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Hospice of San Joaquin has been serving the San Joaquin County and surrounding areas for 44 years Up until a few years ago, when someone said they had hospice care, it was almost guaranteed that it was with Hospice of San Joaquin� However, that is not the case today�
One of the most disheartening things that we are experiencing here at Hospice of San Joaquin is the opposite of years past� At least once or twice a week, we will have an interaction with a caregiver or patient where someone calls Hospice of San Joaquin to complain that they have not seen a nurse in over a week, or that their loved one is in pain, but they do not have any pain medication We of course immediately respond by asking their name so we can locate them in our system, although, at this point, we already have a suspicion that they are not receiving care from Hospice of San Joaquin, because this would not happen here We then confirm with them that they do not receive care from Hospice of San Joaquin and then we work to get them transferred to our services so that we can immediately get the patient seen and symptoms controlled
Why is this happening? It is happening because individuals have discovered that if you provide the absolute minimum care to patients, you can make money owning a hospice� San Joaquin County had about six hospice agencies in 2014; today, there are over 30 hospice agencies The antics they use to get patients are crafty� One of our employees had a family member admitted to the wrong hospice because the hospice agency said “yes, we are hospice in San Joaquin” – a simple play on words and you end up with the wrong hospice agency Why do they do this? Because they want to be Hospice of San Joaquin, but they are not So, protect your families and friends by making sure you get care from Hospice of San Joaquin – the one with the butterfly logo�
In 1980, community volunteers came together to explore starting a hospice program in San Joaquin County Recognizing the need for support for terminally ill patients who had exhausted curative treatment, they founded Hospice of San Joaquin as a non-profit organization In 1989, after nine years of being a volunteer organization, Hospice of San Joaquin became Medicare and Medi-Cal certified�
In 1990, Hospice of San Joaquin was honored as a Daily Point of Light recipient by the President’s Thousand Points of Light National Campaign for its volunteer services At the same time, bereavement services were expanded to include programs for adults and children, school-based programs, grief and loss training sessions, individual counseling, support groups, and the annual memorial service, which included a butterfly release The first children’s bereavement camp in San Joaquin County, Camp Caterpillar, was initiated in 2004 to support children who have experienced loss� We currently have a Camp Caterpillar in Stockton and Lodi We are hoping to start serving the city of Tracy next year
The Tree of Lights campaign, a holiday memorial program, was launched with the support of PG&E and Delta Community College� This initiative has grown to include Tree of Lights events in every city in the county, fostering a sense of community and shared remembrance� It has become the most successful tree lighting event among hospices in California – a testament to the collective spirit of our community
In 2004, the Hospice House was licensed by the Department of Health Care Services, offering an additional dimension of care for terminally ill patients� The Hospice House provides a higher level of care than can be provided in the home The Butterfly Auxiliary members dedicate their efforts to fundraising to create long-term financial support for the Hospice House
In 2017, Hospice of San Joaquin, seeing a need in the community for care before coming on hospice service, started the Pacific Palliative Care program This program manages symptoms for patients who are not terminally ill but need the expertise in symptom management that Hospice of San Joaquin staff has
The success of Hospice of San Joaquin is attributed to the dedication and vision of its founders, staff, volunteers, board members, and community supporters, who have made a significant impact in providing compassionate end-of-life care in the region
Hospice is not a place but a special kind of care that focuses on the quality of life for people and their caregivers who are experiencing an advanced, life-limiting illness Hospice care provides compassionate care for people in the last phases of incurable disease so that they may live as fully and comfortably as possible� This care is usually provided to patients in their homes, whether a residence, assisted living facility or skilled nursing facility
A nurse, social worker, spiritual care provider, home health aide and other patient care team members, in conjunction with the family and personal physician, contribute to a patient and family-centered plan of care The intent of the plan of care is to honor the patient’s wishes and to provide the patient with the highest quality of life possible – comfort being the priority�
Hospice serves patients with any life-limiting illness These include, but are not limited to, cancer, endstage dementia/Alzheimer’s, heart, lung and kidney diseases, and Parkinson’s disease
Our compassionate, professional care promotes comfort, dignity, and self-determination for the patient at the end of life Hospice of San Joaquin staff feel honored to share this special time with patients and families�
For people with life-limiting illnesses, a cure isn’t an option� Hospice can provide compassionate care and symptom management for those with a diagnosis of six months or less to live
Though every person is unique, there are some common indications that it might be time to begin hospice care� If you have noticed any of these conditions, hospice may be appropriate:
1 Frequent hospitalizations or emergency room visits
2 Falls with increasing frequency
3� Increased assistance needed for ADLs (activities of daily living, like using the toilet and eating)
4 Unexplained weight loss (more than 10% of body weight in the past six months)
5� Ineffective pain and symptom control requiring numerous medication changes
6� Continued decline despite ongoing treatment
7 Severe weakness and lethargy (spending most of the time in a chair or bed)
8� Shortness of breath while sitting, lying down, or following minimum exertion
9 Recurrent infections, such as pneumonia or urinary tract infection
Patients with serious illnesses like these may also be right for hospice care:
ALS
Cancer
Cardiac disease
Stroke
Dementia
Liver disease
Pulmonary disease
Renal disease
There are several guidelines to be eligible for hospice care:
Emphasis of treatment is on symptom control and comfort care rather than curative therapy�
The patient has a life-limiting illness for which a cure is no longer probable�
The patient likely has a life expectancy of six months or less, if the disease or illness runs its normal course Patients may continue to qualify for hospice even after six months of service as long as physical decline is still evident
The benefits of hospice care
Compassionate care for your body, mind, and spirit
A team of specialists accessible 24 hours a day, seven days a week
Dignified care where you live
Support and education for you, your family, and your caregivers
A comprehensive plan of care designed with you in mind
Respect for your physical, emotional, financial, and spiritual preferences, goals, and wishes
Medicare, Medi-Cal, and/or private insurance (which a patient might have from their employer) can all help, but Hospice of San Joaquin helps everyone, regardless of their ability to pay� Ask a professional, like the ones here at Hospice of San Joaquin, and/or learn more about how costs are covered
Medicare
Original Medicare coverage for hospice has been part of Medicare Part A for decades With that benefit, the costs of care are covered, as long as the patient qualifies for hospice That’s true with a Medicare Advantage Plan or other Medicare health plan�
Note that Medicare coverage does not include room and board at our Hospice House�
Choosing hospice care means the patient isn’t seeking other kinds of care for a terminal illness� However, the patients can change their minds afterward with no penalty
Hospice care under the Medicare hospice benefit covers but isn’t limited to:
The medicine, supplies, and services needed for pain relief and symptom management
Social and emotional support in the form of social workers, hospice aides, chaplains, and others who work closely with the patient to achieve their goals
Grief counseling for the patient, family members, and other caregivers
Medi-Cal
Similar to Medicare, active Medi-Cal covers all hospice services
If a patient has health insurance through an employer, they are typically covered for hospice services All plans are different but most times, they will be responsible for cost-sharing applied by insurance for things like deductibles, copays, and coinsurance�
Our mission is to provide services to all terminally ill patients, regardless of ability to pay If the patient and their family do not have their own insurance and cannot otherwise afford the service, we’re still here to help Our Charity Care is available for all without coverage Hospice services are never billed to the patient or family, regardless of their insurance status
Palliative care is a home-based, outreach, consultant support service for the discomfort, symptoms, and stress of serious illness It does not replace your primary treatment; palliative care works together with the primary treatment you’re receiving� Patients do not need to be terminally ill; in fact, many will not be terminal for many years to come The goal is to prevent and ease suffering and improve quality of life for you and your family
When can I or my loved one receive services?
When you or your loved one qualify for hospice services but are not choosing a comfort-only care plan
When you are struggling to manage pain or other symptoms of an advanced serious illness
When you want to prevent frequent visits to the emergency room or hospital
When you need education on how to manage the disease
When you can use help with clarifying goals or need connections to community resources
When the hospice physician certifies that you or your loved one have six months or less to live if the disease runs its expected course
When you choose to focus on comfort care and quality of life instead of a cure during those final months
Can I still be trying to cure my disease?
Yes Pacific Palliative Care focuses on managing symptoms even if you’re still pursuing curative treatments, such as a clinical trial
Palliative care can be very effective in managing side effects of curative treatments
No Hospice of San Joaquin is for when you choose to focus on comfort care and quality of life instead of a cure during life’s final months
Who will provide my care?
Pacific Palliative Care is led by our physician in partnership with your physician and driven by our skilled nurse practitioners and registered nurses
How often can I expect to receive services?
Where can I receive services? Guidelines
Palliative care home visits will typically be monthly or every other month and phone support is available 24/7 for urgent needs and any questions
A holistic team made up of doctors, nurse practitioners, nurses, personal care aides, social workers, chaplains, and trained volunteers
Hospice patients typically receive home visits based on individual needs and nursing visits are available 24/7 for urgent needs and any questions
Pacific Palliative Care is currently provided wherever you call home in San Joaquin and Stanislaus counties
Hospice care is provided wherever you call home or at our Hospice House
Myth #1:
Hospice is a place.
Hospice is not a place, but a program of services that cares for individuals with a life-limiting illness� Most hospice patients live in their own homes or the homes of a loved one We also care for patients in nursing homes, assisted living facilities, adult foster care, and hospitals
Myth #2:
Hospice is only for elderly people.
Hospice services are available to individuals of any age with a life-limiting illness�
Myth #3:
Hospice can only help when family members are available to provide care.
