Guilford County, NC

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

[00:00:58] Jeff Thigpen: This is Jeff Thigpen, Guilford County, Register of Deeds with the Good Grief podcast. We have a very special guest with us this morning, Patty Gasparilla. Patty is the director of Kids Path with AuroraCare and deals with the areas of bereavement and counseling relating to children. And so Patty, I just want to say thank you for being here this .morning.

[00:01:22] Patti Gasparello: Well, thank you so much for inviting me, Jeff.

[00:01:24] Jeff Thigpen: Can you tell us about Kid's Path? What's the vision of Kids Path and what are some of the services you provide?

[00:01:30] Patti Gasparello: Okay. Kid’s Path is actually a program within AuthoraCare Collective. And AuthoraCare Collective is actually the name of the agency that originated with hospice of Alamance, Caswell and hospice at Greensboro.

[00:01:44] Patti Gasparello: Kid’s Path is actually a program within AuthoraCare Collective. The two agencies merged actually a year ago, October one and became AuthoraCare. And the merger was a way to pool our resources as well as all of our expertise and skills of various staff members. Kids Path though has actually been around since 2001. When hospice at Greensboro founded the program and the mission of the program is really two programs or two components.

[00:02:12] Patti Gasparello: One is to provide grief counseling to children and teens who has had a loss of a loved one as well as to help children who have very sick family members. The other second program, part of Kid's Path is providing hospice care to children who are living with life-threatening or life-limiting illnesses.

[00:02:33] Patti Gasparello: In 2003, hospice in Alamance Caswell actually joined the Kid's Path program. Meaning Greensboro opened it up to other hospices to use the trademark. So people would know if you have a Kid's Path, you can get either healthcare for children, life-limiting illnesses or grief counseling for children. So we came on board at hospice of Alamance, Caswell in 2003.

[00:02:57] Patti Gasparello: And then when merger happened, I'm now over both Kids Path in Greensboro and in Burlington or AuthoraCare.

[00:03:05] Jeff Thigpen: So, Kid’s Path has been around for awhile. You have organization gone through some consolidations over the past year and are still moving strong. How many staff members do you have and the volunteers?

[00:03:18] Patti Gasparello: In Kid's Path. We have five counselors who were specifically trained to work with children and grief. And that's five with the combined program, both what we call east and west campuses, west being Greensboro, east, being Burlington for the pediatric program. We have a combined total of three nurses and three, two to three social workers.

[00:03:41] Patti Gasparello: Everybody does a little bit of everything. And for the pediatric program, volunteers are very active in our hospice program where they can provide some support to families and children who are sick. They're also very involved with a number of the events we provide in the counseling department.

[00:03:59] Jeff Thigpen: And, you came from Alamance County?

[00:04:01] Patti Gasparello: Yes. I started at hospice at Alamance County over 25 years ago. And so I've been there awhile.

[00:04:09] Jeff Thigpen: Is your background in social work, counseling?

[00:04:11] Patti Gasparello: Actually, yes, I started out after grad school, working in child welfare, then moved to children and mental health, then came on board at hospice of Alamance Caswell, where I was the director of social work. And when we started the Kid's Path program in Burlington, I became the director of it.

[00:04:29] Jeff Thigpen: So you've been doing this work for 25 years over. You've seen some incredible situations in that time. And so much of this is talking about grief and just in terms of the few people that I've known, who've had to deal with these particular kinds of situations with chills.

[00:04:49] Jeff Thigpen: They can be very complex physically, emotionally, socially, financially. And so, you know, how do you navigate within kids path the approach of dealing with grief with children?

[00:05:02] Patti Gasparello: That's a great question. And sometimes I think that, as adults, we sometimes underestimate how observant children are, how they're very intuitive to what's going on in their home and their families.

[00:05:14] Patti Gasparello: And while we often, as adults want to protect children from sadness over what might be happening to someone they care about, we're really not helping them if we do that. So what we've learned is that if we don't include children in what is going on. Whether it's someone who is going to be imminently dying or has a prognosis where they're going to die.

[00:05:35] Patti Gasparello: Then we really rob them of the opportunity to let us know what they need from them and share their feelings with us and help them cope with those feelings. And we also rob them of the opportunity to gain further resilience in, in dealing with difficult things in life. But I think another important part of this, if we don't include them in what's happening, the death of a loved one is that they may get the message that they weren't important enough to be told about what what's going on.

[00:06:03] Jeff Thigpen: So you're dealing with children that both have terminal illnesses, and you're dealing with children that are processing serious illnesses. And some cases, terminal illnesses of friends and loved ones.

[00:06:14] Patti Gasparello: Yes, exactly. There are two programs within Kids Path, one for the counseling for grief, and one for the pediatric program.

[00:06:22] Patti Gasparello: There certainly is a lot of grief in the pediatric program as well. And there's a lot of crossover between the programs.

[00:06:30] Jeff Thigpen: And so in terms of the serious Illness piece and terminal illness I would assume there would be partnerships that you all would be working with related to, I guess there would be like the case management component of it, in terms of the health issues, dealing with the situation the child may be going through. And then you all would be a supportive influence in that kind of situation, right?

[00:06:52] Patti Gasparello: Exactly. For the pediatric program, we're actually provide a nurse who isn't working as the case manager, a social worker slash counselor, a chaplain and volunteer if desired. And that team works with the family, the child and the family, and to provide symptom management for the child to help them understand what physical changes may be happening or what to expect.

[00:07:17] Patti Gasparello: But then the counselor or social worker in there, is the one who would be working with the family, working on the changes in the family, how people are feeling, working with siblings who may feel sort of left out or not understand what's going on. So yes, there is a lot of crossover in both those programs because when parents or guardians are told that their child has a life limiting or threatening illness. The grief for them really begins right away, meaning that it's the loss of a healthy child and you're the parent who's going to have to help them navigate that as well as your own feelings with that in the family.

[00:07:55] Jeff Thigpen: You are not only accessing the situation of a terminally ill child and the pediatric or perinatal care that's going on related to supporting that child. You're assessing the parents. You're looking at the pain and distress that they are going through and the decisions, unfortunately, in cases they have to make. So then you've got also the situations where you have a child going through a terminal situation.

[00:08:19] Jeff Thigpen: Then you have the child processing loss and grief with loved ones around them, including parents and loved ones in that kind of situation. And part of what I see, you know, in looking at it is when you're dealing with children in that situation, you also have to assess where they are. I mean, there's the physical, emotional, spiritual, how does that come out? And it comes out in a lot of ways, right?

[00:08:44] Patti Gasparello: It does. And children who have a terminal prognosis or life limiting illness are really remarkable. I think the thing that I've learned through all these years of working with sick children is that they're incredibly resilient. And the first thing is they just want to be children and yes, you have to be honest with them and share with them what their illness is.

[00:09:05] Patti Gasparello: And children often take an incredible amount of ownership of it. And despite some young ages.  But they really just want to be children. And so you'll have children who beg to go back to school and if they're immune suppressed and really shouldn't be in school, then pre COVID even, then you have to deal with that.

[00:09:25] Patti Gasparello: And because that's where their friends are, that's where activities are. So for the most part, children get on board pretty quickly with ok, and share their feelings and what they want or what normal children with. We do know that as their condition worsens, if they're old enough, there are certain things very important to them.

[00:09:44] Patti Gasparello: Like they want to make sure that they're remembered. They want to leave a legacy. They want to be able to say things to people who are important to them. And so we're very aware of that when we're working with children and families and helping children do those things, as well as help their families know what those children need from them.

[00:10:01] Patti Gasparello: But day to day, they want to do just what everybody else does. It's always interesting when you have teenagers who never wanted to go to school, but when they know that their life is limited, that's where their friends are and that's where normal teenage life is. And so we've had to work with some school systems through the years on accepting children who are fairly ill, but want to be there.

[00:10:23] Jeff Thigpen: Yeah, you mentioned the term resilience a couple of times, and that's something that I have to remember when I have been in situations where I've seen people dealing either with a terminal illness of a child and the, or the child or teen working through it. A lot of times as adults, we want to fix things, right?

[00:10:39] Jeff Thigpen: We want everything to be better. We want to give a simple answer and we want to be able to tell them everything is going to be all right. Unfortunately, sometimes we get into a bunch of cliches.

[00:10:51] Patti Gasparello: We can't fix the sadness that children have, whether it's over the loss of someone or where their own limited life.

[00:10:59] Patti Gasparello:  And so, but what we can do for them is listen. And I mean, truly listen, find time to hear what they have to say. Encourage them, sharing their feelings no matter what those feelings are. We often have a saying, feelings are not right or wrong. They just are. And what's important is helping children be able to express them in ways that are healthy.

[00:11:19] Patti Gasparello:  You know, you don't want children hurting each other or themselves, but anger is a normal feeling. And so we want to encourage kids to be able to express whatever it is and give them ways to express it that are healthy and appropriate.

[00:11:33] Jeff Thigpen: Yeah, exhaustion, fatigue, mood swings and grief as a is, is really an up and down, back and forth kind of a process that's not easy.

[00:11:45] Patti Gasparello: Yeah. And I'm thinking of a young boy who died within the last couple of years, who was nine and had a brain cancer and he really adjusted fairly well. You know, you get that diagnosis and you're in treatment right away. It's like your whole world has changed. Then there may be surgeries. There may be chemo, then maybe you can go to school.

[00:12:06]  Patti Gasparello: Maybe you can't. But then when things level out with. It's a good prognosis, meaning the illness has been contained or not. Then children want to just do what children do, but then as they decline, and there's a real awareness that they're not going to be able to go back to school because they're so sick or join their friends in the kinds of activities that friends do, it can be very, very sad for them.

[00:12:35]  Patti Gasparello: And we have to encourage parents to hear what their children say. And in this one particular case, this young boy who had been going to school part time then was talking one day and the nurse and I were there about wanting to go back the next day. And the mother was encouraging him. We can just go for lunch.

[00:12:55]  Patti Gasparello: That's a fun time. You'll see your friends don't have to do that, do that work. And he was like, no, I want to go for the half day that I've been going. And he was very sick and it was not likely that he'd be able to, well, the next day when he woke up and he realized he couldn't really go. And what was so sad was.

[00:13:13]  Patti Gasparello: When we were there later, it was like, he understood that that was the beginning of things that he wasn't ever going to. He wasn't going to have another upswing. And one of the fascinating things about him was during the last months of his life, he stayed in his parents' bed at the age of nine. And between them, for that safety and security and the day that he realized that he would not be joining his friends at school anymore.

[00:13:40]  Patti Gasparello: He went back to his own room and it was like, he needed to somehow separate from that closeness and start to get used to the idea that he wouldn't be around. And it was so sad, but the family, what was wonderful was I know it's, it's really makes me cry thinking back on it, but what was so beautiful was that then the parents and the brother moved pallets into his room and spent the night with him on the floor, in his room because they didn't want him to be alone and they want it to be with them. But what wisdom.

[00:14:11] Jeff Thigpen: And what resiliency and compassion and support that you find in these situations that help us dig underneath a world with a lot of superficial problems and issues. And you hear a story like this that is incredibly touching, and it serves as an example for us to understand how meaningful the human life is and how in the midst of terminal illness and tragedy and unimaginable situation. People can come together and love and support each other.

[00:14:46] Patti Gasparello: And that's true. And that resiliency and what we learned from children and their families, you can't really learn in books. They teach us so much about life and what's important. And even. Uh, family member said that at the funeral, you know, this is a message to all of you, you know, continue to do fun things.

[00:15:07] Patti Gasparello: Don't put so much pressure on all the things we think we have to do in life. Enjoy your family and children, and, you know, do crazy things like go to a ball game, um, on a Tuesday school night and who cares invite invite all the friends. And I think for parents who lose a child, one of the things they would say is, is just what you're speaking to.

