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June 1, 2018 

Rockbridge Area Hospice 
315 Myers Street 
Lexington, VA 24450
info@rahospice.org

Rockbridge Area Hospice Named a 2018 Hospice Honors Recipient

Rockbridge Area Hospice in Lexington, VA has been named a 2018 Hospice Honors recipient by HEALTHCAREfirst, the leading provider of Web-based home health and hospice software, billing and coding services, CAHPS surveys and advanced analytics. Hospice Honors is a prestigious program that recognizes hospices providing the highest level of quality as measured from the caregiver’s point of view.

“We are excited to recognize the 2018 Hospice Honors recipients for their hard work and dedication to providing exceptional care,” said J. Kevin Porter of HEALTHCAREfirst. “I congratulate Rockbridge Area Hospice on its success in achieving this highest of honors.”

Award criteria were based on Hospice CAHPS survey results for an evaluation period of October 2016 through September 2017. Award recipients were identified by evaluating performance on a set of 24 quality indicator measures. Performance scores were aggregated from all completed surveys and were compared on a question-by-question basis to a National Performance Score calculated from all partnering hospices contained in the HEALTHCAREfirst’s Hospice CAHPS database. Hospice Honors recipients include those hospices scoring above the HEALTHCAREfirst National Performance Score on 20 of the evaluated questions. HEALTHCAREfirst holds a special recognition, Hospice Honors Elite, to honor hospices scoring above the HEALTHCAREfirst National Performance Score on all 24 of the evaluated questions. Please visit HEALTHCAREfirst’s website at www.healthcarefirst.com to learn more about HEALTHCAREfirst Hospice CAHPS survey program as well as the Hospice Honors awards. 
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About Rockbridge Area Hospice
It started at a kitchen table in 1983. Four women began what is now the Rockbridge Area Hospice. From one patient, and income from bake sales, their effort has grown to support all of Rockbridge County. Our mission is that Rockbridge Area Hospice will treat, comfort, and provide supportive care for terminally ill patients and their families to enable them to live life fully. As the only local non-profit hospice, we ensure that all those in our community who need hospice care receive it. Our services are covered by Medicare, Medicaid, private health insurance and our Good Neighbor Fund. Regardless of ability to pay, if a patient qualifies for our services, we will care for them.

About HEALTHCAREfirst
HEALTHCAREfirst provides web-based technologies and services to improve business and clinical operations for over four thousand home health and hospice providers across the United States. Based in Springfield, MO and one of the fastest growing providers of its kind, the company provides agency and clinical management software, outsourced revenue cycle management services (billing, coding and OASIS Review), CAHPS surveys, and advanced analytics, in any combination. HEALTHCAREfirst’s breadth of solutions offers agencies a single source to improve patient care, create operational efficiencies, increase profitability, and simplify CMS compliance. With HEALTHCAREfirst, agencies can focus on patients instead of paperwork. For more information, please call 800.841.6095 or visit the company’s website at www.healthcarefirst.com.

​Once a month, the staff of Rockbridge Area Hospice gather with Chaplain Mark Schroeder to remember those whom we've lost under our care. Our patients become our family, they are someone's loved one, their father, mother, grandparent, sibling, neighbor or friend.

​Below you can find the moving introduction that our Chaplain delivered at our most recent bereavement ceremony:

"We meet people who are not stats, not a percentage of a population according to age, ethnicity, sexual orientation, color, political or religious persuasion. Stats do not have names.  We have never met a statistic, a stat does not cry, nor sing, nor pray nor laugh, live nor die.  The people we have met have names and as each name is unique so is each person prayed with, bathed, administered medicines, and had conversations and thankful for the administrative staff who help every step of the way.  We come as a team to each person who is coming to the end of days.  Each hospice team comes to heal and give comfort to the body, but also the heart, soul and mind of each person in our care.  This healing is quantifiable but is fully enhancing the quality of life to the end. Face time is more important than Facebook time. People we had not known allowed us into their homes, rooms and even their hearts, as their guests to serve and minister to them in their last days on earth. We also remember their final days as they served us in the stories of their lives, their families, their faith, their hopes, their joys, their sorrows, their dreams, their fears, their love."  - Mark Schroeder, Chaplain

​While these were written for children, they are just as true for adults.