Hospice can help coordinate community resources to make home care possible for patients who live alone or do not have someone to provide care We also help individuals find alternative locations where they can safely receive care� This may include adult foster care, nursing facilities, or our hospice site�
Myth #4:
Hospice is for people who have no hope.
Hospice is about a different kind of hope: hope that time with family and friends will be as comfortable and meaningful as possible� Our specialized team ensures that patients will be cared for physically, emotionally, and spiritually and that their families will receive the care and support they need�
Myth #5:
Hospice is only for cancer patients.
Hospice of San Joaquin serves individuals with terminal illnesses, which can include a variety of diagnoses, including end-stage heart disease, kidney disease, lung disease, and memory loss�
Myth #6:
Hospice care is only appropriate in the last few days of life.
Hospice care is for anyone in the advanced stages of illness, when life expectancy is six months or less The hospice team can do much more to help maintain the best quality of life for our patients and families when hospice services begin sooner rather than later�
Myth #7:
If a patient lives longer than six months, hospice cannot continue to care for them.
The patient’s own physician and our hospice medical director periodically review the patient’s medical condition If the illness is following its normal course, then hospice care continues to be appropriate Patients can receive hospice care well beyond six months
Myth #8:
Hospice is expensive.
We accept patients based on their need for care, not their ability to pay� Medicare and Medi-Cal both have a comprehensive hospice benefit Most private insurance also pays for hospice services As a community-based nonprofit hospice, we provide services to all terminally ill patients, regardless of their ability to pay�
Myth #9:
The hospice team disappears after the patient dies.
We offer support to families for a minimum of one year after their loved one dies Grief support counselors, support groups, and self-guided communications are all available to help with the grieving process� We also have a special program for children, teens, and parents�
Myth #10:
Choosing hospice means giving up all medical treatment.
Hospice places the patient and family at the center of the care planning process and provides high-quality pain management and symptom control Medical procedures that focus on comfort care rather than a cure are covered by hospice�
My physician suggested hospice. What now?
We will meet with you and your family at a suitable location to explain the benefits, answer questions, and sign a set of consent forms, which are a Medicare and/or insurance company requirement This will allow us to obtain medical records for the nursing staff� If hospice care is appropriate for you, you’ll begin the admissions process Our team will assess your needs and your family’s needs, and hospice care staff will work with your personal physician to develop a plan of care especially for your situation
Over the first few days under hospice care, our interdisciplinary group (IDG) will contact you and your family to coordinate a schedule for regular nursing visits, personal care, emotional support, and spiritual assistance as agreed within the plan of care
Who will provide the care?
Our IDG, made up of nurses, hospice aides, social workers, chaplains, and volunteers, will review the plan of care with the patient and family regularly to make sure the care needs are kept up to date and are always being met�
The number of visits a patient can expect may be adjusted during the course of the illness as the patient’s condition and goals of care change
Is hospice available after hours?
Yes Hospice care is available seven days a week, 24 hours a day Our nurses are available to respond at any time if aid is required
Can I be cared for if I live in a nursing facility or long-term care facility?
Yes Hospice services are provided to the terminally ill, wherever you may live You may receive visits from IDG staff, along with other services provided by the facility itself The hospice and the facility will coordinate the plan of care in accordance with your needs and wishes�
What happens if I cannot stay at home due to my increasing care needs?
Although Medicare considers this type of care to be custodial care and it is therefore not included under the Medicare hospice benefit, nor under most private insurance, we can assist in making arrangements with inpatient residential centers/skilled nursing facilities so that care can continue at a higher level� If custodial care is not covered by insurance, typically, the patient is responsible for payment
Are hospices inspected and evaluated by state and federal reviewers?
Yes Hospices periodically undergo inspection to ensure federal and state regulatory standards are met These inspections are required in order to be approved for reimbursement by Medicare
What happens after my loved one dies?
If a team member is not present at the time of death, one will arrive soon after being notified At this point, a hospice nurse will make a visit and pronounce the patient, make necessary phone calls to the pre-selected funeral home, prepare the body for pickup, and support the family as needed
When a cure is no longer an option, Hospice of San Joaquin is there with quality hospice care We provide compassionate medical care, counseling, and support, along with state-of-the-art pain control and symptom management� Our professional staff will help you regain your sense of control, while supporting your family, significant other, and caregivers�
Hospice care provides high-quality and compassionate support for individuals dealing with life-limiting illnesses or injuries It employs an interdisciplinary team (IDT) approach to address the various physical, psychological, social, and spiritual needs of patients and their families, with the primary goal of ensuring that patients can live pain-free until the end of their lives, while also offering necessary support to their families
Our “team” consists of the patient’s primary care physician, the hospice medical director, RN case managers, licensed vocational nurses, hospice home health aides, social workers, chaplains, and trained volunteers� Through this interdisciplinary approach, we will:
• Provide an informational visit with a nurse prior to admission
• Manage the patient’s pain and symptoms
• Provide necessary comfort medications, medical supplies, and equipment
• Assist the patient and family with the emotional, psychosocial and spiritual aspects of dying
• Provide education for family and significant others on how to provide care for the patient
• Provide bereavement care and counseling to surviving family and friends
We provide:
• Hospice nurses, social workers, chaplains, home health aides and volunteer visits to the patient at their residence
• An on-call hospice nurse, 24 hours a day
• Medications for pain and symptom management related to the terminal illness
• Durable medical equipment and supplies
• Counseling and spiritual support for the patient and family
• Respite care for the caregiver
• Anticipatory grief support for all family, friends and loved ones
Our Hospice House provides general in-patient care by specially trained professionals Hospice of San Joaquin is the only agency with a Hospice House in San Joaquin County�
Hospice of San Joaquin’s Hospice House is a general in-patient care facility for patients looking to relieve pain and manage symptoms� Our Hospice House is staffed by specially trained professionals, including physicians, registered nurses, certified nursing assistants, social workers, spiritual care counselors, bereavement counselors, and volunteers Our goal is to:
• Relieve pain and manage symptoms
• Comfort and care for each patient according to his or her wishes
• Educate and train caregivers and family about hospice care
• Support all patients and family members who are dealing with emotional, spiritual, and practical concerns during the final weeks of life
The Hospice House offers 24-hour nursing care, meals, laundry, activities, and all the amenities of a cozy home� Features include:
• Six private patient suites, each with an additional bed to accommodate visitors and family members
• Individual bathrooms with caregiver accessibility
• Reading and private conversation areas
• Relaxing garden and grounds with sitting areas and a meditative labyrinth
• Family dining room
• Individual patios accessible from patient suites
• On-site parking
No family can ever prepare for a child’s terminal illness� If your child has an advanced or chronic terminal illness, our services can help ease your child’s discomfort and provide the emotional support you need as a caregiver and parent/guardian
Our team will work with your child’s current health care team and physician� Maintaining these established relationships is key to providing the best possible pediatric hospice care Hospice of San Joaquin works as an extension of your health care team as experts in the field of patient comfort and family support Working together, your child will be comfortably surrounded with supportive and compassionate care�
Your child’s care team will consist of their current health care team and physician, our hospice medical director, registered nurse case managers, licensed vocational nurses, hospice home health aides, social workers, chaplains, and trained volunteers� Our team will:
• Provide an informational visit with a pediatric nurse prior to admission
• Customize a plan of care based on your child and family’s needs
• Manage your child’s pain and symptoms
• Provide necessary comfort medications, medical supplies, and equipment
• Assist your child and family with the emotional, psychosocial and spiritual aspects of the current situation
• Provide education for your family and support team on how to provide care for your child
• Support you through upcoming challenges
• Provide grief counseling, in home support and sibling care
Your team is available 24 hours a day, seven days a week
Pacific Palliative Care is a home-based, outreach, consultant support service for the discomfort, symptoms, and stress of serious illness It does not replace your primary treatment; palliative care works together with the primary treatment you’re receiving The goal is to prevent and ease suffering and improve your quality of life�
Pacific Palliative Care strives to provide you with:
• Assistance and guidance to improve quality of life
• Open discussion about treatment choices, including treatment for your disease and management of your symptoms
• Coordination of your care with all of your health care providers
• Emotional, physical, psychological and spiritual support for you and your family
Pacific Palliative Care is a team approach to patient-centered care.