[00:15:28] Patti Gasparello: They often see themselves after the death, at some point at their values about what's important to them is changed if they gain an awareness for what's important in life. But I would say that they would tell you that the wisdom they gain comes at a great cost because parents, the loss of that child is forever.

[00:15:48] Patti Gasparello: It doesn't mean they can't get to a better place in life and continue moving forward. But the loss is forever because when a child dies, you're also losing the milestones. When a nine-year-old goes into middle school, you won't be at that elementary school graduation or high school or college or their first job or a marriage or a grandchild.

[00:16:09] Patti Gasparello: So that parents continue to grieve at different, at different points of the milestones that they will never see. And it's also the loss of all their hopes and dreams they had for that child. Any of us who are parents know when we saw that little baby, we were already filled with lots of hopes and dreams. And so it is a different kind of loss than any other kind of loss.

[00:16:32] Jeff Thigpen: And through that comment, you're getting into the question. I was going to ask you about grief counseling for children and how it differs from programs offered for adults. And I think that comment alluded to the fact that when you're dealing with an adult who loses a child, it is a, a very special kind of loss, a unique kind of loss.

[00:16:52] Jeff Thigpen: And there has to be this space to process that a supportive counseling and community for that. And then there's also the child who is processing and grieving in situations at the loss of adults. So you're dealing with both, right?

[00:17:08] Patti Gasparello: Yes, we are, and, and siblings of children who die. And I think the, one of the things that when I talked about the wisdom, parents feel like they gain at great cost. I think about a number of the children that we've worked with, who have had significant losses in their lives. So they've come in for bereavement counseling. As young children, we have bereavement camps in the summer and through the years, a number of the children that I've worked with who are 8, 9, 12, when family members died and number of them had parents who died. They now come back as teenagers and young adults and work camp and they share their stories.

[00:17:44] Jeff Thigpen: So you, so these bereavement camps are children in camps with each other, talking about their losses.

[00:17:53] Patti Gasparello: Since we've merged prior to merger, both the west campus, Greensboro had a bereavement camp and east campus. Burlington had a bereavement camp too. And while the camps are a little bit different, both of the goals of the camp are for children to have a safe place, to be able to be with other children who had a significant loss, do some fun activities, do some meaningful remembrances. And so there are wonderful place.

[00:18:18] Patti Gasparello: Like 12 hour camps for one day, the organizations put a lot of time and energy into them because we see how kids connect with each other. It's if someone wants made the comment to me at lunchtime during our camp, how one of our volunteers was sitting at a table with camps and how one kid turned to the other and just said, so who died in your family?

[00:18:38] Patti Gasparello: Like you wouldn't hear that elsewhere death is such a difficult topic in our society. And yet when you give kids a safe space where it's okay to talk about it and express their feelings about it, they just open up. I'm always still after all these years, because I still work camp. I'm always amazed at how open kids can be when we just give them the message that it's important to share your feelings and how open they are and how much we can learn from them.

[00:19:06] Jeff Thigpen: Yeah, giving them that freedom and permission to in that space share, sounds incredibly important. And in the time of COVID 19, we're having this interview. And so I would guess like many support groups and organizations, we've all had to adjust. To this moment where it is incredibly hard to have human contact.

[00:19:25] Patti Gasparello: And it is. And when you think about the added factors that COVID places on children and grief, meaning many are either not in school or part-time in school. There may be changes at home with family incomes. With parents schedule, you may have a parent who's not so into homeschooling. There is a lack of support.

[00:19:45] Patti Gasparello: They also missed out on a lot of activities last spring, graduations, and I think of activities, how many kids, whether it's sports or band or scouts, or there are so many things that kids didn't get where bereaved children may have had an outlet as well as support. So we have had to adjust to it. So what we've done at Kid's Path is we are actually now zooming with children.

[00:20:08] Patti Gasparello: Yes. Instead of coming into one of our two offices, We got on board quickly with, you know, how do we zoom with kids and is this even going to workable? And we've been shocked at how well it's gone. There've been some real advantages, meaning that we see a child in their home environment when we're zooming.

[00:20:25] Patti Gasparello: And we see some of the other people in it, even though we request if possible, let them have a private space and give them that time. But another thing we've done to sort of encourage their expression of grief. We know children do better with expressive arts than with words sometimes. And so we came up with an art supply kit that we put together, our volunteers put together ,certain basic things, and then we have volunteers delivering.

[00:20:53] Patti Gasparello: Leave them right outside the home of the child so that, you know, we've talked to the parents, explained what we're doing and ask them to keep this for their sessions so that children have this paper bag, tote bag with all these supplies. And then when they meet the counselor, they're doing some of the artwork or painting or playing with board games that are grief related and it's been wonderful. And it's really sort of given kids a boost in counseling and our counselors have boost as well.

[00:21:21] Jeff Thigpen: Great. Yeah, this is such a needed organization and part of our community that is there to provide some for both children and adults focused on children, where are y'all located?

[00:21:32] Patti Gasparello: We are located on Summit Avenue in Greensboro, 2500 and in Burlington on Chapel Hill Road914. So most people attend or go to whichever one is closest. But during the era of zoom, we can be flexible, but there are excellent counselors on both campuses. So that is where we're located. But for counseling right now, we are zooming. We do have in our adult program, a number of groups, support groups for people who have had specific losses, a spouse, a suicide and overdose.

[00:22:05] Patti Gasparello: And we also have certain events in Kids Path. We typically have a number of groups and different ways of supporting children. And we are going to have a holiday event coming up in November where we're going to do it virtually and see how that goes in the adult program. They are also having a number of holiday events to choose from.

[00:22:26] Patti Gasparello: So those are all on our website and will be available. The authoritycare.org. And I will tell you, I think if you went to hospice at Greensboro or hospice of Alamance Caswell, it will direct you there. But for those people who want to go directly there, one way, I think it's easy to remember.

[00:22:46] Patti Gasparello: Our name is AuthoraCare is actually spelled like author, like the author of a book, a care.org. And the name actually came from the meaning of the name is that our agency. Providing hospice care to adults, children, as well as counseling, our mission is really to help families write their story. Meaning how can we help you at this point in your life for filling what you see, your story? And so that's why it's easy for me to remember author a care. It, because it is it, the name does come from for you're the author of your story.

[00:23:24] Jeff Thigpen: Yeah, and we will have Risa Hanau in to talk about AuthoraCare. Part of the reason we have these podcasts is to help the community understand the ecosystem that is out there around end of life care and serious illness and bereavement in that space where we are both in the presence of the possibility of dealing with the death of a loved one and, or accessing the systems and the institutions that are in place that are there to support and understand. And a lot of times understanding that ecosystem is very complex and it's very hard and the resources change quickly. Yeah, but hopefully, you know, we'll be able to, to be able to express those. So it's, it's good to see that we can remember how to find Kids Path through author a care.

[00:24:14] Patti Gasparello: And please know, Risa is a close friend, as well as a colleague and has been around quite a while as well. And she will be able to help you understand the merged agency and all the different programs that are provided through a thorough AuthoraCare at this point.

[00:24:31] Patti Gasparello: And so I think that's a great decision because you are right. We've even had different hospital systems. Not sure. Are we here? Are they here? Who do we go through? So I think that will be a great service to people.

[00:24:42] Jeff Thigpen: Yeah. We're looking forward to talking with her. And I just want to, again, thank you Patti, for your work and for what you do with Kids Path. It's a incredibly important service and really appreciate your voice today on the Good Grief podcast. Thank you.

[00:25:00] Patti Gasparello: Thank you.

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

[00:00:59] Jeff Thigpen: Welcome to the Good Grief podcast. This is Jeff Thigpen, Guilford County, Registered of Deeds, and I'm with Carly Malcolm lead for NC fellow from the UNC Institute of Government. Today we have Risa Hanau with us, Risa is the Director of Education for AuthoraCare Collective with offices in Greensboro and Burlington.

[00:01:19] Jeff Thigpen: Risa has worked with hospice care since 1993. And with hospice and palliative care since 2004, which has recently become AuthoraCare Collective. Uh, a palliative care social worker, clinical educator, seasoned teacher in the area of end of life care and ethics. She is a licensed social worker with a master's degree from the University of Pennsylvania, the fighting Quakers.

[00:01:47] Jeff Thigpen: And I'll just end by saying, in this introduction of Risa, I think that you are the real deal when it comes to talking about in the life issues, and you've been really supportive and helpful with this process. And so I want to thank you. And Carly and I are definitely happy to have you with us today. So what inspired you to become involved in hospice and palliative care? Cause it seems like you, your career has been that in that area and what inspired that?

[00:02:14] Risa Hanau: It has been my entire career. I went to college in Philadelphia and went to temple. So the owls and God on a psych degree, and then I decided to get a master's degree in social work. And I went into the track of health and aging.

[00:02:36] Risa Hanau: And my first year field placement was at a very large hospital in downtown Philadelphia. And I was assigned to the oncology unit and it was actually at the start of the aids epidemic. And so my first year of graduate school was focused on taking care of and learning how to care for people approaching the end of their life.

[00:03:03] Risa Hanau: And it really resonated with me and for my second year of graduate school, l focused in a hospital setting on a joint replacement unit, which actually gave me the opportunity to do some teaching and work with support groups. And then my first job out of graduate school, I moved to North Carolina and got a social work job at Moses Cone Hospital.

[00:03:32]  Risa Hanau: On the oncology while you were in the oncology. And I did that for the first four years out of graduate school. And I made a lot of hospice referrals, quite frankly. And I came to be fascinated by the difference between providing care in the hospital and actually being in the home setting. And so I made the transition to working for hospice and that's what I've done ever since.

[00:04:00] Carly Malcolm: Can you tell us what that experience has been like for you? I imagine it comes with a lot of challenges working in that field.

[00:04:06] Risa Hanau: You know, it, it does. And it's often said, oh, that must be such a sad thing to do. And how do you do that? And I will say that many of us want to know that we make a difference in somebody's life.

[00:04:22] Risa Hanau: And the reality is that we cannot cure an illness that can not be cured. And so if my presence, if our organization's presence can do anything to ease the suffering of either the person who is ill or their family, then we have done something very positive. And so as a licensed clinical social worker, as a bereavement counselor, and as an educator, I've had the opportunity to really have an impact in people's lives.

[00:04:56] Risa Hanau: And that is tremendously rewarding. Albeit some very sad things occur in the course of the work that I do.

[00:05:09] Jeff Thigpen: You did a training for the Registered of Deeds office a couple of years ago around grief. And I mean, I thought you were an incredible trainer. And one of the things that impacted me from that experience was I didn't realize how some of my own employees were dealing with issues of grief related to end-of-life care and that kind of thing.

[00:05:30] Jeff Thigpen: And it was really impactful for me to see that that is a part of our experience and from the point of view of the work that you're doing.

Jeff Thigpen: The experience that we had going through the training was I had to do a lot of listening to my employees.

[00:06:00] Jeff Thigpen: And I think based on your experience in dealing with end of life care and end of life issues, the experiences that I see that you've gathered over your years of working in varying levels has been really important, both in terms of just the services you provide, but also the level of attention you bring to the whole person.

[00:06:21] Risa Hanau: Yeah. The reality is that we all experience loss and grief certainly we’re sitting here during COVID and, and the loss and the grief that many people are experiencing. It doesn't only come after the death of a loved one. It can come during an illness. It can come during so many different points in life and it can often be cumulative.

[00:06:48] Risa Hanau: So when one thing happens, it can really trigger or remind us of other losses that we've had. And in the work that, that I have done, that is the reason that education is so important. And I'm so drawn to it is that we don't like to talk about hard things, sad things. And so we tend to shove them down. And if we can do podcasts like this and education in opportunities when we can learn and grow, then we can get a little bit closer to it.

