2 Montgomery Hospice

Adventist HealthCare301-891-7600www.AdventistHealthCare.com

Relationships are essential to life. Fromour beginning, we are born into a net-work of family and friends who supportus. We are often connected to religious

or social communities that give our lives meaning.We grow into and treasure friendships, and workwith colleagues in different settings. We join oth-ers in activities and hobbies of shared interest. Atheart, we are social creatures, and we need othersin various ways throughout the human journey.This is especially true as we think about the endof life.

In fact, the kind of relationships and resourceswe have at the end of our lives is a crucial factorin the quality of our living. We can reach out forrelationships that will help sustain us in the finalseason of our lives, those which lend support whilealso giving us the freedom to live on our own terms.

The good news is that resources are avail-able that will enable people and their loved onesto meet the end of life with support and gentlepresence. The hospice movement was starteddecades ago to address concerns and fears aboutbeing alone, and Montgomery Hospice is a non-profit institution whose mission is precisely togentle the journey for people at the end of life. Weprovide care and support to individuals as long astheir lives may last, and make their final journeys as gentleand meaningful as possible.

We honor the wishes of individuals and families inwhatever way we can. Whenever someone decides to useMontgomery Hospice, we work to respect their own tradi-tions, values and choices. We know that each family andindividual is unique, with special concerns and hopes, sowe work to understand and become supportive partners

with them. We do not overwhelm with around the clockpresence, but offer regular, supportive visits, and we arealways just a phone call away. We begin a conversationabout needs and desires, and offer guidance and resourcesalong the way, but we recognize the fundamental impor-tance of each person’s decision-making. As much as pos-sible, we want people to finish their life journeys ontheir own terms.

Hospice is not a place where people must go; itis a form of care they receive where they are.We come to a “home,” whether it is a house, anapartment, an assisted living facility or a nursinghome.

When families choose Montgomery Hospice,they are offered the support of a comprehensivecare team, which will make regular visits basedupon the needs of the individual. Each team willinclude a doctor with expertise in pain manage-ment and end-of-life care, as well as a nurse whois also trained and skilled in such care. A socialworker works with the family to provide resourc-es around end-of-life decisions and listens withsensitivity to family grief and issues. Sometimesthe social worker can help mediate the differentconcerns or disagreements family members mighthave during anxious moments together. A personwho provides spiritual care (chaplain) is also avail-able. By training and experience, this person isable to offer spiritual support to family membersseeking help in a difficult time. Our chaplains rep-resent a wide spectrum of spiritual traditions andseek to honor the traditions and values of eachfamily. They often work in partnership with localclergy, when appropriate, and will seek to connecta particular religious representative with a family,

if desired. We have certified nursing assistants available toassist each family with some of the tasks of care, such asfeeding, and changing bed sheets or clothing. We also havea large group of volunteers who offer their time and sup-port to families in unique ways, from sitting with an indi-vidual or engaging in conversation, to reading or playing amusical instrument, to offering lavender oil hand massagesfor comfort. Our volunteer managers work to connect just

PERSONALIZED, COMPASSIONATE SUPPORT

MontgomeryHospice.org 3

Last year, Montgomery Hospice volunteers helpedmore than 900 hospice families.

DOES THE HOSPICE HAVE:

n a full-time medical director?

n a dedicated, inpatient, acute carehospice facility?

n accreditation by The JointCommission?

n medical staff with specializedhospice certifications?

n a team of professionals providingmedical, nursing, social work,volunteer, bereavement, andspiritual care?

n staff members available 24 hoursa day, 7 days a week?

n care provided to patients in theirhomes, at nursing homes, and inassisted living facilities?

n close collaborations with patients’doctors?

n professional counselors whoprovide grief support and educa-tion to patients and families?

n tools in place to servenon-English speakingpatients and families?

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Montgomery Hospice is proudto be accredited by The JointCommission.

