911 and COPD

911 and COPD

By Victor Montour

My sound sleep was abruptly disturbed by my phone ringing in the middle of the night. Knowing my friends and family very well, none of them would call me in the middle of the night unless there was a major problem. It’s my mother on the phone calling to tell me she has called 911 because grandma can’t breathe.

I race to the local emergency room and find my mother waiting in the waiting room, almost in tears. After waiting the longest 5 minutes of our life a young nurse comes out and informs us that my grandmother has made it to the emergency room. The nurse then offers to take us to her room.

My grandmother is sitting up in the hospital gurney with a nebulizer mask over her nose and mouth. Her eyes are as big as fifty cent pieces and she is working really hard to breath. The nurse informs my mom and I that she is giving my grandmother a breathing treatment to try and open up her air way.

After 24 hours in the hospital and a multitude of tests the doctor returns and tells us my grandmother has COPD. Not sure what that means I did a little research of my own and this is what I found out.

What is COPD? Chronic Obstructive Pulmonary Disease (COPD) refers to a group of lung diseases that block airflow and makes breathing difficult. Emphysema and chronic bronchitis are the two most common conditions that make up COPD. Chronic bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. Emphysema occurs when the air sacs (alveoli) at the end of the smallest air passages (bronchioles) in the lungs are gradually destroyed.

Damage to your lungs from COPD can’t be reversed, but treatment can help control symptoms and minimize further damage. Symptoms of COPD often don’t appear until significant lung damage has occurred, and they usually worsen over time.

People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse and persist for days or longer.

In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because only about 20 percent of smokers develop COPD.

Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and workplace exposure to dust, smoke or fumes.

As I continue to research COPD I found that a number of skilled nursing facilities, hospices and home care agencies have developed specialty programs that focus on the care and symptom management of COPD. These specialty programs are being developed to provide specially trained nurses and other care givers on the best clinical methods for treating the symptoms of COPD. Finding a hospice or home care agency with these specialty programs will improve your chances of getting the best symptom management for your COPD.

My grandmother lived 9 years with her COPD. In and out of hospitals, nursing homes even homecare for a while. In the end my grandmother was tired of spending her time in the hospital away from her family. She chose to have hospice come in and care for her at home. Hospice was able to treat her symptoms and make her comfortable while allowing her to remain in her home till she passed.

If you would like more information about Front Range Hospice and our COPD program call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

Watch out for our next blog Started Hospice at Home Today – I’m Scared!

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Front Range Hospice

Front Range Hospice


Location of Care

  • Front Range Hospice provides care for patients residing in Weld, Boulder, Broomfield, Adams and Larimer Counties.
  • Front Range Hospice cares for patients and their families in their home, wherever they call home –private residence, assisted living, independent living facilities, and skilled nursing facilities.

Staffing / Visit Patterns

  • Hospice is skilled, intermittent care. Every care plan is individualized to meet your needs.
  • Front Range Hospice clinical staff carry the smallest caseloads in the industry.
  • Our Clinical Team consists of Registered Nurses, Social Workers, Chaplains, Certified Nurses Aides and Volunteers.
  • Front Range Hospice on call team consists of a Medical Director, an RN, a psychosocial team members and an Administrator.
  • Front Range Hospice volunteers are professionally trained to provide companionship throughout the hospice journey as well as Veteran and Vigil volunteers.
  • Our physicians are mobile and are able to visit patients in their own homes. We also work closely with primary care physicians in the community.


  • Front Range Hospice provides care for all patients over the age of 18.
  • When calling Front Range Hospice after hours, the caller is directly connected to a full time Front Range Hospice Nurse or Administrator.
  • Front Range Hospice provides admission services 24 hours a day, 365 days a year. We respond rapidly and can often be at your home within the hour.
  • Front Range Hospice offers individual bereavement counseling.

Insurance / Finances

  • Front Range Hospice provides care for patients with Medicaid, Medicare and all HMO Senior products. We also are contracted with Aetna, United Health Care, Cofinity, Colorado Foundation for Medical Care, Blue Cross, Veterans Administration, and Humana. We continue to add new insurances.

Every uninsured patient’s care is considered on a case by case basis. Front Range Hospice is Different from the Rest!

