With Gratitude and Blessings

By: Nichole Williams, MSW Volunteer Coordinator


Volunteer Brenda and her therapy dog Lilly

In honor of Volunteer Appreciation Week 2016, I want to personally say thank you to all of our volunteers for their commitment, their time, and the incredible service.   Hospice would not be hospice without all of the amazing volunteers!!!

I have been working at Front Range Hospice since the beginning of the year, and I have been given the honor of working with our incredible volunteers through my role as the Volunteer Coordinator.  I have worked in hospice for 12 years, and know the value of the volunteer services.  It is such a pleasure to interact with each of them, to learn about their lives, and walk with them side by side as they provide incredible care to the patients and families that we serve here at Front Range Hospice.  I want to say thank you to ALL of our volunteers, for their kindness, their compassion, their time, and their ability to share with others in their end of life journey.

I asked two of our volunteers to share a little about what it is like to “be a hospice volunteer”:

Brenda shares:

I have been a volunteer of one sort or another for most of my adult life. I started as a pink lady at 18 (I was always taken for a candy striper because I looked so young), and have volunteered for a lot since then.  I volunteered for Attention Homes here in Boulder, as a respite house-parent, a mental health hot line called First Call for Help and one year as a Court-appointed Special Advocate (CASA). When my kids were little, I started two different support organizations for parents (Informed Parenthood – hosted speakers on issues relating to young children, and a Boulder chapter of a national organization supporting parents of gifted children.) I was active in those for several years.

When my dogs started bringing in what I call Goat-heads on their feet, I was challenged to discover the offending plant responsible, which expanded into an interest in identifying native plants. I took and then taught courses in the Native Plant Master program through the CSU Extension office. I volunteered through the Boulder Parks and Open Space department surveying rare plants in Boulder, and also with the Boulder County Parks and Open Space department in evaluation of revegetation projects.

When I was asked to serve as a Lay Eucharistic Minister for my church, I felt completely unworthy for that position, but I discovered how valuable and appreciated a few minutes of my time can be. My more recent volunteer positions are 7 years at the Longmont Humane society, walking dogs, working with them on behavior issues, and working as a receptionist at their clinic. I worked for one year at WOLF, which is a wolf and wolf-dog sanctuary west of Fort Collins. That was really cool.

In regards to why I volunteer as a hospice volunteer, I think that the short answer is because I can, and I get to take my dog. “Because I can” might seem confusing, but it’s like when I volunteered at the animal shelter. So many people would say, “Oh, I could never do that, seeing all those poor dogs. It’s so sad.” I’d tell them “You should try it, you might be surprised”. Hospice is like that. A lot of people think that they couldn’t do it, that it would be too emotional. So, I took my own advice with hospice, and tried it. When you realize what a few minutes of your time can mean to someone, how could you say no?

I volunteered at another hospice organization a few years ago, doing Pet Therapy with my white German shepherd, Maggie. But when she died suddenly of cancer, I didn’t think that my other dog, Lilly, was ready. Now I regret holding her back for so long. After getting her certification, a request came in from Front Range Hospice, and Lilly has been a real hit.

It’s always rewarding to be greeted with a big smile, and to know that the client is saying nice things about us to other people. But the most rewarding, I think, was the memorial service. I had to go through a memorial service in the atrium of a facility, to get to the stairway to visit a client upstairs. When I got to the stair landing, a woman stopped me, petted Lilly said “It’s OK.  My mother really liked dogs.” I went on up to my visit, and when I came back, the woman stopped me again and asked if I would take Lilly to say hello to her daughter, on the opposite side of the atrium. As we moved slowly and quietly around the back of the group, so as not to be disruptive, almost every person there reached out to pet Lilly as we passed and smiled a deep, heartfelt smile.  It was powerful, communal, experience, and a reminder that we touch not only the patient and their families, but sometimes the larger community as well.