[00:07:24] Risa Hanau: When we have an experience. And, that is always helpful because learning during a crisis can be really hard.

[00:07:33] Jeff Thigpen: Yeah. So in terms of the work that you do with AuthoraCare Collective, what are some of the services that it provides?

[00:07:41] Risa Hanau: Great question. It is, you know, the reality AuthoraCare Collective is a merged organization.

[00:07:49] Risa Hanau: We just had our one-year merger anniversary. So we are Hospice and Palliative care of Greensboro and Hospice. Palliative Care Center of Alamance Caswell came together as one hospice organization. We have many commonalities. We both were of our communities. And the reason why we chose the name AuthoraCare Collective.

[00:08:18]  Risa Hanau: Is because we are a collective of services that we provide. We know that people really author their own story. We don't write it for them. They write it for themselves. And while hospice is the service that we are most known for, we really have a broad range of services that include palliative care, that include Kids Path, pediatric care that include grief services for adults and children, and also education for our community.

[00:08:57] Risa Hanau: So we offer many different services and really serve people throughout the community, depending on what their needs are. Sometimes it's helping them complete a living will or healthcare power of attorney. And sometimes it is literally providing that hospice service so that we allow them to stay in their home through the last days of their life and,

[00:09:24] Jeff Thigpen: What are some of the differences between palliative care and hospice?

[00:09:30] Risa Hanau: So that's, that's really a wonderful question. And one that is not. So well understood. So palliative care to palliate is to alleviate suffering. So palliative care is all about the alleviation of suffering. And we know that suffering can be physical. It can be emotional, spiritual, financial, and so palliative care is really thought to be for anybody who is experiencing symptoms related to an illness that is creating suffering.

[00:10:05] Risa Hanau: So somebody who might be going through chemotherapy treatment, somebody who is on dialysis and having difficult symptoms, palliative care is really about controlling symptoms, no matter what somebody's illnesses and no matter where they are in their life expectancy hospital.

[00:10:31] Risa Hanau: Hospice also looks at alleviation of suffering. But hospice is a very well-defined program actually by Medicare, that is specifically for people who are at the end of their illness. So we often think of the hospice patient being one who has a prognosis of perhaps six months or less. And they are not in a position to receive treatment that would be curable. So we sometimes say all hospice care is palliative, but not all palliative care is hospice. Right. Right.

[00:11:15] Carly Malcolm: So you’ve been in this field a long time, you've had a lot of different positions, but right now you're working as the education director. What does that entail? Like what kind of information do you hope to share with the public.

[00:11:26] Risa Hanau: So it's interesting as the director of education, I not only do what we might call outward-facing or this type of education, but I also do a lot of education for our staff. So, you know, it is not the case that our staff automatically calm and are totally comfortable, but some of the difficult conversations that we have.

[00:11:51] Risa Hanau: Not everybody is immediately comfortable with how to fill out a living will or healthcare power of attorney. So I do a lot of education for our own staff because we have very high expectations for both staff and volunteers. So I do presentations on what is ethical care at the end of life? How do we have difficult conversations?

[00:12:21] Risa Hanau: How do we deal with complicated family issues and how do we communicate effectively during COVID when we're all wearing masks? So I do a lot of education for our staff and we base it on the feedback we get through surveys. So our caregivers fill out a survey after our services, and we use that feedback to guide the education.

[00:12:50] Risa Hanau: Then we look at outward-facing community education. And that's where I do a lot of in-services around advanced directives. So, “What are they?” and “Why Would We Need Them?” I go out and I do in-services like I did for Jeff and his staff around maybe there's been a lot of loss in a particular organization. And how do we learn about grief and give some time for process?

[00:13:19] Risa Hanau: I often get asked maybe from Elon University or UNCG to speak to a class about what is end of life and, and how do we approach it and ethical issues. So it's really being able to provide information almost preemptively right. If we use a muscle and we talk about end of life, we talk about planning, we talk about things sooner, rather than later, then ultimately the best hope is that people will make the best use of services should they have a need that arises.

[00:13:59] Carly Malcolm: Right. And those conversations are so important. We've been talking about that on this podcast. How, it's really difficult sometimes to talk about these issues, but really appreciative of the work that you're doing to help folks through that. When you're working with patients and their families, what kinds of considerations do you think they should take into account if they're thinking about accessing AuthroaCare services?

[00:14:22] Risa Hanau: So I think that it is really thinking about who the patient and family is. It is the case that AuthroaCare Collective is really expert in knowing how to manage symptoms and help people journey. But I like to think of the image that we are walking along a path with people. So we are not the ones that are setting the path and we're not the ones that are setting the speed that people are journeying

[00:14:54] Risa Hanau: So we work as a team. We have social workers and chaplains and physicians and nurses and volunteers. And so what we want is for people to let us know what is important to them, we want to learn about their history. We want to learn about their ethnicity. We wanna learn about their religion, their faith, their experience.

[00:15:21] Risa Hanau: Things that have been hard, their struggles. So really what we want to do is set an opportunity for people to feel comfortable, to learn about services, to ask about services, and then to trust us to journey with them during whether it's during palliative care or it's hospice or it's bereavement.

[00:15:49] Risa Hanau: It's really the case that each individual story is going to be different and we want to listen and hear what their story is so that we can give the best services to meet the needs that they have.

[00:16:04] Carly Malcolm: And are there any common questions that you get from folks who are dealing with end-of-life issues?

[00:16:07] Risa Hanau: Oh, we get tons of them. Mostly, I think the question is, “why are you talking to me?”. We don't want to talk about it because we know, unfortunately, that there is an underutilization of hospice services. We understand it's, it's scary. We also understand that people always want to hope that there's another treatment. There's a cure. There's something else. So sometimes it is. Why should I, you know, feel comfortable talking to you?

[00:16:41] Risa Hanau: It's also the reality that there are social determinants of health that certain segments of our communities have been underserved traditionally, and people associate hospice with death and with somehow not being allowed to access services or services being ended. And we need to do a lot of education.

[00:17:06] Risa Hanau: That hospice is not giving up, hospice is not having something taken away. Hospice is a very active type of service when somebody is at a particular place in their illness. So we try to help people get past some of the myths that they have. Some people think that they can't keep their primary doctor when they become a hospice patient.

[00:17:34] Risa Hanau: We want them to keep their own doctor. Sometimes people think that hospice hastens death and the truth is that hospice does nothing to hasten death and we do nothing to prolong life. So there are many myths that are out there and a final one I'll name is that people think only a doctor can call and make a referral.

[00:18:02] Risa Hanau: The truth is anybody can call the office and say, my loved one is having this situation, could you be helpful ultimately, to become a hospice patient or a palliative care patient? We get an order from a doc. But anybody can start that process.

[00:18:26] Jeff Thigpen: Yeah. And I, that, one of the things that I appreciate about what you all do is that you walk into situations where you have patients, families, caregivers, a whole network of relationships in terms of, of what the family is dealing with and, and having the kind of tools to understand in the midst of, of.

[00:18:50] Jeff Thigpen: Of all kinds of impacts on the family, whether the, you know, the first son is dealing with physical and mental issues or spiritual issues or social issues, both within caregiving and also support the idea of communication, being something that's really important and listening is really important. And the idea that sometimes there are no easy fixes in situations and being able to be in that space in a way. That you support a high quality of both caring, communication and support.

[00:19:19] Risa Hanau: The reality is that you know, when we work with patients and families, they have a lifetime of history behind them. We may only have the opportunity to work with them for days or weeks, hopefully months, but we're entering at a time when people have often been stressed for long periods of time.

[00:19:45] Risa Hanau: And we don't just work with patients and families. We also see many patients who live in different facilities. So we also have the opportunity to work with those caregivers. And certainly, we know during this time of COVID, that has created a whole nother level of challenge as we try to take the best care of people and keep everybody safe and family visitation and distance.

[00:20:14] Risa Hanau: There's just so many issues that certainly we, we try to address. And I think I remember, I think a second grade teacher used to tell us to speak less, listen more. We have one mouth and two ears, and often if we can be present, it is about being present with someone.

[00:20:39] Jeff Thigpen: Yeah. And that's kind of a good lead in you know, as, as you and the staff at AuthoraCare are providing the support for those patients and families that are in need. And what are some of the resources that you see that are, that are available both to you and members of your staff who were dealing with the difficulties of the job? I mean, we we've interviewed a couple of, of folks.

[00:21:04] Jeff Thigpen: Um, one is Brooks Johnson that Wake Baptist who is the clinical chaplin. And when you get into these environments where you're dealing with end of life issues and end of life care, the helpers, the workers that are there to support those families, going through those situations, you know, have a tendency to take that on and what's your thoughts on, on self care, I guess and support.

[00:21:28] Risa Hanau: Self care is really a very important issue. I will say that many of us who have been in hospice and end of the life for a long period of time, have a view of life where we really cherish every day. We understand that it's not a given. And so many of us, I think have an appreciation and gratitude, um, for life that has sort of become a part of who we are.

[00:21:57] Risa Hanau: That's not to say that we don't struggle. So we are very clear that we provide opportunities for our staff for self-care. We have employee assistance programs. We offer bereavement to our own staff as they need it. We do things like guided imagery at staff meetings. A couple of weeks ago, I led everybody and we took a nice trip and sat on the beach for about 10 minutes and felt the sun on our faces.

[00:22:29] Risa Hanau: We talked to staff about finding what is important to them and feeding themselves. It's that old analogy that you know, on the plane, you have to put the oxygen mask on yourself before you can help others. And we are experts at helping family members understand that they have to take care of themselves.

[00:22:51] Risa Hanau: If they're going to take care of an ill loved one. And we then also help our staff understand that they need to take care of themselves and also education. You know, we are much more confident and capable if we feel that we are doing a good job. So we do a range of things from education to making use of some humor.

[00:23:16] Risa Hanau: We have purple power day. We have town halls where we all wear purple and send selfies. And we try to recognize that we have many different staff from different disciplines and different backgrounds. And we honor what's important to each employee.

[00:23:34] Jeff Thigpen: I read something that you wrote at a few years ago, and you talked about bedside lessons and it seems like you're in a field of work that you have probably over your career have gained a lot of bedside lessons.

[00:23:48] Risa Hanau: For many years actually I was in administration and then took a position to go back to be the palliative care social worker, because I wanted to reconnect with actually literally being at the bedside and people are amazing people endure and they thrive and they are just. Endlessly fascinating. And just because somebody is ill, that doesn't mean that they don't have a lot to offer.

[00:24:23] Jeff Thigpen: Well Risa. Thank you so much for being a part of the Good Grief Podcast. I think the website for AuthoraCare is authoracare.org, with offices in Greensboro and you consolidated into Alamance, Caswell, so you have a Burlington office as well.

[00:24:42] Risa Hanau: Both of the original campus offices are still in place and we have inpatient hospice units in both locations, Greensboro and Burlington. Our website has wonderful information about services and resources.

[00:24:59] Jeff Thigpen: and I think there's a toll free number that I jotted down. 1-800 588-8879 to reach AuthoraCare.

[00:25:06] Jeff Thigpen: Okay. Well, on behalf of Carly and myself. Thank you very much Risa for being part of the Good Grief Podcast.

[00:25:12] Risa Hanau: Thank you for having me.

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

[00:00:59] Jeff Thigpen: This is Jeff Thigpen Guilford County Register of Deeds with Carly Malcolm, NC lead fellow from the North Carolina Institute of Government. And welcome to the Good Grief podcast. Today we're going to talk about pet loss. This is part two of the two-part series, first we talked to Jorge Ortega, who's the Director of Guilford County Animal Services.

