Gil and Barbara Stein know this simple fact well. Recently, the couple gave their children an incredible gift and quickly discovered the joy of giving. After carefully reviewing the nearby options, the Steins signed a contract on a new villa in Waverly Heights, a lifecare community in Gladwyne, Pa. Waverly Heights is a Main Line community located a mere 10 miles northwest of Philadelphia, Pa.

“We decided moving here would be a gift to our children, since they would never have to worry about taking care of their parents,” Barbara explained. “Since moving, we’ve discovered that it was really a gift for ourselves.”

While the Steins originally planned to move to Waverly Heights in 2012, they decided to relocate a year earlier based on the sage advice of current residents. “All the residents uniformly recommended that we come early and enjoy the lifestyle,” Barbara recalled.

Now that the transition is over, the couple enthusiastically seconds this advice. “To our peers who are on the fence, I would say, based on my own experience, it is better to move here five years early than one day late,” Gil said. “I couldn’t agree more,” Barbara added. “We are enjoying the wonderful lifestyle we have here, and we know that the care here is excellent if and when we need it.”

An alumna of Vassar College, Barbara married Gil on her graduation day. The couple eventually settled in Gladwyne, where they raised two sons and a daughter. While Barbara was a full-time wife and mother, she always made time to give back to her community.

For more than 40 years, Barbara worked on the Vassar Show House Scholarship program. The group partnered with interior designers and landscapers to redecorate estate homes and gardens for public tours. “It was a wonderful experience, and we all became very close friends,” Barbara said. “During our time together, we raised almost four million dollars for scholarships.”

As part of another unique partnership, Barbara became a founding board member of the first hospice program in the Philadelphia area. “Hospice really is a remarkable program,” she said, recalling as one of her most memorable experiences her direct volunteer work with a young family.

A native of Philadelphia and an avid sports fan, Gil’s career path has reflected his many passions. An Army Veteran who served during WW II, Gil graduated from Temple University and Boston University Law School. His varied and prestigious work history has included high-ranking positions in Philadelphia city government and positions as a law firm partner, a member of the U.S. Supreme Court Bar, and president and CEO of the National Hockey League (NHL) – just to name a few.

While he found all his various careers rewarding, his work with the NHL married his passion for law with his love for sports. “Whatever I was doing was my favorite at the time, but being involved with the NHL was probably the thing I most identified with,” Gil said.

While he was never a hockey player himself, Gil has always been a huge fan and getting the opportunity to serve as the president of the NHL was an enormous honor. Gil loved working with the players and coaches and advancing the game. After retiring, he wrote the book POWER PLAYS—An Inside Look at the Big Business of the National Hockey League.

As for their lifestyle today, the Steins are enjoying a mix of new and old interests with lots of new friends. Barbara, a self-proclaimed “professional volunteer,” is still pursuing her passion for giving back. She has joined Waverly’s marketing, special events and movie committees. She also participates in the daily physical activity options, ranging from aquatics to line dancing.

Gil continues to work part-time as an adjunct professor of sports law at Villanova University Law School. He is also using his newfound free time to pursue volunteer activities. In fact, he recently became the editor of the Waverly Heights monthly magazine, Waverly Window. He also participates in Waverly’s putting competition and is a member of the traveling putting team.

“The thing I like best about living here is that you can continue to live the life you were living before, or if you want to get involved, there are myriad activities available,” Gil said. “We’ve always had a nice social life,” Barbara added. “The difference is now it is all right here—right outside our door.”

In fact, the Steins knew almost immediately that they would be most comfortable at Waverly Heights. When considering a life care community, they looked at nearly all of the local options, but always felt at home at Waverly.

“Beauty is terribly important to me; I love green space, and this community is just outstanding in that area,” Barbara said. Gil concurred, “We were very attracted to the natural beauty and lovely living accommodations, and once we came here, we found the activities were just wonderful as well.”