When I talk to someone about my volunteering through Front Range Hospice with my dog Lilly, it usually starts with a complement to Lilly, and a question on what breed she is. (White German Shepherd and husky).  When I tell them that she’s a therapy dog and we see hospice patients, they sometimes say that they’ve thought of doing pet therapy work with their own dog. I explain to them that becoming certified as a therapy dog is really not as hard as they might think and I tell them how to go about it. Some organizations, like hospitals, have a rigorous training and testing program. For others though, the dog’s basic temperament is the most important. There are so many things you can do, from helping CU students to de-stress during finals week, to helping young children learn to read, by reading to your dog, and of course, hospice.

Pamela shares:

My father was diagnosed with terminal cancer in May 2004.  He immediately went into hospice care at home. He was only expected to live for approximately 6 weeks.  He lived for 5 additional months.  Partly because of his attitude and strong nature, and also because of the hospice care he received at home.  Hospice care enabled him to visit with family and friends, to continue many of the activities he enjoyed (golfing, wood work, etc.) and to have closure to his life.  They (hospice staff) were there for both of my parents during this time and they never felt alone in the entire process.

The most rewarding experience in hospice volunteering is meeting some incredible people who I otherwise would have never known, and being able to share their life experiences and thoughts.

Hospice volunteering is a unique experience.  It can be hard because you know that someone is approaching their end of life.  You know that they will pass and watching it can be hard.  It can be wonderful because you can make someone laugh during a difficult time, give them comfort, let them know they (and/or their family )are not alone, and just sit there and be a presence.  You learn that there are some unique wonderful people in the world, and you got to meet one of them and have them be a part of your life.

When someone knows that I do volunteer hospice work (I also volunteer at Longmont Humane Society), they usually comment on how they would never be able to something like hospice as it would be so hard to be around someone dying.  It is hard at times.  It is also something that I know we will all experience.  If I can make a positive effect for an individual or their family, then my life is enriched beyond understanding and I have gained more than anything I could have possibly provided to them.

Hospice volunteering takes a big heart, time, and a willingness to walk with patients and their families as they are dying.  It takes a person who is able to “be” with a person in their end of life process.  Walking this path with people can mean bearing witness to heartache, suffering, pain, grief and loss, and having to say goodbye.  The volunteers who provide care to the patients of Front Range Hospice are a tremendous gift to not only the patients and families, but also to the rest of the hospice team.  Our patients often have a deep connection with their volunteer, they truly are part of the team!

If you would like more information about Front Range Hospice and how to get involved in the volunteer program call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com.

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What to Ask When Looking For a Hospice

By Victor Montour


When people are trying to make decisions about which hospice to enroll in most want to choose a hospice that will deliver the best possible care for whatever time they have left. In order for most people to do this they need advice or information. So here’s my advice.

  • As a consumer you have the right to choose the hospice of your choice. It is unlawful for a healthcare professional to pressure you or make you use a hospice that you have not chosen.
  • You can ask your doctor for advice. Your doctor may be able to tell you the names of the hospices he or she have used in the past and their experience working with them. But also ask your doctor if he or she has a financial relationship with that hospice. Some doctors are employed by hospices, and may have a financial incentive to refer. So beware.
  • If a referral to hospice needs to be made while you’re in an acute care hospital setting, again you will want to ask if the hospice is affiliated to or owned by the hospital. Again beware, some hospital systems require their staff to refer to the hospital owned hospice with little regard to the patients wishes or choice. Remember you have the right to choice and must be allowed to choose the hospice you want to use.

As you are doing your due diligence I recommend you call the hospices in your area. Set up a time to interview your choices. During this interview you as a consumer should find out what you can expect from the hospice.

