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CCA spring forum paves the way for advance directive outreach

ore than 75 people attended CCA's spring forum in May, packing Salinas Valley Memorial Healthcare System's Ryan Ranch conference rooms for a presentation and discussion about advance care planning in Monterey County. Compassionate Care Alliance board member Dr. Marc Tunzi, of Natividad Medical Center, shared the results of a recent study that asked more than 200 Forum participants discuss data presented by Dr. Marc Tunzi. Monterey County Of the patients with advance directives residents where they get advance directive information, who guides them through the in place, nearly 40 percent had designated power of attorney, 30 percent had a living forms and how they initiate related discuswill and 15 percent had both. Only about sions with loved ones. Following his talk, half of those with power of attorney arattendees broke into groups to discuss rangements had discussed them with their the study findings and develop ideas for agent. Fifty percent of those with advance improving advance directive education at directives received related information the local level.

Local hospitals team up to enhance care planning education

from an attorney, while about half that many were guided by a physician or hospital staff member. When asked who was most helpful during the advance care planning process, family members (38 percent) and attorneys (35 percent) topped the list. "It was wonderful to see different professionals gathered together to address the issues surrounding advance care planning. Spirited discussions followed the data presentation and led to excellent ideas for community outreach," says Dr. Tunzi. As a follow-up to the forum, representatives from all four Monterey County hospitals gathered to discuss survey results and event dialogue. Together, these Monterey County Advance Directive Initiative

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notes

Fall 2010

Exit Strategy opens October 8 in Carmel

hen two strangers meet in a snowbound Lake Tahoe cabin on Christmas Eve, miracles happen. That's the foundation of Exit Strategy, an intriguing new CCA production opening this fall at Carmel's Carl Cherry Center for the Arts. The drama, written by CCA Healing Through the Arts committee chair Cindy Gum, runs at 7:30 p.m. each Friday and Saturday evening, and each Sunday at 2 PM, from October 8 through October 30. A gala reception is being planned for the production's opening night. Exit Strategy documents the surprise meeting of a widowed family physician and a feisty woman who has lost her job, home and health insurance. As snow falls outside the Lake Tahoe cabin that has brought them together, they work through challenges related to illness, grief and heal-

End-of-life issues take center stage in new CCA production

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ing. The characters also address paranormal experiences at life's end, health care delivery and the country's medical system. "One of the messages in this play is that people sometimes fall through the cracks despite their best efforts to do otherwise," says Gum. "Our main characters do not want to ask for help or be dependent upon others, and each handles difficult issues differently. I think audience members will identify with, and learn from, those distinct approaches." Following each presentation of the play, Gum will join Exit Strategy cast members and spectators for a discussion. The talk sessions will feature conversation about the conflicts and challenges faced by the play's characters. Members of the audience will also be invited to share their own experiences with issues addressed in the play. Telling personal stories and hearing

how others have coped with illness can be of great help to individuals and families. "As I look around our community and, indeed, around the world, I keep seeing that the arts are the answer," says Paulette Lynch, Arts Council for Monterey County executive director. "The arts provide unique pathways for exploring, understanding and connecting." Exit Strategy brings together an accomplished group of acting professionals. Director Peter Reynolds is a stage, radio and television veteran with more than 40 years of performance experience. He is a former artist-in-residence with The Magic Circle Theatre in Carmel Valley. Richard Boynton, fresh off a performance in Dead Man's Cell Phone at Magic Circle Theatre, and veteran local director and actress Rosemary Luke, who starred in CCA's 2008 production of Legacy, fill the play's main roles.