Transitioning into the role of caregiver can impact your life more than expected� We are here to support you through every step in the process, providing you with:
• Answers about what to expect as your loved one’s illness progresses
• Education on how to properly care for your loved one
• Referrals to professional caregiving agencies if needed
Hospice of San Joaquin offers grief support to anyone who has experienced the loss of a family member or friend� Grief support programs are available to the wider San Joaquin community as well as our hospice families� Grief support groups and programs are designed to help participants understand the experience of grief, develop healthy coping skills, and have opportunities to share feelings with others who have also experienced a loss They include one-on-one sessions, grief support groups, grief workshops and community events� Grief support groups and programs are free for all to use; donations are accepted and go toward continuing our support programs
Most grief support options are hybrid – taking place both virtually over Zoom or at our Stockton office Some options are available in Lodi� Children’s grief support options are also available�
Our spiritual caregivers offer emotional, spiritual, or religious support to our patients and community
Spiritual caregivers do not impose a certain religious belief; instead, they provide a caring presence and a listening ear� They can help you and your family cope with difficult questions or other issues surrounding terminal illness If you are affiliated with a particular religious organization or place of worship, the spiritual caregiver can help communicate your spiritual needs to your personal clergy
Hospice of San Joaquin now provides Full-Circle Aftercare, a concierge service that personally walks the family through each step of closing the personal affairs of a deceased loved one During this difficult time, they will make the calls, close the accounts and set up appointments on your behalf� What takes most families 18 to 24 months to complete, Full-Circle Aftercare can complete, on average, within one to two days
Full-Circle Aftercare is available to our patient families at no additional cost to you We encourage all our families to take advantage of this program� Let Full-Circle Aftercare take care of the paperwork, so you can focus on what matters
Government
• Social Security
• Veterans Administration
• OPM Estate Education
• Wills/Trusts/Probate
• Real Estate Title
• Vehicle Title Finances
• Pension Plans
• 401K/IRA/Annuities
• Credit Cards
• Bank Accounts Protection
• Credit Bureaus/Fraud Alert
• Stop Junk Mail/Solicitor Phone Calls
• Deceased Registry
• Cancel Subscriptions/ Membership Insurance
• Life Insurance
• Medicare/Health Insurance
• Change Beneficiaries
Schedule Your Service
• Call Full-Circle Aftercare at (209) 813-8170
Hospice of San Joaquin offers rewarding experiences for individuals seeking ways to give of themselves and reach out to the community Volunteers are an integral part of our hospice team At Hospice of San Joaquin, you have the chance to find your perfect fit with a variety of opportunities�
Volunteer training classes are offered at least twice a year, depending on demand� We encourage volunteers to attend the upcoming training so they may begin once we receive all required documents Our training program teaches our volunteers how to work with terminally ill patients, provide support to the patient’s family and to be familiar with the signs of oncoming illness or death�
Topics covered include, but are not limited to, History & Philosophy of Hospice, History of Hospice of San Joaquin, Understanding Terminal Illness, Death & Dying Issues, Grief & Loss, Communication & Listening Skills, Pain Management and Family Dynamics�
Additionally, we provide monthly education meetings for our volunteers These meetings are designed as a forum to share experiences and foster personal growth
Volunteers must be at least 18 years of age�
Event volunteers: Orientation is not required for event volunteers If you are interested, please contact Georgie Nguyen at (209) 957-3888 or gnguyen@hospicesj org
Scan the code below or call (209) 957-3888 to get involved
Veterans have served our country proudly in times of war and peace, at home and abroad These men and women often carry experiences from their military service that present unique challenges at the end of life� Across America, hospice professionals are stepping up to build their skills and accept the mission to serve our nation’s veterans
We Honor Veterans is a comprehensive program focused on respectfully celebrating veterans and providing care that recognizes the experiences unique to military families This is a program of the National Hospice and Palliative Care Organization, in collaboration with the Department of Veterans Affairs� We want to recognize all our military patients by saying thank you and welcome home�
As a veteran, your patient care team will discuss with you Hospice of San Joaquin’s veteran pinning ceremony This event can be large or small, formal or informal, based on your preferences You will be provided a special certificate of appreciation and a unique pin that are presented by a current or former serviceman or woman�
A caring friend and Hospice of San Joaquin provide care to a dying man who couldn’t pay for it.
For decades, Enrique Diaz toiled under the California sun, doing farm labor An undocumented immigrant for 50 years, when he wasn’t at work, he lived in the shadows� When Diaz retired in 2010, he had no Social Security benefits, no work pension, no medical insurance, no bank savings, no known family to care for him
And yet, despite being destitute, Diaz died with dignity in a Stockton nursing home on Nov� 13, 2017� He was 82� His friend Rosendo Ortiz and social worker Josie Minor saw to it that Diaz received hospice care – in his Stockton home and elsewhere – as he battled leukemia, a respiratory ailment and other afflictions
“Enrique was content with his simple life He had a peaceful ending,” Minor, of Hospice of San Joaquin, said recently� According to Ortiz, his friend never sought “a death with luxuries ” “But Enrique didn’t want to die on the streets or under a bridge,” said Ortiz
Minor said Diaz was aided by “angels,” starting with Ortiz, who cared for the sickly man for months, without compensation� The other angels: good Samaritans who allow nonprofit hospices like Hospice of San Joaquin to serve the poor “I’m very proud that my agency, a nonprofit, is able to provide services to everyone, including the uninsured,” Minor said “Families who receive hospice are very appreciative So they make contributions for indigent cases�”
Diaz and Ortiz – both Mexico-born – first met in 2000� At the time, Diaz lived in a rundown home, sharing expenses with co-tenants
When Ortiz moved into that home in March 2016, Diaz was no longer working and could not contribute to the rent Ortiz and another housemate split the monthly $400 rent and shared their meals with Diaz Other friends would visit, handing Diaz a few dollars each time� By mid-2016, Diaz’s health was so poor, Ortiz became his full-time caregiver He cooked for him, bathed him, and performed other tasks, even though he also worked a full-time job
In October 2016, Diaz’s condition worsened and he was hospitalized He was then transferred to San Joaquin’s Hospice House� That day, Minor became Diaz’s social worker�
Two months later, Diaz returned to his residence with new accommodations For the first time, he had access to an in-home oxygen tank and comfort medications thanks to a treatment plan established by his hospice team who visited him frequently
Diaz enjoyed living at home for several months before moving to a nursing home with hospice services, which is where he died He is fondly remembered by those who knew him, who are grateful that he had comfort at the end of his life� “He died happy,” Ortiz said�
Hospice of San Joaquin’s mission is to provide services to anyone who is medically eligible regardless of ability to pay Our Charity Care makes that possible Please help us achieve our mission by directly supporting our events today� For more information about ways to donate, visit www�hospicesj�org
March & September Camp Caterpillar
A child grief day camp experience for children who have had a loved one die within the last two years The camp’s name reminds us that nourishment and hard work on grief can bring a new life, like a caterpillar’s journey to becoming a butterfly
May Kentucky Derby West
Watch the Kentucky Derby in real time on a jumbotron while enjoying southern hospitality as you delight in small bites and all the thrills the track has to offer� (Over 21s only)�
June
Annual Memorial Service & Butterfly
Our Memorial Service gives those who have lost a loved one a chance to reflect on life and death� We end with a butterfly release where participants are encouraged to let their memories and love soar on the wings of beautiful butterflies
June
Get active in the community and support Hospice of San Joaquin Every dollar raised through the Butterfly Walk allows Hospice of San Joaquin patients to live life to the fullest through high-level hospice�
August Sip
Calling all wine and food lovers! Come to enjoy premier drinks from over 35 wineries and distilleries together with specialty food tastings from 50 local restaurants (Over 21s only)�
December Tree of Lights
Tree of Lights offers a chance for anyone in the community to recognize the people who have impacted their lives, through a memorial or honorary light dedication�
• Study after study has shown that nonprofit hospices provide better quality care� A 2015 Yale University study found that for-profit hospices fall short in quality, depth of support and how much they spend on nursing per patient
• For-profit hospices are driven by a desire to make money – the more, the better Nonprofit hospices are driven by their mission – to provide compassionate end-of-life care�
• For-profit hospices can cherry-pick their patients� The nonprofits will take homeless patients or those who would be deemed high-cost, complicated patients
• In for-profits, it’s typical for nurses to carry case loads of 20 to 24 patients each Nurses in nonprofits tend to carry case loads of 10 to 14 patients each, so they’re able to spend more time with patients and address patient needs�
• Patients must be educated consumers when choosing a hospice�
Each true statement is worth one point
You or your loved one have metastatic cancer
(cancer that has spread)
You or your loved one are receiving treatments that no longer
work or are becoming more a hindrance than a help
You or your loved one hear the words “end stage” regarding
COPD, CHF or dementia
You or your loved one have been in the hospital for the
same symptoms, 3+ times in the past year�
You or your loved one frequently visit the hospital
just for IV fluids, every few months
You or your loved one are oxygen dependent�
You or your loved one need help with toileting or bathing
You or your loved one are too weak for surgery�
You or your loved one have experienced noticeable changes
in lifestyle or quality of life
You or your loved one have experienced a loss of appetite
or noticeable weight loss
You or your loved one continue to feel lethargic, have loss
of energy, and/or are sleeping more than usual�
You or your loved one have noticeable depression, and/or
a lack of interest in things that used to bring joy�
You or your loved one’s calendar is getting filled with
doctor appointments
You or your loved one’s mobility has become an issue and
there is a need for an EZ Lift Chair, hospital bed, commode or shower chair
You or your loved one have heard talk of a ventilator,
respirator or feeding tube
You or your loved one have a need for in-home caregivers
or aides to assist with daily living activities�
You or your loved one need help with managing medications
You or your loved one have fallen down in recent months,
with or without injury�
If your final score is between 5-10 points, you may qualify for palliative care or hospice With 10 points or higher, hospice is more likely an appropriate choice
This assessment is a general guideline to determine hospice and/or palliative care readiness; a full review of an individual’s recent medical history and consent from the primary physician are needed prior to enrollment�
Remember: anyone can make a referral to Hospice of San Joaquin. Information visits help make difficult conversations possible!
After a family member, caregiver, or friend has called us, we will let you know that you are not alone anymore through this journey Hospice of San Joaquin is now holding your hand and supporting you with an interdisciplinary team (ITD) comprising a social worker, case manager, registered nurse, home health aide, chaplain, and more
Your team will guide you step by step and is available 24/7
Our team is here to assist you in obtaining the patient’s medical records and referrals, ensuring you have the necessary information and support, and, above all, the time to share it with your loved one
Other tasks we will take care of are ordering any DME (Durable Medical Equipment) such as hospital beds, over-table beds, oxygen, and things of that nature
Be confident that Hospice of San Joaquin is the best choice for your loved one We are the ones with the butterfly
Call us now at (209) 957-3888.
