Category: Hospice

Moments that Matter – Michelle Walden, RN, CHPN – Admissions Nurse

Michelle Walden

Describe your position with Cedar Valley Hospice:

As an admissions nurse, I meet with patients and families along with a social worker to discuss hospice criteria and admit patients to our program. It involves meeting with patients and families throughout our service area and offering education and support about terminal illnesses.

How does it support the mission of Cedar Valley Hospice?

Cedar Valley Hospice provides the leadership and sets the standard for excellence in delivering comprehensive palliative and end-of-life care to patients and services to those that grieve. I believe my position is important because I provide that initial information and set the foundation for the primary care staff that will be caring for those patients on a day-to-day basis.

What are the most enjoyable aspects of your job? Why?

I am always meeting new people. I think the best part of my job is knowing that I am helping others and seeing the relief from patients and family members when they realize they are not alone in this end-of-life journey.

Share a memorable story of a family or patient that has impacted you:

I had a patient when I was a home care nurse that really touched my heart. He was a physician before retiring and I had worked with him years ago. Honestly, I was always intimidated by him. When my visits first started with him as a patient he was trying to give me his own assessment. He would tell me his vital signs before I had a chance to do his assessment. One day, he called because he wanted to tell me he didn’t feel right. I told him I would stop over when I was done at a local nursing home. He told me, “You don’t have to do that.’ I remember telling him that I was going to be gone the next day through the weekend and I needed to know he was okay before I left town. Before I left his house that day, he took my hand and thanked me. I would have done the same thing for any of my patients, but the visit that day created a special rapport between us, which allowed him to fully trust me.

In your opinion, what makes Cedar Valley Hospice stand out above the other hospice providers in the area?

I believe that Cedar Valley Hospice patients are not just a number. Our staff truly cares for each and every one of our patients. I worked with another hospice in the Des Moines area as they cared for both of my parents. It was very difficult for me to stop being a hospice nurse and just be a daughter. I had to try to not question why they did things the way they did them, because it wasn’t the Cedar Valley Hospice way. I have helped patients that have had family members with other hospices and they have shared how much better the care is with Cedar Valley Hospice.



“It always seems too early, until it’s too late”

We plan for many things in our lives, and one of those things should be what we want to have happen at the end of life. Advance care planning means a lot more than filling out documents. It’s also about having ongoing conversations with your loved ones concerning your healthcare so you’re prepared if there is a time you are unable to make your own medical decisions. This is a gift to your family. Without the conversation, there can be confusion, conflict and guilt in a situation that is already very stressful. With a plan in place, you can focus on the things that matter.

How do you start the end-of-life conversation? Here are a few tips from the National Hospice and Palliative Care Organization (NHPCO):

One way to approach the subject is to talk about why you have decided to talk about these issues. For example:

  • Did a particular event cause you to make the decision?
  • Did an article in the newspaper or something that happened to a family member make you think about it?
  • What is motivating you to take these actions now?

Sometimes sharing your personal concerns and values, spiritual beliefs, or views about what makes life worth living can be as helpful as talking about specific treatments and circumstances. For example:

  • What aspects of your life give it the most meaning?
  • How do your religious or spiritual beliefs affect your attitudes toward dying and death?
  • What is your view towards death?

Sharing your end-of-life care decisions with your loved ones will also help them ensure your wishes are followed. Decisions may include answers to the following questions:

  • How important is it to you to be physically independent and stay in your own home?
  • Would you want your healthcare agent to take into account the effect your illness has on any other people?
  • Would you prefer to die at home if possible?

Advance care planning also includes having the conversation with your healthcare providers. NHPCO shares a few things to keep in mind when you discuss your concerns and choices:

  • Ask your doctor to explain treatments and procedures that may seem confusing before you complete your directives.
  • Talk about pain management options.
  • Let your doctor know that you are completing your advance directives.
  • Make sure your doctor is willing to follow your directives. The law does not force physicians to follow directives if they disagree with your wishes for moral or ethical reasons.
  • Give your doctor a copy of your completed directives. Make sure your doctor knows the name and telephone number of your appointed healthcare agent.
  • Assure your doctor that your family and your appointed healthcare agent know your wishes.