Message from the Executive Director

"I am only one, but I am still one. I cannot do everything, but I can do something." This Helen Keller quote is a favorite of mine, and it's one that comes to mind when I look back at all Compassionate Care Alliance has accomplished this year. We are an organization that achieves thanks to the combined efforts of many "ones" ­ one volunteer, one supporting business, one professional lending his or her expertise, one board member, one funding partner. The support of each of these individual sources is vital, and our workshops, events and resources are the result of all their contributions. These days, we're busy collaborating on several projects related to advance care planning, and the cooperative spirit is leading to some groundbreaking achievements. On one front, we continue to pilot local POLST outreach. Thanks to the support of the California HealthCare Foundation, CCA has hosted several educational sessions for professionals. This fall, we will begin a series of public workshops that explain POLST, and other end-of-life planning options, to patients, families and interested individuals. Equally exciting is a new initiative aiming to create a managed, systematic approach to advance care planning in Monterey County. The project stems from recent advance directive research findings released by CCA board member Dr. Marc Tunzi during our spring forum, and it brings together an impressive group of area leaders: representatives from all four local hospitals, plus healthcare professionals, attorneys, financial planners and others who help patients and families navigate end-of-life choices. CCA is proud to facilitate this pioneering initiative, and we couldn't be more excited about the knowledge and enthusiasm each participant brings. You can read more about these projects, as well as the upcoming production of our latest play, Exit Strategy, in this issue of CompassioNotes. CCA also thanks its primary spring forum sponsor, Central Coast Senior Services, Inc., partial sponsors Heartland Hospice and Ordway Drug and Medical Supplies, and all the volunteers and professionals making advance directive research and subsequent community I'd also like to take a moment to publicly thank our many donors, supporters and volunteers. You'll see their names listed here in the newsletter. Without these champions, we could not achieve what we do as an organization. Each person contributes to CCA in a different way, and each contribution strengthens our programs and helps us make a bigger impact in the community. From financial support and donations of time, to providing event spaces, moderating workshops and creating new opportunities to inform the public, the gifts of so many supportive individuals, agencies and businesses help us provide resources that might not otherwise be available in Monterey County. Thanks to each one of you for your ongoing interest and support, and I hope to see you at some of our events this fall. You help make Compassionate Care Alliance an organization we can all be proud of. -- Vicki Nelson, Executive Director outreach possible. "We could not be bringing this project to fruition without the help of our partners. The opportunity to help spearhead such important outreach means a great deal to CCA leaders, and to the families who will benefit," says Brusuelas.

LocaL hospitaLs team up

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leaders will put together an action plan for advance care planning education in Monterey County. Participants are enthusiastic about the opportunity to raise awareness about a topic that touches everyone at some point. "Local professionals have voiced a strong commitment to informing patients, clients and members of the public about end-of-life care options. The collaborative spirit that's fueling this project is exciting, as is the ongoing momentum," says CCA board president Mary Brusuelas. Next steps include studying successful advance care planning programs in other regions, refining training opportunities for professionals and volunteers, and continuing to facilitate discussions among local stakeholders. A follow-up forum is also slated for spring 2011. One of those helping move the project forward is Kendra Howell, director of corporate and community development for Salinas Valley Memorial Healthcare System. "A policy-related internship is part of my final public policy master's year at the Panetta Institute, and I'm thrilled to be able to assist Compassionate Care Alliance with its efforts to increase advance directive usage in Monterey County," she says. "I hope that the knowledge and skills I have gained in the classroom will benefit CCA in its work."

Local palliative care programs taking shape

o better assist patients as they make difficult care decisions, area hospitals are developing their own palliative care programs. Mee Memorial Hospital recently hired Dr. Antonio Viscarra, who is finishing a palliative care fellowship with the University of California San Francisco-Fresno, to head up its program. Dr. John Hausdorff leads related initiatives at Community Hospital of the Monterey Peninsula, and Dr. Matt Katics does so at Salinas Valley Memorial Healthcare System (SVMH). Natividad Medical Center is creating its own program, as well. "Our palliative care program uses an interdisciplinary team approach, coordinating with volunteer ambassadors who are trained in the advance directive process," says Dr. David S. Kasting, director of special projects at SVMH. "The Palliative Medicine Program at SVMH, working with the Monterey County Advance Directive Initiative, can help promote this concept through community educaAttorney Eric Holk, Palliative Care Specialist Dr. John tional programs and Hausdorff, Forum Moderator John Berteaux and Palliative informational mesCare Specialist Dr. Matt Katics develop plans for advance care sages." planning outreach.

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A thank you from Compassionate Care Alliance

hanks to the support of the donors and volunteers on this year's Champions List, Compassionate Care Alliance continues to inspire thoughtful dialogue and provide resources for individuals and families facing challenging end-of-life care deci-

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sions. From workshops to art programs to community discussions, our small nonprofit makes a big impact because of collaborations with local individuals, professionals, partner organizations and businesses. The following donations were received

Anton Prange Jeff Pulford Bill Ramsey Judy Reibel Rosemary Rhodenbaugh Richard & Sally Rhodes Scott Robertson Ted & Jan Rose Diane & Joe Rossi Jane Russo Tina Sammut Marjorie Sanders and Jason Gill Mary Lou Schaeffer Donna Schaffer Peggy Schmidt Ryan Shaw Christiane Singer Jill Sleeper Katherine Springer Dr. Laura & Paul Stampleman Dr. Michael Stuntz Teresa & Bill Sullivan Dr. Grant & Wendy Swanson Liz Tarozzi Judy Tatelbaum Daniel Tellep J. Breck Tostevin Mark Travaille Paula Travaille Dr. Marc Tunzi and Dr. Danielle Acton Tom & Karen Wilson Tina Woodward Maureen Wruck & Joel Panzer Hospice Education Institute Hospice Foundation LivHOME Monterey Peninsula Foundation Rabobank Rapid Printers Salinas Valley Memorial Healthcare System Victorian Residential Care Wells Fargo Securities Yellow Brick Road

through July 2010. We apologize to anyone inadvertently left off this list, and we hope you will consider volunteering or making a tax-deductible gift in the coming months. A sincere thank you goes out to all who support our organization.