When speaking with your doctor or discharge planner, make sure to ask for Hospice of San Joaquin by name.
Hospice of San Joaquin
Hospice of San Joaquin,
I wish I could put into words how much you helped and supported me and my family. I don’t live in Stockton and do not have siblings, so to have your input, advice and care meant the world to me!
I truly don’t know what I would have done without Josh and Maryanne supporting and helping me. Their support and the care and concern they showed for my mom truly gave me peace of mind. I cannot thank you all enough!
Mardi
Dear Hospice Staff,
The team from San Joaquin Hospice led by nurse Joanne did a great job in a tough situation. They were able to obtain a sick bed we used downstairs and that made it better for my Debbie. Being here at home was more comfort for her. This kept us closer when closeness matters the most.
Thank you so much!
Michael
The hospice care mom received was the best. The hospice team treated her like she was their mom. We will be forever grateful that we were called to come to mom’s side. We were with mom when she passed which was so special. We were able to say goodbye. It really helped in our grieving process to have been with her. HSJ treats the patient and the family. Fabulous organization!
Dear Hospice,
Thank you for your kindness and sympathy during this difficult time. Thank you so much for “ALL” of your knowledge and support. A special Thank You to all of the Nurses.
It was so comforting to be able to call them anytime of the day or night. Nurse Nichols in particular, he was so compassionate and understanding.
Sincerely,
Martha
Hospice of San Joaquin,
I’d like to thank you all for the wonderful care my mother received from you. The care and attention given to my mama made her passing peaceful. Special thanks to Kim for being caring and including my mama in her plan of care. Also, to Josh for being so kind, caring and helpful. Your genuine empathy and compassion were beyond compare.
I am thankful for all of you for going the extra mile to care for the patients.
Thank you again!
Faye
Our family can’t say enough good things about Hospice of San Joaquin. You always think of this service as end of life, yet there are so many families out there that need this service and have no idea they may qualify for it for short/ long-term care. Nichols and Lenore took the best care of my mom along with my dad. When the time came for my mother’s end-of-life care, hospice was right here with us. Every step of the way, Nichols was my angel. The night my mom passed I was relieved to see him at our door. Such a kind, soft-spoken man. I honestly can’t thank him enough. Lenore was beyond comforting, always treating my mom like she was right there - that woman is so special to my dad and myself. So kind, always and until the end. 10 out of 10.
The nurse from hospice came on a Saturday. They were very nice about getting a hospital bed and other needed equipment that day. During the ten days she was on hospice, we had a case manager nurse named Joni who came every day during the week. I could not have requested a better caregiver. Nurse Joni was professional, compassionate, kind, and caring. She listened to both my friend and me which speaks highly of her because listening has become a lost art. Beyond that, she respected decisions, she suggested alternatives to what we were doing, and explained things. For me, all that hospice offered to my friend and me was made all the more wonderful by Nurse Joni. When an organization has people who care and who show it, it makes the organization shine. Hospice has been absolutely wonderful for the care it gave my friend, but for the support it has offered me after her loss. Mentioning Carol, the aftercare estate specialist, is significantly important as well. She carefully outlined the things that needed to be taken care of and listened to me when I asked questions or told her what I had done. Having people like that after a loss of someone dear to you is such a blessing. Hearing the care and interest in the voices of people is such a help toward healing.
As a family, we cannot say enough about the care that was provided for our beloved father, father-inlaw and grandpa. We were able to stay with him around the clock so he was never alone and the environment was peaceful and serene and the care was exemplary. Our family considers Hospice House of San Joaquin such a gift to us and most importantly our father, who was able to pass with love and dignity.
My mother was suffering at the hospital at the end of her life. Once we decided to bring her home, the hospice team held our hands in caring for her and made sure she was comfortable at home. They were available any time of day and night. Our nurse who visited everyday was very kind and pleasant. I don’t know how we would’ve been able to manage without them.
I never knew anything about hospice until the care home told me they would be contacting me when I brought Gary home. I was so thankful that they came to help me care for Gary. I couldn’t have done it without their help – everyone was so kind and caring and helped me with things I needed to do after he was gone. I miss him so much and I’m crying right now as I’m writing to you. I just can’t express how everyone was so kind and helpful. Everyone who came here was the BEST. You have a good group of people working for you. I loved them all for helping me.
You’re only as old as you feel
Like illness, the experience of aging can be profoundly disorienting, and is unique to every individual Aphorisms like “40 is the new 30” or “70 is the new 50” illustrate the subjectivity of what it means to age or “become old ” In fact, research25 has demonstrated that as we get older, our perception of our age tends to lag behind our actual age It’s no surprise, then, that decisions about the changing conditions of a person’s life – such as moving into a retirement community or assisted living facility – are inherently fraught� In American society, the absence of robust community-based social and personal support for people who are aging, coupled with the increasing precarity of housing for much of the population, have left healthcare institutions “holding the bag” for care of the elderly� It’s hard enough to admit we need help with activities that were once second-nature When the only option for support involves the healthcare system, with all of its baggage and public distrust, it’s no wonder so many Americans resist making plans and taking action to prepare for aging and declining health
According to NPHI survey data2:
Yet, perhaps paradoxically, the same survey showed that a majority have given at least “some thought” to key questions about care they might need as they age�
Similarly, the survey findings demonstrate that beyond an individual awareness of their own aging, most respondents are broadly aware that the US population at large is aging – and they’re concerned� What’s more, data suggest that the population is becoming ever more concerned about the age wave� Comparing the recent NPHI survey with the 2017 Kaiser Family Foundation study that was used as a model, we see a noteworthy trend�
In summary, we can see that Americans are aware of the realities and challenges of aging, both as individuals and as a society� But translating that awareness to consideration and action remains one of the signature challenges facing healthcare providers who serve aging populations� A key factor, yet again, is trust� Only 30% of NPHI survey respondents trust the healthcare system to care for them as they age, and the number drops to 10% for uninsured respondents�
To build a healthcare system that is more responsive to the needs of an aging population, it is critical to look at the specific facets of aging that cause the most concern� Breaking down the NPHI survey data below, we can identify a number of key insights�
Individual fears, concerns, and experiences vary widely, but from these insights we can identify a few key strategies that are cross-cutting� Significantly, these strategies are already being practiced by missiondriven hospice and declining health providers around the country: home-based care, consideration of social determinants of health, and emotional, interpersonal, and spiritual support�
As has been noted previously, the vast majority of older Americans exhibit a clear preference for remaining at home as they age� This is unsurprising – home is where we feel most comfortable and safe Yet, for increasing numbers of Americans, including those in older age ranges, having a stable, safe place to live is becoming more challenging Jennifer Molinsky, a researcher focused on housing for the aging population, noted26 that, “Over 10 million households headed by someone 65 and over are cost burdened (paying more than a third of their income on housing); half of these pay more than 50 percent ” Housing shortages and high prices represent a nationwide crisis across all age demographics, and for older adults, these financial burdens have a significant impact on health and well-being
On top of rising housing costs, financially strapped older Americans may struggle to afford needed healthcare, foregoing medications or preventive visits to save money A recent federal report27 found that some 5 million Medicare beneficiaries struggle to afford their prescriptions, with Black and Latino adults over 65 being 1�5
to 2 times more likely to report difficulty affording prescriptions� The cumulative impact of such experiences, alongside the multifaceted influence of social determinants of health, contribute to the close correlation of life expectancy with wealth or poverty By some estimates28, the gap in life expectancy between the richest 1% and the poorest 1% of Americans is 14 years for men and 10 years for women
Even for better-off Americans who can afford stable housing, aging at home is not necessarily safe or practical One analysis26 found that “less than 4% of homes offer a no-step entry, singlefloor living, and wide enough doors and hallways to accommodate a wheelchair ” The limited stock of such homes, and the high cost of renovating one’s home to be more accessible, represent significant barriers to enabling more of the population to safely age at home These challenges also point to the urgent need for greater access to quality, home-based care, which can help mitigate risks so that residents can remain in place for as long as possible
In addition to basic architectural considerations related to aging in place, a lack of cohesive, community-based support puts older Americans at even greater risk� Given the massive role that social determinants of health play in influencing health outcomes, it is critical that individuals who are aging at home have access to support for nutrition, transportation, and physical activity� Institutions like assisted living facilities account for many of these needs in their basic operational models, but given that the vast majority of Americans would prefer to remain at home, it is critical to bolster the availability of such services in the community Currently, older Americans are forced to choose between the risks of living on their own terms at home and the safety that institutions can offer Community-based support services offer a way out of this binary
On top of the more straightforward benefits of services like meal delivery, community-based services for adults who are aging in place can also help combat isolation and loneliness� The National Academy of Sciences29 detailed the striking associations between isolation and loneliness and adverse health risks�
• About a quarter of adults over 65 are socially isolated, and nearly 50% report feeling lonely
• Loneliness was associated with a 59% increased risk of functional decline and a 45% increased risk of death
• Social isolation was associated with a 50% increased risk of developing dementia
The paradox is that the individuals who are most isolated and at highest risk are, by definition, most likely to go unnoticed in the community Without strong social and community ties, many older adults, particularly those with chronic health conditions that limit their mobility, may languish in their homes, disconnected from the kinds of support that might be most valuable The National Academy of Sciences report notes, “nearly all persons who are 50 years of age or older interact with the health care system in some way… so this interaction may serve as a touchpoint to identify those who are isolated or lonely�” This observation aligns with other research that has linked isolation with increased hospital readmissions and Medicare expenditures (though data on these points is mixed)� Given the clear impact of isolation on health outcomes, and the healthcare system’s unique position to intervene, it is critical that social connection be prioritized in support services for aging populations