A few questions you can ask your healthcare provider are:

  • Will you talk openly and candidly with me and my family about my illness?
  • What decisions will my family and I have to make, and what kinds of recommendations will you give to help us make these decisions?
  • What will you do if I have a lot of pain or other uncomfortable symptoms?
  • How will you help us find excellent professionals with special training when we need them (e.g., medical, surgical and hospice and palliative care specialists, faith leaders, social workers, etc.)?
  • Will you let me know if treatment stops working so that my family and I can make appropriate decisions?
  • Will you still be available to me even when I am close to the end of my life?

Cedar Valley Hospice can help if you are ready to have these conversations or need assistance filling out your advance directives. We also can speak to your group, organization or congregation about advance care planning and provide copies of Five Wishes. For more information or to schedule a presentation, contact us today or call 319.272.2002.

The following are more resources on advance care planning and advance directives.

Independence hospice pioneer’s vision becomes a reality

Dorothy Burkhart, second from left, joined longtime friends Kitty Myers and Lorraine Mochal at Cedar Valley Hospice’s Diamond and Pearl Gala celebrating the organization’s 30th anniversary in 2009. While there, Kitty won an auction bid for a skydiving adventure – one she took to the sky on Sept. 26, 2010. She wore her husband, Dick’s orange jumpsuit in honor of him. All three ladies were pioneers in starting Independence’s first hospice. Also pictured are Cedar Valley Hospice supporters Cary Nielsen, Pat and Burnell Haven and Wilbur Nielsen.

Dorothy Burkhart, second from left, joined longtime friends Kitty Myers and Lorraine Mochal at Cedar Valley Hospice’s Diamond and Pearl Gala celebrating the organization’s 30th anniversary in 2009. While there, Kitty won an auction bid for a skydiving adventure – one she took to the sky on Sept. 26, 2010. She wore her husband, Dick’s orange jumpsuit in honor of him. All three ladies were pioneers in starting Independence’s first hospice. Also pictured are Cedar Valley Hospice supporters Cary Nielsen, Pat and Burnell Haven and Wilbur Nielsen.

Note: In December, a plaque was posted in the Cedar Valley Hospice Independence office to pay special tribute to longtime advocate and the founder of the first hospice in Independence, Dorothy Burkhart. Her story is below. 
By Stephanie Abel Hohenzy

Hospice began in Independence with the dream of a mother.

When Dorothy Burkhart held the hand of her only daughter, Lynn, for the final time in July 1978, it changed her life. It bothered her that at the age of 35, Lynn would not see her two children grow or live life by her husband’s side. As Lynn’s main caregiver, it was difficult to watch her body go through the final stages of breast cancer. It wasn’t until she traveled to her Florida home and volunteered for a hospice there, that she learned the value and comfort such a program could offer terminally ill patients and their families.

Upon her return to Independence, she set out on a mission – to start a local hospice. She didn’t want another family to ever have to go through life’s most difficult stage alone. Her son, Brooks, remembers how “fired up” she was, which, he adds, wasn’t uncommon for his mother when she set her mind to something. She started talking to friends and enlisted their help to gather support in the community.

“She went right to the town’s prominent family physicians, Dr. Myers and Dr. Mochal, and their wives and said flat out, ‘We are going to start a hospice.’ When my mother asked for something, you didn’t turn her down,” says Brooks.

Dorothy often went door to door asking for donations but raising money was difficult at first since the concept of hospice was generally foreign to most. Although there had been only a few contributions, in 1982, a Board of Directors was formed. So, in a number of meetings headquartered in Dick and Kitty Myers’ backyard, the Myers, Mochals, Dorothy and others started Buchanan County Hospice. These community pioneers often contributed their own funds at meetings to carry out the work of the new organization.

Thanks to Bob Richards, the administrator at People’s Memorial Hospital at the time, office space was opened for the endeavor. The hospital also provided a hospice in-patient room, which was furnished with a home-like setting thanks to a generous memorial gift from the Orval Shatzer family of Jesup, following his death.

A coordinator was hired in 1983 and the first training program took place in 1984. One year later, the organization cared for its first patient. In the following years, the organization grew, gaining more support. Dorothy then went out and found more resources to begin to train volunteers to help patients’ families. By 1989, they had trained volunteers numbering far more than their patient load. They then started a program called Project Love to provide respite care for the chronically ill – providing caregivers with much-needed support when their loved ones aren’t hospice eligible or ready for hospice.

