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Grief Resource & Counseling Center

Life in Pinehurst was far from the golfing good life Elton and Jo Ellen Yates had expected when they bought the lot for their retirement home. Not after a progressive neurological disease forced Elton Yates into early retirement at age 58 and at the height of his career as a Texaco executive.

When he lost his battle with Shy-Drager Syndrome five years later, his wife lost a big part of her heart. “He was my whole life,” she says.

With her best friend gone, Jo Ellen Yates was left with the emotional and physical toll of years of caregiving—as well as the pain of her loss—and she felt very much alone. Other than the people across the street and the daughter who had relocated to help care for her father, Yates knew hardly anyone in town.

She tried a grief support group at a local church, and it helped—for a while. Then the members started drifting away. “I sort of went downhill from there,” she says.

Not long afterward, a friend invited her to a Foundation of FirstHealth “Promise of Hope” program on organ donation. As the speaker recounted the tragic loss of a young daughter and her joy at meeting the woman who had received her daughter’s heart, Yates started to cry. And couldn’t stop.

“My friend said, ‘I think you need help,’” she recalls.

The friend called Carole White, now retired from the FirstHealth Hospice Foundation, and White called Tina Markoff of FirstHealth Hospice & Palliative Care. Their meeting was the start of an emotional turn-around for Yates that continues to this day.

“One-on-one counseling is a first step,” Yates says. “It was for me.”

In addition to the clinical care for which it is widely recognized, FirstHealth Hospice has a Grief Resource & Counseling Center that provides a variety of programs for patients and families.

All of the services are free and available to anyone needing them, whether there has been Hospice involvement or not. In addition to individual or group counseling sessions, there are support groups that address the spectrum of issues relating to grief and loss, some targeting specific groups such as grieving parents or caregivers.

Yates has been through one particular support group four times and met her best friend there. They continue to participate in an ongoing group and also meet socially with several other program participants for a monthly lunch at a local restaurant.

As a member of the Hospice Foundation Board, Yates frequently finds herself called upon to talk about grief programs, adding her voice to what she defines as “ringing endorsements for Hospice.”

“I’ve been going (to Hospice programs) for seven years,” she says, “and I have never heard one less-than-perfect tribute.”

“When FirstHealth Hospice & Palliative Care promises quality care, it delivers. As the only not-for-profit hospice serving the region, our outstanding organization is known and admired for its expertise in end-of-life care. Its dedicated professionals have the highest certifications available in their fields, and its medical director and most of its nurses and nursing assistants are nationally certified in hospice and palliative care. Its unique Grief Resource & Counseling Center is dedicated to meeting the needs of the community at large as well as those of our hospice patients and families, and its grief counselors provide training on a local, regional, national and international level. Most importantly, no one who needs or wants the services of FirstHealth Hospice & Palliative Care is ever turned away. That’s our hallmark, a standard of care that is delivered professionally and, yes, even lovingly, because caring for people continues to the very end of life.”

Bob Tweed
Past Chair
FirstHealth Hospice Foundation

Children and grief

Pat Bartley recognizes that children grieve differently from adults. They experience the same physical, emotional and social symptoms of grief as adults, but they express them in different ways.

“First, their understanding of death changes as they develop and mature, so their grief may be revisited with each new developmental stage and result in new and greater understanding,” she says. “Also, children have wonderful self-regulatory mechanisms that protect them from too much at once, so they move in and out of grief rather easily. This can be difficult for grownups to understand. A child can be playful and having fun, and then move into grieving and wander back out.”

Bartley is a licensed professional counselor with FirstHealth Hospice & Palliative Care who works as a bereavement counselor for children and teens. She holds many of her counseling sessions in a playroom where the children can play or express their grief in expressive arts.

“Children seem to know how much they can take,” she says. “They work things out in their play, drama, art, etc., so it’s not all cognitive and overwhelming the way adults can process. They like honest, simple answers and really do thrive in a supportive environment.”

Hospice’s Grief Resource & Counseling Center offers a variety of programs for grieving children and teens. One recent program targeted children ages 5 to 8 and included age-appropriate art and drama activities as well as simple yoga poses and relaxation techniques. Another program offered the same kinds of activities for children ages 8 to 12, and there was also a Teens Talk support group for older children—those between the ages of 13 and 17.