The activities and the people have made what is undoubtedly a picturesque location a true home for the Steins. “The biggest thing we have here is a sense of community,” Barbara said. “The residents and staff are there for each other, and it is just a really warm environment.”

Having found that sense of community that is missing in so much of adult life, the Steins have never looked back. “So many people tell us that they are not ready to move, but I’m not really sure what that means,” Barbara said. As a trained social worker with a Master’s in Social Services from Bryn Mawr College, Barbara saw firsthand the importance of planning for one’s later years. She had been an advocate of lifecare communities long before considering their own move; however, she could have never dreamt how much moving would enrich their quality of life.

From pursuing beloved activities to hosting new friends, the Steins are fully enjoying everything that Waverly Heights has to offer. When they were researching life care communities, they thought they were giving a gift to their children. When they moved, they realized that the gift was really for them—and that it just keeps giving. Today, the Steins are thrilled to be literally living in the present.

Grieving people may have unusual dreams, be absent-minded, withdraw socially, or lack the desire to participate in activities that used to be enjoyable. While these feelings and behaviors are normal during grief, they generally change over time. In general, grief makes room for a lot of thoughts, behaviors, feelings, and beliefs that might be considered unusual at other times. Following significant loss, however, most of these components of grief are, in fact, quite normal.

One method of dealing with grief is to be more aware of the ways we express it. Even the exact words we use (to ourselves and to others) can make a difference. For example, when we think, “I regret that I was not in the room when he died,” we’re less likely to wallow in the feeling than if we think, “I feel guilty that I was not in the room when he died.”

*Ways to Cope with Grief and Begin Healing*
Grieving people have two choices. The first choice is to try to avoid their grief and the emotions associated with their loss and continue on, hoping to forget. This is a risky choice, because when grief is ignored, it continues to cause distress.
The other choice is to acknowledge grief and seek healing and growth. Coping with and adjusting to loss is slow, hard work. As difficult as it may sound, it is healing to embrace your grief and give it the full attention and expression it demands. While a “stiff upper lip” at times of significant loss may seem admirable, it doesn’t serve the human need to express grief. It is essential to let yourself feel all the emotions that arise, as painful as they may be, and to treat yourself with patience and kindness.

*Grief Support*
Although it is common for people to want to find their own way through grief and avoid seeking help, grief support can make a remarkable difference. Experiencing the death of a loved one can overwhelm our ability to cope; some things are simply bigger than we are and require more resources than we have available.
It is a sign of strength to reach out for help and resources in times of need. Most people feel strengthened, encouraged, and supported when they learn about grief, understand how it affects them, identify coping strategies, and learn new methods to help themselves through the grief experience.

Content developed through a collaboration between AssistGuide Information Services (AGIS) and the National Hospice and Palliative Care Organization. For more information or to learn more about related issues visit AGIS’s End of Life section at: http://www.agis.com/eldercare-basics/Support-Services/End-of-Life/

I have been a patient care volunteer since 2006 and was recently present at the death of a 35-year-old mother of five who had been under our care.

When I arrived for my evening shift, I went to the patient’s room and introduced myself to everyone surrounding her bedside. I let them know that I didn’t want to disturb their privacy and would be nearby, ready to help. Sadly the patient died soon after.

There was an immediate initial emotional outpouring. Her brother was first to exit the room, crying and unable to find comfort anywhere. He sank into a nearby chair, attempting to curl into a fetal position. Others then emerged quietly crying, walking with no apparent direction or course of action in mind. Many others simply hugged in silent understanding. Most striking was the 8-year-old daughter, who ran from the room, hugging a pillow. She was sobbing uncontrollably, repositioning herself from chair to chair in a nearby room.

During all of the commotion and emotion, the young husband seemed unaffected by what had transpired and how his future had just been so dramatically altered.

It wasn’t long before the family dynamics changed to that of support roles. Small groups of family and friends began to make plans. The group also consoled — lending compassion and strength to those needing it most, especially the daughter and her father, who were in apparent shock.