In 1991, Hospice of Buchanan County was able to look at expanding its offices and services thanks to a bequest from Cecilia (Slater) Pochedly. However, as hospice grew, they realized that more services could be provided to patients if they were Medicare certified. With that in mind, negotiations began with Cedar Valley Hospice, and an agreement was signed in 1992. Drs. Myer and Mochal stepped up again, donating their office building on First Street East, where Cedar Valley Hospice currently resides.

Dorothy remained involved as a volunteer over the years and was a valued donor. She enjoyed watching the hospice she helped start, prosper to include not only Buchanan county but Fayette, Delaware, Linn and Benton.

Since then, over 1,000 families have been served, including Dorothy’s husband, Dwight, in 1996, and Dorothy, who passed away on Sept. 2 at the age of 99.

Brooks and his wife, Hildegard, are so grateful to Cedar Valley Hospice and the support they provided for his mother. Team physician Dr. Duane Jasper was also an instrumental part of the care team.

“Jasper didn’t waste any time, he knew it was the right moment for my mother to be placed in hospice care,” says Brooks. “Cedar Valley Hospice showed up within a few hours. I will never forget our nurse, Jean. She was excellent. The knowledge and caring she had made all the difference for my mother and for us. We knew we could leave because hospice was there.”

Dorothy had struggled with a constant restlessness for weeks. This all changed when Cedar Valley Hospice became involved, says Hildegard.

“The Cedar Valley Hospice Nurse was the only one that could calm her down. It was wonderful,” Hildegard adds. “She advised us how to talk to Dorothy to help bring her peace…telling her that she was going to see her Lynnie, which, when other conversation failed, she would nod and relax.”

“Cedar Valley Hospice takes all the guesswork out of caring for your loved one,” adds Brooks. “We know how it started and have seen them in action…they are the experts…How could it be done any better?”

Dorothy’s dream came true. No family has to be alone at the end of a loved one’s journey and throughout their bereavement. 

Hildegard looks at a photo of Dorothy and a tear rolls down her face, “Lynn would be proud.”


Preparing for National Hospice & Palliative Care Month

Each year we recognize November as National Hospice and Palliative Care Month. During this time, we encourage those in our communities to increase their understanding and awareness of end-of-life care. There are many misconceptions about hospice and people who don’t understand what it is. At Cedar Valley Hospice, we understand that. We feel honored to be a part of the lives of patients and families during this very intimate time. Hospice and palliative care empowers those facing a life-limiting illness to live as fully as possible, surrounded and supported by family and loved ones. Our staff is there to companion patients on their end-of-life journey, provide support for families and friends to help them understand the dying process. Grief services are also available after the death and are provided at no cost.

During the month of November, we will be at our Waterloo, Independence and Waverly offices providing education on hospice and palliative care. You are invited to come learn more about the services Cedar Valley Hospice provides and the resources available. Come meet the staff, get a flu shot or enjoy some refreshments. Cedar Valley Hospice is the original hospice and will continue to be here setting the standard for excellence in providing comprehensive palliative and end-of-life care to patients and services for those who grieve. Below are the events taking place during November:

-Waterloo Open House, Health Checks & Meet the Staff: Tuesday, November 3, 2015 from 11:00-1:00. Kimball Ridge Center Lobby, 2101 Kimball Ave., Waterloo. We will have cookies and refreshments and will be handing out information. Covenant Wellness Services will be providing free bone density scans and BMI testing.

-Independence Open House, Health Checks & Meet the Staff: Thursday, November 5, 2015 from 11:00-1:00. Cedar Valley Hospice Independence office, 801 First St. E., Independence. We will have cookies and refreshments along with a raffle prize drawing. Sweet Spot will be selling cupcakes and Hartig Drug will offer flu shots for $25 or free with a Medicare card.

-Waverly Open House, Health Checks & Meet the Staff: Wednesday, November 11, 2015 11:30-1:30. Cedar Valley Hospice Waverly Office, 207 20th St. NW, Waverly. We will have cookies and refreshments and a raffle prize drawing. Also, Bremer County Public Health will be offering flu shots for $26 or free with a Medicare card.

