Lodi Tree of Lights Turns 18

Our MissionThe mission of Hospice of San Joaquin, a not-for-profit organization, is to provide comprehensive medical and compassionate care, counseling and support to terminally ill patients and their families, regardless of ability to pay, and to educate and collaborate with health care providers and the public in promoting quality end-of-life care.

A nonprofit agency serving the community since 1980Hospice 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 Hospice Agency and is certified by the Centers for MediCare and Medi-Cal Services to provide the Hospice Medicare/Medi-Cal Benefit. The Joint Commission has accredited Hospice of San Joaquin.

For more information or referral, call (209) 957-3888.

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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

Quality You Can TrustJoint Commission Accredited

NHPC & Gene Acevedo

Hospice care helps pa-tients and families focus on living. This is the message that Hospice of San Joaquin is sharing with the community during National Hospice and Palliative Care Month. How-ever, this important message lasts beyond the month of November and is important all year round.

“November is an impor-tant month to raise aware-ness about the importance of quality of life when cure is no longer possible,” said Stephen Guasco, Executive Director of Hospice of San Joaquin. “However care does not follow a calendar nor is limited to a particular season. The needs of our patients ar-rive any day at any time, so our message must make an impression that stays with people all year long.”

Every November hospice

agencies across the coun-try raise awareness of the compassionate care hospice and palliative education pro-vides. The Seasons of Caring t h e m e reminds p e o p l e that life’s final sea-sons can b e s o m e of the most f u l f i l l i ng , e s p e c i a l l y when hospice care supports the patient and family.

Hospice care includes a professional team, experts in medical care to keep patients comfortable and able to en-joy quality time with their loved ones. The team offers medical answers, advice on what to expect, and helps families with the duties of

being a caregiver. The team also provides emotional and sp i r i - tual support for the

entire family. “ W i t h t h e

help of hospice, p a t i e n t s a n d families alike can focus on what’s most important – enjoying life t o g e t h e r and living the final seasons to

their full-est,” said Guasco,

“It’s about quality of life.”“There’s an inaccurate

perception among the Ameri-can public that hospice means you’ve given up,” said J. Donald Schumacher, presi-dent and CEO of the National Hospice and Palliative Care Organization. “Those of us who have worked in the field have seen firsthand how hos-

pice and palliative care can improve the quality of life. And there’s a growing body of research showing that hospice and palliative care may pro-long the lives of some people who receive care.”

Patient / Physician com-munication is the key in un-derstanding the disease trajec-tory and options to balance quality of life at end-of-life care. “It is unfortunate that more than 70 percent of the population will jeopardize quality of life with curable measures which have no ben-efits in prolonging life once cure is exhausted.” explained Audrey Wuerl, RN, Education Coordinator, Hospice of San Joaquin.

For more information about Hospice of San Joaquin, and how your family may benefit from hospice care, call (209) 957-3888, or you may visit the agency’s website www.hospicesj.org.

By Gene Acevedo Community Outreach Director

Every day, patients and their families receive life-limiting diagnoses along with advice about the treatment options that are available. However, the shock, fear, and anxiety from this knowledge can increase the complexity of the situation and make it dif-ficult for patients and families to understand the diagnosis or suggested treatment pro-cedures.

For this very reason, Hos-pice of San Joaquin has in-creased its commitment to quality-of-life by offering

Transitions—a program de-signed to provide palliative education, emotional support, and community resource in-formation to participants with life-limiting or advancing chronic illnesses.

Richard and Diane Park were recent recipients of the Transitions Program. Mr. Park had numerous life limiting conditions and according to his physician he developed a potentially fatal allergic reaction alongside had other life limiting diagnosis. His recovery prognosis was un-certain. The complexity of the numerous medical op-

tions was overwhelming, and their family physician suggested the Hospice of San Joaquin Transitions Program as a professional resource for support.

Mrs. Park states, “Hospice of San Joaquin Transitions Coordinator, Pam Byrne is exceptionally knowledgeable and encouraging. She was caring, accessible and very well informed. Her support was like being thrown a life jacket in a stormy sea.”

Transitions is a commu-nity support program for in-dividuals and families facing advancing chronic or life-lim-

iting illness. Transitions Program is

separate from hospice care. It is sponsored by Hospice of San Joaquin and is free of charge to participants.