Researchers5 have indicated that so-called “social prescribing” can be a valuable tool for intervening in cases of social isolation: “[social prescribing] is believed to result in better social and clinical outcomes for people with chronic conditions and their caretakers, [and] a more cost-efficient way to use health and social care ” Yet, translating this recommendation into action has remained challenging First, although social isolation may be associated with greater Medicare expenditures
and increased hospitalizations, other research suggests that high-risk, isolated populations may be less likely to use preventive healthcare, such as primary care visits or routine screenings� As a result, the patients who would benefit most from social prescribing in the primary care context may be hardest to reach�
Perhaps more importantly, the National Academy report notes that “���despite the promising nature of many community-based programs, this type of support often remains underused due to the weak or nonexistent link between health care practitioners and community-based services�” A significant exception to this trend are “safety net” healthcare organizations that serve the needs of declining health and aging populations� Mission-driven hospices, specifically, tend to have deeper community ties, and may therefore be better equipped to connect high risk patients with community-based social support One study30 of 203 US hospice organizations (80% of which were nonprofit) found that more than 80% reported using internal funds to pay for nonclinical services not covered by Medicare The most commonly reported expenses were for food, utilities, shelter, and funeral costs Beyond paying for such support directly, the vast majority of these organizations “reported collaborating with community agencies to help patients and families to access available resources to obtain a similar range of basic necessities and services�”
Another key facet of the nonprofit hospice model is the significant role that volunteers play Given the largely charitable, volunteer-based roots of the hospice movement, the Medicare hospice benefit stipulates that volunteers should deliver 5% of total care hours� While many nonprofit providers that began as hospices have broadened their service lines to provide care for non-hospice patients, the presence of volunteers remains integral� These volunteers offer a wide range of non-medical services, from transportation to music and pet therapy to death doula programs� Such services have direct value for patients, caregivers, and families, but they also illustrate the deep ties nonprofits tend to have to the communities they
serve� Because almost all of the original hospices in the US were nonprofit, such organizations have often been operational for significantly longer than more recent for-profit competitors The longevity of nonprofits has enabled them to develop deep roots in the community, and strong volunteer programs are a testament to that presence
Hospice and end-of-life care will be discussed in more detail in the following chapter However, it is critical to note that many hospice organizations have vastly expanded their service offerings across the care continuum, indicating that aging populations could benefit from engagement with community-based providers as a complement to their primary care and specialist teams The multidisciplinary approach such organizations offer, alongside their deep connections to community support services, have significant potential to reduce isolation, address social determinants, and improve health outcomes
As challenging as aging and illness can be, nothing about human existence is more fundamentally incomprehensible than death� No matter one’s religious or spiritual beliefs – or lack thereof – few of us can ever truly conceive of what it means to die until we’re directly confronted with the possibility� This is a uniquely modern problem – the proportion of people who die suddenly or accidentally continues to shrink And while that’s a credit to modern safety regulations, hygiene, and medical advances, it’s had the unintended consequence of forcing us to contemplate something we’re by and large either unwilling or unable to truly process� Significantly, what people fear most about death is not death itself, or the afterlife, but how their death will affect others – financially, emotionally, practically� The grief of loved ones left behind, in other words, may be more painful to think about than our own needs
As life expectancy has increased and treatments for a variety of ailments, and even aging itself, have become more sophisticated, the experiences of declining health and death have become increasingly medicalized While medicine has
much to offer, it has not solved the fundamental reality of mortality There will always come a point at which the potential for cure or recovery goes from slim, to remote, to nonexistent Physicians, particularly in certain specialties like oncology, may be reluctant to accept this diminished chance at a cure� As human beings, physicians feel invested in each patient’s case, and as physicians, they are trained to use their knowledge to “solve” discrete problems As a result, they are comfortable describing additional therapeutic options, or clinical trials a patient could join, but they are less comfortable accepting the reality of decline and death
The role of physicians, and the healthcare system more broadly, in counseling patients about their options at the end of life is massive In NPHI’s survey,2 about two-thirds of respondents said they would be comfortable talking about their end-of-life care wishes with a doctor or healthcare provider – more than spouses, priests and spiritual advisors, or other family members� About 75% of respondents believed Medicare should cover such conversations, yet only 14% reported having had a conversation with a healthcare provider about their end-of-life wishes and only 29% have documentation of their wishes
“Life is pleasant� Death is peaceful� It’s the transition that’s troublesome�”
These data points indicate a willingness to talk about death, and a desire to have such conversations in a healthcare context Yet, simultaneously, we see very little followthrough to action, with the most commonly cited rationale being “I haven’t gotten around to it” (56%)� Part of the explanation appears rooted in the central theme of distrust Even as most respondents report relatively high trust in doctors and nurses as individuals, they remain overwhelmingly distrustful of the healthcare system, particularly in the context of end-of-life care�
The pain of grief often feels overwhelming, especially when you need to take care of so many important business details� This is a time when grievers must do an especially good job taking care of themselves�
The following truths may help you better understand the grieving process:
• Each person experiences and copes with grief differently
• Grief is a process; it will take as long as it needs to take Keep your loved one’s clothing and possessions until you are ready to decide what you want to do Don’t allow others to “take over” or rush you through the grieving process�
• Take good care of yourself; be gentle and patient� The stress of grief can affect eating and sleeping patterns� Be sure you get enough fluids, exercise, healthy foods and sleep�
• You do not have to grieve alone Contact friends who are good listeners and others with similar experiences who are willing to provide support
• Don’t hide your grief from children in the family Be open and honest with them because they are also grieving Listen to their concerns and answer their questions honestly
• Use prescribed medication only under your doctor’s supervision� If you experience any physical symptoms, please consult your physician�
• Alcohol and sedatives will complicate the grieving process
• Crying is healthy and biologically necessary� Do not apologize for your tears as they provide physical, as well as emotional, release
Thinking about the circumstances that might surround the end of your own life, how important is each of the following to you?
84%
Ensuring family is not burdened by tough decisions about your care
83%
Ensuring family is not burdened financially by your care
64%
Living as long as possible
In order to improve the frequency and value of end-of-life planning conversations, it is essential to understand the specific concerns patients have Asked what concerns them most about their own death, NPHI survey respondents rated “how my loved ones will be affected” (59%) and “missing the lives and events of others” (51%) highest, well above other options like “whether there is an afterlife” (28%) or “what will happen to my body after I die” (20%) Similarly, asked what is most important to them at the end of life, we see an emphasis on loved ones�
Significantly, the single lowest-rated factor surrounding end of life was “living as long as possible�” A related question takes this insight a step further – only 13% of respondents said that “preventing death and extending life” should be the most important task for healthcare at the end of life Of course, in a perfect world, we’d all want
to live “as long as possible,” but when considering the end of life, individual priorities appear to shift towards the impact on others, as well as comfort (85%) and peace (85%)�
Another area that respondents place great emphasis on is where they will die�
The widespread preference for receiving care in the home and remaining at home throughout the aging process has been discussed throughout this document, and will be explored further in the next section This preference for the “comforts of home” applies equally to the end-of-life context�
As utilization of hospice care has risen in recent decades, public awareness of hospice has accordingly risen as well� According to NPHI’s survey data,2 96% of respondents have at least heard of the term� Among respondents who have at least some familiarity, hospice is regarded favorably by three-quarters and, interestingly, there is a strong correlation between degree of familiarity and favorability ratings�
Even as hospice utilization has increased nationwide, notable disparities exist between white and non-white communities A 2020 Johns Hopkins study31 found that:
“34 9% of Black study participants who died used hospice services over the study period, compared with 46 2% of white participants Black Americans were significantly less likely than white Americans to use three or more days of hospice� Also, Black Americans were more likely to have multiple emergency room visits and hospitalizations, or to undergo intensive treatments in the last six months of life – regardless of the cause of death�”
Given the historical injustices that Black communities have faced – particularly in the context of healthcare – it is unsurprising that there is hesitancy to opt for a service that will, by definition, involve the cessation of curative treatment� Yet, it is also well-established32 that in many cases, patients on hospice actually live longer than similar patients who undergo intensive treatment�
Such positive responses may conflict with the experience of some hospice professionals; anecdotes from interviews with those working in hospice often portray the word itself as triggering, and many go to great lengths to avoid mentioning “the h-word” in front of patients and families A possible interpretation of this disconnect is that the moment hospice is introduced to a family is inevitably a moment of crisis, fear, confusion, or despair – particularly when, as is often the case, hospice referral happens in the final days of life No matter how enlightened or open-minded a patient and their loved ones might be about the prospect of death, the event itself remains tragic Reflecting on the experience after the fact, families may be more likely to view the experience positively, which would explain the connection between firsthand experience, familiarity with hospice, and high favorability� Indeed, another common experience reported by hospice workers is families telling them, “I just wish we had called sooner�”