Also, as part of the Cedar Valley Hospice Speakers Bureau program, our staff can provide presentations on many topics related to hospice and palliative care, death, dying, grief and more. Presentations are provided at no cost and a way of giving back to those who share in our mission of serving those in need with care and compassion. If you are a part of a community group, church or business and would like to invite us to speak, call us at 319-272-2002. To see a list of topics and descriptions, click here.

We truly believe in our mission, and for 36 years have served thousands of patients and families. Calling hospice can be a difficult decision, but the benefits of hospice care truly make an incredible difference to both the patient and family. To learn more about Cedar Valley Hospice, visit or call 319-272-2002.

Pain Awareness Month – Benefits of Palliative Care, LINK

September is Pain Awareness Month and a perfect opportunity to focus on awareness of issues in the area of pain and pain management. It’s also a great time to talk about palliative care. For those that don’t know what palliative care is, it is a type of care that focuses on pain and symptom management and places attention on the patient rather than the disease or illness. Palliative care can be provided anywhere – home, hospital, assisted living facility or nursing facility.

Cedar Valley Hospice staff are trained experts in this area and we also offer a program, LINK, specifically for palliative care. LINK stands for Listen, Inform, Navigate and Knowledge and was developed to provide supportive care to those individuals and families facing a life-limiting illness and don’t yet qualify for hospice, or simply aren’t ready for hospice. The goals of LINK are: listen to patients and families, inform patients and families of resources in their communities, navigate the current health care system and educate patients and family members on health care choices and treatments.

Patients on the LINK program receive visits from a nurse and social worker that offer support, companionship and assistance. Someone might consider LINK if they have recurrent hospital admission for an advanced illness, difficulty managing symptoms, family conflicts regarding course of treatment or distress, anxiety or loss of hope. To be eligible for LINK, patients must be diagnosed with an advanced stage of a life limiting illness with a physical and/or psychosocial need.

The difference between LINK and hospice is LINK patients can still be seeking a cure for their illness. All hospice care is palliative but not all palliative care is hospice. Many patients on LINK might qualify for hospice but may not be ready to take that step yet.

LINK social worker, Erin Hubbard, says this program is beneficial to help those who may qualify for hospice in the future be prepared and know not to be afraid of making that transition to hospice.

Erin’s favorite part of her job is building relationships with patients and coming into their lives at a time when they need support, guidance and direction.

“We help ease the stress of their diagnosis and help patients make necessary decisions,” Erin said.

Having a palliative care program is another quality that makes Cedar Valley Hospice unique. Palliative care provides a way for those with a life-limiting illness or chronic pain to take control of their lives which helps improve quality of life. For questions on palliative care or the LINK program or to find out how LINK can help you or your loved ones, click here or call Cedar Valley Hospice at 319.272.2002.

Paying For End-Of-Life Care

One of the many misconceptions of hospice is that it costs too much. Many families are not aware that hospice is paid for through the Medicare or Medicaid Hospice Benefit and most private insurers.

Cedar Valley Hospice is a not-for-profit organization and provides care to anyone who qualifies for admission, regardless of inability to pay. Community contributions assure care for those who cannot pay and for costs not covered by insurance.

The Medicare Hospice Benefit provides a model for financing end-of-life care that can bring great relief and support to families during one of life’s most difficult times. There is never a charge to Medicare or Medicaid recipients for hospice services. As a result, the financial burdens often associated with caring for a terminally-ill patient are lifted.

Hospice care at Cedar Valley Hospice also offers supports to the loved ones of the patient; this brings an added level of relief to the dying person, knowing their loved ones are being cared for as well.

Medicare covers these services from a hospice provider when related to the terminal prognosis:

  • Nursing care
  • Medical equipment (example – wheelchair or hospital bed)
  • Medical supplies (like bandages and catheters)
  • Drugs for symptom control and pain relief
  • Short-term care in the hospital or the Cedar Valley Hospice Home, including respite and inpatient for pain and symptom management
  • Home health aide and homemaker services
  • Physical and occupational therapy
  • Speech therapy
  • Social work services
  • Dietary counseling
  • Grief support (The grief services at Cedar Valley Hospice are always provided at no cost to anyone in the community grieving the death of a loved one)

Medicare will still pay for covered benefits for any health problems that aren’t related to a terminal illness.