Ms. Byrne, Ph,D., R.N. says, “When you or some-one you love has advancing chronic or life limiting illness your life is affected in count-less ways. Coping with the changes may be challenging or difficult. The Transitions Program is here to help and to offer information, respect, comfort and support when you need it most.”

Lodi Tree of Lights Turns 18

Transitions: Participant Family Appreciates the Support

NATioNAl HoSPiCe MoNTH:

Seasons of Caring

Stephen Guasco, Execu-tive Director, Hospice of San

Joaquin appreciates the City of Lodi and its residents’ part-nership.(Photo By Gene ACevedo)

Richard Park Transitions Participant(photo by Diane Park)

Lodi Tree of Lights Turns 18

By Barbara Pombo, Development Director

During the evening of December 3rd, two thousand, two hundred and fifty (2,250) lights will simultaneously light up following the com-munity’s count down at the 18th Annual Tree of Lights, lighting ceremony.

“On behalf Hospice of San Joaquin’s patients as well as their families, we wish to thank the City of Lodi for –once again– partnering in the Tree of Lights Celebra-tion,” said Stephen Guasco, Executive Director of the many contributions the City of Lodi and its residents offer to the agency.

This year, volunteers re-placed all lights with high energy saving bulbs. Each bulb will now use 7-tenths of a watt generating a 90 percent reduction in power consump-tion —from 5,000 watts per hour to 500 watts per hour. The energy saving upgrade was made possible by pub-lic benefit money provided through the Lodi Electric Utilities secured through the efforts of Rob Lechner.

Hospice of San Joaquin appreciates everyone collabo-rating in making tree of lights a reality, “members of Lodi’s Public Works Department, under the supervision of Curt Juran, have each volunteered

three of their Saturdays to test the lights, replace all of the bulbs with the energy efficient bulbs and placing as well as removing the lights from the tree,” highlighted Guasco.

Among the Lodi Tree of

Lights partners is the West Coast Arborists. “Without the West Coast Arborists lighting-up our Lodi Tree would be very difficult,” explained Bar-bara Pombo, Development Director at Hospice of San

Joaquin. The West Coast Arborist pro-

vides staff and equipment to string and remove the lights.

The City’s Parade of Lights will follow the Tree of Lights’ lighting program which is schedule at 5:30 pm.

This year the Lodi High Meistensigners will provide music under the direction of Amy Dalhstrom. Pastor Rod Suess from Vinewood Com-munity Church will give the invocation. The Lodi Chap-ter of the Hospice Butterfly Auxiliary will serve cookies and cider.

Should you desire to light-up a light for a loved one, you may contact Hospice of San Joaquin’s events line at (209) 922-0242, or you may go online at www.hospicesj.org. Your donation will light-up the Tree of Lights and it will support Hospice of San Joaquin’s programs. Your loved ones name will be posted on the Memory Boards provided by PG&E Volunteer Dave Bender and family.

Tree of Lights 2009(Photo by www.ulmerphoto.com)

Board of Directorsofficers: edward G. Schroeder,

President; President & Ceo, o ‘ Connor Woods

G a y l e R i l e y , R N , v i c e P r e s i d e n t ; Nurse , Hea l thcare Administrator

C h r i s M c c a f f r e y , T r e a s u r e r ; v i c e P r e s i d e n t - M o r g a n Stanley

Chris olin, Secretary; Community volunteer

Members: Mark Wallace, ex-oficio

director of Human R e s o u r c e s , L o d i Memorial Hospital

d i a n e P a r k ; F u n d d e v e l o p m e n t Consultant

Gary Giannini; Principal at Schwartz Giannini

Jack Gilliland, Md RetiredJacqueline Bagatta, RN;

deputy d i rec to r – San Joaquin General Hospital

Margo Kozina; Teacher, St. Mary‘ s High School

Peter G. Gormsen, C.P.A.; degreogori, Gormsen, Ringer, Inc.