[00:01:20] Jeff Thigpen: Jorge is actually with us and will be a part of the discussion. But today we're going to talk specifically, beginning with Kristie Yeatts. Kristie is the Bereavement Counselor for Trellis Supportive Care. She's been with Trellis for three years. In this role, she's got a bachelor's degree in Elementary Education and Teaching and a post-baccalaureate. Certificate in Animal Assisted Therapy with experience and things like everything from wildlife rehabilitation to veterinary assistance and works in many areas of grief and bereavement counseling. Um, so thank you for being with us. Kristie. Thank you for having me. Great. Um, you have experience with bereavement coordination in many different areas related to loss.

[00:02:10] Jeff Thigpen: What do you see as some of the similarities and differences that go on or exists between pet bereavement and other types of grief and bereavement counseling?

[00:02:39] Kristie Yeatts: Well, they're all losses. And so as far as similarities go, we know that dogs and cats can live very long lives. Some of them, you know, upwards of 20 years or more, uh, and some cases, so they become kind of fixtures in our families. So when you lose a beloved pet, it's very much like losing a family member or a loved one who is human.

[00:03:04] Jeff Thigpen: Hmm. Yeah. When I was talking to Carly when we were talking about our pets and I specifically remember as a child, my first feeling of loss and that was around the death of an animal, it was my dog. And, and the things that I learned, that I didn't know I was learning from that early on, that impacted my ability to both grieve through the loss of a pet, but also understand that within the context of, of loved ones who passed away. So, absolutely.

[00:03:24] Carly Malcolm: And so, sorry, Kristie, the way that we got connected with you is after hearing about the pet loss support group, um, can you tell us what that looks like and what that support group does?

[00:03:31] Kristie Yeatts: Sure. We're a small group. Um, normally there are no more than six people present for our groups. Um, especially now that the pandemic has become part of our norm, but, um, we are meeting virtually at this time on Zoom and we meet once a month for an hour. It's usually the third Monday of the month. And basically, what we do is we follow.

[00:03:57] Kristie Yeatts: We follow some research that's been done as far as pet loss and even human loss goes, um, a guy named William Warden created four tasks of war of mourning. And so what we do is we work through those four tasks. So it's kind of like a four-session arc. And when people join us in the first session we go through task one.

[00:04:19] Kristie Yeatts: And the second session is task two. And hopefully, by about the third or fourth session, people are reaching some sort of. Um, place in their lives where they can begin to think about moving forward a little, we don't like to use the word closure, but, um, certainly we hope that they are at least able to start thinking about moving forward.

[00:04:40] Carly Malcolm: And I'm sure that's comforting to have that sense of community when you're going through that kind of loss as well. Kristie Yeatts: Right. Carly Malcolm: Have you seen any practices or rituals that people do? Um, in order to remember their pet?

[00:05:06] Kristie Yeatts: We talked about that in group quite a bit. And, um, some of the rituals that people have mentioned besides, um, having their pets cremated and it is, um, having decorative urns in the home. Um, we've had people share jewelry that they'd got with some of the cremains and then, um, memorial shadow boxes are a big thing. Um, as well as scrapbooks. Creating slideshow, um, having ceremonies just as you would for your humans who have passed on.

[00:05:29] Jeff Thigpen: Um, you know, I mentioned a minute ago, the idea of pet loss related to children, and my first experience with death. How do you recommend parents and guardians navigate that kind of issue with their children?

[00:05:48] Kristie Yeatts: I would have to say that, you must keep everything honest first and foremost. You want to be honest with your child, yet age-appropriate. Um, avoid terms like pass away or went to sleep because then your child is going to fear going to sleep and never waking up. Um, and to this topic and to this end, um, I actually authored a book that's available on Amazon.

[00:06:14] Kristie Yeatts: And it's called, How Will I Know When My Pet is Going to Die? and it's really kind of, um, centered more towards an age group, maybe middle elementary school age level. So, um, it, and it talks kind of to children about what to expect and what to look for, as well as some things that they might do to remember their pets with love.

[00:06:40] Jeff Thigpen: What inspired you to write that book?

[00:06:50] Kristie Yeatts: Um, seeing so many people struggling with that topic in general, and knowing that as a former teacher, there are definitely ways that you can approach the subject and broach it with integrity. And yet at the same time, answer the child's questions without leaving the important details out and also without leaving them entirely out of the process.

[00:07:09] Kristie Yeatts: You know, allowing the child to be part of whatever arrangements are being made, or even letting them choose something special to include in an, in a memorial box or a memorial shadow box that can be very meaningful, meaningful for a child.

[00:07:28] Carly Malcolm: And this may be something that most people know, but I'm not familiar. What is a shadow box?

[00:07:32] Kristie Yeatts: A shadow box is just kind of like a picture frame, but it's built out so that you can put items such as a leash or a food bowl or something, you might want to remember on many of them have a background that you can put push pins in or something to affix, um, just different mementos of your pet.

[00:07:58] Carly Malcolm: That sounds really nice. So for seniors, especially, losing a pet, might bring up thoughts and feelings about, you know, your own mortality. And I imagine that some seniors might feel reluctant to adopt another pet that might outlive them. How do you navigate those kinds of thoughts and feelings with people in the support group?

[00:08:16] Kristie Yeatts: We've had a few seniors who have visited and they are reluctant to take on the responsibility again of having another pet. Um, one thing I will say is that a lot of the veterinary offices have things very similar to what humans have, advanced care planning. So if you know that you've adopted an african gray, um, a bird that can live many, many years, and it's going to outlive you, you can make arrangements for those things.

[00:08:47] Kristie Yeatts: And I've even encouraged that because I think especially for the pets, it's the best thing to do. Um, I think that when it comes to adopting another pet, it really does come down to that delicate balance of what are the benefits versus the risks of having one and whether or not that person's capable of caring for it at the time. So it, it really does come down to, are they ready for?

[00:09:09] Jeff Thigpen: Jorge, we talked a little bit about that in the podcast episode we did with you. Do you have any feedback related to that and what she said?

[00:09:25] Jorge Ortega: No, I agree. Kristie. I agree with you. I think, especially when we're talking about seniors, when were doing the adoption counseling, we definitely want to talk and we'd spend a lot of time with the family or the individual. Cause sometimes it's, uh, the daughter of the senior that comes in with mom and saying, hey, mom just lost her pet and we want to get her another pet. So sometimes they're difficult conversations, but we need to have those conversations for the benefit of both the individual and the pet. Um, cause then there has to be a plan for the pet. Um, like you said if an african gray is going to live forever. I mean, it might be cute. He might look at birds, but there has to be a plan for what happens to that pet.

[00:10:00] Jeff Thigpen: Um, and, and I think in terms of the pet adoption piece, um, the idea of when adopting pets, in general, you know how certain pets adapt to other ones when, when there is a loss and then you bring in a new pet through adoption.

[00:10:28] Jorge Ortega: Yeah. Kind of going again, what Kristie said with that risk, you know, risk-reward, or like, what are the benefits? Um, you have to take everything into consideration. Whether is this is, is this just filling a void, or how is the pet that is currently at the home going to feel by bringing in a new pet? Or are we going to just kind of create more stress, um, on, you know, everything that's going on in the family or with the family right now?

[00:10:52] Jorge Ortega: Um, so there's, there's a lot of conversations we have with families who are interested in adopting to fill a void. Um, we want to make sure they're making the right decision at the right time.

[00:11:32] Carly Malcolm: And this may be a question for both of you, Jorge and Kristie, but Kristie first, aside from your pet loss support group, what kind of resources are available to people who are grieving the loss of a pet?

[00:11:16] Kristie Yeatts: Right now our website trellissupport.org has a few resources online. Um, just some basic articles on what to do or have to cope during the pandemic, because that's a hot topic right now. Um, in the past I've asked group members to share what they have found helpful and what they've told me is there are Facebook groups, um, anything that's associated with the rainbow bridge, there's usually something for pet loss.

[00:11:44] Kristie Yeatts: Um, I've also found twoheartspetlosscenter.com to be a very helpful website, as well as Alan Wolfelt's, The Center for Loss and Life Transition. He has a website that has some resources for pet losses as well. And I also encourage people to reach out to me directly. If there's something that I can help them to find or a resource that I can help locate for them. I'm always glad to do that.

[00:12:08] Carly Malcolm: Do you have anything to add, Jorge?

[00:12:28] Jorge Ortega: No, I mean, us as animal services, we don't have any services that we, you know, physically provide, but we, we do, um, prefer them to either veterinary hospitals or, um, some folks that we have them talk to our veterinarian and they provide them with some resources.

[00:12:28] Jorge Ortega: So it's good to know that Kristie is here and Chrisy, I'm glad we're, we're talking and we're meeting, you know, this way, because I think I'm definitely gonna reach, reach out to you after this. And see how we can work together.

[00:13:01] Jeff Thigpen: Yeah. Well, and, and we're glad to have both of you here and Kristie, we're going to make sure that when, when this is put out there, we're going to put all those links and the information that you shared about resources, um, as a part of the podcast. And also, what was the name of your book again?

[00:13:10] Kristie Yeatts: It's called, How Will I Know When My Pet is Going to Die?

[00:13:18] Jeff Thigpen: Okay, great. And is, I guess I can be found on Amazon or you could do a Google. Kristie Yeatts: Amazon. Jeff Thigpen: All right. Well, we thank you for being with us today in talking about, both of you, um, talking about issues of pet loss and bereavement and how important it is to understand, um, and the resources that are within our area to, to give that support.

[00:13:35] Jeff Thigpen: We have Kristie Yeatts, Bereavement Counselor, Bereavement Coordinator for Trellis Supportive Care, who has been with us, and Jorge Ortega, Guilford County Animal Services Director on behalf of, uh, Carly, Malcolm and myself. Thank you both for being apart of this topic and I thank you for being part of the Good Grief podcast.

[00:13:57] Kristie Yeatts: Thanks for having me. Jorge Ortega: Thank you. Jeff Thigpen: All right, thanks.

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Pet Loss Resources:

https://twoheartspetlosscenter.com

https://www.trellissupport.org

Book by Kristie Yeatts: How Will I Know When My Pet is Going to Die?

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

[00:01:00] Jeff Thigpen: This is Jeff Thigpen, Guilford County Register of Deeds and Carly Malcolm, NC lead fellow from the North Carolina Institue of Government and welcome to the Good Grief podcast. Today, we're going to talk about pet loss and we have with us today, Jorge Ortega is the Animal Services Director for the Guilford County Animal Services Department.

[00:01:21] Jeff Thigpen:  He's got a wealth of experience in the area of caring for animals through his work with animal services, petred.org is an organization he's been working with related to community outreach programs and works to every day to have a positive impact on pets and animals. He's been here for three years prior to coming to Guilford.

[00:01:41] Jeff Thigpen:  One of the roles he has had was Vice President of Operations for the Humane Society of Charlotte. And Jorge is a graduate of the University of Puerto Rico. Um, thank you for being with us today, Jorge.

[00:01:53] Jorge Ortega: I'm glad I'm here. Thank you for having me.

[00:01:57] Jeff Thigpen: That's right. We're glad to have you. You and I were telling you before we started, I really appreciate your service to Guilford county and what you've been doing as a director, or you've been here for, like I said, three years, and I think you’ve stabilized a lot of things and you, you, um, I've done a lot of good stuff at the shelter.

[00:02:15] Jeff Thigpen: And, um, and so today we're, we're bringing you in to get some expertise and talking like I said about pet loss, and I guess I'll start out by saying, you know, how does the animal shelter deal with issues of pet loss?