The team members at Cedar Valley Hospice are experts in medical care, pain management and provide emotional and spiritual support expressly tailored to the patient’s needs and wishes. Families making end-of-life decisions for a loved one need compassion and support, not financial worries. Cedar Valley Hospice is here to Make Each Moment Matter and alleviates those concerns so that the main focus for the patient and family is spending time with their loved one.

Click here to read more about the Medicare hospice benefit, or visit

To learn more about the services at Cedar Valley Hospice and the resources available to patients, families and the community, call 319.272.2002 or visit

Tim Moses, Son

Don’t Wait to Call – Five Myths of Hospice

Far too many people wait until they are in the midst of a health care crisis before thinking about what options are available and what care they or their loved ones would have wanted. Hospice professionals deal with these challenging situations every day – that’s what they are trained to do.

When a family is coping with a terminal illness, hospice provides comfort and dignity, making sure every day is as good a day as possible. Hospice care includes expert medical care, pain management and emotional and spiritual support. Care is provided by an inter-disciplinary team of professionals, including trained volunteers, focused on making the wishes of the patient and family the center of care.

At Cedar Valley Hospice, we often hear, “we wish we would have called sooner.” This is because many people are scared of hospice and are faced with many misconceptions about it.

“We waited too late, we thought it was something that Dad would overcome. I wish we would have contacted Cedar Valley Hospice sooner because it would have taken the pressure off of us as kids. I’m glad we did make the call because it helped things go more smoothly at the end.” Tim Moses, Son

Here are five common myths of hospice:

MYTH: Hospice is a place.
FACT: Hospice services are provided in a patient’s own home, a nursing home, long-term care facility or hospital. Cedar Valley Hospice also offers a hospice home available for short-term stays to manage a pain crisis, provide respite or residential.

MYTH: Only a physician decides it is time for hospice.
FACT: Anyone can make a referral – family member, clergy, physician, hospital, nursing home.

MYTH: Hospice means not returning to medical treatment.
FACT: Hospice nurses and physicians are experts in the latest medications and devices for pain and symptom management. Once on a hospice program you are being cared for physically, socially and emotionally. Many times this quality care improves a patient’s health to a point that they no longer qualify for hospice, resulting in a graduation from the hospice program. At this time patients may choose to seek curative treatment again.

MYTH: Hospice is only for the last few days of life.
FACT: Hospice is for patients with a prognosis of six months or less. Research shows that those on a hospice program, live longer compared to someone with the same diagnosis and prognosis of someone who is not.

MYTH: All hospices are the same.
FACT: There are certain services hospices are required to provide for Medicare certification. Cedar Valley Hospice offers what is required and a variety of additional services to meet the needs of patients and families. These services include: grief services for families and children, a LINK palliative care program for people with a serious illness but do not yet qualify for hospice and CASS (Cedar AIDS Support System) case management for people with HIV and AIDS. There are also for-profit hospices and not-for-profit. Cedar Valley Hospice is a not-for-profit organization.

When hospice is involved at the end of life, there are many benefits to the patient, their family and friends. The sooner the call is made, the sooner our staff can begin building relationships come in and start a plan of care. This helps improve quality of life for the patient and helps ease many concerns from family members. Calling Cedar Valley Hospice allows family members to be the husband, the daughter, the sister or brother again, rather than only a caregiver. One of the best ways to make sure you and your loved ones benefit fully from hospice, is to talk about it and educate yourself before it becomes an issue before you would ever need this type of care.

Along with providing hospice services, Cedar Valley Hospice provides many different resources to the community. Our speakers bureau program provides presentations at no cost to any groups in the community and there are several topics including general hospice, grief, death and much more. Cedar Valley Hospice grief support services are offered to anyone in the community grieving the death of a loved one. There are also several different grief support groups taking place in our service area communities. We also offer workplace resources and tips for supporting employees going through a difficult time through the Caring Connections program. To learn more about Cedar Valley Hospice and the resources available to the community, call 319.272.2002 or visit

The Role of Spiritual Care Counselors at Cedar Valley Hospice

Spiritual support is available for anyone at Cedar Valley Hospice regardless of religious beliefs. Spiritual care counselors at Cedar Valley Hospice provide spiritual support to patients and their families and caregivers. They offer a non-denominational, open, giving relationship outside the clinical medical routine. For some patients, the chaplain can help ease the social isolation of this life stage.