1. Do not try to keep what is going on from your kids. These videos on are Snapchat and other social media. Even elementary school kids talk about shootings. Focus on how people came together and helped out to keep people safe. Your family style may be to protect the kids from this reality, but many other families are telling their kids and then all kids talk to each other in school.
2. During the unfolding of a tragic event such as Parkland School Shooting and other situations, most TV is live and you cannot anticipate what your children may see. Turn on the radio or show them pre-recorded news broadcast.
3. Talk to your kids about the event that is happening in simple language that they can understand, which is age appropriate (i.e. Some bad people shot at some people in a building etc. Some people are hurt and some have died)
4. Reassure the kids about their safety. Tell them that while this is important that most of the world is safe and that the area you live in is safe. Also, reassure them that the police, security and many other government officials are doing a lot of things to keep them safe.
5. Children need words. Tell them what you are feeling, what you think about the situation. Then, encourage them to talk about what they think. It is important to validate their feelings and clear up any misunderstanding and misinformation they have.
6. Be proactive and find ways to help. Say a prayer, light a candle, give blood, go to your place of worship, you and your kids can donate some money to an organization that is helping with the situation. Make sure some of it comes from your kids, no matter how small the amount.
7. Reassure your kids a little more, watch them a little more, do obvious gestures that show you are keeping them safe and watching over them. Remember kids may have very illogical fears.
8. Kids grieve very differently from adults. They may not talk about things for weeks or months. Be available to talk about their grief whenever it may come up.
9. Keep as many normal routines going as possible; but, allow a little more time knowing that grief is exhausting for you and your children. Routines are very important, because doing normal things in abnormal times help us to feel normal again.
10. Remember for your kids and for yourself, the concept of possible vs. probable. School shootings are possible anywhere, anytime, but they are not probable in our lives today. But are children should know what to do. While events may be tragic, try to put losses in perspective; that many things we do are risky in life, but we do them because fear does not stop death, fear stops life. Most of us will go to the movies and be very safe.

Source: 
Grief.com
David Kessler

The month of November is recognized as National Hospice and Palliative Care Month and hospices across the country are reaching out to help raise awareness about the highest quality of care for all individuals coping with a life-limiting illness. The theme this year is "It's about how you live". 

Every year, nearly 1.6 million people living with a life-limiting illness receive care from hospice and palliative care providers in this country,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.  Rockbridge Area Hospice treats over 150 individuals each year ensuring that the patients and their families find dignity, respect and love during one of life's most difficult journey's.  

Hospice is not a place. Rockbridge Area Hospice provides care to provide pain management, symptom control, psycho-social support, and spiritual care to patients and their families when a cure is not possible. This care is provided at their home, in a facility or even at the local hospital.

Throughout the month of November, Rockbridge Area Hospice will be joining other hospice and palliative care organizations across the nation in posting information on social media platforms and hosting activities that will help the local community understand how important hospice care truly can be. 

The ninth annual Classic Kenney's Cruise-In Saturday September 30th at Rockbridge County High School raised over $73,000 dollars for Rockbridge Area Hospice patients and families, a record breaking event. 

Organizers and volunteers welcomed 860 registered vehicles and are estimating that attendance was close to 10,000 spectators. "This was the most successful car show to date, a truly remarkable day for Rockbridge Area Hospice and all of the companies that provided sponsorship and prizes as well as the volunteers that worked tirelessly before during and after event, " said WD Goad of Goad's Body Shop, which presents the annual Kenney's Classic Cruise-In.  

The Results: 