Phy l l i s Berger, esq. ; Professor, Humphreys College School of Law

Scott Beattie; Partner/Lawyer At Calone Law Group

Steve Larson; Grants officer Port of Stockton

S t e p h e n G u a s c o ; 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; director,

Clinical ServicesJo Paganini, MSW; director,

Social Services Becky Burnett, RN; Hospice

House ManagerPam Byrne, Ph.d., RN;

Transitions Program Coordinator

Audrey Wuerl, RN, BSN; education Coordinator

Steve Parsons, CPA; director operations / Finance

Patty A. Rieber; Human Resource Manager

Leo Ronquillo; Information Systems Manager

Gene Acevedo, MBA; director, Community outreach and Public Relations

Barbara A. Pombo, MBA; director, development

Carolyn Gomes; Annual G i f t s & e v e n t s Coordinator

Carr ie Lane, M. dIv.; B e r e a v e m e n t Coordinator

Becky Freeman; volunteer Coordinator

Jim R. Russow, M. dIv., d MIN.; Chaplain

Message fromthe Executive Director

During this Holiday Season, Hospice of San Joaquin celebrates a unique partnership with our Community. It was thirty years ago that Articles of Incorporation were filed with the State of California to establish Hospice of San Joaquin. The filing of those Articles on November 5,

1980 fulfilled the dream of those twelve dedicated pro-fessionals who comprised our first Board of Directors. Their dream was to create an agency that provides “palliative and supportive services which coordinate and facilitate physical, emo-tional and spiritual care for the dying persons and their families.”

Hospice of San Joaquin continues to fulfill that

dream by striving to provide the highest level of care for both our patients and their families. Hospice of San Joaquin continues its voluntary Accreditation through the Joint Commission – the Nation’s leading health care accrediting body, evaluating and accrediting more than 19,600 healthcare organizations in the United States. Ac-creditation through the Joint Commission is the highest seal of approval for the delivery of health care services.

Throughout this Newsletter, you will see articles and pictures of a few of the many contributions by individu-als and companies throughout San Joaquin County who appreciate and support Hospice of San Joaquin’s long history as the County’s only not-for-profit hospice. Our partnership with the community ensures that the dream of our twelve founders will live many more years into the future.

Sincerely

Stephen Guasco, Executive DirectorHospice of San Joaquin

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

By Audrey Wuerl, RN, BSN, CHPN, Education Coordinator

In previous articles, I have discussed challenging behav-iors in Alzheimer’s disease, such as wandering, that cause families distress and result in the patient being insti-tutionalized. In this article I will address a behavior concerning disruption of the sleep-wake cycle, one that results in increased confu-sion, restlessness, agitation, and anxiety—especially after dusk—and may continue throughout the night. It has been documented to occur in 20 percent of all patients with Alzheimer’s disease, and has been appropriately named sundowning as it coincides with “the sun going down.”1 Sundowning syndrome is also known as Sundowner’s syndrome. Sundowning can be especially difficult for caregivers as it is, in effect, wandering after dark.When Does Sundowning occur?

When I refer to the sleep-wake cycle, I am referring to a patient’s circadian rhythm. Circadian rhythmicity is what regulates all of our bodily processes, including body temperature, secretion of hormones, heart rate, and so on, and is controlled by the brain. We see behavioral changes in these patients be-cause Alzheimer’s disease causes damage to the brain resulting in brain cell death, and shrinkage of the organ. Most of the behavioral issues concerning this dementia are caused by ongoing changes in the brain. We tend to see sundowning in the Moder-ately Severe or Mid-stage of this disease, which we call Stage 6. Sundowning occurs while the patient is still am-bulatory. While this behavior is challenging for families and staff, the good news is it tends to peak in this stage and then diminish as Alzheimer’s progresses.What the experts Say About Sundowning

In a recent study entitled Sundowning and Circadian Rhythms in Alzheimer’s Dis-ease, researchers investigat-ed the relationship between sundowning and circadian rhythms. They concluded that while behavioral symptoms associated with dementia can occur at any time of day, Alzheimer’s disease caused disturbances of circadian rhythms; and, sundowning was related to a phase delay

in body temperature that was a result of the disease pro-cess. 2 The authors point out therapeutic goals for sleep disturbances, such as respi-ratory problems like sleep apnea, differ from those used to treat sundowning, where the emphasis is on patient safety and comfort rather than sedation and sleep. For that reason, they conclude the term “sundowning” should be associated with behavioral disturbances that occur during the late afternoon and evening hours when the patient is ex-pected to be awake.