  • What services they provide? And when are the services provided? Listen to see if the hospice will work around your needs and preferences or are you put into a model of care that is centered around the hospice and its staff.
  • Does the hospice provide all four levels of hospice care?” (That’s routine home care, inpatient care, continuous care at home, and respite care). Medicare-certified hospices are required to provide all four, but many don’t. To learn more about the four levels of care in hospice check out our blog Do You Know The Four Levels of Care
  • The most important question to ask “Is your hospice certified by The Joint Commission or the Community Health Accreditation Program?” Abbreviated as TJC and CHAP, these are organizations that visit and inspect hospices regularly. As a consumer you have the right to see the results from the inspections. You will want to look for any patient care issues. A hospice with a large number of deficiencies or more deficiencies in patient care should be avoided as a consumer.
  • Another very important question to ask is “Are your physicians board-certified in hospice and palliative care?” This is a good indication that a hospice takes its medical care very seriously.
  • You will want to ask the hospice” Do you allow your patients to utilize their PCP while receiving hospice services?” If the hospice tells you, you have to use the hospice physician, beware again. As a consumer you have the right to use your primary care provider as the physician to direct your care on hospice. This being said, you may have to change physicians if you choose to be placed in a skilled nursing facility or are receiving care in a facility that only allows physicians to provide care that are credentialed to provide care in the said facility.
  • Ask does the hospice measure and improve the quality of care that they provide to their patients? If they reply yes your next question needs to be How?” Any hospice that doesn’t have a quick and clear answer for this question probably isn’t serious about patient care.
  • Does the hospice have any special programs or other certifications?
  • You could ask what makes their hospice stand out among the rest.

Finally, one last word of advice. Choosing wisely takes time. So start thinking early about what hospice you’d want when the time comes. How early? People typically enroll in hospice very late. More than half of patients in the U.S. enroll in the last three weeks of life, and about a third enroll in the last week. That’s too late to make careful decisions. So start asking questions now. Think of it as insurance, so when the time comes — as it will, for all of us — you’ll be ready to make a thoughtful choice that’s consistent with your preferences.

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


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Metastatic Cancer

By Victor Montour

What is metastatic cancer?

Metastatic cancer is cancer that has spread from the original place the cancer started to another place in the body. Any tumor formed by metastatic cancer cells is called a metastatic tumor or a metastasis. Metastatic cancer has the same name and the same type of cancer cells as the original or primary cancer. For example, breast cancer that spreads to the lung and forms a metastatic tumor is called metastatic breast cancer, not lung cancer. Most people who sure come to cancer sure come to metastatic cancer.

Can any type of cancer form a metastatic tumor?

Virtually all cancers, including cancers of the blood and the lymphatic symptom can form metastatic tumors. Although rare, the metastasis of blood and lymphatic cancers to the lung, heart, central nervous system, and other tissues has been reported.

Where does cancer spread?

The most common sites for metastasis are listed in the table below. Although most cancers have the ability to spread to many different parts of the body, they usually spread to one site more often than others. Please note the table below excludes the lymph nodes for several types of cancers.

Cancer type Main sites of metastasis
Bladder Bone, liver, lung
Breast Bone, brain, liver, lung
Colorectal Liver, lung, peritoneum
Kidney Adrenal gland, bone, brain, liver, lung
Lung Adrenal gland, bone, brain, liver, other lung
Melanoma Bone, brain, liver, lung, skin/muscle
Ovary Liver, lung, peritoneum
Pancreas Liver, lung, peritoneum
Prostate Adrenal gland, bone, liver, lung
Stomach Liver, lung, peritoneum
Thyroid Bone, liver, lung
Uterus Bone, liver, lung, peritoneum, vagina

How does cancer spread?

Cancer cell metastasis usually involves the following steps:

  • Local invasion: Cancer cells invade nearby normal tissue.
  • Intravasation: Cancer cells invade and move through the walls of nearby lymph vessels or blood vessels.
  • Circulation: Cancer cells move through the lymphatic system and the bloodstream to other parts of the body.
  • Arrest and Extravasation: Cancer cells arrest, or stop moving in small blood vessels called capillaries at a distant location. They then invade the walls of the capillaries and migrate into the surrounding tissue
  • Proliferation: Cancer cells multiply at the distant location to form small tumors known as micrometastases.
  • Angiogenesis: Micrometastases stimulates the growth of new blood vessels to obtain a blood supply. A blood supply is needed to obtain the oxygen and nutrients necessary for continued tumor growth.