Truck
1st Place Mike Pugh Forest, VA 4x4 Truck
2nd Place Richard Simmons Troutville, VA 1936 Dodge Pickup
3rd Place Russ Harlow Lexington, VA 1936 Chevy Pickup
Motorcycle
1st Place: Dale Meador Bedford, VA 1975 Harley Davidson Shovel head
2nd Place: Tom Groton Salem, VA 2005 Custom 
3rd Place: Peter Knick Lexington, VA 1939 Indian Sport Scout
50's 
1st Place: Douglas & Anna Witt Evington, VA 1938 Ford Truck 
2nd Place: Bert Brasz Lexington, VA 1931 Ford Model A pickup
3rd Place: Coffman Verona, VA 1941 Willy's
60's-70's
1st Place: Don Carter Natural Bridge, VA 1964 Buick Riviera 
2nd Place: Zach Straits Staunton, VA 1961 Ford Starliner
3rd Place: Robert Reed Lynchburg, VA 1970 Road Runner
80's
1st Place: Dave Simmons Roanoke, VA 2010 Dodge Challenger SRT8
2nd Place: Stephanie Noel Daleville, VA 2011 Pontiac Trans Am 
3rd Place: Dave & Sandy Mayberry Evington, VA 2011 Camaro Bumblebee
Best Paint
Zach Straits Staunton, VA 1961 Ford Starliner
Farthest Distance 
Bryan Shorter Panama City, Florida 1966 Chevelle SS
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To view more pictures and info from this event, be sure to visit the official page on Facebook, Classic Kenney's Cruise In. 
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How to Know if You Need Help
Sometimes it is difficult to determine whether a person needs additional help in dealing with grief issues. The following are some clues to look for in helping you to make the determination of whether you need additional help in grieving.
Postponing Grief
If you find yourself ignoring your grief thinking that it will go away, you may be having a complicated grief reaction.  Denial is normal early in grief, but long term denial is a sign that you may not be working through your grief.
Displacing Grief Emotions
Do you find yourself angry, bitter, and possibly even feeling hateful emotions?  If you are connecting these emotions to your grief that is normal, but if you are displacing these emotions on other family members or other things in your life this may be a sign that you need help in working through your grief.
Replacing Grief
Do you find yourself not wanting to leave work?  Are you drinking more?  Or are you looking to reinvest yourself in a new relationship?  You may be attempting to replace your grief, trying to displace those emotions so that you don’t have to feel them by filling them with other activities.
Feeling only physical symptoms of grief
Do you find yourself completely preoccupied by your health condition?  Do you find you have more physical ailments after the death of your loved one?  You may be trying to ignore your grief emotions and your grief is presenting itself in physical form.  You would do well to speak with a professional and begin working out your grief.
 
If you think that you or a loved one need help dealing with grief, please call or email:
Kam Flynn, MSW
Patient and Family Care Supervisor
540-463-1848
Kam.Flynn@RAHospice.org

It’s commonly known that morphine and related medications are used in palliative and hospice care and we’re often asked about their role in the dying process. Morphine and other medications in the morphine family, such as hydromorphone, codeine and fentanyl, are called opioids and may be used to control pain or shortness of breath throughout an illness or at the end of life. A patient’s doctor may prescribe morphine if the person is experiencing moderate to severe pain or shortness of breath, which helps maintain a level of comfort up to the time of death.

When a patient is receiving regular pain medication such as morphine in the final hours or days of life, there is always a “last dose”. To family at the bedside, it may seem like the drug caused or contributed to the death, especially if death occurs within a few minutes. However, this dose does not actually cause the person’s dying. It is simply the last medication given in the minutes or hours before the death naturally occurs.
We know that morphine and other opioids are not a factor in the death of a person with advanced illness. The following information explains why:

1. There is no evidence that supports the idea that opioids speed up the dying process when the patient receives the right dose. In fact, research suggests that using opioids to treat pain or shortness of breath near the end of life may actually help a person live a bit longer. Pain and shortness of breath are exhausting, and people nearing the end of life have limited strength and energy. So, it makes sense that treating these symptoms might slow down the rate of decline, if only for a few hours.

2. If a person has never received morphine, the initial doses given are low and are gradually increased to relieve the person’s level of pain or shortness of breath. After a few days of regular doses, the body will adjust and the patient becomes less likely to be affected by the side effects. It would take a much larger dose increase over a short time frame to harm someone.

3. The last dose is the same as the doses the patient has previously received and tolerated. The way the medication is given might change when someone can’t swallow any longer. If the medication needs to be given by a different route, the dose is calculated to equal the amount previously given by mouth.

4. There’s a difference between natural dying and dying from too much morphine. When someone has received too much morphine they typically can not be woken up. The person’s breathing becomes very slow and regular. Sometimes only one or two breaths are taken in a minute and they’ll appear calm and comfortable.
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Bottom line, morphine and related medications often play an important role in maintaining the person’s comfort throughout an illness and the dying process, but are never utilized as means to bring about death.