  • Our focus is to allow patients to live and die in the environment of their choice.
  • Our response time from referral to admission is less than two hours – guaranteed.
  • We are Joint Commission Accreditated which is the Gold Standard in the industry and rare in the hospice world.
  • Members of Studer Group, a healthcare consulting firm that focuses on the experience of care
  • We understand that there are no do over’s in end of life care so we strive to get it right, every time.
  • We strive to provide Legendary End of Life Care.

Front Range Hospice
(303)957-3101 or (970) 776-8080

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Front Range Hospice Non-Profit Memorial Fund 501(c) 3

Front Range Hospice Non-Profit Memorial Fund 501(c) 3

As mentioned in a prior post there’s not much difference in for-profit and non-profit organizations. Providing legendary care however is a huge difference. Legendary Care is not just a slogan; it is the heartbeat and soul of Front Range Hospice.

At Front Range Hospice we go above and beyond to provide Legendary Care to patients, families and referral sources. Putting people first and doing the right thing is the beginning of our legendary care. Meeting this goal is sometimes challenging with the current Medicare hospice benefit limitations patients and families are faced with everyday. To help bridge this gap in coverage Front Range Hospice started the Front Range Hospice Non-Profit Memorial Fund.

When donating to the Front Range Hospice Non-Profit Memorial Fund people are not donating money to fund a beautiful fountain in the city park or a unit in a hospital wing named after a benefactor. What they will find is 100% of all donations go to pay for things not covered by the Medicare hospice benefit. Here are examples of what we have used the money for:

  • A patient suffering from end stage COPD wants nothing more than to see his only son before dying. The son is a single guy trying to pay for college and support himself on minimum wage and doesn’t have the money saved up to fly home to see his father. Putting people first and doing the right thing, the memorial fund was used to purchase a round trip airline ticket and then a shuttle to and from the airport so this father and son could spend time together and say their “I love you, I am sorry, and goodbye”. What better example of doing the right thing.
  • The Front Range Hospice Non-Profit Memorial fund has been used for filling propane tanks so a patient’s home can be warm during the winter. One patient was quite young and had been the major wage earner. Our certified nurse’s aide arrived one winter morning at the home and when she went in she could see her breath. The patient was under four blankets and still shivering. When she found out that the family was rationing their propane because they could not afford to fill the tank she called the office. A propane company was out to the home that afternoon and filled the tank. When they were told to send the bill to Front Range Hospice Memorial Fund, they reduced the bill.
  • The fund often buys clothing for residents in nursing homes who have no family.
  • The fund buys pocket talkers (amplifiers) so a patient can hear the laughter of their grandchildren in the home.

These are just a few examples of the many things that the donations to the Front Range Hospice Non-Profit Memorial Fund has done to ease the end of life journey of patients and families.

Front Range Hospice does not receive payment from this fund nor is there a cost associated with administrating the fund as all administrative functions are either donated or paid for privately. 100% of all funds are used to ease the journey of the patient and their family. When approving expenses, the committee asks one question. “Would anyone that donated this money object to this expenditure?”

Front Range Hospice, going above and beyond to provide Legendary Care to patients and families by putting people first and always doing the right thing.

For more information call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com. If you would like to give a tax deductible donation, send your check to:

Front Range Hospice Memorial Fund

3770 Puritan Way Unit #E

Frederick CO 80516

Look for our next blog – Summary of Front Range Hospice Services

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As hospice liaisons we are asked on a daily basis “are you a non-profit hospice?” After being asked this question day after day we thought what a great topic for our blog page. All of us at Front Range Hospice believe that knowledge is power, so visit our blog page frequently or like us on face book to get the answers to the questions you may have.


by Victor Montour

The Medicare Hospice benefit is a highly regulated program with very specific requirements that are monitored closely. This oversight is in part needed because approximately 90% of hospice patients are receiving services under their Medicare benefit.

Medicare pays all hospices a per diem rate, which is the dollar amount Medicare, has determined that will cover essentially all of the expenses related to the management of the patient’s care. This dollar amount varies from state-to-state and then from county-to-county. The rate is based on the location the care is provided not the location of the hospice office. There is no difference in the rate between for-profit or non-profit.

Perhaps the most significant difference between a non-profit hospice and for- profit hospice is that non-profits do not pay taxes. This is an exclusive quality of all non-profits no matter what the goals of that organization may be. A common misconception is that “non-profit” means monies are not exchanged or that the non-profit organization is run by volunteers, donations, and grant money. Some of this is true; however it is not completely true, as non-profits have employees that receive compensation. In the case of a non-profit hospice, Medicare pays them the exact same per diem that the for-profit hospices receive. They are just not taxed on that money due to how their business is structured. The taxes that are assessed to the for- profit hospices are paid to the county in which they are located; this money is then used to support local government, social programs, and special projects that benefit the community.