Each summer, FirstHealth Hospice & Palliative Care hosts a special camp that allows children to participate in the usual fun activities of summer while sharing the experiences of loss with peers who have gone through the same thing. There are two sessions of Camp Lost & Found, one age-appropriate for teens and the other focusing on younger children.

Providing help when help is needed

Sometimes the families of FirstHealth Hospice & Palliative Care patients need a little more help than usual. This is especially likely to occur when the patient is younger, and the spouse has to work or care for children. Or in cases where money is a real issue for the family.

At these times, the needs-based Substitute Caregiver program can help.

Families determine the level of assistance they need and select a qualified caregiver. Money from the Substitute Caregivers fund—as much as $2,500 per family—can be used either to engage the services of a qualified health care worker or to supplement the assistance of available relatives or friends.

By the end of July 2008, more than $30,000 in 2008 funding had been disbursed to assist Hospice & Palliative Care families in need.

Finding support

Cyndi Miecznikowski found comfort in keeping a journal during the last days of her mother’s life, jotting down random thoughts, reminiscences and bits of conversation with both her parents. By the time of her mother’s death, she had an irreplaceable book of memories.

Now Miecznikowski, who teaches in the English Department at UNC– Pembroke, encourages others to deal with their grief by writing.

In addition to the Therapeutic Writing workshop she offers periodically to the community through the FirstHealth Grief Resource & Counseling Center, Miecznikowski works with Hospice grief counselor Keith McDaniel to offer an occasional journaling support group for people who have suffered a loss.

“It’s a unique service,” says Volunteer Coordinator Susanne Tyndall Martínez.

During the 2007 fiscal year, 435 people participated in a total of 75 Hospice support group sessions. During just the first nine months of the following year, 479 people had attended 82 sessions.

“This is quite impressive when you consider the fact that this information doesn’t include the last three months of the fiscal year,” says Tina Markoff, assistant director of Hospice Support Services.

Hospice support groups focus on a variety of subjects and target all age groups. One program focuses on the grief process and adjustment to life without the loved one while others address such issues as dreams and grief, or such practical matters as approaching holidays and anniversaries and when to clean out the loved one’s closet.

There are groups for caregivers, and some specifically target men, children and teens. Some involve reading and discussing books.

Living with Grief Teleconference

A couple of years ago, veteran journalist Cokie Roberts of ABC News and National Public Radio moderated a panel of experts who had gathered to discuss end-of-life matters.

The group’s two-and-a-half-hour give-and-take was broadcast nationally as a live teleconference, and covered issues ranging from how various health care settings and cultural differences can influence ethical decisions to ethics and law. Participants included ethicists, educators, gerontologists and hospice experts.

Presented by the Hospice Foundation of America, that “Living with Grief” teleconference was sponsored locally by FirstHealth Hospice & Palliative Care. Area health care professionals and interested members of the community were invited to participate at no charge by gathering in Moore Regional Hospital’s Monroe Auditorium.

The “Living with Grief” teleconference is an annual event, and FirstHealth Hospice & Palliative Care has participated for more than a dozen years. In addition to end-of-life matters, topics have included pain management, grief and loss, and grieving children and adolescents.

Continuing education units are available for the professionals who attend.

Hospice Lending Library

In addition to the various other services it provides, FirstHealth Hospice & Palliative Care has its own lending library.

Books, tapes, CDs and DVDs are available on a variety of topics including caregiving, grief and loss, end-of-life issues, even the afterlife. Interested individuals are invited to browse the area at their convenience and to check out the items for as long as they need them—at no charge.

The library is located in the FirstHealth Hospice & Palliative Care building on Aviemore Drive in Pinehurst.

Advance Directive

People who are specially trained are available through FirstHealth Hospice & Palliative Care to offer assistance to the public on advance directives. There is no charge for the service.

Advance directives allow individuals to make their own decisions regarding the care they would prefer to receive if they should develop a terminal illness or suffer a life-threatening injury. They include living wills, health care powers of attorney, do-not-resuscitate (DNR) orders, and the newest form, MOST (Medical Orders for Scope of Treatment).

In April 2008, in conjunction with the first-ever National Healthcare Decisions Day, FirstHealth Hospice & Palliative Care hosted an event that highlighted the importance of advance directives in health care decisions.