[00:02:26] Jorge Ortega: We are in a unique situation with pet loss. Um, not only do we work with our community and supporting our community members when they are having to make these difficult decisions or these situations pop up in their personal lives.

[00:02:42] Jorge Ortega: But we also have to deal with pet loss in the shelter and staff, and as staff members at the animal services, we have to make decisions for humane euthanasia on pets that are not doing well, whether it's severe medical or severe behavior or a combination of both. Um, so, so pet loss for us, it, it comes in two different facets.

[00:03:04] Jorge Ortega So it is the community support piece. And trying to be supportive and understanding and compassionate to our community members, but also that same piece that we share with our community, we also are internally dealing with it.

[00:03:16] Jeff Thigpen: There’s this concept that everybody says our euphemism of, of animals being put down. Um, what does that mean?

[00:03:25] Jorge Ortega: Yeah, I think that's more like slang of a humane euthanasia process or putting the animal to sleep. Um, I, I think we get comfortable with certain words or certain phrases in our life that it's easier to say I'm going to put the dog down than it is that I'm going to go to the veterinarian and humanely euthanize my pet of 13 years.

[00:03:46] Jorge Ortega: Um, so, so that, that, that word usually means that we're going to humanely euthanize them or that pet.

[00:03:54] Jeff Thigpen: And I, now I'm kind of adding in a question is, is I know that the concept of, of shelters that are successful and the concept within those communities of things like euthanasia and all that kind of stuff, how do you all, uh, address the idea of success at the shelter as it relates to concepts like that?

[00:04:17] Jorge Ortega: Yeah, I think success starts with keeping the animal from coming into the shelter in the first place. And so success is really working with our community, identifying what those pet needs are in certain areas. Um, we know there are food resource deserts and all other kinds of resource deserts in our own community.

[00:04:33] Jorge Ortega: And sometimes we forget that there are pet resource deserts as well. So first and foremost, we've got to look at it. Then, if the animal does come into the shelter, how do we manage the animal through the shelter and how do we make those decisions? Um, most importantly, we try to avoid the euthanasia decision. We try to get the animal, you know, either returned to his own place, to a rescue organization or find him a new home through adoption.

[00:04:56] Jorge Ortega: But if we have to make a euthanasia decision it's made as a group, um, there are seven or eight of us involved in those conversations on a weekly basis. We sit there and we look at our animal inventory and then we make those decisions if we have to make them.

[00:05:13] Carly Malcolm: When somebody has a pet that dies, logistically what actions should they take?

[00:05:18] Jorge Ortega: I think it all really starts with having a good relationship with your veterinarian. Um, I know some of us cannot afford regular veterinary care, so we don't have that relationship or that rapport with our vet. But I think it's important to have a relationship with a veterinarian because he or she can counsel you through that process of what are the next steps.

[00:05:42] Jorge Ortega: Um, we, as animal services are there to provide and help counsel through those services. And of course, we are the ones that kind of come in on the last minute of saying, hey, this is what I'm seeing, this is what I'm facing. How can you help me? What do you recommend? So we have trained veterinary staff, we can not provide the veterinary care to treat an animal, but we can provide the veterinary care to actually help you with that humane euthanasia decision.

[00:06:10] Carly Malcolm: Yeah. I actually had a situation over the summer, unfortunately, where a kitten that my friend was fostering passed away in the middle of the night and we had no idea what to do. So not something you think about until you have to think about it. Um, so it's, it's good to know who you can call in that kind of situation. Um, another question, when a pet dies, how does that affect other pets in that home? You know, a lot of dogs, we see them as like best friends or, you know, so, so what kind of impact does that have?

[00:06:38] Jorge Ortega: Yeah, it, it, I think we don't take the time to consider that fact of, we, we just don't think that pets grieve, whether it's a bird or whether it's a dog or a cat, I think they grieve just like we all grieve in different. Um, it's, it's always important as a family unit to, to keep those things into consideration, especially if you have an ill pet or an aging pet that might be happening down the road is how, like, how is this companion going to take this after?

[00:07:07] Jorge Ortega: Um, it's things that we see as well. Cause we have pets that come into the shelter that are bonded, where we would consider that they both came in. So it's very important for us to keep them together as much as possible. And it's not a euthanasia decision, but we would prefer that they get adopted together or they get placed together, kind of in the same concept, because if they have that bond, how do you, how do you manage that afterward? Cause they’ll grieve just like we would grieve.

[00:07:34] Carly Malcolm: And then what would happen when someone that's someone being a human, um, when someone dies and they leave a pet behind, if nobody is willing to step in and take care of that pet.

[00:07:43] Jorge Ortega: Yeah. So we have had situations where, um, pets have been brought into our shelter due to their owner’s passing. Um, we try our very best to track the family, next of kin, or try to find if there's neighbors or friends or relatives, you know, who might be that to care for. Um, It happens and it's really sad. And so when we have those situations come into the organization, we're really trying to make sure that we are taking care of that pet the best we can and trying to place that animal either into a new, you know, home or in a, if it's a hospice situation where we know the animals are going to be cared for.

[00:08:26] And everyone that's involved understand the reason why the animal came into the facility.

[00:08:33] Jeff Thigpen: Yeah, we're just throwing questions at you, in terms of folks who've lost a pet, have you experienced, um, over the animal shelter, the idea of, of people who have already lost the pet and then they come in and they will not adopt again. Um, why are some things that people need to consider? In that kind of environment.

[00:08:54] Jorge Ortega: Yeah. It kind of goes back to the question of, I have another pet and he's missing the pet that we just lost two weeks ago and I want to get another pet. Um, we have to take into consideration is not just cause to provide company for the pet, but is that other pet going to be willing to accept a new pet coming into the home?

[00:09:12] Jorge Ortega: Because it's not just about a void. It's about are they going to get along? And are you going to create, your family's already going through a lot of stress and a lot of loss, the last thing you want to do is go to this shelter, to the pet store or wherever it may be to get a new dog, come home and then gets into a fight with the dog that's already there.

[00:09:30] Jorge Ortega: Then you have this additional stress. What I would recommend to family members who have just lost a pet and are thinking, ah, we need to get one, you know, we need to get fluffy a friend. Is take your time, be there for fluffy, you know, spoil fluffy. You know, if you have to go buy a cheeseburger for fluffy, buy a cheeseburger for fluffy, take your time in making that decision.

[00:09:50] Jorge Ortega: Because sometimes it's, it's, it's like we wouldn't jump into, you know, if we lost a spouse or a partner we're not jumping into the next spouse or partner. Yeah. I think we need to take to those situations the same way. And the biggest challenge here is that they can't tell us anything. They can't tell us how they're feeling or what's, what are they thinking?

[00:10:08] Jorge Ortega: So we really have to take the time to have those conversations with folks when they tell us, hey, I just lost our dog and we want to get another dog. If it's going to be the only dog in the home, that's a different story. But if they have another pet or pets, then we try to talk to them to really make sure that they're taking the time they need to make that decision.

[00:10:28] Jeff Thigpen: Um, and two things I'll say about you is when we started doing our end of life project and we started talking about the Good Grief podcast and all that kind of stuff. I remember being at a department head meeting and we're talking about the bereavement policy for the county, I think, um, and, and, and I think I was saying something, yeah, we got this end of life project and you were saying, we, you know, we talk about bereavement, but you know what? People lose pets. And, and I think for a second people kind of went I can't believe he said that. And then all of a sudden they're like yeah we do.

[00:11:01] Jeff Thigpen: And, and I think that these segments on pet loss are really important because when we talk about end of life issues, a lot of these subjects are going to talk about, um, people who lose their lives and everything.

[00:11:14] Jeff Thigpen: But a lot of times we don't consider or think about the impact that the loss of a pet has unless you really have a pet. And then you go through that grieving process, um, of, of, of a pet. And I think that the idea of this topic came up out of that, uh, discussion. So in a way, I really appreciate the fact that you were kind of on board and an ally to that, um, when we started it. So if we want, if people want to get more information about the Guilford county animal shelter and the services you provide, those kinds of things, what's the easiest way for them?

[00:11:46] Jorge Ortega: The easiest way to get the most information right away is through our website, through the county website. So you can go to the county website, click on the animal services logo tab, and that'll take you to all your information. If you wanted to speak with someone in color and may number, which is 336-641-3400. Um, then someone there can, can help you out. Um, but, you know, when we're talking about the importance of pets in our lives, we have programs in the community right now.

[00:12:14] Jorge Ortega: Like we've partnered with Meals on Wheels, and we know that some of these home-bound seniors will share their human meal with their pets. So what we've done is we partnered and animal services providing the pet food. So this way we know the human gets all the meal and nutrition that they need. But so is their pets.

[00:12:34] Jorge Ortega: And then when it comes to it, if someone has to go into the hospital or they have to go wherever, they're not going to make a decision because their pets not going to be cared for that's. So, so we have teamed up with partners in our community that will provide free boarding while these individuals, so they don't have to worry about, you know, so, and I know we're talking about end of life and what happens when, when we lose our pets via.Pets play a vital role in our lives in some individuals, that, this is all we have. That's all they have. So, yeah.

[00:13:07] Jeff Thigpen: That's true. And, um, and I really appreciate the, uh, the heart you bring to your work at the Guilford county animal shelter. Um, and the impact it's having on this community. Um, I know you care about it. And one of the, you know, just as on a personal level, you, you do some work outside of Guilford county, helping communities when they're dealing with crisis and hardship in terms of how they're dealing with their pets and given communities.

[00:13:33] Jeff Thigpen: I know you're from Puerto Rican. I think when the hurricane struck down there, you like organized and, and, and there was a recent hurricane in North Carolina where it was like, I was working with people down in Pender county to try to help my home county, get the resources they needed. And I'm in a conversation I think, with our Clerk.And he goes, well, yeah, Jorge is doing some organizing. You, you like got thousands of pounds of dog food or something and got it to a community in Eastern North Carolina. Um, I remember that correctly. Can you talk to us about some of that work?

[00:14:04] Jorge Ortega: Yeah, so, so before I joined the county, I was doing some consulting work, in Puerto Rico and helping and working with nonprofit organizations in there.

[00:14:14] Jorge Ortega: Um, we, we, we were part of a movement to set up an organization that's made up of. It's a coalition really of different organizations, community organizations that have already been therein, in a long time, just animal welfare. And similar to what we have started here in Guilford county is really just getting to meet people where they're at in their communities before those pats actually make it into a shelter.

[00:14:39] Jorge Ortega: Um, the euthanasia rate in Puerto Rico is really sad. It's really high. So what we were trying to do is just really bring those resources to the community with, you know, free pet food, free spay and neuter or free vaccines. So he got that started and then hurricane Maria came around. So our shift went from.

[00:14:55] Jorge Ortega: Getting these resources locally into a certain community to more of a global impact and trying to get containers full of pet food and pet supplies to the island. And then I joined Guilford county. So I had to put like a pin on what I was going on down there. Cause then I this, but, um, then the hurricanes hit and that was that first year I was here and, um, Carteret county needs some assistance. And I had some, some friends and some I have, I had, I have some great friends in Charlotte. Um, and if they're there at global restore and they reached out to them, they help us get a whole bunch of, you know, product and supplies and pet food together. And we. - Jeff Thigpen, do you remember how many pounds that was?

[00:15:37] Jorge Ortega: Wow. I think it was probably close to 40,000 pounds of pet food that we had donated in a warehouse in Charlotte.

[00:15:45] Jeff Thigpen: Um, the reason why I'm asking that is because I know in Robin told me that, that you did that I hadn't met you yet. And my comment was 40,000 pounds of pet food. Seriously, who was this dude? So that was very important.

