

“When we learned howimportant holiday gather-ingsweretoher,andthatshehadmissed the last one,weplanned a special holiday in March —Spring Christmas.” Shared Diane Medina, Social Worker, HSJ. Ms. Medina alongwithBecky Freeman,Volunteer Coordinator, and a group of volunteers planned and made the event happen. “Hospice of San Joaquin did everything right for her and wewillalwaysbethankfulforthe services.” Robert Gamaza expressed his gratitude.

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Santa VisitedSan Joaquin in the Spring

All three chapters of the HospiceofSanJoaquinButterflyAuxiliary raised awareness forthe Hospice House by hosting their beautiful Spring Tea or Luncheon fundraiser events in May. The sold-out teaswerepersonalized by the Auxiliary members as they shared tradi-tionalfinechinasettingsmakingevery table unique.

Dolores Arbios said, “I thor-oughly enjoyed the tea, es-pecially visiting with all thepeople there. Everythingwas

Auxiliary Supports Hospice House through Spring Teas & Luncheon

so beautifully done! I even wonaprize!Thebasketwasloadedwithstuffincludinganafghan.Iamlookingforwardto attending next year.”

Adding to the excitement arethemultipleraffleprizeskindly donated by our local business community. “We are happy to see how theattendees enjoyed their time and the Auxiliary appreciates everyone for their support,” said Sharon Stokes, Chair of the Lodi Luncheon event.

Tatiana Castleton (standing,) Butterfly Auxiliary member, greets guests to the 2009 Stockton Spring Tea on April.

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Choosing the RightLevel of Care

By Audrey Wuerl, RN, BSNEducation Coordinator

We have discussed the ben-efits of hospice care for thosefacing life-limiting illnesses in prior newsletters, but wehavenotaddressedwhatphysi-cians and patients must consider whennavigatingvariousoptionswhenfacedwiththoseillnesses.Choicesforcare,whencureisnolonger possible, have improved greatly in recent years. For instance,many hospitals nowhave Palliative Care Teams to assist physicians in accessing the next level of care for patients and family members (caregivers) toallowapeacefullifeclosure.Sometimes patients can access both programs simultaneously, and other times, hospice care can followapalliativecourseinthehospital setting.

What are the differences betweenreceivingservicesfromthe hospital-based palliative care team and services received from hospice? These concepts are parallel, but generally do not overlap one another. Both philosophies provide quality of lifewhenquantity isno longerpossible. However, palliativecarefollowsthecurativecoursethat the patient has been on, fre-quently in the hospital setting. On the other hand, hospice care follows the palliative course,provided in the home, and is appropriatewhen all curativemeasures aswell as therapieshave been exhausted.

Howcan a physician knowwhichprogram,whenchoosingbetween hospital-based pal-liativecareorhospicecare,willbenefithis/herpatientbest?Andfurther,whatconstitutesaqualitypalliativecareteam?And,howdoes one choose an outstanding hospice?

A recent article in the Journal of the American Medical As-sociation attempts to clarify the choices.1 Today, physicians and patients can access over 1,400 hospital-based palliative care programsandtherearenowwellover 4,700 hospice programs in the United States. The reason for this expansion is to accommodate anagingpopulation livingwithchronic illnesses; and, simply, cureisnotalwaysanoption.Thegoodnewsisthattheseprogramsprovide options and understand-ingtheoptionsallowsfamiliestomake informed decisions. This willbeespeciallyimportanttothe76 million baby-boomer genera-tion as they confront end-of-life issuesfortheirparents,aswellasfor themselves.

Physicians have been trained tomakeobjective,well-thought-out decisions regarding care for theirpatients.Choosingbetweena hospital-based palliative care team and a traditional hospice approachwill depend on theneeds of the patient, the disease trajectory, and the desires of the patient.Knowingwhateachcanoffer, what guidelines shouldbe used in choosing a program, andwhattoexpectfromeachisagoodplacetostart.Butfirst,

determining the patient’s prefer-ences regarding quality of life willhelpclarifymutualgoals.