Montgomery Hospice vol-untarily participates in therigorous Joint Commissionaccreditation program. TheJoint Commission inspectsMontgomery Hospice for com-pliance with Medicare regula-tions, as well as their own rigorous standards, atleast every three years. Asking about a hospice’sparticipation in an accreditation program is oneway families can determine the quality of a hos-pice provider.

From The Joint Commission:

“The Joint Commission is the nation’s predominantstandards-setting and accrediting body in healthcare. Since 1951, The Joint Commission has main-tained state-of-the-art standards that focus on im-proving the quality and safety of care provided byhealth care organizations.

“The Joint Commission’s comprehensive accredita-tion process evaluates an organization’s compliancewith these standards and other accreditation require-ments. Joint Commission accreditation is recognizednationwide as a symbol of quality that reflects anorganization’s commitment to meeting certain per-formance standards. To earn and maintain The JointCommission’s Gold Seal of Approval™, an organiza-tion must undergo an on-site survey by a Joint Com-mission survey team at least every three years.”

the right volunteer with an individual based on his or herinterests and needs. All of the members of this compre-hensive care team are offered to each family, but each fam-ily decides which of these supports would be most helpfulgiven their own situation.

If an individual’s symptoms cannot be managed ad-equately at “home,” then we have an inpatient facilitycalled Casey House where we work to help get someone’ssymptoms under control. It is a unique place. It does notlook like a medical facility from the outside, and this is bydesign. It is meant to be a family-friendly place for fami-lies that are going through a difficult time. There is a large,warm meeting place located in the central section whereindividuals can gather, and a beautiful garden surroundingthe building for solitude and reflection. Family memberscan come and go at any time. Family pets are welcomevisitors. A chef is on staff to help with meals. Volunteers arealso there to provide a caring presence. Casey House is notneeded for most families in our program, but for some it isthe right choice.

Montgomery Hospice offers to be a companion onpeople’s most important journey. Our staff and volunteerswill provide a comforting presence and a human touch.Montgomery Hospice will bear witness to the dignity ofa single human life. Following their lead, we will supportpeople as they live out their lives.

– Kip IngramMontgomery Hospice Bereavement Counselor

F I N D I N G A Q U A L I T Y H O S P I C E Q U E S T I O N S T O A S K

rvengies?

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CASEY HOUSE

4 Montgomery Hospice

n What is hospice?Hospice is care that focuses on medical and personalcomfort for people living with a life-limiting illness.

Hospice care helps patients with physical symptomslike pain or nausea. Hospice staff members alsocomfort patients, families and friends by helping themfeel emotionally and spiritually at peace. They worktogether with patients and families to bring dignityand well-being to anyone affected by illness and loss.

n What is Montgomery Hospice?Montgomery Hospice is a nonprofit organizationthat has been providing hospice care to people inMontgomery County for more than 30 years. We arethe largest hospice in the county.

Besides hospice services, we provide professionalgrief support for anyone who lives in the county.

n Is Montgomery Hospice a part of theMontgomery County government?No.

n Whom does Montgomery Hospice care for?Montgomery Hospice helps our seriously ill neighborsin Montgomery County who have decided (after talk-ing with their doctors) to concentrate on living theirlives as fully as possible rather than aggressivelyfighting a disease. For some patients, hospice canbe an alternative to staying in – or returning to – ahospital.

n Is hospice only for people with cancer?No. Montgomery Hospice can help patients with anyillness (including cancer, dementia, heart diseaseand others).

n How are hospice services paid for?Hospice services are paid for by:

n Medicare (Part A)n Medicaidn Private insurance companies,

or byn Montgomery Hospice. We care for patients who

do not have insurance or any other way to pay.

n Where do patients receive hospice care?Montgomery Hospice usually cares for patients andfamilies in their own homes, wherever they live. Besideshouses and apartments, we care for patients in assist-ed living facilities and nursing homes, and also at CaseyHouse, the only health care facility in MontgomeryCounty exclusively designed for hospice patients.

n Who cares for the patient?The team of people that work together to care forthe patient includes doctors, nurses, hospice aides,social workers, spiritual counselors (chaplains)and volunteers.

n What services are provided by MontgomeryHospice?n Expert pain and symptom reliefn Medicationsn Medical equipment, such as oxygen, wheelchairs,

walkers and hospital bedsn Medical suppliesn Nurses available by phone 24 hours a day,

7 days a weekn Assistance with patient personal caren Grief support

n Do Montgomery Hospice patients have to stopall medications?No.