Cindy Gum Stan Gum Dr. John Hausdorff Sylvia Hayden Helen Hempel Karen Hendrickson Eric Holk Kendra Howell Mike Hutchinson Patricia Iman Ute Isbill-William Carole January Erickson Carol Jones Dr. David Kasting Dr. Matt Katics Shirley Kiatta Alice Kinsler Dr. Harry Knaster Louis Kolowski Anne Leach Henry Leinen Michelle Limo Lynn Lozier Mitch Matthews Susan Mayer Kathee McFarland Leslie McGuire Anne McGowan Lisa Mineta John O'Brien Jeanette Pagliaro Matthew Parcasio Noel Perry Suzette Perry Tino Plank Jean Rasch Steve Raymond James Reese Amy Reid Elaine Richelieu Elizabeth Robbins Jane Russo Jaime Simpson Peggy Schmidt Lori Silver Sheila Snyder Jack Stanley Teresa Sullivan Elisa Swanson Dr. Marc Tunzi Isela Ulloa Kelly Vasquez Jan Wachtel Jeff Walbeck Judy Walbeck Matt Walbeck Jennifer Walker Ellen Watson Lesley Wei Brenda Wilkerson Chris Williams Alma Wood

Individual Donors

Jennifer Allen & John Hain Margarite Alvarez Beverley Ambort Nancy Ausonio Margaret & Rick Baldwin Carolyn Barber & Walt Beam Dr. Charles Bates Gretchen Bell Michael Bellini Ute Bender Joseph Bileci Norma Brambilla Scott Bray Ann & Charlie Brown Mary Brusuelas & Ed Gallo John & Mary Cain Lou Calcagno Vince & Jennifer Cardinale Holly Carlin Fran Cava Dr. Esmond Chan Pat Chapman Nancy & Robert Chien Art & Noreen Christopher Dean Collins William & Mary Ellen Comport Meg Connors Paul & Kathleen Coss Amelia Craig Christie Denhart Stevan Dority Paula & Sam Downing Jean Duff Dr. June Dunbar Karen Engell Abbie Eldredge Shary Farr Brian Finegan Patrick & Anita Flanigan Alyce Foster Carol Galginaitis Joel & Dena Gambord Jim & Jeri Gattis Evalyn Gendel & Emmett Bonner Nadya Giusi Earl Godfrey Warren & Patty Goldman Marilyn Green Dr. Stan & Cindy Gum Lee Gutierrez

Pauline Hamerly Linda Hardenstein Barry Harrow & Ann Flood Dr. John Hausdorff Arnold & Janet Hedlund Helen Hempel Vern Horton Lisa Hoivik Penny & Arnie Horwitch Richard Ingle Pam Itani Dr. Ken Jensen Gayle Jones Sandy Kahn Dr. Bill Kennedy Tom & Shirley Kiatta Alice Kinsler Dr. Mark Klein Peter Lampman Sandy Larson Sam & Shirley Lavorato Linda Lee Mary Lenahan Cea Ritch Lewis Pat Lintell Susan & Bill Little Jean Lovell Roger & Carolann Manley Janis Marquez Mitch & Angie Matthews Thomas McCullough Onette McElroy Dr. Ellen McEwen Barbara McGowan Andrea Mennenga Tom & Frances Mill Harriet Mitteldorf Barbara Moore Erna Morris MarthaElin Mountain Konny Murray Barbara Nelson Lana Neroda Jeff Newman John O'Brien Robert Olson Stuart Osaki Janna Ottman Barbara Ottone Barbara Parrish Norman & Janet Pease Jackie Pierce & Michael Masuda Jeff Pepper Jennifer Pettley Tino Plank

Champions Advance Directive Initiative

Mary Brusuelas Tiffany DiTullio Dr. Peyman Haghighat Dr. John Hausdorff Kendra Howell Mike Hutchinson Dr. David Kasting Dr. Matt Katics Pat Lintell Dr. Sandra Montijo Graciela Navarro Isela Ulloa

POLST/Advance Care Planning Workshops

Anne Albano Gail Babcock Steve Brooks Stevan Dority Dr. Leslie Foote Barry Harrow Dr. John Hausdorff Helen Hempel Eric Holk Shirley Kiatta Dr. Harry Knaster Kathee McFarland Jean Rasch Jack Stanley Dr. Grant Swanson Kelly Vasquez Jackie Woods