[00:15:57] Jorge Ortega: Yeah, we had, we had a lot of, a lot of different, um, pet food manufacturers donate. Um, and so we had one central location where all the food would go to. So yeah, it was just awesome. I was just happy to help and happy to represent Guilford county saying that, hey, we're out here helping.

[00:16:56] Jeff Thigpen: So Jorge, you all have a new animal shelter that is being built. Can you talk to us about that?

[00:17:00] Jorge Ortega: Yeah. Um, very exciting time in animal services history, we are building a new 30,000 square foot state-of-the-art animal care facility. Um, which is about a quarter-mile down the road from where we're currently at, which is great, cause it's still convenient.

[00:17:16] Jorge Ortega So for those individuals that are used to visiting our facility, it's not a, you know, detour to their routine. Um, it's, it's going to be a facility that, you know, will last us for a long time. Um, it's going to, um, provide resources that are much needed in the current facility that we do not currently have.

[00:17:35] Jorge Ortega So the animal care. The level of animal care that we're going to be able to provide. And the new facility is just going to be tenfold from where we're at now.

[00:17:42] Jeff Thigpen: Oh, great. That sounds like it's got a bright future. And if we want to get more information about the animal shelter where do we go and what do we do?

[00:17:51] Jorge Ortega: Yeah. So you can go to the website, to the Guilford County, uh, website and just find the animal services logo, click on that or the animal services tab and click on that and it’ll give you all the information on animal servers. Or even feel free to call us at 336-641-3400 and one of our, um, animal care receptionists would be more than happy to help you out.

[00:18:14] Jeff Thigpen: Awesome. Well, we're glad you're in Guilford county. We're glad that you're doing the work, um, within the county and outside the county in terms of your help of other communities.

[00:18:23] Jeff Thigpen: Um, and we appreciate you being here. We know you're an ally around issues of loss and bereavement and pet loss. I think I said that twice, didn't I, um yeah I did.

[00:18:35] Jorge Ortega: It’s so important. And we got to talk about it twice

[00:18:37] Jeff Thigpen: Yes, we have to talk about it twice. Thank you very much for being a part of the Good Grief podcast, Jorge Ortega Director at Guilford County Animal Services.

[00:18:45] Jorge Ortega: Thank you for having me.

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

[00:01:00] Jeff Thigpen: This is the Good Grief podcast. I'm Jeff Thigpen Guilford County Register of Deeds. And I'm joined with Carly Malcolm, who is the lead for NC fellow from the North Carolina Institute of Government. Today, we have Michael Moyer with us. Michael is the Cemetery Superintendent for the City of Greensboro. That is a department that is located within the Parks and Rec department.

[00:01:20] Jeff Thigpen: We're going to get to know Michael today, learn about his role as a cemetery superintendent and how the City of Greensboro operates and manages its cemeteries. So, Michael, thank you for being with us today.

[00:01:34] Michael Moye: Glad to be here.

[00:01:36] Jeff Thigpen: All right. How did you become a funeral director and what’s your background that prepared you to become a Cemetery Superintendent?

[00:01:42] Michael Moye: Well, funeral service is actually a second career for me, which is fairly common in the funeral industry you usually have people who will born into it and have done nothing else or people that go into it because they feel it's their calling. And I followed to that last category. I spent my early career in the communications field.

[00:02:00] Michael Moye: It’s funny, I had always wanted to be a funeral director but when I was growing up, my father thought that was a dumb idea. So I, you know, our generation didn't argue with our parents, like kids do today, I did what he had always wanted to do, which was go to engineering school and had a successful career. But finally got the point that I was old enough to do what I wanted to do and took early retirement and went back to school and went to Gupton Jones in Atlanta, which is the largest mortuary school in the country.

[00:02:28] Michael Moye: And only had to go for a year because I already had college. And. never looked back. So I was at a local funeral home for a number of years, a local family-owned funeral home as a funeral director when I was thinking about retirement, the city kind of reached out and approached me. They were having some struggles with the city cemeteries and asked what my background was I ended up applying and getting that job.

[00:02:55] Jeff Thigpen: And this, about 30 years of being in the field right?

[00:02:55] Michael Moye: Yes. Yes. Almost exactly 30 years.

[00:03:00] Carly Malcolm: And you're also the past president of the North Carolina Funeral Directors Association. Can you tell us about that group and maybe also explain what the North Carolina Board of Funeral Services is?

[00:03:11] Michael Moye: The North Carolina Funeral Directors Association or commonly referred to as NCFDA.

[00:03:17] Michael Moye: An association of funeral directors and funeral homes, and it's kind of a fraternal organization. It's its task is to promote funeral service, to provide continuing education opportunities, and to keep funeral directors and all up to speed with the latest trends in technology and government laws and things that we'll need.

[00:03:41] Michael Moye: Looking after, you know, that kind of stuff. And I was elected by my peers to be president of that association back when I was still in, at the local funeral home. The other organization, there is not an organization is a state board is the North Carolina Board of Funeral Service or NCBFS. That is the actual regulatory agency that is tasked with enforcing all the rules and the laws and things that pertained to funeral service.

[00:04:09] Michael Moye: It is responsible for issuing state licenses, both to individuals and firms. Um, it regulates funeral home establishments, pre-need funeral funding, and is really the consumer watchdog that protects the public. Those members are appointed by the governor, the Lieutenant governor, and the speaker of the house.

[00:04:28] Carly Malcolm: And so we've got a few different kinds of cemeteries. There's the private, the public, and then the government operated. Could you explain the differences between those?

[00:04:36] Michael Moye: Sure, as you say, cemeteries normally fall into one of three categories. Private cemeteries, these are usually family cemeteries or church cemeteries. Family cemeteries are usually more frequently found in rural areas.

[00:04:51] Michael Moye: And we're used to started years and years ago with multiple generations of a family or families being buried in that cemetery. Until the early 20th century, it was very common for churches to have their own cemeteries adjacent to the actual church. It is funny in Guilford County, the two oldest church cemeteries are Alamance Presbyterian Church and Buffalo Presbyterian church.

[00:05:15] Michael Moye: They both started in 1756 and is a friendly rivalry as to which one is the eldest of course they were both chartered within about a week of each other. There are actually religious cemeteries that would be considered private cemeteries as well. Here in Greensboro, we have the Hebrew cemetery, which is at the corner of Vanstory street in what is now Gate City Boulevard, I will forever call it High Point Road.

[00:05:36] Michael Moye: And it's operated by the Jewish congregation here to serve their congregations. There's an Islamic cemetery on Rock Creek Dairy Road serves the Muslim population. And then in some larger areas like particularly North Carolina, I think in Charlotte, there's a Catholic center.

[00:05:54] Michael Moye: That's very prevalent up north to have cemeteries actually run by the Catholic diocese, but not as common down here. So public cemeteries or more commonly referred to as for-profits cemeteries. These are run by large corporations, is a business entity. They're open to anyone who wants to purchase properties, there doesn't have to be any religious sect or anything like that.

[00:06:15] Michael Moye: They're run as a profit center or a business. And some examples in our area would be Guilford Memorial Park, Lake View Memorial Park. Westminster Gardens are down in High Point, Floral Garden Park are some of the larger for-profit cemeteries here in the area.

[00:06:37] Michael Moye: Government cemeteries typically fall into two classes. They're usually more commonly the veteran’s cemeteries operated by the federal and state governments like Arlington or the National Cemetery at Salisbury. There's a state veteran's cemetery over near Asheville, or they are cemeteries operated by municipal governments and that's where our cemeteries fall. Um, the cities come under the municipal government cemetery.

[00:06:59] Michael Moye: This might also be a time, I'd heard you asked before about perpetual care. A lot of cemeteries use the term perpetual care in their advertisement or in their promotions and it's probably one of the most misunderstood terms by the public that you will encounter. Our perpetual care has nothing to do with the day-to-day maintenance at a cemetery.

[00:07:19] Michael Moye: I always tell people when they ask me about it, instead of saying perpetual care, use the term never abandon, the purpose of the state perpetual care fund is to guarantee that if an operator of a cemetery goes bankrupt or out of business, or just simply walks away from it. Then the state can use the funds that have been deposited in a perpetual care fund to step in and make sure the cemetery is operated until they can find a new owner or a new operator.

[00:07:52] Carly Malcolm: And where do those funds come from?

[00:07:58] Michael Moye: They're usually a percentage of the sale, the property sales, you know, 15, 20% of the property sale goes into the state fund and it's managed by the state.

[00:08:06] Carly Malcolm: So that's, that's a good segway into my next question, which is what happens when a cemetery is full?

[00:08:13] Michael Moye: Well, there again, that's a term that's kind of often misunderstood, it is not unusual for a cemetery to be sold out. It's almost unheard of for one to be full. The difference being an example. Greene Hill here in Greensboro is one of the oldest city cemeteries. It is close to being sold out, will probably be sold out within the next two years. As far as us having property available for sale, it will never be full because back in the late 1800s and early 1900s, there were families that would have bought 10, 12 big, large family, plots.

[00:08:49] Michael Moye: They might've used four or five or six of those. And now the family is so scared or they don't even know that they own the property or they’re relocated geographically. So they have no desire to be buried in the Greensboro area. So those spaces will never be used. And therefore the cemetery technical will never be full.

[00:09:06] Jeff Thigpen: I am going to go back to the perpetual care.

[00:09:08] Michael Moye: Sure.

[00:09:10] Jeff Thigpen: We had a situation where there was a graveyard that was found off of Pomona in Greensboro.

[00:09:18] Michael Moye: Up next to the railroad tracks.

[00:09:20] Jeff Thigpen: Yeah right next to the railroad tracks. And I went out and walked it. And we could never find out who quote-unquote owned it. Of course, there was a church that was close to that area. And I know at some point they put the railroad crossing in, but you know, the land is still there. The graves are still there and it seems like you're already familiar with that property.

[00:09:40] Michael Moye: Yeah, I was asked questions about it a number of years ago and the best we could determine, it was either an old church cemetery that the church had out front and had been abandoned for years and years.

[00:09:51] Michael Moye: Or quite possibly some sort of family cemetery that was no longer in use and maintained. We could find no records of ownership like you mentioned. Almost all of the graves out there were unmarked or just marked with simple stones with no inscriptions on them. So there was no real way to determine it, but logically it either had to be a church that had moved on or a family cemetery that was no longer used.

[00:10:17] Jeff Thigpen: Yeah, well thank you for that. Let's talk about the City of  Greensboro. Can you give us an overview of the cemeteries operated by the city? And of course, we'll ask you about, you know, about, you know, people choosing to be buried in it, but can you give us an overview of the cemeteries

[00:10:30] Michael Moye: Sure, Greensboro operators four municipal cemeteries they are Greenhill, Union, Maplewood and Forest Lawn?

[00:10:37] 30] Michael Moye: Green hill is the oldest of the cemeteries and it's located right downtown on Horton Street and it opened in 1877. Greenhill is composed of 51 acres which is landlocked, with nothing but city streets around it. Now they had been approximately 14,000 interments in Greenhill. And as I said early, it will probably be sold out, not full within the next two years or so.

[00:11:02] Michael Moye: So I'm down to less than 25 grave spaces that we can sell to people, right there. Union is the second oldest and probably the least known of the city cemeteries. It is located at the corner of South Elm and Whittington Street. It originally opened in 1880 and was founded by the congregations of St. Jane's Presbyterian Church, St. Matthew's Methodist church, and Providence Baptist Church to provide burial space for the city's African-American community back when they were not allowed to be buried at Greenhill. In 1993, it was actually placed on the national register of historic places in the early 1900s the city took over Union strictly just from a maintenance standpoint because it was closed and had been no burials in Union since 1918, which coincides when Maplewood was opened in 1918.