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Visiting AngelsGaithersburg, MD301-355-6578Silver Spring, MD301-578-1616

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n What are Complementary Therapies?Montgomery Hospice uses ComplementaryTherapies such as massage, music andaromatherapy. For some patients, thesetechniques (used along with conventionalmedical care) provide comfort, and easepain and anxiety.

QUESTIONS & ANSWERS

MontgomeryHospice.org 5

n How are decisions made about the care of thepatient?Montgomery Hospice respects and honors the wishesof our patients. Their priorities guide us.

n Are patients’ family doctors still involved when apatient chooses hospice?Yes. Patients can keep their own doctors whilereceiving hospice care.

n Can patients who sign up for hospice carechange their minds?Yes. Patients can stop hospice care whenever theywant, for whatever reason.

n Do patients ever leave hospice care?Yes. Some patients leave hospice.

n When patients decide to use hospice, do theydie sooner?NO. Studies have shown that patients can livelonger when they use hospice services.When people sign up for hospice, they get expertmedical care that helps alleviate pain and othersymptoms. They also get expert care that helps themdeal with issues such as spiritual questions or familyproblems or logistics. The purpose of hospice care isto support people so they can use the time that theyhave in the best possible way.

n Does choosing hospice care mean that “there isnothing else that can be done”?NO. Hospice is the “something else” that can bedone. Hospice care is specialized medical care forpatients near the end of their lives. Hospice carehelps patients be comfortable. Hospice helps familiesfind some peace. The members of the hospice teamhave many ways to help.

n How does hospice help patients with pain?Hospice professionals have many ways to alleviatepain. Medications are typically used, starting out withsmall doses and milder drugs. Stronger medications(such as narcotics) can be prescribed, depending onthe needs of the individual patient.

n Do hospice patients become addicted topainkillers?NO. Use of narcotic drugs to control pain ismedically appropriate. Patients using medicationsfor pain relief (with the close support of the hospiceteam) do not become addicted.

n Do patients using painkillers sleep all the time?NO. Although pain medication can have the short-term side effect of sleepiness, that usually lessensafter a few days, with the appropriate medication andthe appropriate dosage.

n Does signing up for hospice mean giving up hope?NO. Being in hospice means a shift in focus, with ateam of caring professionals who work to understandand to help patients achieve their other goals andto work towards comfort, peace and reconciliation.Hospice allows people to live fully in the time thatthey have left.

Feel free to call Montgomery Hospice to discuss aparticular patient and what services might be availablefor that person, now or in the future. Gatheringinformation for the future can ease stress andhelp with decision-making.

Call Montgomery Hospice (301-921-4400)any time, any day.

As needed, we will visit patients andfamilies to answer questions atno charge.

n How does a familyknow when theirloved one couldbenefit from hos-pice services?Montgomery Hospicedoctors and nursesare familiar withsymptoms that indi-cate that a personmay qualify for hos-pice benefits. Thesymptoms are differ-ent depending on thedisease, but ofteninclude things suchas significant weightloss, a decrease inability to participatein normal daily activi-ties or multiple tripsto the hospital in ashort period of time.

Sandy Spring Bank17801 Georgia AvenueOlney, MD 20832800-399-5919

www.sandyspringbank.com

6 Montgomery Hospice MontgomeryHospice.org 7

Family & Nursing Care 962 Wayne Avenue, Suite 500Silver Spring, MD 20910

DONATE TO MONTGOMERY HOSPICE:

• Online: www.montgomeryhospice.org/donate

• Or mail a check:

Montgomery Hospice1355 Piccard Drive, Suite 100Rockville, MD 20850

• Or call us at 301-921-4400

MONTGOMERY HOSPICE IS A COMMUNITYSUPPORTED NONPROFIT.