Held at the Moore County Senior Enrichment Center, the program was called “Your Health Care Decisions: Expressing Your Medical Wishes.” Featured speakers included a physician, two Hospice professionals and an attorney who discussed the new North Carolina Advance Directives forms.

The Unique Vigil of LightKeeper Volunteers Letters

The simplest volunteer opportunity with FirstHealth Hospice & Palliative Care may also be one of the most difficult. It’s with the LightKeeper program, which matches specially trained volunteers with patients who are actively dying—usually within the last 24 to 48 hours of life.

In the Sandhills, where so many people come to retire great distances from relatives and close friends, the goal is to ensure that no one has to die alone. Volunteers simply sit with patients, all of whom are Hospice patients. Many are spending their final days in nursing homes.

A Hospice volunteer since 1984, Madeleine Katavolas has done about a half-dozen LightKeeper vigils and now volunteers “now and again” when she is called upon. She says the program is especially comforting to families who, for whatever reason, cannot be with their loved one.

Nurses are close by, she says, but can’t be constantly with the patient. That’s the mission of the LightKeeper volunteer.

“Sometimes you can just hold a person’s hand,” Katavolas says. “Who knows? I think sometimes they are aware that you are there.”

February 1, 2008
Charlotte Patterson, Director
FirstHealth Hospice & Palliative Care
5 Aviemore Drive
Pinehurst, NC 28374

Dear Mrs. Patterson:

My husband died Jan. 29, after a long battle with COPD. When he knew that his time was near, he asked me to promise him that I would let him die at home. I was able to grant him this last wish only because of the wise and compassionate care provided by your staff.

I am writing to express my deep appreciation for the exemplary work of nurses Donna Neal, Kim Wands, Jenny Black and Shelley Stewart; social worker Joanne Hansz; and nursing aide Kathy Marks. Their empathy and creativity went beyond what was professionally required of them.

I am especially grateful to Donna Neal and Kathy Marks, who lovingly guided both my husband and me as he made the transition from life to death. And they stayed to manage everything from the initial clean-up of the bedroom to helping me cope with my exhaustion and grief.

A good death does not just happen. It is the result of a carefully choreographed dance in which the Hospice staff senses when to lead and when to follow. The three months of Hospice care have been an exemplary demonstration of that. Not that my husband’s death was easy. Those who knew him at any stage of his life knew him as someone who insisted on controlling his destiny. As death approached, his struggle and agitation certainly made his suffering worse. It was hard for him to relinquish control, even at the end.

But the Hospice staff knew when to give him space and when to intervene. They knew when to accept his refusal of meds and when to increase dosages. They recognized when I could no longer manage as his sole caregiver and arranged for competent full-time assistance within a day of the need for it. And they found a male aide, Gordon Johnson, who was physically strong enough and emotionally empathetic enough to be a comfort to both of us in his final days.

You attended one or more of the presentations given locally last fall by Dr. Ira Byock, a renowned specialist in end-of-life care. I eagerly attended his lectures, too, not guessing how soon I would be seeing what he preaches put into practice. I am copying this to Dr. Byock, because he searches world wide for examples of excellence in end-of-life care. I want him to know that no better palliative care could be found than that given in Pinehurst.

A grateful wife


Mrs. Patterson:

Thanks to everyone in your organization for helping our dad throughout his terminal illness. He was so nervous to begin Hospice care, but everyone he came in contact with made him feel comfor table and more and more confident that he’d made the right decision. During one of the last lucid conversations he had with me, he stated that he “didn’t know what in the world we would’ve done” without your care.

Alvin and Jeanne, how great you both are at introducing a patient and family to Hospice.

Sandy, thank you for your kind and gentle way, reinforcing that we could always call for your help at any time.

Tiffany, what kindness, grace and professionalism you showed when coming to the house when Dad passed. Your strength and poise in such a situation were inspiring.

Terry, Terry, Terry … the best. It’s as simple as that. No one could’ve done a better job getting through to our dad what types of changes he was facing and what types of decisions he at some point needed to rely on his children for. You had such a kind, honest and straightforward spark with him. He really appreciated everything you did for him.

To everyone else in your organization—operators, other on-call nurses, directors, etc., please know what a spectacular job your office does. We are grateful to you all.

Tracy McFadyen Omer
Labadie, Mo.