As for myself, I observed all of this not wanting to intrude on their grief. I was taken back when someone approached me, taking my hand and telling me how thankful they were for the support that our organization and its volunteers had given during such a difficult time.

It’s fascinating to note that despite knowing the probable outcome, how despondent the family was when the actual death occurred. Perhaps no one can really ever be totally prepared. I am only grateful that in some small way I was able to help support someone else in their time of need.

As for the father and children left behind, I know that his family will be there for him as will Hospice of the Chesapeake.

The two married after Larry had enlisted in the Army and Glea began her teaching career. When Larry had signed to stay in the Army for three more years, the couple lived in Japan where their oldest son was born.

After returning to the U.S., Glea taught Kindergarten for two years and preschool for 18 while Larry’s career focused on economics and banking. A bank officer and director, he was also a Professor of Business Economics and Public Policy at Indiana University and served for 17 years as President and CEO of the Conference of State Bank Supervisors in Washington, D.C.

With the couple’s 65 years of marriage came three more sons, five grandchildren and now four great-grandchildren.

As a founding Board Member, Larry helped with the initial planning and marketing of Westminster at Lake Ridge, a CCRC which opened in January of 1993. Eventually, the couple, attracted to the community’s financial position and professional care, decided to move in from their home in Arlington, Va.

“We thought it was a great place to retire to,” said Glea. “We’ve met so many friends and one of the nicest things about being here is you’re never at a loss of things to do.”

Since their move, Glea has helped start the community’s drama group and participates in Capital Hospice training while playing the chimes in her free time. Larry continues to engage in the community’s financial matters. He is in his 10th year as a member of the Westminster Ingleside Investment Committee. Also serving on the Westminster Ingleside Foundation Board, Larry raises money to enable his home and two related communities to provide support for residents who need financial assistance as well as other special programs.

They enjoy their spacious cottage house and the freedom they have to continue their tradition of spending summers in Vermont without the worries of making sure their home is being taken care of.

“The staff is wonderful,” said Glea. “Every time we come back, the same people are here and that makes us feel great.”

With a helpful staff, a sense of security and numerous opportunities to stay active, the Kreiders certainly have more great memories to look forward to.

A resident of Fairhaven, a Continuing Care Retirement Community in Sykesville, Maryland, Troxell had watched her husband fight a ten-year battle with prostate cancer. “For six years he was symptom free, but his PSA [prostate specific antigen] score kept getting worse. When we lived in New York, he underwent experimental treatments at Memorial Sloan-Kettering Cancer Center, but nothing worked,” Troxell explains. “Finally, we looked at each other, and we both just knew. We had been toying with the idea of moving to Fairhaven, and we decided it was time.”

After the move, Troxell’s husband continued to undergo chemotherapy treatments at Carroll Cancer Center. “Eventually, his physician told us there was nothing more that could be done, which was very difficult for him to admit to us. Although we had access to Fairhaven’s excellent nursing facility, I preferred to keep my husband in our cottage, but I needed help. Carroll Hospice was recommended and I contacted them right away,” Troxell recalls.

Troxell and her husband relied on Carroll Hospice home care for the next six months. “They provided outstanding care to my husband, and supported me every step of the way. From mastering his medication regimen to moving him around, there was a lot for me to learn. But I knew I could call them at any time, even
10 p.m. on Saturday night, and they would help us.”

Troxell was particularly impressed with the hospice nurses and aides: “They were so gentle with my husband. They treated him with respect and even humor when appropriate. I remember the day my husband died, a nurse came to our home late on a Friday night, in a horrible rainstorm, to make a legal death pronouncement, just so I wouldn’t have to call the police to do it.”

Now, Troxell extols the benefits of hospice care””and the importance of requesting it early. “I tell people not to wait until the last minute to call hospice. It’s hard, because it means facing the fact that a loved one is dying, but it really is the best thing you can do, for yourself and your loved one. The earlier you call, the more hospice can do to help you.”