The ability of a cancer cell to metastasize successfully depends on its individual properties. Not all of the steps above are needed for metastasis to occur.

Symptoms of metastatic cancer

Some people with metastatic tumors do not have symptoms. Their metastases are found by x-rays or other testing. When symptoms occur, the type and frequency of the symptoms will depend on the size and the location of the metastasis.

Can you have a metastatic tumor without having a primary cancer?

No, a metastatic tumor is always caused by a cancer cell from a primary cancer located in another part of the body. However, in some patients a metastatic tumor is diagnosed but the primary tumor cannot be fund, despite extensive test, because it either is to small to see or has completely regressed. The pathologist knows that the diagnosed tumor is metastasis because the cells do not look like those of the organ or tissue the tumor is found in.

Treatment for metastatic cancer:

Your oncologist will work closely with you on a treatment plan and provide you options with the most successful treatment for the primary or metastatic cancer you or your loved one may have. We recommend that you talk with your oncologist or primary care doctor about your treatment goals and options. With this conversation we all so recommend you talk to your family and doctor about options if treatment fails or is not an option due to a decline in health.  It is never too late to have the conversation about your end of life wishes.

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

Watch out for our next blog: What to ask when looking for a hospice.


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Thank you, Social Workers!

By Lydia Appling, MSW, LCSW

thank you

Please join all of us at Front Range Hospice this month by showing your appreciation for social workers. Front Range Hospice would like to say to all of our fellow Social Workers….. Thank you…. We thank you for your hard work and your dedication to ensure the clients in our communities are well served.

Social work is a profession concerned with helping individuals, families, groups and communities to enhance their individual and collective well-being. It aims to help people develop their skills and their ability to use their own resources and those of the community to resolve problems. In hospice social workers meet people who have the impression social workers only help low income families who need help to apply for public assistance. You can find a social worker anywhere now days. You can find them in schools, healthcare systems, counseling centers, military bases, judicial systems, legislation or perhaps in line at the grocery store. Ones income does not dictate who may utilize the services provided by a social worker.

There are a vast array of areas a social worker may focus their career on. Most people think of a social worker as a child and family social worker who makes their primary focus to protect vulnerable children and support families in need of assistance. You will be surprised to learn that Social workers help people solve and cope with problems in their everyday lives. One group of social workers, clinical social workers, also diagnose and treat mental, behavioral, and emotional issues that most people deal with on a daily basis or perhaps during a crisis. The social worker is an invaluable role needed in the healthcare field.

Social workers provide an enhanced level of communication. It all starts at a basic level of listening to hear the specific needs, then assessing to understand the need of a patient or the family. While following up with the patient and family to ensure the needs have been met. During this time the social worker is building trust, offering respect and dignity while providing support and compassion without judgment. Advocacy, advocacy, advocacy. A social worker is your best advocate, another primary intervention the social worker uses to help someone communicate their needs while empowering people to take action or control for themselves.

It is this commitment to help individuals, families, groups and communities to enhance their individual and collective well-being that makes social workers a very special group of people. We are willing to give a little of our self for the wellbeing of a stranger. That being said, I found the following quote on line and it just resonated with me. “Doctors and Nurses Cure The Patients, But The Social Workers Heal The Families”.

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

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A Calling to Serve

By Victor Montour

Today I’m writing this blog trying to understand why anyone would opt to have an end of life experience full of pain and discomfort. Most of us in hospice care have been drawn to do this type of work by a higher power you could say. I would call it a calling… a calling to give back to those who need us the most.

Over the last couple of months I have had the pleasure of meeting a family who are in the middle of the end of life journey. I met with the family and the patient to discuss how the hospice benefit works and the services that can be expected. During our meeting I was able to hear the views of the patient and the family, views that clearly paint a picture of dislike of modern medicine and the modern pharmaceutical treatments available today.