Hospital-based Palliative Care

The hospital-based palliative care team comes into play fol-lowing a patient’s hospital ad-mission, and prior to discharge. For example, if chemotherapy is ordered by the physician, this could be administered in the hospital but not by the hospice as chemotherapy is considered a therapy (and precludes hospice admission). It is important to re-member that hospitals are acute facilities that strive to restore patients to optimum function. When that is not a viable option due to terminal or life-limiting disease, the hospital-based team can assist the physician in struc-turing a plan of care that strives tomaximizequalityoflifewhilemanaging pain and symptoms. In this sense, the palliative care team might suggest early hospice referral as the patient wouldbe leaving that setting. Gener-ally, the patient and family are participants so that the outcome best benefits and supports thepatient’s desires.

The physician needs to be confident the hospital-based palliative care team incorporates holistic care at its very base—physical comfort, emotional support, psychological support, and shared decision making—and coordinates the care across differentcaresettings,aswellasbeing patient/family centered. A candid prognostic dialog be-comes paramount now, as thiscommunication integrates the gapbetweenthepatient’sneedsand the physician’s expertise. The physician should expect thefollowingfromthehospital-based palliative care team:

Evidence-based symptompalliation and psychological support

Shared decision making that supports both the patient and the family or caregiver

Dignity and respect regarding

cultural valuesAssistspatients/familieswith

practical,financialandlegalas-sistance

Coordination of care across the health care setting that helps patients move from one setting to another in a seamless fashion.

The hospital-based palliative careteamcanworkcloselywiththe localhospicewhenpatientshave completed all therapies and there is a prognosis of six months or less. I have found thatwhenworkingwithphysi-cians,patientsandfamilieswhoare considering hospice care in the last months, all appreciate a coordinated healthcare approach. An approach that helps guide the patient as he navigates through the system, providing appropri-ate care at each stage. The pres-ence of a hospice nurse on the hospital-based palliative team can serve as a resource to advise when thepatientwouldbenefitnowmorefromhospiceservices,and advocate for the patient/fam-ily regarding those services.

Hospice Based Palliative Care

When the patient is not hos-pitalized or for those currently undergoing therapy, he/she can still access the expertise of the hospice nurse regarding pain and system management. Many hospices provide limited support to those patients not yet eligible for hospice care, or those not emotionally ready for hospice. These are non-reimbursed ser-vices that hospices do as com-munity outreach. Medicare stipulates all curative measures must be exhausted, and all thera-pies completed, before patients come onto hospice care. So, an early referral from the hospital-based team for these services can foster a caring relationship with the casemanager and thepatient “before need.” This helps alleviate fears on the part of the patient and family, and allowsfor a rapport to develop should the patient come onto hospice services at a later date.

Physicians,whodetermineitis time for a hospice referral due to patient preference and disease trajectory,maywonder how toselect a competent hospice orga-nization. Not all hospices are cre-ated equal: some are very good, and some are truly excellent. But, like choosing a hospital-based palliative care team, there are guidelines for determining high-quality hospice programs. The physician can ask,

Is the hospice accredited or •certified through a national organization?Arestaffcertifiedinhospice•and palliative care medicine?Does each team member use •a standardized assessment tool?Does each patient have one •casemanagerandsocialwork-er assigned to them?Howdoestheprogrammoni-•tor and improve its quality of care?MosthospiceswillbeMedi-

carecertified,asMedicareistheprimary payerwho reimbursesfor patient care. But if the hos-pice is Joint Commission Certi-fied, they have put themselvesto a higher standard and the level of accountability is much higher. The Joint Commission for the Accreditation of Health-care Organizations (JCAHO) is an independent governing body that oversees hospitals and nurs-ing homes.

By voluntarily undertaking this outside review and evalu-ation process, in addition to the mandated (Federal) Medicare and State Department of Health annual reporting, this hospice demonstrates a commitment to quality care, continuous im-provement and public account-ability for the care and service of terminally ill patients and their families. When the hospice has thiscertification,bothphysicianand patient can rest assured they have chosen a truly excellent hospice. Guiding principles should be competent, compas-sionate, and coordinated care.

