‘Choosing Quality: Caring Conversations’

What: Workshop about planning, implementing end-of-life decisions

When: 1-4 p.m., Wednesday, April 27

Where: Olympic Medical Center (Olympic Memorial Hospital), Linkletter Room, 939 Caroline St., Port Angeles

Cost: Free

More info: Call 582-3796 (RSVPs welcomed but not required).

Awkward, uncomfortable and possibly a bit frightening — but the conversation is worth having.

Paul Fiorini, chaplain/bereavement coordinator at Assured Hospice of Clallam and Jefferson Counties, knows there is a disconnect between what people want to say when they or a loved one is dying and what actually happens, which is usually silence.

“It’s a basic fear about death and dying,” Fiorini says. “Both ends of the spectrum don’t want the other person to feel uncomfortable. Plus there may be (a lot of) emotional content when they have that conversation.”

Fiorini and company hope to break down some of those barriers at “Choosing Quality: Caring Conversations,” a free workshop held by local Assured Hospice groups and physicians on Wednesday, April 27, in Port Angeles.

Held at Olympic Medical Center’s Linkletter Room at Olympic Memorial Hospital from 1-4 p.m., the event aims to bring community members and experts in end-of-life situations together.

Topics include how to have end-of-life conversations with your doctor and family with Dr. Paul Cunningham, medical director and physician at Jamestown Family Health Clinic, and Michele Stafford, DO, Olympic Medical Center; advanced directive/living will education with Cunningham and Stafford; funeral home conversations with Steve Ford of Drennan & Ford Funeral Home and Crematory; and the final end-of-life conversation with Fiorini.

“We want to empower people to have these conversations,” Fiorini says.

Fiorini has worked with hospice organizations for nearly seven years. Beyond the medical benefits — studies show patients live longer with hospice and that spouses of those receiving hospice care report lowered levels of depression — he said the process of going through the end of someone’s life can be relationship-building, honoring and, oddly enough, empowering.

“When people are dying they are losing control of everything,” Fiorini says.

“We like to give them a little of that power back.”

Personal perspective

Brenda Francis, nurse liaison/patient care representative with Assured Hospice, planned on studying art in college, but an experience she had when she gave birth to a son prematurely sparked an interest in nursing. She went on to work in hospitals with families dealing with the loss of infant deaths, then took a job at Olympic Medical Center as a nurse until taking a position with Assured Hospice.

“I love what this position offers to the community,” Francis says.

Working as a go-between with what prospective hospice users need, Francis knows first-hand the impact of hospice care in her own life. When her mother was stricken with cancer and bone marrow transplants failed, Francis had the talk with her mother’s doctor about key end-of-life decisions and hospice.

Not long after, Francis’ aunt was diagnosed with ovarian cancer.

“It was the same conversation,” Francis recalls. “I brought in hospice as soon as I could.”

Though she spent years facing her loved ones’ deaths, Francis says the experience was uplifting.

“I felt honored — it was an incredible experience,” she says. “They weren’t the worst days of my life. They were the best days of my life.”

She translates that to her job, coming face-to-face with families struggling with the reality of loss.

“Going in there is such a privilege; I can only see it as that. I grieve, but I don’t get so grief-stricken that I can’t function,” Francis says.

“We’re really big on empowering people in their choices in health care,” she says. “They need to hear it’s OK to talk about dying.”

Services

Assured Hospice of Clallam and Jefferson Counties is part of LHC Group, a nationwide network of post-acute care partners for hospitals, physicians and families. The business offers nursing services to manage pain and other symptoms, certified nursing assistants (CNAs) or bath aides for hygiene care, a social worker to help with applying for Medicare/Medicaid, veterans benefits, etc., and a chaplain for spiritual and emotional needs. Therapists provide massage and music therapy.

Assured Hospice also has volunteers who provide massage and music therapy, can do some light housework and even help with journaling, videos or picture albums.

“That passing on is important,” Fiorini says.

(Olympic Peninsula residents also have the option of Volunteer Hospice of Clallam County; see vhocc.org.)

Hospice care is covered by Medicare and private insurance. Francis notes that, “Medicare covers as many of those conversations as needed.”

Fiorini says he’s excited to see the promotion of Honoring Choices, a program that encourages doctors to be more apt to have end-of-life conversations.

The No. 1 factor in using hospice is the doctor’s recommendation, Fiorini says.

“All the power seems to be in the doctor’s hands,” Fiorini says. “If it’s not important, (people) don’t bring it up. And a lot of doctors don’t want to have that conversation.”

As chaplain/bereavement coordinator at Assured Hospice, Fiorini says he often sees families at their seemingly lowest points.

“We deal with a lot of crisis situations,” he says. “(But) I think I’m kind of wired to be in these situations. We’re trying to love them within the context of our work, our calling.”

“Our focus is not about death but about the last stage of life, be it a week, a month a year,” he says.