Exit Strategy

Richard Boynton Cindy Gum Jill Jackson Pat Lintell Rosemary Luke Peter Reynolds David Travaille Debbie Travaille

Foundations and Businesses

Ambassadors Providing Amazing Care Arts Council for Monterey County Central Coast Senior Services, Inc. Choice Home Health Care 1st Capital Bank Community Foundation for Monterey County Community Hospital of the Monterey Peninsula Harden Foundation HCR ManorCare Foundation

Forum

Donna Abbott Carolyn Barber Walt Beam John Berteaux Dr. Adam Bolour Susan Borrego Lillian Capehart Vince Cardinale Dr. Jeanette Cisneros Ida Corby Amelia Craig Dolors Dannemiller Mary Dixon Stevan Dority Kathleen Finnigan Maryann Finnigan Joy Flynn Wall Dr. Leslie Foote Maria Fuenzelida

Compassionate Care Alliance

Board of Directors President Mary Brusuelas, RN Vice President Amelia Craig Secretary/Treasurer Mitch Matthews Teresa Sullivan Marc Tunzi, MD Healing Through the Arts Chair Cindy Gum

New production inspires and enlightens

Nonprofit Org. U.S. Postage

save the Date: exit strategy

Exit Strategy, CCA's latest production, opens this October at the Carl Cherry Center for the Arts in Carmel. Filled with surprises, miracles and real end-of-life matters, the hopeful story follows the challenges of a widowed family physician and a charismatic woman who has lost her job, home and health insurance. When: 7:30 p.m. each Friday and Saturday evening, and each Sunday afternoon at 2 p.m., from October 8-30, 2010 Where: Carl Cherry Center for the Arts, 4th Ave. and Guadalupe St., Carmel-by-the-Sea Tickets: $20.00 information: 831-655-9506 or www.ComCareAlliance.org

RETURN SERVICE REQUESTED

Permit #38 Monterey, CA

PAID

P.O. Box 1785 Monterey, CA 93942 (831) 655-9506 www.ComCareAlliance.org

Local health care leaders collaborate on POLST efforts

CCA's advance care planning workshops start in September

Opening Night Reception; Drama and Desserts

Join the cast and playwright Cindy Gum for a special gala reception taking place after the show. Enjoy delectable desserts. Share an imperial of 2005 Silver Oak Cabernet Sauvignon. tickets: $100.00/person

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Rosemary Luke, shown at a 2008 Legacy performance, returns to star in Exit Strategy.

early two years after California lawmakers signed legislation requiring that providers honor the Physician Orders for Life Sustaining Treatment (POLST) form, CCA continues leading outreach to inform local residents about the form and its value. POLST clarifies an individual's wishes regarding pain management, resuscitation, feeding procedures and other medical interventions. The form was first developed 20 years ago in Oregon, in response to concerns that traditional Do Not Resuscitate (DNR) orders and advance directives do not adequately communicate patients' wishes for the treatment decisions they might face. POLST documents are completed with the approval of a patient and his or her physician; rather than taking the place of a living will or durable power of attorney, POLST remains with patients wherever they travel or receive care. Matthew Parcasio, client care sales coordinator for Victorian Home Care in Monterey, has provided support and counseling to individuals and their families in a variety of health care settings. "The overall response to POLST from our clients has been positive. Most clients have been able to complete the form, acquire a doctor's signature and have a copy readily available within days of starting home care services," he says, adding that some families ask that he and his colleagues guide them through the document's completion. "One of our goals is to treat clients with dignity and respect. Because of POLST, clients are assured their wishes are followed in the event of an emergency." Compassionate Care Alliance is one of 18 agencies to receive California HealthCare Foundation funds supporting POLST outreach

A volunteer panelist answers questions following a workshop on POLST held at Carmel Foundation. efforts for professionals and members of the public. The organization has worked with bioethics committees at area hospitals to help develop POLST usage policies. CCA also initiated a POLST workgroup and trained volunteers to share information with emergency responders, hospital personnel, doctors, attorneys, home health agencies, skilled nursing facility staff and hospice employees about the form. A specialized workshop aimed at home health agencies workers is being organized for late January, 2011. Now, group leaders are putting together public workshops designed to help patients and families incorporate POLST into long-term advance care plans. Sessions will take place from September through November and, following a holiday season break, will continue in early 2011. The goal is to raise POLST awareness among patients as well as healthy individuals. "I'm the durable power of attorney for health care for an elderly woman," says a recent advance care planning workshop attendee. "If I hadn't attended the workshop, I wouldn't have gone to her doctor with a POLST form and started the discussion for her future healthcare decisions."

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