[00:11:52] Michael Moye: And although they have been no burials there in over a hundred years, we're still tasked with maintaining it, keeping it up, and that sort of thing. So the next cemetery is Maple Wood Cemetery. It opened in 1919 and is located on Bingum Street with the main entrance on Peachtree Street off of East market, it is comprised of 26 acres.

[00:12:10] Michael Moye: And there's been a total of 13,750 burials, roughly in there. And as of October, this year, it sold out. Uh, it is not full. I still will have burials down there for families had already owned spaces and can continue to use ones that they've previously purchased, but it's landlocked, and no opportunity for expansion.

[00:12:31] Michael Moye: So we have nothing else to sell the public and the last of the cemeteries is Forest Lawn Cemetery, and technically it's the newest of the city cemeteries relatively speaking since it opened in 1928. It is also the largest and the most active with 81 acres. And was constructed in 1926 and 1927 using prison labor.

[00:12:53] Michael Moye: And at the time it was constructed, it was way outside the city corporate limits of Greensboro, and people thought it was a foolish idea, but as you can imagine, the city has completely grown up around it now and everything. We've had over 21,000 burials at Forest Lawn and as I said it is the cities most active. Of the 81 acres, 51 have been developed and there is 30 acres that is still not cleared and can be cleared for future development.

[00:13:21] Jeff Thigpen: If someone wants to choose to be buried in a municipal cemetery, what is the process around all that? And then the cost and that kind of thing.

[00:13:31] Michael Moye: In terms of one of the city cemeteries and for that matter just about any cemetery the local funeral home would normally contact our office. Sometimes the family will contact us directly if a local funeral home is not actually going to be involved in the internment, for example, if they just had a simple cremation and in the future choose to bury the ashes, they would reach out to us directly.

[00:13:58] Michael Moye: Our office has a standard service form that we would have them fill out. It has just tons of biographical information and things that we need for our database and our record. Based on the information that they provide, we would determine the location of the grave, if they already own property, or if not, we would schedule an appointment to meet with a family, for them to select a grave space.

[00:14:19] Michael Moye: If they wanted to purchase one, based on the schedule, we would open the grave prior to the service. And what's involved is, is not just as simple as it sounds. You actually have to go out and locate property corners and measure and get the exact location of the grave. Cemeteries have specialized equipment.

[00:14:40] Michael Moye: For example, our backhoe has a bucket on its the exact width of a grave, which is much wider than a normal backhoe bucket. So we opened consistent width all the time. And that's based on vault sizes and stuff. So we know we're going to cover it on there and we have special equipment used to haul the excess dirt.

[00:14:58] Michael Moye: And then following the service, the process is reversed and we haul everything back in and cover the grave up once the services finished and everything. Someone had asked me, I think, in the conversation about the term six feet deep and where that came from. It's really an inaccurate term, today most graves are really approximately 55 inches deep, which is less than six feet, obviously.

[00:15:30] Michael Moye: The 55 inches allows for the outer burial container or the burial container to be in place in the bottom of the grave and still have the state mandated 18 inches of cover, over the top of it. And that's a relatively new state requirement that came about following hurricane Ike with so many graves floated up down east.

[00:15:49] Michael Moye: And you saw pictures of vaults and caskets floating up and down the tar river. And following that the state passed some new rules that require you to have a minimum of 18 inches of dirt on top of the barrel container to make sure it stays weighted down in everything. The term six feet deep actually goes back to colonial times.

[00:16:10] Michael Moye: And the reason for that was if you put the body or the burial container, whether it was just a body in a shroud or wooden casket or wicker basket, if the bottom of it was six feet deep, that meant that the top of the barrel container or the body was at least 48 inches below ground level, which is a depth to keep an animal from being able to determine there was a decaying body and digging it up. Oh, wow. So that's kind of an understood or misunderstood term, you know. so really it's

[00:16:42] Jeff Thigpen: Oh, wow. So really I'm not buried six feet under I'm five foot, seven inches under.

[00:16:45] Michael Moye: Yeah, something like that about 5 feet under. Yeah, that six feet under was that it got you down so that wild animals couldn't detect or determine, you know, a decaying body and be prone to digging it up and stuff.

[00:17:02] Jeff Thigpen: Well, and I don't know how much is a plot?

[00:17:05] Michael Moye: Currently, plots in city cemeteries. If you're a city resident is $1,200 each, which is, if you compare it to the for-profit cemeteries, $1,500 if you are a nonresident.

[00:17:16] Michael Moye: And we also have discounted graves in our veterans section. Our regulations require those to be sold at half the price of the normal grave space. Currently a space in the veteran section at Forest Lawn is only $600, but only the veteran can be buried there.

[00:17:37] Michael Moye: Their spouse cannot be buried with them in the future. And that's that discount is because back in the early 1930s, when that session was developed, the government provided some assistance for the cost and everything. So that was the agreement that it looks just like Arlington a Salsbury National, the same white upright headstones, but there again only the veteran can be buried there.

[00:18:00] Carly Malcolm: Let's talk about an exhumation. Can you talk about what that is, how often it happens and why it would happen?

[00:18:07] Michael Moye: Sure. Exhumations are probably more common referred to as disinterment, are not common at all. On average, our staff would perform an exhumation or a disinterment about once every 12 to 18 months. Unusual for us.

[00:18:20] Michael Moye: Last month in October, we did four in one week, which is like two or three years worth. Usually, they're done when a family has relocated and they want someone who may have died young and was buried here in Greensboro. 20, 30, 40 years ago, moved to be with the rest of the family. Sometimes, you know, granddad was buried and now all the rest of his family is being cremated and their ashes are putting in the column burial at their church.

[00:18:45] Michael Moye: And so they all decide to exhume a body and have it cremated and added with the rest of the family. And there are those rare occasions where a court can order a disinterment. If there's a legal issue, such as, after burial somebody raises a question about the cause of death, or if there's a big estate and an unknown relatives start coming out of the woodwork and they want to do a paternity test or something like that, but that is almost never done.

[00:19:11] Jeff Thigpen: Can I ask you? If a person is cremated and they wanted to be buried in a city cemetery, would the cost of the plot still be the same?

[00:19:19] Michael Moye: Cost of the plot would be the same. The difference being that, that our, our regulation state that if you bought a single grave space for $1,200. Both your and your wife's ashes could go in the same grave space.

[00:19:34] Michael Moye: So it would basically be split. It'd be like $600 for each kind of thing, if you look at it from that perspective, the opening of the grave is much less. For example, right now, during the week, the opening of a traditional grave for a casketed burial is $800 in it's only $400 for cremation. We also the city, unlike some of the for-profit cemeteries, we did not require a fancy urn or an urn vault or anything like that.

[00:20:00] Michael Moye: You can use what's called in the profession, the temporary container, which is just the simple container that comes straight back from the crematory. And that meets our standards and stuff. We are not a profit center, so we're not trying to see how much we can sell you before you get out the door.

[00:20:16] Jeff Thigpen: And that brings up my next question, but in some of our podcasts, interviews, and interview and folks in the field, we're finding that there are more cremations that are beginning to happen.

[00:20:28] Michael Moye: That's a very much a geographical thing, you know, you always think about when you hear cremation, you think about California, you know, Hawaii, actually the highest number of cremations are probably in Washington state and Oregon, it's a geographical thing.

[00:20:45] Michael Moye: It's a church-oriented thing. Yeah. We are still considered for lack of a better term, the Bible belt. So cremations while they've increased in some of the metropolitan areas it is almost unheard of in rural areas. When I was at the funeral home, if I could find out where the deceased person's church membership was, I could just about tell you whether they're going to be cremated or a traditional burial before the family ever walked in the door.

[00:21:10] That's some, some churches I knew there was a 90% cremation rate and some churches I knew there was a 0% cremation, um the funeral home or the local family funeral home, where I was employed for a number of years had multiple branches. And the cremation rate varied greatly by branches, the downtown Elm Street branch had a much higher cremation rate than some of the rural areas up in Stokes county or Rockingham county, so it’s like that. So it's very much a religious, geographical thing just like styles of caskets, and that kind of thing varied by geographical regions.

[00:21:49] Jeff Thigpen: That makes sense. So what options are there out there for people who, who need financial assistance in terms of burying someone.

[00:21:54] Michael Moye: Unfortunately in North Carolina, not much at all. They're very few options for indigent burial.

[00:22:00] Michael Moye: Each of the hundred counties sets their own rate for reimbursement. In Guilford County this is a whopping $540 and it hasn't changed in 20 years. And that doesn't mean that you're guaranteed to get the finance if the budget hasn't run dry. For example, this year, with all the setbacks from COVID and in revenue stream interruptions, the county could come out in December and say, we have no more money for indigent burials.

[00:22:25] Michael Moye: So your funeral home is not guaranteed that. Usually a reputable funeral home will work with a family and they'll take that $540 and at the very least they'll perform a simple cremation, which is lower than their normal cost, and help the family out. In the case of the city's municipal cemeteries, if a person is indigent and the term already known to the Guilford County Social Services Department, in for example, if they have an assigned social worker and are truly being considered as indigent.

[00:22:57] Michael Moye: That social worker certifies him as indigent. Then we're authorized to provide them a free grave space and wave our normal charges, but that almost never happens because someone being on the common term welfare or SSI or receiving food stamps does not mean they're indigent. In fact, that actually hurts because they're getting income coming in.

[00:23:20] Michael Moye: There with the exception of some homeless people who have zero income is almost impossible to be declared indigent here in North Carolina.

[00:23:29] Jeff Thigpen: In terms of Guilford County, the city has a city-owned cemetery system, I guess if that is what you want to call it, High Point has one as well.

[00:23:36] Michael Moye: High Point has a couple of city cemeteries, not as large as Greensboro.

[00:23:41] Jeff Thigpen: Okay. Are they about the only two? Do you know?

[00:24:02] Michael Moye: Oh no, no. I mean, Charlotte has. Jeff Thigpen: Oh, I mean in Guilford county. Michael Moye: All the others are going to be private or public cemeteries. I don't know, I mean, you know, High Point and Greensboro, Zapple, you know, Julian, any of those kinds are not going to have city-operated cemeteries in our county.

[00:24:08] Jeff Thigpen: Do you see in the next like 10 or 15 years there being any need for additional space for city owned cemeteries.

[00:24:10] Michael Moye: Yes and no. I see it as a funeral director. I'm not sure city officials in Greensboro, see it as a priority. For example, there's an additional 30 acres at Forest Lawn. Will that be allowed to be cleared? And used a cemetery property? I don't know, as a funeral director, I can say, yes, there's a need for it in the next 20 years, 10 years.

[00:24:30] Michael Moye: We'll definitely need that space or to start getting that space or to start getting that space prepared. But I will also be honest to say that under belt land backs up to country parks. So the city may look at what is best for our city to expand country park or to expand Forest Lawn Cemetery. So there's decisions way above my pay grade.

[00:24:53] Jeff Thigpen: Yeah, well, and I thank you for all this. I mean, I really appreciate these some really important questions. And when we started this end of life project, we talked about, you know, the need for the public to understand more information of when they are mourning loved ones and to the resources in the community and that kind of thing, you know, you're one of those positions, like the Register of Deeds, you know, nobody kind of knows what I do.

[00:25:18] Jeff Thigpen: Until they have a baby, get married, someone dies, or they buy a house, it's really important. And to be the cemetery superintendent, you know, It's one of those positions where people will be like, well, you know, I don't know who that guy is, or lady is whatever and what they do, but you know, you're around in case we need you right there.

[00:25:39] Michael Moye: I'm one of those people that you need, but you don't ever want to talk to.

[00:25:46] Jeff Thigpen: Oh yeah, there you go. You need, but you don't ever want to talk to. And when you do it, you probably can't talk. It's a one-way conversation.