Further, the authors cau-tion that this population is difficult to accurately study as many patients with Alzheim-er’s disease are hospitalized during the later stages—which contributes to changes in circadian rhythms—or, have other comorbidities that affect their sleep. For families and caregivers or institutions, it is important to keep in mind that each patient is individual and their needs (and behav-iors) should be addressed on that basis. Suspected Causes of Sundowning

There are identified trig-gers that tend to precede sun-downing behavior, although there is not consensus on actu-ally why the patients react to the triggers. Most behaviors are attributed to the following factors:• End-of-day (afternoon)

confusion or exhaustion• Disturbance in the “bio-

logical clock” (this is the circadian rhythm)

• Decreased ability to handle stress

San Joaquin’s Tree of Lights on the steps of City Hall.

In 2006, Cynthia Haynes’ Tree of Lights vision to in-corporate other communities took yet another step towards growth. This time along with friends and colleagues, she initiated a partnership with Hospice of San Joaquin

and the Lockeford/Clements Chamber of Commerce. As a result, the local commu-nity now enjoys the local tree lighting ceremony, “The over-all Lockeford/Clements com-munity joins us in lighting the tree,” explained Tim Fowler, former Chamber President, “while some people who

Cynthia Hanes, PG&E Employee and Volunteer; Carolyn Gomes, Program Coordinator, and Stephen Guasco, Executive Director, Hospice of San Joaquin, converse about the 2010 Lodi and Lockeford Tree of Lights. (Photo by Lewis W. Stewart)

Pacific Gas and electric Company employee/volunteer honored for service to Hospice of San Joaquin in northeast San Joaquin County

PG&E honors Cynthia HaynesBy Barbara PomboDevelopment Director

Pacific Gas and Electric (PG&E) is recognizing Cyn-thia Haynes with the presti-gious Mielke Award. Cynthia Haynes, PG&E employee, and volunteer with Hospice of San Joaquin, is recognized for her dedication and persever-ance to increase participation in Tree of Lights. Annu-ally, across the state PG&E selects one recipient, out of 400,000 members, to receive the Mielke Award based on outstanding, above and be-yond community service.

Ms. Haynes became in-spired by the PG&E/Hospice of San Joaquin’s Tree of Lights Stockton partnership. In 1997, her inspiration led her to engage at Hospice of San Joaquin and to expand the Tree of Lights in Lodi. “The Tree of Lights used to be at Hutchins Street Square and we wanted to make the lighting more visible for ev-eryone to learn about hospice services,” shared Ms. Haynes, “hospice care brings families together and I understand what it means to have choices at end-of-life as my grandfa-ther received the service.”

Part of her plan was to initiate the Parade of Lights in Lodi which has now become a tradition following the light-ing ceremony of Hospice of

are not fully aware of hos-pice services appreciate the ceremony; others who have received hospice services have a deeper and meaningful experience.”

The Tree of Lights in Lockeford, Tracy, Manteca and Stockton is made pos-sible by PG&E Employee Volunteers (see adjacent list). Starting in Stockton in 1988 this dedicated crew and their family members have string lights and maintained the memory boards adding new location ass interest grew across the County.

The Lockeford Tree Lighting attracts the entire community including fami-lies, businesses and a unique group which adds a musi-cal contribution — caroling on horseback. Community participation has grown sub-stantially over the years. The 5th Annual Tree of Lights in Lockeford is set for Decem-ber 1st, with Cynthia Haynes once again energetically and expertly leading the effort.

Mark RasmussenDave AyersLisa WallaceJimmy PachecoGreg CobarrubiasEmily Barnett (no longer with PG&E)Theresa EnglishBob SeversonKen Ruffin SrChad LavezzoEvan Slayton

Baird BeesonRobert BeesonJosh CasenavePat WindschitlRich CodyGerrett MatthewsChris TarpScott WhitneyMark FortDave DiebnerJohn ChristensenDustin Powell

Pacific Gas & electric employee Volunteers

Alzheimer ’s Disease:

Understandingthe

Sundowning Syndrome

• Poorly lit rooms and increased shadows (coupled with possibly poor eyesight)

• Difficulty differentiating dreams from reality

• Restlessness due to bore-dom

• Decreased need for sleep (common in older adults)