Your donations make it possible for Montgomery Hospice to:

• support grieving families and individuals, regardless of whether theyused hospice services

• complement our professional medical care with massage, touch,music and aroma therapies

• provide inpatient care at Casey House for seriously ill members of ourcommunity

• provide specialized, compassionate pediatric hospice services

• provide hospice care to those who have no insurance or not enoughinsurance

www.familynursingcare.com301-588-8200

8 Montgomery Hospice

Joseph Gawler’s Sons, LLC5130 Wisconsin Avenue, NWWashington, DC 20016202-966-6400www.dignitymemorial.com/joseph-gawlers-sons

Montgomery

Hospice’s

Child Lossgroup

is for parents

grieving the death

of either young or

adult children.

WHERE DO I GO FROM HERE?

When a loved one dies, Montgomery Hospice sup-port continues. Our bereavement counselors offerto stay in touch with our patients’ family membersfor a year after the death, as they go through the

bittersweet challenges of birthdays, holidays, anniversaries andother “firsts” without their loved one. Quarterly bereavement mail-ings contain information about the grief journey, articles and poetryabout grief and healing, and a list of upcoming support groups andworkshops.

Our programs are not just for Montgomery Hospice families.They are available to anyone from the community who needs griefsupport in the Montgomery County area. Many people find it help-ful to talk privately, one on one, with someone who is familiar withthe territory of grief. For those who desire one or two face-to-facevisits, our bereavement team also offers to meet with individuals atour office, or in their homes if transportation or mobility is an issue.

Our workshop offerings include Guided Imagery, Journalingand Grief, Grieving Mindfully, Beyond Words: Grief Expressionthrough Art Making, and a group for Men Only. Our more gen-eral drop-in discussions about grief and healing were developed tomeet both the growing needs of our community and to explore griefin different ways. While conventional wisdom would suggest that“talking about it” is the best way to heal after the death of a lovedone, it is clear not everyone processes the intense emotions follow-ing a loss in quite the same way. Tools such as journaling, art andmeditation offer different avenues for comfort and meaning-makingin the difficult days following a loss. Men, for example, often findcomfort and validation in meeting with other men going throughthe same struggle.

Montgomery Hospice offers six-week groups for hospice familiesand Montgomery County residents who feel being part of a longer

term support group might be helpful. We offer General Loss foranyone grieving the death of a loved one, Parent Loss, and ChildLoss. Our Parent Loss group supports adults who have lost one orboth parents, and our Child Loss group is for parents grieving thedeath of either young or adult children. We also offer Connectionstwice a year, a six-week group for families with young children orteens who have experienced the loss of a parent or sibling. The par-ents and children meet in separate rooms to talk about their loss withpeers their own age. Teens, especially, are often glad to know thatthey’re not the only teens in the area grieving the death of a parentor brother/sister.

Montgomery Hospice bereavement counselors also refer to othergrief resources in the area for those that may need them. The griefjourney never looks the same for any two people, and the MontgomeryHospice Bereavement Care team works to meet each individual’sspecific needs.

Montgomery Hospice Offers Many Grief Support Programs

MontgomeryHospice.org 9

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WHAT CAN I DO AS I GRIEVE?

n Natural Remedies – get out in nature, walk,garden, golf

n Make Email Connections – askfamily/friends to share stories, stay in touchthrough social media, blogs or chat rooms

n Write a letter, start a journal

n Volunteer in a meaningful place

n Sort through your loved one’s things/create a memory box

n Develop a hobby/take a class

n Find things of interest to read/watch afavorite TV program

n Connect with others – sports, leisure,activities

n Get a health tune up with your doctor

n Give yourself permission to take a nap

n Treat yourself to a favorite meal orrestaurant (with friends)

n Participate in a religious/socialcommunity

Everyone experiences loss differently, and each person finds distinctive ways to workthrough grief. In order to encourage your own ideas of things to try, we offer a listof activities which have been helpful or meaningful to others.