What bereaved survivors wish they'd known about the grieving process
 
Bereaved people often brace for the so-called stages of grief, only to discover their own grieving process unfolds differently. The stages of grief -- popularized from earlier theories put forth by Elisabeth Kubler-Ross in her 1969 book On Death and Dying, and later modified by others -- initially described responses to terminal illness: denial, anger, bargaining, depression, acceptance. While some find those responses relevant to coping with death, psychologists increasingly believe that the idea of "stages" oversimplifies a complex experience. And grieving survivors seem to agree.

"When we're confronted with emotional chaos, we yearn for clarity, and the Kubler-Ross stages of grief serve as a kind of road map," says Robert Neimeyer, a professor of psychology at the University of Memphis who studies grief. "But it's more accurate to think about phases of adaptation rather than stages of grief. And they overlap rather than fall in sequence."

No two people mourn the same way. The grieving process is shaped by one's relationship to the deceased and the nature of the death, Neimeyer says. For example, "non-normative losses" -- sudden or untimely deaths (accidents, homicides, deaths in youth or life's prime) -- tend to trigger more intense anger and disbelief, and longer depression.

What all survivors share: Death presents challenges, from processing the loss and coping with grief symptoms through reformulating a relationship to the late loved one -- tasks that can take months and years to work through.

Grief task #1: Acknowledging the Reality of Loss
The finality of death is always a shock, even after a known terminal illness. After helping her 62-year-old husband battle a brain tumor for four years, Maureen McFadden thought she'd girded herself for his eventual passing. "A nun warned me that for all the pain I'd already gone through, I would not be prepared for what grief is. She was right," says the Brooklyn, New York, widow. "Even though I understood the outcome when he was first diagnosed, I had no idea that I was still hoping. When someone dies, you're just not prepared for that, because humans don't know how to live without hope."
It wasn't until after the busy period of nursing, funeral planning, and the memorial services that the truth struck -- "as if I'd been shot," McFadden says. Later, one of her husband's physicians told her that people who are constantly at a dying loved one's side often have the hardest initial response. "He said they seem to hold an unarticulated belief that just by virtue of their presence and determination, they will keep the person alive," she says. "The eventual death seems like a terrible failure."
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Accepting that death is real (and not your fault) isn't the same as being OK with it. It merely means absorbing the truth of what has happened. This can be as difficult and painful as smacking through the first high breakers at the ocean's shore. For some people, acknowledgment happens quickly; others remain in disbelief for months or years (or experience disbelief in periodic bursts).

What helps:

Experiencing the rituals of death. Lise Funderberg and her sisters allowed someone else to organize a quick memorial service because "we were so out of it, floating in Jell-O." Looking back, she wishes they had done it themselves. "We didn't even put anything in the papers. I wish we had known how a ritual of closure is really important for everyone in the community of the deceased, everyone who loved him," says the author of Pig Candy: Taking My Father South, Taking My Father Home. "It's not like we would be doing another one."

Knowing there are no shortcuts through grief. "Grief can begin even before death, during caregiving. But grief doesn't end until we do," says Sherry E. Showalter, a social worker in Tarpon Springs, Florida, who's the author of Healing Heartaches: Stories of Loss and Life.

Practicing your faith traditions. Some research shows that survivors with a spiritual life tend to absorb grief more quickly, possibly because -- psychologists believe -- people who eventually find meaning in loss are generally better able to cope with it.

Grief task #2: Weathering the stress of separation
Mourning brings many physical and emotional hallmarks: crying, being unable to cry, sleeplessness, not eating, numbness, feeling forlorn, withdrawing socially, and so on. The exact mix is different for everyone.

Anger is a common response, especially to a violent or untimely death. "My anger was so primal and intense, that this good person, my dad, had to die. It was illogical. I was mad at the world. I even thought, 'Why couldn't it have been my mom?' who was already sick and not a contributing member of society," says Harriet, a San Francisco producer whose father died at 69 after a cancer diagnosis.

Intense emotions can be a way to "hang on" to the deceased person, bereavement counselors say. It's a tangible connection to the person who died. "It feels like power, like life," one widow says of her white-hot anger. Letting go of the emotion, or learning to live with it, can feel like letting go of the person who died. Naturally, there can be a built-in reluctance to do that.