• Caregiver communicated fatigueI often tell families that

being a caregiver may be the most important job they will undertake in their en-tire lifetime. Taking care of themselves will allow them to have the energy to care for their loved one. Learning what to expect and what is expected can help them feel more comfortable in this new role. (And, if their loved one is now institutionalized, the “caregiver” role does not just go away. In fact, it can be con-fused with the guilt often felt when families can no longer care for the patient at home.) If hospice care is involved by this point, the hospice team will provide teaching about the disease process so the family can feel confident when giving care, as well as addressing the psychological and social needs of the patient and family. If the patient is institutionalized, hospice will support the facility in identi-fying stages and what changes to expect—and communicate these changes to the family.Coping with Sundowning Behavior

The following suggestions can help keep the Alzheimer’s patient safe, and reduce anxi-ety. Try to maintain a struc-tured routine that provides activities within the patient’s coping ability, as well as applying the following tips to cope with sundowning behavior. • Plan activities for earlier

in the day, rather than in the afternoon, to avoid exhaustion.

• Discourage daytime napping and encourage exercise such as taking a walk to use extra energy

and promote sense of well-being.

• Take special notice of the patient’s diet—limit caffeine and sweets to early in the day to reduce sleeplessness and agita-tion.

• Monitor noise levels from televisions, radios, or ste-reos to decrease agitation.

• Keep sleeping room partially lit to prevent patient from becoming disoriented.

• Caregivers should remember to take care of themselves to avoid transferring stress.1We can better accept the

changes that occur in the Alzheimer’s patient if we understand the changes that occur in the brain. Confusion, restlessness and agitation oc-cur because the brain can no longer sort out clues in the patient’s environment. As Al-zheimer’s disease progresses, more and more nerve cells or neurons (we normally have about 100 billion!) in the brain die, resulting in brain shrinkage. This “shrinking” equates to losses in functional ability. The FAST scale helps illustrate for families and caregivers or institutions, the expected losses at each stage. Sundowning occurs in Stage 6, so beside the disruption of the sleep-wake cycle, the patient may begin to exhibit suspiciousness concerning his or her surroundings, delu-sions regarding the caregiver as really being an “imposter” and repetitive behaviors. So, too, this is the stage in which we begin to see wandering behavior.

Understanding what trig-gers sundowning, taking steps to reduce those trig-gers, and realizing the main goal should always be safety for the patient, helps us all cope better when caring for the Alzheimer’s patient. And, knowing what to expect as Al-zheimer’s disease progresses and sundowning behaviors occur, receiving the necessary support along the way, will make this road a little easier to navigate—for family and caregivers alike.1 Alzheimer’s Association.

2007. Sleeplessness and Sundowning¬, pp. 1–2. Accessed May 4, 2009.

2 Volicer, L, Harper, D, Manning, B.C., Goldstein, R. and Satlin, A. (2001, May). Sundowning and Circadian Rhythms in Alzheimer’s Disease. American Journal of Psychiatry, 158:5, pp. 704–711.

Below are the dedicated professionals who responded affirmatively to supporting the concept of Hospice in the Stockton/San Joaquin communities and helped guide its growth by participating as the founding Board of Direc-tors. The list includes their names and their respectful titles as they served at the formed Hospice of San Joaquin Board.

John Morozumi, M.D., PhysicianOrt Lofttus, President, KJOY, KJAXRobert Browne, M.D., President, S.J. Medical SocietyMike Monnich, Director, S.J. Medical SocietyShiela Stephens, R.N., BSN, Oncology Dept. HeadKaren Hanson, MSW, Oncology Social WorkerJoan Heffernan, Board of Directors at Newman Club Lois Erickson, R.N., BSN, NurseFranke Hey, School Board Member and Symphony

League FundraiserRabbi Chester, Rabbi, Temple IsraelFather Harmon Skillon, Priest, St. Edwards ChurchReverend Holmes, Minister, Trinity Lutheran Church

Hospicio de San Joaquin ofrece sus servicios en

españolSi desea que alguien le interprete este boletín en su idioma, por favor comuníquese con

Gene Acevedo, Director de Relaciones Públicas

Josie Minor, Maestra en Trabajo SocialDiane Medina, Maestra en Trabajo Social

(209) 957-3888

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By Gene Acevedo, Commu-nity Outreach Director

The holidays will not be what they used to be… shared Jo Williams of Lin-den, this winter holds her first holidays without her husband Steve Williams who died May 2, 2010.