The benefits of addressing these disparities extend beyond social justice� One study33 found that “Medicare spends about 20% more on the last year of life for Black and Hispanic people than White people,” suggesting that greater hospice utilization would have a significant impact on overall healthcare spending Of course, all Medicare beneficiaries should be entitled to choose the care that aligns with their goals Yet, in practice, more intensive treatment is often the default approach in end-of-life situations – less a choice patients make than something that happens to them
“You’ll go in there and they’ll eat you alive��� I hate to say [something] bad about hospitals, but it’s true�”
Black-owned hospice executive34
Reviewing NPHI’s survey data,2 there is a clear tension between the overwhelmingly negative view respondents had of the healthcare system at large and the generally favorable view those same respondents had of hospice Respondents were also divided over how well the healthcare system provides end-of-life care�
Hospice care has always occupied a unique place within the healthcare system Its religious and charitable origins set it apart from other types of healthcare, yet many aspects of the hospice model are now being touted as the future of healthcare in general Multidisciplinary teams, patient-centered care, shared decision-making, social determinants of health, home-based care – these principles are now mainstream among healthcare thought leaders, and may represent the future trajectory of healthcare Hospice leaders have been advocating these same concepts for more than 50 years, suggesting that experts in end-of-life care may be well-suited to guide the rest of the field
The even distribution of “very good”/“excellent” and “poor,” coupled with the very high number of “fair” or “not sure” ratings, suggest a wide variance in personal experiences with end-oflife healthcare� A 2023 New York Times article35 highlighted the persistent reality of aggressive, invasive medical treatment at the end of life The “comments” section of the article – while obviously anecdotal – includes hundreds of accounts of horrifying end-of-life experiences, an alarming number of which center on the role of financial incentives�
More specifically, given the problematic influence of financial incentives and profiteering, it is community-based hospice organizations that have the opportunity to be the leaders of this movement� This is not a moral argument about the virtue of nonprofit tax status as such A wealth of evidence highlights the clear differences between nonprofits and for-profits, from frequency of visits to breadth of services to the types of patients cared for The RAND Corporation conducted a study36 to examine family experiences with both types of organizations and found that “caregivers whose family member received care in a not-forprofit hospice reported the best care experiences, generally followed by those who received care in a for-profit independent hospice Those who received care in a for-profit state/regional chain or a for-profit national chain reported the worst care experiences ”
“For my aunt, the cancer treatment was the “end” of a life she enjoyed and the beginning of a life no one would want�”
“Make a living will, folks��� [otherwise] you will become a living, breathing, suffering piggy bank for the medical community And call hospice They are experts and will remove your loved one from the grips of an outof-control and profit-based system that is regularly torturing people to death ”
Setting aside more general considerations about the role of profit in healthcare, the issue is particularly problematic in the hospice context� In an editorial response to the RAND study, one researcher summarized37 the issue:
“Even if patients or their families experience poor quality care and wish to change hospice agencies (as one could with a physician or home health agency), the short time frame of hospice enrollment (one-quarter of patients are enrolled for a week or less) and the potential of disruption during an extremely stressful time make such switching of hospices essentially impossible� Because hospice is generally a once-in-a-lifetime experience for families, comparative experience does not exist and reporting deficiencies or quality concerns after a patient has died may seem futile ”
These factors, in addition to the flat rate that Medicare pays for all hospice patients, present clear incentives for hospice companies to seek out lower-need patients and offer fewer services� By contrast, nonprofits are the experts at delivering quality care to the highest need patients, no matter what the financial consequences�
Hospice of San Joaquin offers grief support services to residents of the surrounding areas who have suffered the loss of a loved one within the last 13 months
Grief support services include:
• Living with Grief Groups: Offered throughout the year, this multi-week series for adults focuses on grief education and support�
• Healing All Together (HAT): This group provides activities and information to meet the unique needs of school-aged children, teens and their families who have lost a significant person in their lives
• Holiday Grief Groups: Support that helps the grieving deal with the special challenges of the winter holidays�
• Additional Services: Hospice of San Joaquin provides other services including educational and informational materials, referrals, pamphlets, books and other resources about grief for all ages�
The Bereavement Department at Hospice of San Joaquin will be happy to assist you with literature, phone calls, information about grief groups and the like� Call the Hospice of San Joaquin number at (209) 957-3888 for assistance
Other options for support include church groups, friends and co-workers who are a support (not all friends can deal with grief), and your physician
Each person experiences the process differently Psychologist J William Worden identified four tasks of the grieving process that may be of help to you:
• One: Accepting the reality of the loss�
• Two: Working through the pain of grief
• Three: Adjusting to an environment where the loved one is missing
• Four: Remembering the loved one with less pain�
“It’s not just about nonprofit versus for-profit� It’s
about how much more we offer�
We’ve been here for 25 years� We’re going to be here for the next 25 years�”
An often overlooked aspect of hospice care is robust grief and bereavement support for families both before and after the patient has died� number of studies have outlined the detrimental impact of grief on caregiver mental health By some estimates,38 about 20% of caregivers will experience psychiatric symptoms like depression or “complicated grief” after the loss of a loved one As in many other aspects of healthcare, there are also noteworthy disparities in impact for the most vulnerable communities; one study noted that “Individuals with lower income, lower education, and those who are African Americans are also more likely to exhibit greater depression and complicated grief after the death ”
Additional research39 has noted that targeted interventions to address caregiver grief both before and after the death of the care recipient have led to reduced depression among caregivers� In particular, caregivers and families of Alzheimer’s patients who received tailored grief support reported significantly greater resilience and lower rates of chronic depression than those in the control group The study also found that these results were sustained for over a year, suggesting that early, sustained grief support is key to improving long-term mental health outcomes for caregivers
These positive outcomes demonstrate the potential benefits of greater hospice utilization, since the hospice model prioritizes grief support for caregivers and families� The inverse may also be true In one study,40 over 18 months of follow up, surviving spouses whose loved one underwent a life-sustaining treatment in the final month reported greater increases in depressive symptoms than those who did not�
There is also a significant body of research indicating that the impact of grief extends beyond mental health By some estimates,41 becoming a widow increases one’s mortality risk by 48%, with a diverse, interconnected set of potential factors influencing that increase On top of the emotional and mental strain associated with loss, surviving spouses must adapt to practical changes in their living circumstances and disruptions in their degree of social connection� Men, in particular, are less likely to have a close confidant than women, which may make them more vulnerable to adverse outcomes after losing a spouse�
Hospice providers have expertise providing end-of-life care not just for patients but for their caregivers and families as well, and studies suggest that such support has a positive influence on health outcomes for the bereaved Nicholas Christakis42 explored the relationship between spouse survival and hospice utilization, finding that both men and women whose partners had used hospice care lived longer after the partner’s death than those who did not use hospice�
Given that hospice quality metrics rely heavily on family member satisfaction, often reported after the patient has died, it is unsurprising that nonprofit hospices perform significantly better than their for-profit counterparts One study43 examining the association between amount of volunteer support and family satisfaction found, “Bereaved family members in hospice programs that use a higher rate of direct volunteer patient care hours reported higher ratings of the quality of care for that hospice program ” Similarly, lower rates of volunteer involvement were directly associated with lower “excellent” ratings from patients
The complex experience of grief has clear implications for caregiver and family health and well-being� With half a century of experience delivering expert care at the end of life, nonprofit hospice organizations are uniquely equipped to address this challenge Significantly, many nonprofit hospices extend their grief support offerings to the entire community, not just family members of patients they have served Such comprehensive support is deeply interconnected to the role that philanthropy and volunteerism play in the nonprofit hospice model As a result, increasing competition from for-profit providers poses a dire threat to long-term community grief support
An 85 year-old living with dementia A 65 year-old managing cardiovascular disease A 45 year-old diagnosed with advanced cancer A child born with a congenital heart defect Being diagnosed with a serious or chronic illness is a profoundly disorienting experience at any age� Despite the distinct pathology of different conditions, reckoning with a drastic shift in health status causes a break in one’s sense of self� We all have an internal narrative, a story we are constantly writing about who we are as human beings, and with a change in physical or mental circumstances, that narrative can collapse—this is not what was “supposed” to happen� For both the patient and their loved ones, real support is about something bigger than treatment It’s about conceptualizing what a new story can look like, and having the courage to write it
“I cannot make you understand I cannot make anyone understand what is happening inside me� I cannot even explain it to myself�”
Kafka, The Metamorphosis
“As people become more aware of the finitude of their life, they do not ask for much… They ask only to be permitted, insofar as possible, to keep shaping the story of their life in the world - to make choices and sustain connections to others according to their own priorities�”
Gawande, Being Mortal
In the context of serious illness, the idea of “care” is often synonymous with “treatment�” Disease is a problem to be solved, not a state of being to be understood, processed, and managed� As physician specialization has accelerated over the past 50 years, the healthcare system has gotten better at treating the illness, perhaps to the detriment of caring for the patient� The exception to this is the field of palliative medicine, which offers a more holistic view that focuses on the human being with an illness, rather than just the illness There is broad recognition in the medical community of the value that palliative medicine can have In 2008, the American Board of Medical Specialties (ABMS) began offering board certifications19 in hospice and palliative medicine across 10 different subspecialties – “the first time 10 ABMS member boards have collaborated to offer certification in one area ”