Another confusing emotion: Relief. "I felt horribly guilty that I was so relieved when my mom died," says the daughter of an alcoholic. Caregivers, for example, often feel surprise (and, in turn, guilt) that they feel a lifting of a physical and/or emotional burden when caregiving ends. This is a natural response that's separate from the sadness of losing the person. It's entirely possible, and normal, to feel two such different emotions at the same time.

What helps:

Letting yourself experience turbulent emotions rather than shutting them down. "Wallowing is good," says Cherie Spino, a mom of four in Toledo, Ohio, whose mother was killed at age 69 by a drunk driver. "You have to go through it, dwell on the person and your sadness, cry."

Redirecting anger. Within a few years of her dad's death, Harriet, the producer, "used my rage to fuel my passion" for a new project about cancer.

Asking what the deceased person would suggest. Maureen McFadden, whose husband died of a brain tumor, says she partly transitioned out of anger when the thought struck her, "What would Jim want from me?"

Reading about others' experiences. Literature about grief can point out common threads. Survivors often point to Joan Didion's The Year of Magical Thinking and A Grief Observed, by C.S. Lewis.

Seeking bereavement support. Professionally led support groups or individual counseling provide skilled guidance as you navigate confusing or painful emotions. The goal isn't to make the feelings go away but to help you embrace their purpose. Some people are ready immediately for this kind of help while some come to it long after the loss, and others do fine on their own.

Grief task #3: Adjusting to Everyday Life After a Loss
After the funeral and burial, mundane life patterns such as shopping and working must eventually resume, now in altered form. "Everyday life" often leaves survivors experiencing long-term reactions on top of the more familiar emotional and physical manifestations of grief.

Most common: yearning (intense longing for the person who has died), stress, and depression. These can prevail whether the relationship was happy or turbulent.

"Whatever unresolved issues you have, they get magnified and are elusive at the same time; you feel alone in the world," says Ellie, whose parents and sister all died within five years. "I felt so isolated in my grief."

What helps:

Not rushing yourself. "Being without my parents knocked me down and kept me down for a long time; it was as if something had been severed in me," says Ellie. "Time and new experiences helped, but it was mostly a matter of putting one foot in front of the other."

Ignoring the "grief police." Don't let others rush your adjustment. Turn a deaf ear to the well-meaning comments people make that miss the mark -- including "It's time to move on."

Getting help as needed with practical tasks. Handling finances, cooking, yard work, and so on can swamp a bereaved person, especially if they're unfamiliar duties. This just adds to stress and prolongs pain.

Inching toward new ways of doing things. One woman who had a standing Saturday morning long phone call with her late mother felt bereft at that hour each week. "I switched my walking time to then and called my sister while I walked, which shook up my routine and dulled the pain."

Not expecting you can medicate the pain away. Antidepressants have a place in helping someone who has a chemical imbalance causing depression. But antidepressants can also impede the grieving process, and they can't remove the yearning that's associated with depression. The goal should be to think about the deceased with less pain, over time, and to derive a measure of comfort from such thoughts.

Grief task #4: Revising your relationship to the deceased
Your relationship to the person who died doesn't end with his or her death; it changes. "The goal of grieving is not to let go but to find a way to hold on with less pain," Neimeyer says.

Simon Ruben of Israel's University of Haifa describes the grieving process as being "two-tracked," with two processes happening simultaneously. On one track, we cope with the visible symptoms and emotions (anger, depression, sleeplessness, and so on). On the other track, less obvious but equally important, we're working to reframe our relationship to the loved one who has died.

Nobody forgets a loved one. The question is, how do we hold him or her in our memory, our rituals, and our conversation in a way that's manageable, possibly even comforting, rather than painful?

What helps:

Reminiscing aloud. "Loss is so taboo in American culture. You're supposed to have a funeral and move on," says Jennifer Amandari of Los Angeles, who lost her mother when she was 16 and then lost an infant daughter six years ago. "But not talking about the person stunts your ability to heal and work the loss into your life."

Having your grief witnessed. When psychologist Robert Neimeyer's teenage son got choked up at Thanksgiving on realizing he was seated in his late grandmother's chair, the table conversation came to a halt. Rather than rushing the awkward moment, someone shared his own memory of her. "We all began to recall 'Gloria stories,' and it was a beautiful moment that allowed us to continue a connection to her," Neimeyer says.