Mr. Williams was diag-nosed with cancer in April and within a window of 10-days Mrs. Williams had lost her husband. “At first I was refusing to believe he was gone; emotions of anger, disbelief, and emptiness filled me,” she noted in a quiet tone.

As she attended Hospice of San Joaquin’s Memorial

Service and learned about the agency’s bereavement groups; she also learned she was not alone. Mrs. Williams remem-bers her first day as she signed up to attend a group, “The first day I was trembling with fear… especially because you don’t want to show your weaknesses among a group of strangers.”

Hospice of San Joaquin of-fers six-week group sessions for participants to learn about coping with their loss, reflect about ways to cope with the grief, explore care methods, and ultimately participants discuss transformation and growth following their loss. Mrs. Williams’s group was

formed of 14 participants who had lost their spouses.

“It’s been wonderful, from day one, I felt I knew ev-eryone,” she shared. Simi-lar to other individuals par-ticipating on bereavement groups, Jo Williams found herself surrounded by new acquaintances whose relation is building up to a new level of friendship. “We continue meeting at restaurants and we have even visited among each others homes.”

As the holidays are ap-proaching she knows her family will come together; however, without Steve these holidays will be different. “I know I will enjoy each holiday

with my family. However as the holidays approach, the days will be difficult because we don’t have the acceleration of happiness,” explained Ms. Williams. Prior to the holidays, the 14 member group is planning to support each other.

For anyone in the com-munity who has lost a loved one in the past year, Hospice of San Joaquin has bereavement groups throughout the year. You may contact Carrie Lane, Bereavement Coordinator, Hospice of San Joaquin at (209) 957-3888 or you may learn more on line at www.hospicesj.org.

New Friendships Start in Grief Groups

Ms. Smith reminisces, “…my mom loved piano music.”

Linda Smith discovered her passion for music since her early childhood, “I would play all kinds of television commercials.” Following her music passion, her mother decided that she would learn piano at age 5. “My mom was a Southern Baptist and she wanted me to learn how to play hymns rather than ciga-rette or beer commercials,” Ms Smith explained.

Neither Linda or her

mother ever imagined that her music would benefit Hos-pice of San Joaquin’s patients; but, she quickly learned about the appreciation and need for her talent, “at first I thought the music would be a distrac-tion; but, as soon as I started playing people came out and appreciated the music.”

Today, she visits regularly throughout the month and plays the hymns her mother enjoyed during her life. Now-adays she also plays pieces following special requests.

liVe PiANo MuSiC

A TreAT AT Hospice House

Linda Smith, Volunteer Piano Player at Hospice of San JoaquinPhoto By Gene Acevedo

“We have seen how some of our guests come around Linda to sing along while she plays,” noted Verna Baker, Hospice House Cook.

The grand piano was a kind donation to Hospice of San Joaquin In Memory of Daniel Paul Sheehy by Bev-erly, Matthew, Stephanie & Michael Sheehy.

By Gene AcevedoCommunity Outreach Director

As the temperature begins to drop, the fireplace at Hos-pice House exudes the “pres-ence of home”. Hospice of San Joaquin’s professional staff and volunteers ensure that both patients and their families feel comfortable (and warm) during their visit. Twice a month Hospice House guests receive a special treat —live piano music by Linda Smith, volunteer at Hospice of San Joaquin.

While Hospice of San Joaquin offers music ther-apy to both inpatients and outpatients, Hospice House residents and their families enjoy the selections Linda Smith plays on the grand piano. ““Music therapy of-fers patients various forms of comfort; including mental and physical relaxation and reminiscence of life’s events (joyous and sorrowful). Each person has their own emo-tional response to music and more often than not, it touches the soul and brings a gentle comfort and peace to the lis-tener,” explained Jo Paganini, Director of Social Services at Hospice of San Joaquin.

For the past three years Linda Smith has offered her talent as a volunteer. “Af-ter loosing my mother… A friend [Sharon Benninger volunteers as a Team Member and with the Butterfly Auxil-iary] recommended that I to start playing the piano at Hos-pice of San Joaquin’s House,”

Care choices at end-of-life can be daunting and poorly understood—and, choosing between “quality of life” and “quantity of life” can be frightening for individuals and families alike.