Now, as a nurse it is not my place to judge someone or force my views, beliefs or opinions onto anyone who has a different approach to their healthcare. My philosophy about nursing is to meet the patient where they are and help them achieve the healthcare goals they have for themselves. Sometimes, just sometimes the cures and treatments of modern medicine are put on the back burner so a patient and a family can explore alternative treatments.

So alternative treatment is what this pt and family has opted to do while on the end of life journey. Because Front Range Hospice and all or staff are caring, compassionate and concerned for anyone on the end of life journey, we continued to communicate with the family to provide support and appropriate guidance.

I followed up with the family on average every two weeks. Each and every communication the conversation was the same. The pt is getting weaker, not eating and having more pain. Each week I could hear the stress and uncertainty in the voice of the family. The family has lots of questions about how to care for the patient. After each of the calls and while typing this blog, I get a tear in my eye and it’s hard to swallow.

The family clearly see’s the patients health declining and the care required to care for the patient is increasing. The increase in the care needs has clearly placed an added burden on the family. But, the family is still trying other alternative treatments. Alternative treatment sometimes outweighs the physical, psychological and spiritual support a hospice team could provide for all of them.

So I write this blog still trying to understand why with a heavy heart. Most people think those of us working in hospice have a difficult job and its depressing. Most of us would say no, it’s magical, humbling and most rewarding work we could ever do. So we will be here waiting, ready and willing to accept hospice appropriate patients with open arms

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


Watch out for our next blog: Thank you, Social Workers!





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In Home Medical Oxygen Safety

By Victor Montour


The exact number of people receiving home oxygen therapy is unknown. In a 2006 study done for the American Association for Homecare, Morrison Informatics, Inc. noted that more than 1 million Medicare recipients use at home medical oxygen therapy.

With the increase in the aging population it is becoming more important for people using home medical oxygen to understand the proper use and safety precautions for in home oxygen use. Practicing oxygen safety is necessary to prevent injury and the loss of property from fire. Learning how to properly store and use your home oxygen system is critical. Below are the three most common oxygen delivery systems supplied for at home use.

  1. Liquid
  2. Compressed gas storage –E Tank.
  3. Oxygen Concentrator

Because oxygen is a non-flammable, colorless, odorless and tasteless gas the user and caregiver are not aware of the hazard oxygen presents in the home. With proper use of oxygen at home the environment around the patient becomes saturated or most commonly called enriched with oxygen. What does that mean?

On any given day there is 21% oxygen in the air. When you place a patient on oxygen in a room the concentration of oxygen in the room will increase. This increase continues the longer the patient is using oxygen. This constant increase of oxygen not only enriches the air, but it enriches the patients hair, clothing, bedding and any other combustible material in the home. An oxygen enriched atmosphere cannot be detected by normal human senses. Oxygen also does not give any physiological effects which could alert people to the presence of an oxygen enriched environment.

As mentioned before, oxygen by itself is non-flammable, but, when you put it with a combustible material and an ignition source you will have yourself a faster starting and hotter burning fire.  Oxygen can and will accelerate burning during a fire.

During 2002-2005, oxygen equipment was involved in an estimated average of 209 home fires reported to local fire departments per year. These fires caused an average of 46 civilian deaths and 62 civilian injuries per year. One of every five such fires resulted in death.

Smoking is by far the leading cause of burns, reported fires, deaths, and injuries involving home medical oxygen.


Fire Safety Tips

  • DO NOT SMOKE in the home of the oxygen set-up or around an oxygen patient.
  • Oxygen is not a flammable gas and will not explode. However, oxygen can cause fires to burn things faster and ignite easier.
  • DO NOT use petroleum-based ointments or lotions in or around your nose, such as Vaseline, Vicks, Chapstick, etc. Oxygen can react violently with these oily substances and can cause burns.
  • Keep all oxygen equipment at least 15 feet from any type of open flame.
  • Do Not use open flames while using oxygen. This includes matches, cigarettes, fireplaces, barbeques, stoves, space heaters, candles, E-cigarettes, electric razors, toys that make a spark, etc.
  • Have working smoke alarms installed throughout your home.
  • Prepare a home escape plan for you and your family in the event of a fire.
  • Use caution with oxygen tubing so you do not trip over it or become entangled in furniture.
  • Notify the local fire department, gas and electric companies and telephone company when home oxygen therapy is started. Request a “priority service listing.” This is for those times when there is a power or telephone failure or repairs are needed on any utility