The hospital-based palliative care team offers very important services for the patient, but those services vary from hospital to hospital and not all hospitals have such teams. But, hospice services and team members are the same from hospice to hospice and are mandated by Medicare. Bothstructures,however,striveto provide an interdisciplin-ary approach (physical, social, psychological, spiritual) to care. Whether care is received from the hospital-based team or the hospice team, both must strive to provide patient/family centered, competent and compassionate care.Thisallowsforalifeclo-surewithdignityandrespect—hallmarks of all palliative care.1 — Teno, JM, Connor, SF, Re-ferring a patient and family to high-quality palliative care at the close of life. Journal of the American Medical Association, 2009, (301), No 6; 651-658.

© gilbertguide.com

The one thing in life that never changes is that things alwayschange.Wewelcomesome changes. We turn a knobandwatercomesintothe

house from somewhereoutside. We need not walkacrossthe room to change the chan-nel on the TV. We can call home from the

condiment aisle at the store toinquireifweneedketchup.Some changes are good and make our lives much easier in manyways.

But of some changes weareapprehensive…whydokidsweartheirpantssostrangely? Of other changes weareafraid…ifIfeelthisbadnow,howmuchworstwillit get? As I become more and moresick,willIbecomeaburden to my loved ones? Will I be able to handle the pain? HowdoIfacethesefears?HowdoIcopewiththesechanges?

For many people, a spiritual faith is an important toolindealingwithchange,whetherthatbethechangethedying person experiences or thechangewhichisbroughtabout in the home and life of thefamilywhoarecaregivers.This faith may be founded

uponthesacredwritings,spe-cifictraditionsandceremoniesofaparticularreligion,whichprovide a stable foundation in the midst of devastating change. This faith brings us the promise that God does not change, that God continues to bewithyouinthesetroubledchangesasGodwaswithyou“inthewaythingsusedtobe.”

It is faith that gives us the assurance that this life is not all there is. Faith gives us the foundation for the hope that whenthepainisover,weareat peace in God’s presence surroundedbylovedoneswhohave gone before us. Faith gives strength to endure the ordealofthejourneytowarddeathbecauseweknowthatthe best is really yet to come. It is faith that gives us comfort whenwe“seeangels”,whenwebelievethatapersonalGodiswithusaswepassthrough the valley of the shadowofdeath.

Faith in God may be hard todefine,butasweapproachdeath,weknowthatfaithisthe substance of our hope, the foundation of our anticipation of a peaceful release from the pains of life and the indescrib-ablewonderofendlessjoyinthepresenceofthosewelove.

And in the end, it is faith whichisasourceofstrengthwhichthoseleftbehindwilluse to comfort one another and cope themselves.

Jim RussowChaplain

Quality of Life:Faith and Change

Calendar Summer 2009Truckin’ for HospiceSaturday, July 25, 2009Registration starts at 8:00 a.m.Starts at the Eagles Nest / Har-ley Davidson 13900 Harlan Rd, Lathrop , CAFun motorcycle, car, truck ride to help raise funds and awareness for Hospice. Presented by the California Truckin’ Association / San Joaquin Unit 500 partici-pants expected.Sponsorships available and $30.00 per rider with advance registration. More information and registration forms available at www.truckinforhospice.comRegister now(209) 835-2224Lillian Sealy, Event Chair

MidNite Club Golf TournamentSaturday, July 25, 2009 8:30 a.m.Registration Starts at 10:00 a.m.Lyons Golf CourseRough & Ready IslandGold Tournament to benefit Hospice of San Joaquin. More information call:Jose Santiago (209) 478 – 0151Bob Young (209) 986 – 8288Tim Montgomery – Lyon ’s (209) 462-3879 $ 70.00 per player