A recent article appear-ing in The Record (As-sociated Press, June 29, 2010) highlighted the di-lemma many people face when confronted with a life-limiting illness. Titled, Americans Are Treated, And Overtreated, To Death, it brings to light the often futile attempts made to prolong life at a point when honest discussion regard-ing goals of care should be taking place. Indeed, Americans are spending more time in hospitals dur-ing their final days, often pursuing treatments that only buy weeks of time rather than any “cure.”

As our population ages, diseases once thought only “chronic” have in fact become life-limiting; and, for hospice admissions, cancer related deaths account for fewer than fifty percent of all terminally treated deaths.1 Americans are now “sicker” as they approach end of life, and often the treatment is a greater burden than the illness itself. At a time when health care costs are skyrocketing, exploring options for care with an emphasis on quality of life when quantity is no longer possible can be the best solution in the final months.

Physician-patient discussions regarding options when goals of care are changing can be extremely beneficial for individuals as they explore treatment choices. According to this article, “one large study of Medicare records found that nearly twelve percent of cancer patients who died in 1999 received chemo in the last two weeks of life, up from ten percent in 1993.” People simply do not want to give up—and hope can be a wonderful thing. How about, hope for pain to be controlled, or hope for exhausting symptoms

to be managed? Hope to spend time with loved ones, or just hope to have “time to say good-bye”?

Hospice stresses quality of life, patient autonomy, a belief in dignity and re-spect, and support for pa-tient, caregiver, and family during these final months. This option can be a wel-come relief for patients both physically and finan-cially when all therapies have been exhausted. But all too often patients are referred late in the disease trajectory. According to the National Hospice and Palliative Care Organiza-tion of all patients receiv-ing hospice care in 2009,

the average length of stay was sixty-nine days, with thirty-five percent dying within seven days of admission.

Choosing hospice care at end of life has proven to prolong the lives of certain patients. A study done in 2007 and published in the New England Journal of Medicine, showed patients’ survival rates improved under hospice care, es-pecially for congestive heart failure and lung cancer, probably due to

earlier referral for services and better pain and symptom management.2

When do we say, “enough is enough”? At what point do we recognize continued, aggressive care (without result) as futile and stop treating, and over treating people to death? As this article illustrates, having honest, meaningful physician-patient conversations regarding disease prognosis can allow time to concentrate on what is really important now—and, help those facing life-limiting illness time to “celebrate the rest of their lives.”1,2 NHPCO Facts and Figures: Hospice Care in America, National Hospice and Palliative Care Organization, 2010 Edition, retrieved from www.nhpco.org/research October 15, 2010

Whendo We

Say enough?

By Audrey Wuerl, RN, BSN, CHPNeducation Coordinator

Helping Teens to Copewith Grief and LossNovember 20, 2010

2:30– 5:00 pm

Losing a loved one is hard.Family, friends, and teachers

don’t always understandwhat you are going through.

We do!

Come and meet other teenswho have had a loss and

let us help you learn some waysto get through the

holidays and beyond!

This workshop is for high-school students who have lost a loved one and is led by Hospice of San Joaquin Bereavement Sta� and volunteers. The cost is FREE but pre-registration is required.

Please call to register (209) 957-3888

Register at(209) 957-3888

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JOIN THE TEAM Volunteer at Hospice of San Joaquin

Volunteer TrainingMarch 3 — March 22, 2011

Monday & Thursday Evenings6:00 to 9:00 pm

For further information or to register, callthe Volunteer Coordinator at

(209) 957-3888

Experience the rewards and satisfaction of making a difference in the lives of others

Tree of Lights 2010 Light Up a Light… Light Up a Life

During this special season, honor or remember a loved one through Hospice of San Joaquin’s “Tree of Lights”. Your gifts directly benefit patient’s quality of life

Please print

Donor’s Name:

Street:

City, State, Zip

Phone

Select a light Color Select a location Red Green Blue White Yellow Treetop

$ 5.00 $ 10.00 $ 25.00 $ 50.00 $ 100.00 $ 200.00

Stockton: Lockeford Lodi Rio Vista Manteca Tracy

Please Print: In MEMORY of:

In HONOR of:

Send Notice of gift to:

Street:

City, State, Zip: Check enclosed and completed form mailed to: Hospice of San Joaquin Tree of Lights

3888 Pacific Avenue, Stockton, CA 95204 Please charge my donation to

MasterCard Visa Am Ex Discover Credit Card #

Name on Card: Exp Date: Signature:

Or, visit our website to make your gift online If your gift includes more names, download form online

www.hospicesj.org

Fall 2010 Calendar

The Quarter in Review

Kids KornerA special group just for children who are grieving the recent loss of a loved oneJanuary 15, January 29, February 12, and February 26, 20119:00 am — 11:00 am at HSJAdministration BuildingA special little “korner of the world” where grieving kids can share, heal, and grow in a safe supportive atmosphere with their peersCost: Free —However, preregistration is REQUIRED; space is limitedContact: Hospice of San Joaquin’s Bereavement Coordinator(209) 957-3888

Teen to Teen Helping teens to cope with grief and lossNovember 20, 2010 2:30 — 5:00 pm at HSJAdministration BuildingThis workshop is for high-school aged teens who have lost a loved one.Cost: Free —However, preregistration is REQUIRED; space is limitedContact: Hospice of San Joaquin’s Bereavement Coordinator(209) 957-3888

(left) Dr. Berlin, Volunteers at Camp Caterpillar 2010, the annual, day camp supports children K - 8th grade grieving the lost a loved one in the past 12 months.(Photo bywww.ulmerphoto.com)

(right) During the evening of October 4, 2010, Hospice

of San Joaquin appreciated members of the Butterfly

Auxiliary, along with friends and supporters of the agency

in an evening titled —“Sharing the Care”

(photo by www.ulmerphoto.com)

(left) Barbara Galgiani Presi-dent of the Butterfly Auxiliary surprised Hospice of San Joaquin with a pre-season check by the Auxiliary’s ongo-ing fundraising efforts.(left to right) Edwarde Schroeder, Board President; Barbara Galgiani, Butterfly Auxiliary President; Stephen Guasco, Executive Director

(photo by www.ulmerphoto.com)

(right) Olive Garden Staff appreciated Hospice of San Joaquin dedication to provide the next level of care when cure is no

longer an option. On labor day, Olive Garden surprised the agency’s

staff with a free meal at Hospice House.

(Photo By Gene Acevedo)

Tree of Lights

The community is invited to join with family and friends to remember and honor loved ones by dedicating a light on the Tree of Lights! Names of honorees and donors are placed on a marquee at the base of each tree. The tree will remain lit for the entire holiday season. Proceeds from this event help Hospice of San Joaquin provide care for terminally ill patients and their families. Additionally, it allows the agency to support the community with bereavement programs for those grieving the loss of a loved one. You may donate a light by calling (209) 922-0242.

Stockton – Tree of LightsTuesday, November 23, 2010 — 6:00 pmSan Joaquin Delta College5151 Pacific Avenue, Stockton

Manteca – Tree of LightsWednesday, December 1, 2010 — 6:00 pmManteca Doctors Hospital1260 E. North Street, Manteca

Lockeford – Tree of LightsWednesday, December 1, 2010 — 6:00 pmPreceding the Cowboy Craft Faire19000 N. HWY 88, Lockeford

Lodi – Tree of LightsThursday, December 2, 2010 — 5:30 pmCity of Lodi at City Hall 221 W. Pine Street, Lodi

Tracy – Tree of LightsFriday, December 3, 2010 — 6:00 pmTracy Outlets 1005 E. Pescadero Ave. Tracy

Rio Vista – Tree of LightsSaturday, December 4, 2010 — 5:30 pmCity of Rio Vista at City hall One Main Street, Rio Vista

Butterfly Auxiliary meetings are open to anyone interested in membership.

Stockton Chapter Meetings are held the first Thursday of every month (February - November) at 6:00pm at the Hospice of San Joaquin Office.

Lodi Chapter meetings are held the second Thursday of every month (February - November) at 6pm at Vinewood Community Church in Lodi.

Tracy Chapter, meets on the first Monday of the month.New members are most welcome!! For information, call Gloria Bacchetti (209) 835-9569

Fundraising events benefit Hospice House, the only residential hospice home in San Joaquin County.

For membership information,visit our website atwww.hospicesj.orgor call 209-922-0380

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