Such broad recognition of the value of palliative medicine has had mixed results One analysis20 found that acceptance of palliative medicine has increased to the point where 85% of medium to large hospitals now have palliative medicine teams present Yet, the same paper used survey data of current palliative medicine practitioners to warn of a looming shortage of palliative specialists, with “19% [of providers] expressing a 50% or higher chance of leaving the field in 5 years, 47% intending to leave in 10 years, and 66% leaving in 15 years�” Low reimbursement rates for palliative medicine result in less competitive salaries, which drives more new medical school graduates towards other specialties� Against the backdrop of an aging population with ever more patients managing multiple chronic, complex, serious health conditions, this projected shortfall should be cause for alarm�
As disorienting as a diagnosis of serious illness can be, it’s something the majority of Americans have given at least some thought to�
The challenge, of course, is that it is impossible to truly think through what it will be like to have a serious illness until it happens Further complicating matters is the well-documented difficulty of providing an accurate prognosis
The groundbreaking research of Nicholas Christakis has highlighted the tendency of physicians to be overly optimistic in their predictions of life expectancy, in particular among oncologists Aside from the clinical difficulty of accurately determining prognosis, there is a deeply human factor at play here� No one wants to be the bearer of bad news, yet looking at actual patient preference is instructive�
While it is unsurprising that, given the choice, the majority of Americans would prefer both honesty and hope, it’s striking just how few seem to prioritize hope over honesty Concluding that physicians need to be more forthright with patients navigating declining health is easier said than done�
Fo
W h e n a p at i e nt i s
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Vulnerable populations face both greater risk of developing certain serious and chronic illnesses, as well as worse outcomes from those conditions� The factors driving these disparities are complex –from a lack of preventative care to the influence of social determinants – and earlier, more sustained engagement of palliative medicine would have distinct benefits in these populations It is impossible to talk about the future of healthcare in the US without centering the experiences of vulnerable populations “By the year 2044, [minorities] will account for more than half of the total U�S� population, and by 2060, nearly one in five of the nation’s total population will be foreign born ”3 Alarmingly, insofar as certain disparities have decreased in recent years, the cause is often a decline in the health of majority groups, rather than improvements in minority health By reimagining healthcare to be responsive to communities with the greatest health needs, we can elevate the quality and accessibility of care for all�
Along racial and ethnic lines, the interplay between trust in the healthcare system, proactive health management, and development of chronic disease is a major driver of disparate outcomes�
NPHI’s survey data2 showed that about 1 in 5 Americans actively avoid healthcare unless it is absolutely necessary� Among Black respondents who avoid healthcare, some 76% say it is because the healthcare system does not treat their racial or ethnic group well (compared with only 23% of white respondents) This finding aligns with studies showing that Black and hispanic patients receive fewer primary care visits and preventive health measures, like cancer screenings and flu vaccines
Lower rates of primary care utilization in these communities, along with environmental factors like access to nutritious food, contribute to higher incidence of chronic diseases This is particularly noteworthy with respect to conditions related to obesity, such as diabetes and heart disease�
• 47%21 of Black adults have been diagnosed with cardiovascular disease, compared with 36% of white adults�
• Black adults are 30% more likely3 than whites to die prematurely from heart disease�
• Black men are twice as likely as white men to die prematurely from stroke�
“Racial and ethnic disparities are arguably the most obstinate inequities in health over time�”
Communities in Action3
• Hispanic women are more than twice as likely as white women to have diabetes
• American Indians are three times more likely than whites to have diabetes
Black Americans also face higher risk and mortality for certain types of cancer The death of actor Chadwick Boseman at age 43 highlighted the elevated risk for colon cancer in the Black community, prompting discussion about the importance of earlier screenings for at-risk groups� It is noteworthy that overall incidence of colon cancer among younger people is also on the rise Focusing on improving screening practices and treatment for the highest-risk communities is about more than justice – it’s about improving outcomes for the entire population
As it pertains to palliative medicine, one welldocumented form of health inequity is treatment for pain� A 2016 study22 found that Black patients were half as likely to receive pain medication as white patients reporting the same symptoms There are similar disparities in pain treatment related to gender Women may be perceived as less tolerant of pain and more likely to exaggerate it, resulting in under-treatment� For example, pelvic pain, a common cause of pain among women, goes untreated in one-third of all cases
Compounding these trends is a lack of awareness of palliative medicine among non-white communities One study of adults in California found that three-quarters of Black and hispanic patients had never heard of palliative care, compared with only half of white patients Access to and utilization of palliative consultations varies widely by institution, but lack of awareness, unequal treatment of pain, and higher incidence of serious illness all suggest that non-white communities would benefit from better integration of palliative approaches A recent mixed-methods study23 found that “[Minority] patient and family caregivers revealed positive experiences with palliative care but demonstrated experiences of discrimination in health care before referral to palliative care ”
In addition to racial and ethnic disparities, rural populations are also vulnerable to unequal access to care� One study3 highlighted a disconcerting trend: “ after a period of steady decline over decades, rural counties are experiencing an increase in the number of premature deaths�” The same study found that, compared with urban residents, “ rural communities have higher rates of preventable conditions (such as obesity, diabetes, cancer, and injury), and higher rates of related high-risk health behaviors (such as smoking, physical inactivity, poor diet, and limited use of seatbelts) ”
As in the context of racial disparities, awareness and comprehension of what palliative medicine is and can offer are significant factors in underutilization of these services in rural communities Conflation of palliative and hospice – among physicians and patients –fuels the perception that introducing palliative medicine means that the physician has “given up” and death is near� That association has also contributed to the proliferation of terms used to describe palliative programs: serious/advanced illness care, symptom management, supportive care, etc Improved education of the general public and healthcare providers are essential to bringing the benefits of palliative medicine to more patients across the continuum of care
The barriers to wider access to palliative medicine extend far beyond individual attitudes and perceptions, however, particularly in the rural context� In one qualitative study24 of rural palliative practitioners in Indiana, participants cited poor compensation, lack of outpatient resources, and logistical challenges of following up with patients who live in remote areas Thus communities with some of the highest need for palliative services may be least able to access those services
Pre-planning your funeral will make certain that your choices are respected and carried out, without leaving your family to wonder what your wishes might have been You also have the option of paying for your funeral in advance�
When you’re ready to make a plan, send an email or call your chosen funeral home to set up an appointment�
Whether you’re planning for yourself or for a loved one, the funeral service is one of the most important elements of a person’s final arrangements� With the opportunity for great personalization, the funeral service can truly reflect the uniqueness of the life it honors
Regardless of whether you or your loved one have opted for burial or for cremation, the funeral or memorial service fills an important role It can:
• Honor, recognize and celebrate the life of the deceased
• Allow friends and family to say their last goodbyes
• Provide closure after the loss of a loved one
• Allow friends to console the family of the loved ones
In general terms, a funeral is a gathering of family and friends after the death of a loved one that allows them the opportunity to mourn, support each other and pay tribute to the life of the deceased�
When considering final arrangements for yourself or a loved one, one of the first decisions you might make is whether you prefer burial or cremation This decision often influences other important considerations, such as elements of the funeral service and type of cemetery property
A formal or informal ceremony or ritual prior to burial, a funeral service often provides a sense of closure to family and friends� Although your faith or culture may dictate some of the elements, you may want to personalize other aspects of the service At a funeral service, a casket or urn is present, though you may choose to have the casket open or closed
Held the night before or immediately prior to the funeral service, the visitation – also called a “wake” or a “viewing” – provides a way for friends and acquaintances to pay respect and offer condolences to your family� As with the funeral service, you may want to decide if you want an open or closed casket, should one be present
At a memorial or tribute service, a casket or urn is usually not present Otherwise similar to a funeral or visitation, a memorial service gives family and friends a time to come together in your memory and celebrate your life
A graveside service may be held at the gravesite, just prior to burial of a casket or urn It usually consists of final remarks, prayers or memories The service may occur after or in place of a funeral service
There’s no one, right way to plan a funeral service – each funeral should be as unique and memorable as the life it honors When planning your own funeral service in advance, think about the way you want to be remembered Perhaps you’d like a traditional funeral aligned with certain religious or ethnic customs Or, a celebration focusing on great memories made with family and friends may be your preference Maybe it’s a combination of both You can have one service, or several, to honor your life
Regardless of the service or services you choose to include in your funeral plan, you can personalize them in almost any way imaginable For example, just consider the following questions:
• Where will the funeral be held? At your place of worship? At the funeral home?
• Who will officiate the service?
• Will your service adhere to the traditions of your faith or culture?
• Do you want a eulogy, and who should deliver it?
• Would you like an open or closed casket?
• What music should be played?
• What readings would you like to have?
• Is there a special poem you’d like shared with the guests?
• Are there any special photographs or other memorabilia you would like displayed?
• Should the décor reflect a particular hobby or interest of yours, such as fishing or gardening?
• Is there a particular emblem or engraving you want on your headstone or marker?
• Should there be refreshments served or a more elaborate party held after the service?