Marsha’s husband, Jere, was in the hospital undergoing treatment for a variety of respiratory problems when the doctor recommended that he be put on a respirator. At the time, the doctor indicated that he may never come off the respirator again. Jere and his family decided against going forward with the treatment, and, at the recommendation of the hospital, began looking into hospice care. “Jere wanted to come home. He wanted to be with his family,” says Marsha.

The Gaegers contacted Season’s Hospice, to get in-home, end-of-life care for Jere. “They knew what he would need to live at home comfortably and made sure that he had everything,” Marsha said. After helping Jere and his family settle into a routine, Season’s Hospice caregivers provided constant care for the next eight months. Their priority was always making sure that Jere remained comfortable.

Marsha notes that the “kindness, thoughtfulness, and caring” of the staff members was unparalleled. “I felt like there were angels at our door every time they rang the bell,” she says. She believes that the ability to live at home surrounded by family and friends allowed Jere to exceed the doctor’s prognosis by two months-giving the family more time to make memories.

One of the most poignant times was this past holiday season. Marsha remembers, “Jere read The Night Before Christmas to our grandchildren every Christmas. He would do a Santa Claus impression while he was reading. It was really sweet.” She continues, “He got to do that for the last time this year, and then he asked one of our sons to take over for him. That was really special.”

The help of experts, who knew exactly how to provide care and comfort, gave Marsha and her children much needed peace of mind during a difficult time. “The children really took to the Season’s staff. They knew that we were fine as long as they were around, and that if I needed anything, all I had to do was pick up the phone,” she says. For the Gaegers, hospice care relieved the burden of caregiving and gave them more of the most precious of gifts: time together.

In 1969, Mr. Montiel and his wife and eight children moved to the D.C. area. Several members of the large family have remained in the area, including Mr. Montiel himself, who still lives in McLean. After retiring, he remained active and independent for many years. Just a year ago, his children began noticing that their father was suffering from increasing memory loss.

One of his daughters, Maria Koropecky, recalls, “When my father developed severe memory problems, it became dangerous for him to live alone.” The family knew they needed help. They began looking for a safe environment for Mr. Montiel to live while they made important care decisions.

When Mr. Montiel’s family learned that the nearby Sunrise of McLean offered short-term, respite stays, they decided that their father would move there temporarily. Their plan changed quickly. “Initially, we intended for my father to live at the Sunrise for a few months while we made other arrangements, but it became obvious that he was getting the care he needed there,” says Maria.

One of the primary reasons for their decision was the highly-qualified staff members who worked in the Reminiscence Program, the Sunrise program dedicated entirely to the care of patients with Alzheimer’s and other memory disorders. Then-coordinator of Reminiscence Services, Kate Caldwell, was instrumental in helping Mr. Montiel settle into his new community.

When Kate made a career change and founded ElderTree, LLC, a geriatric care management firm specializing in Alzheimer’s and memory impairment, Maria knew that she wanted her to remain a part of her father’s caregiving team. ElderTree offers consultations, placement, assessments, written care plans, and long-term care management for seniors and their families. For the Montiel family, Kate’s expert advice continues to be integral to caregiving decisions.

Maria explains, “I visit my father often and I know him well, but I will never know someone with dementia as well as Kate does.” She continues, “Kate helps me put everything into perspective. She helps me see what to focus on in terms of my father’s needs.” Tapping in to her years of experience in elder care, Kate is able to offer recommendations, advice, and support to Maria and her family.

Caregiving for a relative with memory loss can be stressful, confusing, and difficult. Maria states simply, “You can’t begin to even imagine what this is like until you experience it.” However, assembling a team of qualified professionals to help can make all the difference. “Kate has been working in the eldercare field for so long, so I know she understands, and I know that I want to tap into all that expertise,” Maria concludes.

A patient and family may turn to hospice care when the goals of patient care have switched from curing to comforting. Any individual of any age with any diagnosis of a terminal disease may turn to hospice.