Every hospice must follow the guidelines that Medicare has designated, and every hospice is run differently and is special in its own way. This flexibility is an intricate part of the Medicare Hospice Regulations. There are regulations of what needs to be provided and there is flexibility in how this is provided. Beyond the Medicare criteria, every hospice has the ability to do things in their own special way. For example, aroma therapy, music and pet therapies are just some of the complementary therapies that a hospice may have to offer. You may find different complementary services throughout the other hospices of Colorado. It is these special extras that make each hospice unique and establishes a personal fit to those that are entering hospice. It is indeed these special “extras” that may help a person when they are deciding which hospice is right for themselves or their loved one.

When you really look at the differences between for-profit and non-profit hospice organizations, I believe you will see they really aren’t so different. Hospices, regardless of how they are organized, are here to help people live their lives with dignity and in comfort. They want to help the patient as well as the family, their caregivers, and their physicians. All hospice organizations follow the Conditions of Participation, have wonderful and caring staff members, and are prone to giving back to their community.

The major difference that really stands out is the one of personal choice. When you are choosing the hospice that is right for you, finding the organization that has the personal touches that appeal to you may be the motivating factor that you would want to consider.

Watch for our next blog – Front Range Hospice Non-Profit Memorial Fund

For more information call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

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Hospice Care in an Assisted Living Facility? Why Not?

Hospice Care in an Assisted Living Facility?  Why Not?
Written by Barbara Reed

Many people live fulfilling lives in Assisted Living communities. Their days include social events, dining, perhaps volunteer opportunities, and a measure of independence in their own apartments.    Many develop deep friendships with other residents and affection for the staff.  Families of residents often form a strong bond after seeing one another visiting family members on a regular basis.  In short – the time spent living in Assisted Living can be very rewarding for the resident and the family, and a deeply meaningful experience for the staff at the facility. So why would anyone want to change all these components just because a person qualifies for hospice?  When one’s health condition changes and a person can qualify for hospice care, most of the time that person can stay in the assisted living community – with additional support from the hospice team.  The hospice team works hand in hand with the community team, ensuring that the care plan created by hospice is manageable within the level of care that the assisted living community offers. This goes back to the core values of honoring the wishes of a patient and the family.


I’ve had an opportunity to see first-hand how this collaborative care can be so successful.  Before joining Front Range Hospice, I worked for over 8 years for a large assisted living provider.  I saw on a daily basis how complimentary these two disciplines can be……from the perspective of the assisted living community.  We all want the least restrictive, most independent environment for the resident.  The collaborative relationship between assisted living and hospice creates the best end of life quality for the resident and the family.  A referral for hospice care early in the resident’s disease process allows the two teams to develop strategy to maximize all of the ways hospice provides care.


I recall clearly a patient in her 40’s for which the assisted living community and Front Range Hospice provided amazing care.  She had no family living locally and she had been ill long enough that only her most loyal friends stayed in touch.  When I was first made aware of her situation, it was through a phone call from the case manager at the local hospital – looking for a good fit for her favorite patient.  I was able to show the case manager how closely the wellness team and Front Range Hospice work together. On the recommendation of the case manager, the patient moved into our community and became our resident.  As she began her decline, these two teams decided to host a tea party in her room – complete with china cups, tea pots, and sweets.  We took turns enjoying the company of our resident/patient and we were so happy to do this for her!  

September 7th – 13th is National Assisted Living Week – a time to honor the incredible work done every day by our Assisted Living partners. 

Please remember that a move from the familiar surroundings of home – whether someone lives in their own home or in an assisted living community – can be very stressful.  Front Range Hospice will work closely with the assisted living team to ensure the best possible care is given wherever the patient calls home.  It is essential to understand what care is needed now, and as the patient’s health declines – what the assisted living community, family, and patient should expect going forward.   Honest and open communication is the key to caring successfully for a hospice patient in an Assisted Living community.

If you are considering relocating a patient or a loved one from Assisted Living simply because that person qualifies for hospice, please consider the option to have that person stay in his or her home – surrounded by their familiar support systems and receiving  Legendary Care from Front Range Hospice.