Afternoon Grief Support GroupStarting September 30, 2014, for anyone grieving the death of aloved one, a six-week group led by Montgomery Hospice profes-sional counselors. 1:00-2:30 p.m. Tuesdays, Trinity Lutheran,11200 Old Georgetown Rd. North Bethesda.

Parent Loss Support GroupStarting October 1, 2014, for adults who have experienced the deathof one or both parents, a six-week group led by Montgomery Hos-pice professional counselors. 6:30-8:00 p.m. Wednesdays. Mont-gomery Hills Baptist Church, 9727 Georgia Avenue, Wheaton.

Evening Grief Support GroupStarting September 29, 2014, for anyone grieving the death of aloved one, a six-week group led by Montgomery Hospice profes-sional counselors. 6:30-8:00 p.m. Mondays. Montgomery Hos-pice, 1355 Piccard Drive, Rockville.

Child, Adolescent and Teenager Grief Support GroupStarting October 1, 2014, for children (4 years old) throughteens who have experienced the death of a parent or sibling.Parent/Guardian Group meets at the same time. A six-weekgroup led by Montgomery Hospice professional counselors.6:00-7:30 p.m. Wednesdays. Montgomery Hospice, 1355 Pic-card Drive, Rockville.

For a list of current workshops and groups, call 301-921-4400 orgo to www.montgomeryhospice.org/GriefPrograms/

SIX-WEEK SUPPORT GROUPS

WE’RE HONORED TO BE THERE“At a time when we might have felt very alonein the world, our family felt we had thesupport to prepare for and cope with theoverwhelming loss we were experiencing.”

“I will never forget the peace you gave us.”

“What Montgomery Hospice provided forour family was so very important ingetting us through this most difficult time.”

10 Montgomery Hospice

Pettit Family Charitable Foundation18205 D Flower Hill WayGaithersburg, MD 20879

Men don’t always fit the typical moldwhen it comes to expressing theirgrief. Family members or friends maylook at a man after a significant loss

and question why he seems to shed few tears. Theymay wonder why he does not show much emotionwhen others around him are expressing their feel-ings in a direct way. On the surface, he may seemunaffected in tone, or distracted with accomplishingtasks, or seething with emotion but somehow unwill-ing to talk about it. He may seem to want to be alonemore, and he resists sitting around with others talk-ing about his feelings. Those concerned may won-der why he does not seem to grieve like others and ifsomething is wrong.

Recent research suggests that men certainly feeland are affected by loss in big ways. For example,widowers are at risk for higher rates of depression,health problems and overall mortality than widows.They seek and receive less social support and are 5to 12 times more likely to commit suicide. There isno doubt that men feel the impact of losses in theirlives, so what is happening with their grief? Are theyin denial? Have they been taught by society that menare not allowed to cry and show their feelings? Or isthere something else going on?

A number of researchers in men’s grief, such asKenneth Doka and Terry Martin, have recognizedthat people, both men and women, have differentgrieving styles as individuals. Neither all men norall women are alike. One cannot lump them intodistinct groups, with each one containing separate“masculine” and “feminine” elements. Some menmay be more emotionally expressive than others,some women less so, and each individual is shapedby his or her own unique circumstances and loss.What Doka and Martin have noticed, however, isthat people tend to gravitate toward two patterns ofgrieving: intuitive (expressive emotion) and instru-mental (practical emotion). And they have foundthat men more often are instrumental grievers.

Instrumental grievers (practical grievers) experi-ence their world more intellectually and less throughintense feelings. They find more energy when solv-ing a problem or accomplishing a task. They cry less,or rarely, and they are more awkward around theemotional expressions of others. They tend to focuson behaviors, and their emotions are often managedin small amounts, which are tied to certain activi-ties. Intuitive grievers (expressive grievers) cry more,experience their feelings more intensely, and find itcomforting to share feelings with others. While most

DO REAL MEN CRY?Help for Men Who Grieve andThose Who Care About Them

MontgomeryHospice.org 11

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Emphasize problem solving. Begin withtheir strengths and what is working forthem. Focus on what needs to be done.