Moonlight Sip & StrollSaturday, August 15, 20096:00 p.m. Heron Lakes Drive at Brookside Classics AreaCapture the moonlight ambiance & enjoy a summer’s evening stroll while wine & brew tasting and sampling a large assortment of fine foods, move & groove to live music.$ 50.00 per person$ 60.00 per person at the door(209) 922-0380 or website for ticketsButterfly Auxiliary Hotline

Camp CaterpillarSaturday, September 19, 20098:00 a.m. Registration Hospice of San JoaquinCamp Caterpillar is a day camp at Micke Grove Park for children entering Kindergarten through sixth grade, who have had a loved one die within the last two years. Pre enrollment required, cost is free(209) 957-3888Carrie Vanderkar,BereavementCoordinator

28th Annual Recognition DinnerThursday, July 16, 20095:45 p.m. Stockton Golf and Country Club 3800 W Country Club Blvd. , StocktonSpecial Honoree, Steve Stange Health Care Partner, Award presentations to Board, Staff, Community Donors, Benefactors & HSJ Butterfly AuxiliaryTickets are $35.00 ea.(209) 922-0242Carolyn Gomes, Events Coodi-nator

Live! At Lincoln CenterFriday, July 17, 2009Friday, August 21, Friday, September 186:00 p.m. to 9:00 p.m. Lincoln Center848 W Benjamin Holt DrConveniently located on both sides of Benjamin Holt Drive off of Pacific AvenueFriday nights are filled with special plans to help raise aware-ness and funds for Hospice of San Joaquin (and other chari-ties).For questions contact (209) 477-4868Lincoln Center Marketing Office

Kids Korner The fall session beginsSaturday, September 269 am – 11:15 a.m.A special place where grieving kids can share, heal and grow in a safe, supportive atmosphere with their peers.(209) 957-3888Carrie Vanderkar,Bereavement Coordinator

Understanding Your GriefAugust 12, 20095:30 – 7:00 p.m.A one time workshop for the newly bereaved. Pre enrollment required, cost is free.(209) 957-3888Carrie Vanderkar,Bereavement Coordinator

The Quarterin Review

The Quarterin Review

(above) Robbin Panko, Home Health Aide, Hospice of San Joaquin gives patient Anna Pennington and granddaughter Debra Stephens a personalized quilt she made. The quilt includes printed photos of Anna Pennington’s life.

(below-left) Hospice of San Joaquin welcomes, Candace Johnson, Sharon Harding, Naima Laird, Ceil Chatham, Mike Smith, and Judy Winkley as new hospice patient team member volunteers.

(below) Volunteer Ron Turner gives Michael Gotschall a memento at the end of the 2009 Memo-rial Service — Hope for the Journey.

(right) Jessica Delk, presents

a $500 dollar check to

Hospice of San Joaquin. Funds raised as part of her

Senior project at her high

school.(L-R) Jessica

Delk; Josie E. Minor,

MSW; Camille García,

mentor; Jerrye Wright, RN,

Hospice House Manager

(left) Elizabeth Stockman

(middle) accompanied by Stephanie and Christian

Vallejo presented a $186.00

donation to Hospice

House. She asked for

donations to Hospice of

San Joaquin instead of

birthday gifts.

Saturday, July 25, 2009Registration starts at 8:00 a.m.Starts at the Eagles Nest / Harley Davidson 13900 Harlan Rd, Lathrop, CA

Fun motorcycle, car, truck ride to help raise funds and awarenessforHospice.Presented by the California Truckin’ Association / San Joaquin Unit 500 participants expected.Sponsorships available and $30.00perriderwithadvanceregistration. More information and registration at

(209) 835-2224www.truckinforhospice.com

8 t h A N N UA L

HOSPICE OF SAN JOAQUIN’S SEVENTH ANNUAL

CAMP CATERPILLAR

Children’s HealingGrief Day Camp

Saturday, September 19, 2009 8:00 a.m.

Camp Caterpillar is a day camp at Micke Grove Park for children entering Kindergarten through sixth grade, who have had a loved one die with-in the last two years. Pre enrollment required,

cost is freeRegistration Hospice of San Joaquin

(209) 957-3888