Spiritual Care at Cedar Valley Hospice

With three full-time spiritual care counselors and two part-time spiritual care counselors on staff at Cedar Valley Hospice, we are equipped to help any patient, family and congregation with their spiritual needs. As a part of National Pastoral Care Week October 19-25, we want to outline how our spiritual care services work so you can be aware of them and the benefits they offer.

  • Notification from a spiritual care counselor- When a member of a congregation is admitted to Cedar Valley Hospice, one of our spiritual care counselors, with the patient’s permission, will notify their pastor, reverend, rabbi or other clergy member. They will also update them when there are changes in the patient’s condition or when a death has occurred.
  • Spiritual care services are optional- Not every patient chooses to use Cedar Valley Hospice’s spiritual care services; they are available for those who wish to use them.
  • Spiritual care services can be accessed at any time- When a patient is admitted to Cedar Valley Hospice, they may initially choose not to use spiritual care services. However, as they near their death, they or their family may decide they want to have the comfort our spiritual care counselors provide.
  • The Cedar Valley Hospice spiritual care counselor does not replace a pastor, reverend or other clergy member- They act more as a coordinator for spiritual care, supplementing when necessary to help patients and families face death with dignity and peace.
  • Our spiritual care counselors respect all religions and beliefs- Regardless of the religious and spiritual beliefs of a patient, Cedar Valley Hospice spiritual care counselors provide and coordinate spiritual support in ways that will help comfort the patient and their family.

The spiritual care counselors at Cedar Valley Hospice are experts in working with clergy members, families and congregations. In addition to providing spiritual care to hospice patients, our spiritual care counselors also offer in-service training for church staff and small to large groups in a faith community, as well as ongoing resources for congregations. When it comes to providing spiritual care for hospice patients, the spiritual care counselors at Cedar Valley Hospice are here to be a source of comfort and help you get the support you need.

The Benefits of Hospice Care in Assisted Living Facilities

Hospice care in an assisted living facility allows a patient to stay where they are comfortable while receiving the care they need.

Hospice care in an assisted living facility allows a patient to stay where they are comfortable while receiving the care they need.

There are currently over 735,000 people across the United States living in assisted living settings, and that number is expected to increase according to the National Center for Assisted Living. As Baby Boomers, a generation of over 70 million Americans, continue to age, many of them will seek out the services provided by assisted living centers.

Assisted living facilities in Iowa and across the country provide environments that allow residents to continue living as independently as possible while offering assistance with medical, social, emotional or other needs. As part of National Assisted Living Week 2014, Cedar Valley Hospice not only wants to recognize the great work of assisted living facilities, but also discuss the care we provide to patients in assisted living facilities.

Services for Patients

If a patient has been admitted to Cedar Valley Hospice, our staff can provide them the medical care they need wherever they call home. Our staff members are experts in assessing and managing pain and other symptoms at the end of life.

Care from Cedar Valley Hospice in assisted living facilities integrates smoothly with the care and services the patient already receives. The main goal is to make their days as comfortable and pain-free as possible.

Cedar Valley Hospice also has resources available to help patients complete advanced directives, including living wills, durable power of attorney for health care and IPOST that a social worker can help with. This helps make a patient’s wishes about their treatment known in a legal document.

Services for Family Members and Friends

The interdisciplinary care team at Cedar Valley Hospice is trained in helping patients and their families make the transition into end-of-life care. They provide emotional and social support throughout a patient’s last months, and after the patient has died, they continue to be a resource for grieving family members and friends including Assisted Living staff. Cedar Valley Hospice grief services are always available to anyone in the community.

Cedar Valley Hospice can also help arrange visits for spiritual support as well. We respect the faith and beliefs of all of our patients and will help to arrange for spiritual support visits if requested.

Care in assisted living facilities from Cedar Valley Hospice is aimed at making a patient’s life as comfortable as possible, giving them a voice when they can no longer speak, and supporting their family in the last days of their life and after their death.

To learn more about how we help serve patients in assisted living facilities, contact Cedar Valley Hospice today. Family members and healthcare professionals can also make referrals directly from our website.