Receiving hospice services
Reimbursement sources, such as Medicare, Medicaid, or private insurance, generally require a prognosis of six months or less for services to be covered. In addition to traditional medical hospices, there is also a non-medical hospice program in Montgomery County that offers practical and emotional support for patients with a year’s prognosis or less who may choose to continue their curative treatments.

Hospice is unique in that care and support are provided to the entire family, not just the patient. A team of skilled professionals and volunteers work to serve the special needs of the individual patient and family. Choice is at the center of the hospice approach – a person faced with a life-limiting illness is encouraged to remain independent and in control of his or her life.

Hospice care is usually provided in the patient’s home or the home of a loved one. Many hospice patients live out their lives in the comfort of familiar daily routines, surrounded by their treasured possessions and their friends and families. However, hospice services may be provided in long-term care facilities or in-patient hospice residential settings.

Choosing a hospice provider
Once you have decided that Hospice is the right care option for you or your loved one, there are a number of issues to address before choosing a specific program or provider. The best way to find a quality hospice provider is through a recommendation from a friend, family member, or health care professional-such as a social worker or hospital discharge planner.

While deciding on the program that is right for your family, look into any accreditations, certifications, or licensures that the program has received. JCAHO (Joint Commission on Accreditation of Healthcare Organizations) is a not-for-profit organization that provides accreditation for health care organizations and programs. You can contact them at 630-792-5000 or www.jcaho.org for more information about specific programs.

Whether or not the program is Medicare certified is also important. Programs certified by Medicare have met certain minimum requirements for operation. According to Caring Connections, a consumer education program provided by the National Hospice and Palliative Care Organization (NHPCO), “More than 90% of hospices in the United States are certified by Medicare. Medicare defines a set of hospice core services, which means that hospices are required to provide these set of services to each person they serve, regardless of the person’s insurance.” If your state has licensure requirements, inquire to ensure that the provider has met all those requirements.

After establishing that an agency meets certain minimum requirements, request that they send you any brochures or written materials; specifically request information on services, costs, payment procedures, and liability insurance coverage. Ask if the provider can supply references from professionals in your community. Before arranging for services or signing a contract with any specific provider, you may want to consider the questions in the box above.

Services provided by hospices
Hospice team members focus primarily on managing the patient’s pain and symptoms. Medication, medical supplies, and equipment are all provided to make the patient more comfortable. Other services, such as speech and physical therapy, are available should they become necessary. If managing pain and symptoms in the home environment becomes impossible, hospice providers can offer short-term inpatient care.

Hospice providers also teach family members how to properly care for the patient. Additionally, information and support is available to help patients and families deal with the emotional, psychosocial, and spiritual aspects of dying. Surviving family members and friends will receive bereavement care and counseling from the hospice professionals.

Paying for hospice care
Most hospice services are fully or partially covered by Medicare, Medicaid, private insurers, or prepaid health plans. The non-medical Hospice services available in Montgomery County are offered free of charge and are delivered by a staff of trained volunteers. For traditional Hospice services, financial assistance is available for those unable to pay for care.

NHPCO notes that, “Eighty percent of people who use hospice care are over the age of 65, and are thus entitled to the services offered by the Medicare Hospice Benefit. This benefit covers virtually all aspects of hospice care with little out-of-pocket expense to the patient or family.” In order to receive the Medicare Hospice Benefit, patients must be eligible for Medicare Part A, have a terminal disease or condition with a less than six months prognosis, sign a document certifying that they are choosing hospice care instead of routine Medicare benefits for their illness. Patients may only receive covered benefits from a Medicare-approved hospice program. In addition to Medicare’s coverage, hospice services are also generally covered by Medicaid or private insurers.

For more information, see Caring Connections website at www.caringinfo.org or the American Cancer Society’s information on hospice care at www.cancer.org.