Reflecting on the legacy of the person who died (alone or with others). How did he or she inspire you? What was his or her life's meaning and purpose? Questions like these help shape a perspective on the seeming meaninglessness of death.

Following rituals that celebrate or honor the deceased. Victorians made an art of the rituals of remembrance, from wearing black and jewelry made from the hair of the deceased to producing funeral cards and postmortem photography. Such traditions help survivors maintain a connection and continuity. Family members join Lisa Byers of Toledo, Ohio, on an annual visit to the grave of her late husband, who died of a heart attack at age 46. Patti Anderson, who lives in Cincinnati, joins her out-of-state sisters in annual trips for their mother's birthday. They've turned it into a memorial to her, complete with a special dinner devoted to reminiscing. Another family sends balloons aloft on the anniversary of their father's death -- followed by a dinner at his favorite restaurant.

Creating a memorial. Cherie Spino and her sisters plan to make a wall hanging from scraps of their mother's clothing that they'd saved. Others have found solace in creating scrapbooks or PowerPoint presentations with old photos, symbolically lighting a Caring candle and posting a dedication, or planting a tree or garden.
 
Grief task #5: Rewriting the storyline of your life
"Grief is more than an emotion; it's a process of reconstructing a world of meaning that's been challenged by loss," psychologist Neimeyer says. When our life is closely entwined with another's, and that person dies, it's as if a main character in a book dropped out. How can future chapters be rewritten so the book makes sense?

And yet there must be a rewrite, because life is a narrative. An important part of grieving is to gain a perspective on the meaning of the loss and to reconstruct a world in which you can live effectively afterward. Who will now do the things that your loved one once did for you? Who will you confide in about your promotion or your child's first steps? Will you ever be able to walk into a hospital or nursing home again? Be able to love again? How has the meaning of your life changed?

One challenge: This involves integrating the reality of death into a cultural system that likes to pretend death doesn't exist.

What helps:

Finding compassion in the workplace, one's place of worship, and social organizations. It can be incredibly useful to reintegrating into life after a loss to have it acknowledged, rather than ignored without comment. Example: a manager stepping forward to say, "I'm sorry for your loss; let's talk about what you feel like tackling now."

Putting your life story on paper. Neimeyer has his patients write the chapter titles of their life stories. Then he asks them to reflect, in writing, on specific questions: How did you organize the flow of your self-narrative? What are the major themes that tie it together? If you were to give a title to your self-narrative, what would it be?

Recognizing that you're not the same person as before. Losing any loved one is a transformative experience. Expect and embrace change, rather than avoiding it and expecting to return to your "old self."

Expecting the intensity of your grief to vary. "Whenever I go to a funeral, I cry and cry now -- for my own loss," says one woman. Mother's Day, birthdays, and anniversaries can ignite surges of depression years later -- or there may not even be an obvious trigger.

Being open to help. It's worth noting that there may be a syndrome called complicated grief, in which grief reaches a point where therapy can be useful. Is prolonged grief a new psychological disorder? Many psychologists now think so and want to see it become a recognized disorder. But more relevant than labels is being open to help if you feel stuck.

A "Happy" Ending?
Important point: Completing these five tasks doesn't "end" the grieving process. They may never be fully completed. Grief isn't a disease, after all; it's a transition.
"Grief is like a room we may enter or leave again and again, for years," psychologist Robert Neimeyer says. "The character and quality of grief may change across time, but it remains available to us as a resource that we can revisit."

That positive word, resource, is a deliberate choice: "Being able to revisit earlier losses and their implications for us can enrich our lives and make our narrative more coherent about who we are and how we got to be who we are," Neimeyer adds.

"I still feel such a sense of loss," says writer Lise Funderberg of her father's death in 2006. "But qualities of that experience were incredibly moving -- the compassion and charity shown to me and witnessed by me. It's strange to hold two opposing ideas in your head: that an experience can be horrible and yet have good effects. Things were stirred up by my dad's dying that are pretty incredible and life-affirming. I now know that if you've loved a person, you will always grieve them. It just changes over time."

By Paula Spencer Scott, Caring.com Author
https://www.caring.com/articles/five-stages-of-grief