Find rituals that matter.

Engage in supportive social activities.

These can be fun outings without neces-sarily being focused on grief.

Encourage creation of a “memorial.”

This can be any activity undertaken tohonor a loved one.

Acknowledge anger when present andsuggest a healthy expression of it that isnot destructive to them or others.

Honor the space a grieving man may

need. Do not force him to talk “for hisown good,” or attempt to fit him into apreconceived idea of how grief should beexpressed.

SELECTED BIBLIOGRAPHY:

Tom Golden, Swallowed by a Snake: TheGift of the Masculine Side of Grieving

Elizabeth Levang, When Men Grieve:Why Men Grieve Differently & How YouCan Help

Gerald Schaefer, The Widower’s Tool-box: Repairing Your Life After Losing aSpouse

Jason Troyer, Counseling Widowers

Kenneth Doka and Terry Martin, GrievingBeyond Gender: Understanding theWays Men and Women Mourn

Terry Martin and Kenneth Doka, MenDon’t Cry . . . Women Do: TranscendingStereotypes of Grief

of us are not exclusively one pattern(instrumental or intuitive), but acombination, we lean more towardone or the other. Whether by in-stinct or social conditioning, mentend toward the instrumental style.

Given the difference in styles,one can begin to understand whyand how many men would seem togrieve differently. They still sufferthe impact of a loss and carry theemotion of it, but they work it outin different ways. As one man saidto me in the early days of his grief,with a combination of frustrationand pain, “I wish I could just fastforward through this part and get tothe end.” I would remind him thatsuffering in grief is unavoidable andthere is no one magical techniqueto make it speed up or go away,yet there is something important inhis desire to approach the grief journey as a series of problemsto solve and tasks to undertake. The key is to build upon hisstrengths and begin to engage in conversation about the manytasks, problems and decisions he is facing. Conversations aboutemotions still have a place, but we can come at them in a waythat is tied to certain purposes and activities.

One common experience many grieving men face is a deepsense of loneliness, and this can present an issue which needsto be addressed. For example, it is not uncommon for a wid-ower to acknowledge that his wife was the one who managedthe social calendar for activities with friends. She may have alsobeen the “hub” of communication with children and other fam-ily members over the years. So after her death, finding a wayto take up and fulfill her crucial role presents a problem. It isimportant to find the kind of social support which enables awidower to endure lonely times. Finding good ways to managesocial activities and supportive connections with others is a cru-cial part of the grief journey for many men.

This same task-oriented approach can be used to addressmany of the issues that men often face in grief: denial and shock,guilt and regret, anger, a sense of helplessness or powerlessness,mixed feelings of longing for a loved one and relief that his orher suffering is over. One important activity for grieving men isto engage in meaningful rituals. Such actions can be simple orintricate, a one-time event or an ongoing routine. To engagein a grieving ritual is to do something specific which connects

to a loved one in a meaningful way. It may be listening to acertain piece of music or looking at pictures in a way that letsyour emotions come forth. It may be building a memorial ofsome kind or creating something in a loved one’s memory. Itmay be a ritual to express anger or acknowledge guilt. It maybe a ritual to channel energy into a sport or hobby. The powerof ritual for many men is that it gives them something to do intheir grief, a task in which to engage, a channel for the emotionthey carry. In the end, the issue is not whether real men cry, butunderstanding how men grieve and how best to support themin the grief journey.

– Kip IngramMontgomery Hospice Bereavement Counselor

Montgomery Hospice offers several free multi-week

workshops/supportgroups formen throughout the

year, and anyone from the community may call to sign

up. There are also a number of supportive organiza-

tions for men, including the National Widowers’ Organi-

zation (nationalwidowers.org) and Tom Golden’s page

for men and grief (www.menweb.org/mengrief.htm).

HELPING MEN GRIEVE

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