“Pain management had been a constant struggle,” said Margaret’s daughter-in-law, Robbie. So was the relatively simple act of changing the linens or any other movement that might suggest to Margaret that she was falling again. When Margaret developed pneumonia and her health declined further, her physician, Dr. Anil Patel, recommended that the family consider hospice care. They knew that hospice care was available in the home, but they were surprised to learn that home can include assisted living or long-term care facilities, or even hospitals.

Luckily, Margaret lived at one of several area facilities that participate in Capital Hospice’s Centers of Excellence, a new program designed to make hospice care more accessible in long-term care facilities.

“The American Medical Directors Association has indicated that a significant percentage of nursing home residents may be hospice eligible. Our goal is to make access to hospice expertise easy,” said J. Cameron Muir, M.D., Capital Hospice Vice President of Medical Services. Hospice experts are able to offer end-of-life care and pain management specially tailored to the patient’s needs, as well as grief support to the family and long-term care facility staff, who often become part of a resident’s extended family.

For instance, when Capital Hospice’s Georgine Tedrow, an RN with advanced training in pain and symptom management, began to work with Margaret and her family, she recommended changes to her care plan. Georgine also recommended changes in Margaret’s medication to better manage her pain. And she changed her physical therapy goals to make them more realistic. At her suggestion, a Capital Hospice chaplain came to visit Margaret to address her spiritual needs. And when Margaret became agitated by people in or near her room, Georgine told her it was okay to ask them to quiet down or leave.

Robbie found that Georgine’s expertise and self-assurance inspired confidence in her mother-in-law. When Margaret was feeling better, she began calling Georgine “the boss.” Robbie related that during the next couple of months Margaret was comfortable enough to become quite social again.

Margaret died in late December 2004, her pain under control, her family at ease with her care and by her side. Robbie says Capital Hospice left an indelible mark on her family: “It affected my mother-in-law’s overall quality of life. At one point, I’d look into her eyes and the spark seemed to be gone. Then it returned. That’s what hospice did.”

In addition to her azaleas, Mrs. Brown maintained a half-acre vegetable garden into her early 80s. When she was not outside tending her plants, she was working her magic with a needle and thread-making crewel and needlepoint pillows and clothes for her granddaughter and outfitting her doll collection.

After her husband passed away, Mrs. Brown remained independent. Sonnie explains, “My mother showed immense strength after my father passed away. She never drove, and she had never paid the bills, but she managed to live independently into her 80s.” Last year, Mrs. Brown was admitted to the hospital because of a heart condition. She was also suffering from increasing dementia.

At the doctor’s insistence, the family began to consider assisted living for Mrs. Brown. “We were hoping that she would like it and want to stay,” says Sonnie. Unfortunately, Mrs. Brown started to decline. When her doctor authorized hospice treatment, the family decided to bring Mrs. Brown back to her long-time home.

Through Family & Nursing Care, a home care agency serving Suburban Maryland and Washington, D.C., they arranged for nursing assistants to help make it possible for Mrs. Brown to remain at home. Montgomery Hospice was brought in to provide hospice services.

Sonnie recalls, “Once we found a competent set of caregivers who understood hospice and were certified, I was able to trust them implicitly.” The caregivers from Family and Nursing Care now provide daily assistance for Mrs. Brown. Finding reliable caregivers for her mother has been such a relief for Sonnie. “I know that I can trust them, which has allowed me to go back to work,” Sonnie notes. Her mother’s quality of life has improved as well. “She is now getting the medication she should have been taking for years, and she knows she is well cared for,” says Sonnie.

Montgomery Hospice and Family and Nursing Care are working together to provide comprehensive care. Caregivers from Family and Nursing Care provide daily care to Mrs. Brown, while the chaplain, social worker, and nurse from Montgomery Hospice attend to her spiritual, emotional, and medical needs. “This situation has worked out so well for my mother and my family because everyone involved realizes that it is a team effort, and we all respect and care about each other,” concludes Sonnie.

With the care and assistance that Mrs. Brown is receiving, she has been able to live comfortably in the home that she built and watch her beloved azaleas bloom.