Follow us on Facebook: www.facebook.com/FRHospice

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What Is A Hospice Nurse

What Is A Hospice Nurse

Outside its noisy along the houses on a street in the suburbs of Denver. But inside one tidy living room, all is quiet except for the sound of a woman’s raspy breathing. The patient is huddled in an easy chair under a handmade pink-and-blue afghan, a knit cap on her head and booties on her feet. Her cancer has returned with a vengeance and she has only a few weeks to live. A Front Range Hospice nurse kneels down beside her, listens to her breathing, and then checks her blood pressure. The nurse has already had oxygen tanks delivered to the home, the nurse shows family members how to work them, organizes the medicine, and assesses how her patient has been eating and sleeping. The nurse now takes a moment to connect one-on-one with her patient. The nurse wraps her hands around the woman’s hands and rubs them together to warm them. She looks into her eyes and asks softly, “are you feeling a little better today?”

Getting to know our patients and families, and helping them through the toughest time of their lives is what Front Range Hospice nurses appreciate most about being a hospice nurse. We don’t know of another place or position where we can do more for people.

The patients at Front Range Hospice have all been told that they have six months or less to live. Rather than continue with often-difficult or painful treatments that probably won’t extend their lives, they have decided to stop trying for a cure that most likely won’t come. Instead, with the help of hospice care, they’ll focus on comfort and living whatever they have left of their lives to the fullest — usually in their own home.

Being able to die at home is a major part of the appeal of hospice, but patients and family members may not see it that way at first. A lot of people still view hospice as giving up and letting the disease win. That’s why the decision to call in hospice care can be an incredibly difficult one for a family to make. Once they do, though, most patients and their families soon understand the value of having a team of dedicated professionals — including social workers, certified nursing assistance, chaplains, and nurses — work together to provide not only physical but also emotional and spiritual support.

When a nurse takes their first job in hospice care they have the same fears as anyone about hospice. A veteran nurse, who’d worked in operating rooms, expected it to be unbearably sad. But on her first day, she was surprised that the family members were relaxed and sharing funny stories about their dying father. There’s still happiness in the sadness of it. She realized that hospice is not just about death– it’s about life. The life of one’s past, present and future.

By spending time inside patients’ home the nurse gets to witness the blessings of a peaceful ending to life. The nurse may have seen family members resolve longstanding, hurtful disputes and be reunited. For some patients the victories have been smaller but equally profound: a visit to a hair salon or being able to sit outside on a nice day. But getting patients and their relatives to that place of peace and acceptance can be tough. Some families are divided or resistant to the idea of hospice. A family may ask the nurse to cover her badge and not mention hospice to the patent, thinking that if their grandmother saw the word hospice or heard it she’d give up and die.

Others may unnecessarily worry about drug addiction and won’t give their sick relative pain medicine when it’s needed. Some patients are afraid of taking morphine, thinking it will stop their breathing or make them feel out of it. “Did you take your pain medicine?” The nurse asks her patient, who is holding her rib cage in agony. The nurse squats beside the hesitant woman and assures her she’ll stay with her while she takes it, to make sure she’s okay. The patient is worried she’ll just sleep away the time she has left, but pain medicine often allows a person to feel better and actually do more. 

Many days Front Range Hospice nurses are busy juggling crises — one patient may have fallen down, another may be vomiting, and another is close to dying. Other days our nurses delicately navigate the fears of patients and families with their gentle, grounded spirits. During and after visiting patients our nurses find that people want to know the same things: how long they have left and what the final moments will be like. Some only want to know if the nurse can keep them calm and out of pain. They can. Others want details, so the nurse explains that after they stop eating and drinking, for example, they will become semi-comatose and just gradually slip away.

Some still wonder if they could be the rare person who survives. “Has there ever been a case where somebody walks away from this?” one 75-year-old grandfather asks the nurse hopefully. “I don’t know,” the nurse says after a moment. She explains that it’s hard to say with his kidney disease. “Live each day,” the nurse tells him. Then, noting his jokes about eating whatever he wants and having his daughter and wife wait on him, the nurse adds with a smile.

Because many people see hospice care as the end of hope, there are even some doctors who are reluctant to bring up the option. As a result, more than a third of hospice patients don’t start hospice care until they have just days left to live. Ironically, some patients who get hospice care live longer than those who don’t, studies show. But many wait until it’s nearly too late, and those people often sacrifice the chance for closure.