Oxygen Storage and Handling 

  • Oxygen tanks should be stored in a stand or cart to prevent tipping and falling.
  • Store extra, unsecured tanks by placing them flat on the floor. Do not allow tanks to stand or lean in an upright position while unsecured.
  • DO NOT store oxygen systems in unventilated areas such as closets or cabinets.
  • Do Not drape clothing or other combustible material over oxygen systems.
  • DO NOT store oxygen systems in the trunk of your car.
  • Keep all oxygen equipment at least 15 feet from any type of open flame or electrical outlet.

If you would like more information about Front Range Hospice or have questions about in home oxygen safety please call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

Watch out for our next blog: A Calling to Serve





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Huntington’s Disease (HD)


By Victor Montour

Huntington’s disease (HD) is a fatal genetic disorder that causes the progressive breakdown of nerve cells in the brain. It deteriorates a person’s physical and mental abilities during their prime working years and has no cure. HD is known as the quintessential family disease because every child of a parent with HD has a 50/50 chance of carrying the faulty gene. Today, there are approximately 30,000 symptomatic Americans and more than 200,000 at-risk of inheriting the disease.

Many describe the symptoms of HD as having ALS, Parkinson’s and Alzheimer’s – simultaneously.

Symptoms usually appear between the ages of 30 to 50, and worsen over a 10 to 25 year period. Ultimately, the weakened individual succumbs to pneumonia, heart failure or other complications. Everyone has the gene that causes HD, but only those that inherit the expansion of the gene will develop HD and perhaps pass it on to each of their children. Every person who inherits the expanded HD gene will eventually develop the disease. Over time, HD affects the individual’s ability to reason, walk and speak.

Symptoms Include:

  • Personality changes, mood swings & depression
  • Forgetfulness & impaired judgment
  • Unsteady gait & involuntary movements (chorea)
  • Slurred speech, difficulty in swallowing & significant weight loss



HD affects the whole brain, but certain areas are more vulnerable than others. Pictured above are the basal ganglia – a group of nerves cell clusters, called nuclei. These nuclei play a key role in movement and behavior control and are the parts of the brain most prominently affected in early HD.


Stages of HD

Although symptoms of HD vary from person to person, even within the same family, the progression of the disease can be roughly divided into three stages.

Early stage HD usually includes subtle changes in coordination, perhaps some jerky involuntary movements (chorea), difficulty thinking through problems and often a depressed or irritable mood. Medications are often effective in treating depression or other emotional problems. The effects of the disease may make the person less able to work at their customary level and less functional in their regular activities at home.

In the middle stage, the movement disorder may become more of a problem. Medication for chorea may be considered to provide relief from involuntary movements. Occupational and physical therapists may be needed to help maintain control of voluntary movements and to deal with changes in thinking and reasoning abilities. Diminished speech and difficulty swallowing may require help from a speech language pathologist. Ordinary activities will become harder to do.

In the late stage, the person with HD is totally dependent on others for their care. Choking becomes a major concern. Chorea may be severe or it may cease. At this stage, the person with HD can no longer walk and will be unable to speak. However, he or she is generally still able to comprehend language and retains an awareness of family and friends. When a person with HD dies, it is typically from complications of the disease, such as choking or infection and not from the disease itself.

In all stages of HD, weight loss can be an important complication that can correspond with worsening symptoms.

Huntington’s disease and Hospice Care

The nurses at Front Range Hospice know most people with HD experience many, symptoms: These symptoms and less common symptoms are addressed by our hospice nurses along with possible interventions to maximize ones comfort and dignity.

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

Watch out for our next blog: In Home Medical Oxygen Safety

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