Get multiple copies of the death certificate The executor and funeral director will need to contact the following agencies, most of which will request at least one copy of the death certificate:
1 Social Security (800-772-1213; www socialsecurity gov) to discuss ceasing benefits, obtaining survivor benefits and Medicare� Veterans Affairs may also be necessary for the cessation of benefits (800-827-1000; www va gov)
2� Health, life, homeowner, automobile, and other insurance companies to cease or transfer benefits�
3� Utility companies to change or stop services�
4� Employer for pension plans or employment benefits; each separate claim will require a separate copy of the death certificate
5 Probate attorney for asset, trust, and estate inventory
6 Tax preparer to determine if an estate tax return or final income tax return should be filed
7 State department of motor vehicle services to cancel driver’s license
8 Bank for safe deposits and remaining accounts; you may be advised to open a new account for the estate
9 Notify the post office of the death and the location to which mail should be forwarded (Going through your loved one’s mail can help you become aware of bills, subscriptions, or other accounts or services that should be canceled�)
10� Notify the police if your loved one left behind a house that will sit vacant so that they can periodically monitor the home against suspicious activity
Giving permission to your loved one to let go without making them feel guilty for leaving or trying to keep them with you to meet your own needs can be difficult A dying person will normally try to hold on even though it brings prolonged discomfort, in order to be sure that those who are going to be left behind will be alright� Therefore, your ability to release the dying person from this concern and give them assurance that it’s alright to let go whenever they are ready is one of the greatest gifts you have to give your loved one at this time
When the person is ready to die and you are able to let go, then it is time to say “goodbye ” Saying “goodbye” is your final gift of love� It achieves closure and makes the final release possible� It may be helpful to lay in bed with the person and hold them, or to take their hand and then say everything you need to say It may be as simple as saying “I love you ” It may include saying “I’m sorry for whatever I contributed to any tensions of difficulties in our relationship�” It may also include saying “Thank you for…” Tears are a normal and natural part of saying “goodbye ” Tears do not need to be hidden from your loved one� Tears express your love and help you to let go�
The chaplain is an integral part of the hospice care team and is responsible for addressing the spiritual and emotional needs of the hospice patient and family The chaplain’s role is not to change personal beliefs, judge, or have all of the answers� Our chaplain will honor and respect the spirituality, faith, or belief system of each patient and family It’s our goal and privilege to support patients and families on the path of this very unique journey We want to be responsive to your emotional needs and your spiritual well-being each step of the way�
1 I have expressed my love Yes No
2 I have said my “goodbyes ” Yes No
3� I have expressed my thanks and gratitude� Yes No
4 My life has meaning and purpose Yes No
5 My family relationships are healthy Yes No
6� I feel forgiven� Yes No
7 I have addressed my fears and regrets Yes No
8 I have addressed my questions about God, the end of life, or the “afterlife ” Yes No
9� I feel that I am at peace with my circumstances� Yes No
10 I am receiving the emotional and spiritual support that I need Yes No
If you answered “No” to one or more of these questions, please call our Bereavement Department at (209) 957-3888.
Social Security survivors benefits help ease the financial burden that follows a worker’s death� Almost all children under age 18 will get monthly benefits if a working parent dies Other family members may be eligible for benefits, too
Anyone who has worked and paid Social Security (FICA) taxes has been earning survivors benefits for his or her family The amount of work needed to pay survivors benefits depends on the worker’s age at the time of death� It may be as little as 1�5 years for a young worker� No one needs more than 10 years�
Here is a list of family members who usually can get benefits:
• Widows and widowers age 60 or older
• Widows and widowers at any age if caring for the deceased’s child(ren) who are under age 16 or disabled
• Divorced wives and husbands age 60 or older, if married to the deceased 10 years or more
• Widows, widowers, divorced wives, and divorced husbands age 50 or older, if they are disabled
• Children up to age 18
• Children age 18-19, if they attend high school full time
• Children over age 18, if they became disabled before age 22
• The deceased worker’s parents age 62 or older, if they were being supported by the worker
In addition to the monthly benefits for family members, a one-time payment of $255 can be paid to a spouse who was living with the worker at the time of death If there is none, it can be paid to:
• A spouse who is eligible for benefits
• A child or children eligible for benefits
• This payment cannot be made if there is no eligible spouse or child
You can apply for benefits by telephone or by going to any Social Security office You may need some of the documents shown in the “Information needed” section but don’t delay your application because you don’t have all the information� If you don’t have a document you need, the Social Security office can help you get it�
• Your Social Security number and the deceased worker’s Social Security number
• A death certificate
• Proof of the deceased worker’s earnings for last year (W-2 forms or self-employment tax return)
• Your birth certificate
• A marriage certificate, if you are applying for benefits as a widow, widower, divorced wife or divorced husband
• A divorce decree, if you are applying for benefits as a divorced wife or husband
• Children’s birth certificates and Social Security numbers, if applying for children’s benefits
• Your checking or savings account information, if you want direct deposit of your benefits
You will need to submit original documents or copies certified by the issuing office� You can mail them or bring them to the office Social Security will make photocopies and return your documents
You may contact the Social Security office to find out which benefits are available for your individual circumstances, to change records, and to stop automatic deposits
For the local Social Security office nearest you, please visit: www.ssa.gov
The national phone number is: 1-800-772-1213
Your chosen funeral home may file Form SSA-721 which informs Social Security of a death
You do not need to order a certified copy of the death certificate to send to your Social Security administration office�
I wanted to spare you as much anxiety, doubt and confusion as possible at the time of my death, so in this book, I have suggested some arrangements in advance
This book includes important information, funeral service guidelines and cemetery requests, which are all important to the funeral director while assisting you to plan the details of my service�
I’ve also included some personal material for eulogies, obituaries and other remembrances
Please accept these arrangements in the spirit in which they are given – with love, hoping to give you comfort and helping you to remember the times we shared�
With love,
Signature:
Name:
Address:
Telephone:
Relationship:
Notes:
Name:
Address:
Occupation:
Employer:
Business/Industry:
Name of Spouse:
I have completed a Living Will, had it signed and notarized� It includes instructions for:
• Medical treatment choices for serious illness
• How/where I wish to spend my final days
• Whom I wish to be present at time of death
• Requests for a funeral or other memorial
Location:
I have completed a Durable Power of Attorney for Health Care and named a Health Care Agent to make health care decisions if I am unable to do so
Location:
I have completed a Durable Power of Attorney for Finances and named an agent to manage my finances if I am unable to do so Location:
I have a copy of my DD2-14�
Body Donation:
I
I have completed a Last Will and Testament
Location:
Executor:
I have given the following person(s) passwords and access to my email, social media, financial and legal information, and discussed what to do with them�
Name:
Name:
I have stocks and bonds� Company:
Retirement:
I have a retirement account through my employer/broker/financial institute Company:
I have a safe deposit box:
Location:
Who has access:
Life Insurance Policy:
I
Funeral Home:
Place of Worship and Address:
Other Location and Address:
Clergy or Officiant:
or Funeral Home to recommend
Name:
Contact Information:
Personal Items:
Eyeglasses: Remove Leave on
Jewelry: Remove Leave on
Clothing: Purchase at the time Selected
Musical Tributes:
Soloists:
Organist/Pianist:
Congregational Hymns:
Favorite Genre or Artist:
Community Organizations or Clubs that may participate:
Notes:
Name of Cemetery:
Address:
Property, Crypt or Niche owned:
If yes, specify location written on cemetery purchase agreement:
Final Resting Place: Earth Burial Mausoleum
Interment following cremation Other
Marker or Monument:
Purchased: Yes No
If no, inscription instructions:
Reception Details:
Reception Location: Reception Room Place of Worship Other
Reception to follow cemetery
Reception to follow service
Place of Death:
Spouse, Widow or Widower of:
Children, their spouses and their places of residence:
Date of Death:
Married for (number of years):
Grandchildren, their spouses and their places of residence:
Siblings, their spouses and their places of residence:
Education:
Clubs and Organizations:
Name:
Address:
Name:
Address:
Address:
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���this publication is also available as a digital e-book? Simply scan the QR code to the right using a QR code reader�
And the best part is, it can be shared with family and friends, whether via text message, email, social media, or even your own website� It’s simple, and it’s instant�
Our friendly, professional advance planning staff is here to serve you. Together, throughout all of our locations, we can determine the best plans for you and your loved ones. Contact us today. www.plfryandson.com www.frymemorialchapel.com www.deeganfuneralchapels.com
Bringing together decades of experience caring for families of all cultural backgrounds and diverse walks of life.
We pledge to treat you and your loved ones just like family, and we guarantee to offer services that meet all of your specifications while exceeding all of your expectations.
We provide funeral home, burial, and cremation services, and our friendly, professional staff is at your service - 24/7.
Whether you are pre-planning or need to hold a service soon, we are ready to offer you warm, friendly, and empathetic service.
Deegan-Ripon Memorial Chapel
111 South Palm Avenue Ripon, CA 95366
209-599-3413
Deegan Funeral Chapel 1441 San Joaquin Street Escalon, CA 95320 209-838-7321
Fry Memorial Chapel 550 South Central Avenue Tracy, CA 95376
209-836-1970 Tracy Mausoleum 8842 West Schulte Road Tracy, CA 95304 209-836-1970
For over 30 years, our experienced financial professionals have helped families pursue their financial goals. Specializing in retirement planning, estate planning, and wealth management, we work closely with our clients and customize our guidance around their unique needs. We can help you prepare for retirement and leave a legacy for your family.
At Phillips Financial, we are committed to helping you understand your current financial situation and guiding you toward the optimal decisions to shape your financial future. Our goal is to work with you to build your wealth and preserve your legacy. Discover more about how our financial professionals approach wealth management.
Our financial professionals have invested years into obtaining the experience necessary to serve you. Armed with degrees from top universities such as Harvard and UC Berkeley, our financial professionals analyze financial products, develop financial planning strategies, and manage portfolios based on your investment objectives. We’re also constantly learning more about how to optimize and improve wealth management strategies for our clients.
However, while we keep best practices in mind, we know that every situation is unique — and we constantly tailor our services to your preferences and your family’s needs. We never give our clients off-the-rack advice. Instead, we look closely at their specific financial situations. We listen to their personal concerns. And we work with them to craft an individualized and comprehensive financial plan.
Ultimately, if something is important to you, it’s important to us. When you choose our financial services firm, we work closely with you, your CPA, and your attorney to create a comprehensive, cohesive financial plan for you and your family.
Comfort-focused approach to enhance quality of care.
The cemetery gates and mausoleum at San Joaquin Catholic Cemetery in Stockton are open daily between 8:00 am and 4:30 pm.
Burial services and pre-arrangements are by appointment only. These appointments must be scheduled with the cemetery staff.