More often than we like the nurse gets a message: The man she’d just seen for the first time two hours earlier has already died. “Ooh,” the nurse says, letting out a long, frustrated sigh. The nurse knows what we could have done for him if we had more time — the same thing we all want for ourselves when our life is ending: a chance to have those last conversations, to be comfortable, at home, surrounded by loved ones.

That’s why the nurse tries to focus on what patients want and need. And when a terminally ill person hangs on longer than seems possible, nurses learn from experience that the patient may be waiting for something to be resolved. An example of this is a dying woman’s adult children are gathered at her bedside. One of the daughters, in particular, is heartbroken and distraught. The chaplain leads them in prayer and then the children, leaning on each other, leave the room. “Look, they’re together”, the nurse whispers to her patient. Sensing she is worried about them. “If you want, it’s okay to go. They’re going to be okay.” Within minutes, the patient dies with the nurse holding her hand.

“People are so afraid of how it’s going to end but when you’ve been there and held their hand and watched them take their last breath, you see that it’s a really powerful moment — powerful and peaceful.”

Like us on Face Book at https://www.facebook.com/FRHospice


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Balm for the Broken-Hearted: The Bereavement Program

Balm for the Broken-Hearted: The Bereavement Program
Jonathan C. Wretlind, M.Div
Chaplain and Bereavement Coordinator, Front Range Hospice

One of the great benefits of hospice care is the emotional support offered by chaplains, social workers, and the bereavement program. A well-organized bereavement program is crucial to providing the best care to hospice families. Hospice is not only about caring for the patient, but realizing that death of a loved-one impacts the entire family-system. Offering each family the opportunity to receive support for 13 months following a death, the bereavement coordinator “follows” family members by mail and phone in order to provide assistance to those who need it and are willing to receive help. It is a free benefit, and one that is often overlooked in presenting the benefits of hospice to family members considering hospice care for a loved-one.

One of the main goals of a bereavement program is to identify those individuals in a family that may need extra support, may experience “complicated grief”, and may need ongoing professional support through a referral to a local therapist or counselor. Complicated grief can be a serious psychological condition, and can mimic symptoms similar to Post-Traumatic Stress Disorder (PTSD), and is a form of secondary trauma itself. It may even lead to fully-developed PTSD, cause permanent brain damage, and even lead to suicide or homicide. Even “normal” grieving itself can result in depression, loss of productivity, or illness. It is because of this potential consequence of grief that Medicare requires the hospice program to provide bereavement services as part of the Conditions of Participation (CoP), even though it is non-reimbursed by Medicare/Medicaid.

The Bereavement Coordinator continually contacts family members who are in the bereavement program to “check-in” with them at predetermined intervals according to a plan-of-care based on an individuals’ risk for complicated grief. This is done through phone-calls, letters, or through support groups in order to continually assess which family members may need extra support in order to prevent complications due to grief. The plan-of-care may need to be altered depending on what is reported to the bereavement coordinator or bereavement program assistants or what other objective risk-factors (such as alcohol abuse, family dysfunction, lack of support system or suicidal ideation) are discovered through interaction with the bereaved individual. There are many factors which plays into an individual’s risk for complicated grief, and the bereavement coordinator along with hospice social-workers and chaplains record what is learned about the bereaved using a document called a Bereavement Assessment. This document is reviewed for each family member in the bereavement program on a regular basis by the psycho-social team, and modified if necessary.

Part of the bereavement program also includes grief counseling services through one-on-one counseling with a qualified counselor, or through group-sessions held throughout the year and conducted by the psycho-social team. Counseling may also be offered prior to the patient’s death if needed for family-members who are having difficulty with coping with “anticipated grief.” These are free benefits through our hospice program, and extremely beneficial to those willing to receive help. When a person is identified with a high-risk for complicated grieving and/or may be experiencing extremely poor coping, a referral may be made to a local counselor or therapist qualified to handle difficult cases of complicated grief. Also, family members who reside out of our service area may be referred to another grief program or counselor in their area.

I am proud to be part of Front Range Hospice’s bereavement program as both a chaplain and the bereavement coordinator, working with a team of top-notch bereavement assistants and volunteers. I have heard many stories and reports from our families of the legendary care that Front Range provides, and honored to be able to help the bereaved in their time of need.

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