[00:25:53] Carly Malcolm: What kind of permits who a person need for burial or an exhumation?

[00:25:57] Michael Moye: There are no state or federal permits required for burials in North Carolina other than in the case of the veteran, you have to have a copy of his discharge proving he is eligible to be buried in a veterans location. The responsibility is really on the funeral home and the funeral director to file a legal death certificate with Jeff and his office, to make sure those legal requirements are met. But, the cemetery doesn’t need or require a copy of that. In the case of an exhumation or a disinterment you have to have an executed form from the local health department and that is mandated. Must be filed and signed off by the health department and a copy provided to the funeral home before we can perform an exhumation. The exception being a cremation, once a body is cremated whether the ashes are buried or not, the state doesn’t care they consider the cremation the final disposition.

[00:26:50] Michael Moye: So, I would not need a permit if someone’s ashes were buried at a cemetery and they wanted to have them disinterned. The only other type of permit that comes into play really in funeral services is what's referred to as a burial transit permit. That is required if you transport a body across state lines either the funeral home does it. For example, if somebody dies in one of the Northern North Carolina counties and they take them into Virginia to bury them, they have to file a burial transit permit with the state of Virginia. And so, and where that body came from and where it was interned. Uh, or if you ship a body by common carrier, like on the airlines, if somebody dies in California and they ship them back here to North Carolina, They have to file a burial of transit permit, showing where the body is ending up.

[00:28:25] Michael Moye: Again, doesn't apply to cremations. If somebody dies and is cremated in California, the family can bring to ashes back and no permits are required.

[00:28:42] Carly Malcolm: So what's the cost of a disinterment. If someone decides that they want their loved one to exhumed.

[00:28:47] Michael Moye: The costs are covered on two different ends. You've got the disinterment cost, which is involved in the location where the body is buried, being removed, and transported to a new location. And then you have the new burial cost, which involved the opening and closing of the new grave.

[00:29:06] Michael Moye: And the purchase of the new grade, that kind of thing on the receiving end. So on average, for example, if we had a body to be exhumed in a city cemetery and moved to another location, you're looking at my charges currently have a couple of thousand dollars. The vault company is typically going to be around $400, plus any mileage, if there's a distance for it to be transferred in, then.

[00:29:30] Michael Moye: On the receiving end of whatever those current cemetery charges are. And I'll use the city as an example if you were disinterning a body in a city cemetery and moving it to within another city cemetery, all tow where you probably looking at 4,000 to $4,500.

[00:29:50] Jeff Thigpen: And how many staff do you have that work with you? And, or per funeral usually, that work with you.

[00:29:55] Michael Moye: Well per funeral there are normally two.

[00:29:58] Michael Moye: Let me tell you my sad tale. We operate, as I said, four-city cemeteries, they total roughly 175 acres between the four. We do all our own mowing and all our own weed eating, open and close all our own graves. The city treats me like a homeowner. If I have a water pipe that breaks or something, I have to fix it myself and we handle any complaints we get about maintenance issues and stuff. And we do all that with eight people, and we bury about 300 plus people a year. So my guys do not stand still very often.

[00:30:33] Jeff Thigpen: Yeah. That's a lot of work maintaining, Thank you.

[00:30:37] Michael Moye: Thank you.

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

[00:00:59] Jeff Thigpen: This is the Good Grief podcast. I'm Jeff Thigpen Guilford County Register of Deeds. And I'm joined with Carly Malcolm, who is the lead for NC fellow from the North Carolina Insititue of Government. Today, we have a very special guest, a fellow department director in Guilford county. Robert Shelley, Robert is the Director of Guilford Counties Veteran's Services.

[00:01:21] Jeff Thigpen: He came to Guilford county in October of 2018 from Cumberland county where he was the veteran services officer down there. He was the president of the Cumberland county veterans. Robert served in the United States Marines for 20 years, retiring as a staff Sergeant and has a bachelor's degree from Ashford University in Human Resource Management and Services.

[00:01:44] Jeff Thigpen: He has veteran services offices in both Greensboro and High Point. And I just want to say Robert that as a fellow department director, I have really appreciated your commitment and vision to the office and your support of veterans. So thank you for being with us.

[00:02:00] Robert Shelly: Thank you sir for having me.

[00:02:01] Jeff Thigpen: Robert, where did your passion come from in terms of serving veterans?

[00:02:07] Robert Shelly: When you look at a position like this, it is not a job, it's a way of life. Um, as a Marine veteran for 20 plus years, honorably discharged. Um, once I retired, uh, might look back on in 1997 when my father passed away. And there was a gentleman who helped us with his benefits. And since returning from the military I have been in public service.

[00:02:30] Robert Shelly: And this was a logical step for me to turn into because those individuals that we help, we're making a significant impact on their lives. So looking at the gentleman who helped us with my mother, I want to give back to our county and the surrounding counties as well. My father was a Marine as well.

[00:02:54] Jeff Thigpen: So your father was a vet as well? Having it in the blood in the family. Right? Absolutely. Um, how do veterans access support services?

[00:03:02] Robert Shelly: In Guilford county you can contact us in a variety of ways via email. shelley@giveforcountync.gov and by phone 336-641- 4 6 8. And currently, we only have two veteran service officers in Guilford county.

[00:03:19] Robert Shelly: So we would ask you to be a little patient with us as a turnaround time may be a little lengthy, but we're in the process of hiring two new veteran service officers that will bring the office to four people.

[00:03:32] Jeff Thigpen: And that's been a real commitment that you've made as a leader in that department is to really look at staffing levels in Guilford county and making sure that they're adequate to serve.

[00:03:43] Robert Shelly: Absolutely. When you look at the staffing levels, what my vision would be is a team that could both do office support and out in the community for outreach, get into those veterans where they are so inspirational during this common cold, you want to be able to go to their homes, places of business, public libraries, somewhere where they don't have to travel a far distance.

[00:04:09] Carly Malcolm: So here, we're kind of focusing on, you know, end of life issues. So when we're talking about aging veterans, what kinds of challenges do they face?

[00:04:17] Robert Shelly: Well, many of our Asian veterans don't understand the various benefits administration and what benefits are out there for them. Um, before we even get to that aging life cycle, we want them to apply for benefits as early as possible. Um, because there are some benefits that are available to them way before we get to an age where we think we may lose one of our veterans.

[00:04:43] Carly Malcolm: So what kind of resources are available to them in sort of the final stages of life?

[00:04:47] Robert Shelly: Mostly the hospice care, um, various, um, hospital care teams that most people don't think about or prepare for.

[00:05:01] Robert Shelly: But there are ways to prepare for it at the end of life, but most surfaces around hospice care at that time.

[00:05:10] Jeff Thigpen: In terms of, um, regular services of veterans through your office, you're probably involved with a number of community organizations or inter-governmental organizations. Can you talk a little bit about that?

[00:05:21] Robert Shelly: We worked closely with, um, Guilford County Continuum of Care, American Legion, Disabled American Veterans Lorillard association in Cumberland county, veterans service officers, and there are numerous organizations we belong to. And just recently we became a part of the Guilford Care Program for caregivers of veterans, which is a very important component, um, uh, providing services to caregivers as well.

[00:05:47] Jeff Thigpen: What resources are available to surviving family members of deceased veterans?

[00:05:53] Robert Shelly: When we look at our surviving spouses, whether it's male or female, what we're looking at is normally dependent devotee compensation, which is a monthly amount that they give to the surviving spouse. If the veteran had filed their disability compensation, claims, and referee and amount about $1,400 a month.

[00:06:14] Robert Shelly: And then you look at the widow's pension, which is an income-based program. Um, and we're still one thing we're working on as an organization is getting away from that war to dollar amount. Because if you look at$ 779, most people can't live on that. And it's below the poverty level and there's benefits that the widow can apply for even we do helpless children, other veterans due to mental or physical condition prior to the age of 18.

[00:06:46] Carly Malcolm: So, can you tell us about what happens when a veteran passes away? Like, how are they honored?

[00:06:52] Robert Shelly: We're starting with the process of what happens when a veteran passes away. First, we offer our condolences and sympathy to the family and what we would ask them before they start this process, even though it's a traumatic time, is to contact us as soon as they've contacted a funeral home, because there are some proper steps you want to take for our to report.

[00:07:14] Robert Shelly: The various benefits that this veteran has to seized, um, as we are well-known in the military, not everyone gets that funeral detail. Um, right now, due to COVID, you're not seeing many of those funeral details that go out, but nevertheless, they are given the flag. Um, what we do have with Randolph county veterans is the detail that will come out seven mandates. And they play taps. They fold the flag and they honor that next of kin of that veteran.

[00:07:48] Jeff Thigpen: Um, in the, particularly in the last few years, there's been a movement that has come up related to increasing awareness and understanding of mental health issues that veterans are facing. Um, and you know, the idea of, um, the number of veterans.

[00:08:09] Jeff Thigpen: Um, you have PTSD and also issues of suicide awareness, um, and having the support they need coming back in many cases from, from combat situations. Can you talk a little bit about, um, that in general, they end up in DC support services and things like that that could be available proactively.

[00:08:36] Robert Shelly: Let me start off with, there are a great number of support organizations out there, especially your veterans, hospital administration.

[00:08:44] Robert Shelly: However, there is a shortage nationwide of mental health specialists. And when you look at the sheer number of veterans that we have coming back, not just from posttraumatic stress. But the ones that have experienced military sexual trauma, and then some daily traumas of life and adjusting back from a wartime conflict, or just a traumatic event in general, what we have is a shortage of mental health specialists to deal with the issues that we have.

[00:09:15] Robert Shelly: Um, I'm thankful and grateful that Guilford county with Sandhills is opening up two new facilities on Maples. And just luckily there, we should be able to tie into that resource as well. But now we talk about telehealth and a lot of our veterans are receiving mental health treatment through telehealth and the psychologist could be in Dallas, Texas could be in California, so we're no longer regionalize with how our veterans give support.

[00:09:50] Robert Shelly: The most important thing that I would speak on is that getting the veterans to talk about their mental health condition and not sitting back in having a lesser quality of life, NGS dealing would have themselves in suffering through a process when there are individuals who are waiting and willing to support them in all the needs that they have.

[00:10:16] Jeff Thigpen: Yes. incredibly important. Talk about the, um, we're going to be interviewing folks that, for example, talk about suicide awareness and mental health issues. And you know, one of the things that comez up is, is that in, in some cases, people are within a culture where they, um, they arent necessarily able, they're not able to talk about it, but they want to talk about it.

[00:10:38] Jeff Thigpen: And there's sometimes, there needs to be particular ways and support structures that are there to help people in those situations. And I think, um, are definitely a part of that category of folks. Um, because on the one hand there's, there's the comradery of being in the service, the relationships they have, some of the common experiences, and then there are some of the common needs that come from that experience.

[00:11:00] Robert Shelly: One of the things that I left out earlier is that the veterans hostile administration has started hiring peer support specialists that deal with just the very topic that you're talking about. Um, I could sit here and talk to my brother who's an army veteran and he would understand everything that I'd gone through.

[00:11:19] Robert Shelly: Then I could sit here with someone else who has no experience of conflict are dealing with trauma and they wouldn't be able to relate to me as those peer support specialists relate in every aspect of life to what that trauma is. So that's been a great joy to all of us. And most of your veteran service officers have gone through the same training for peer support specialists is having a conversation and building a rapport with the individual and having them simply open up is not going to happen on the first visit.

[00:11:56] Robert Shelly: And I personally take it one step further. I give them my personal phone number to give me a call at the business. Because that might be the time that they need to reach out and talk to someone. And then we have the veteran’s crisis hotline that they can call and it'll put them in contact with someone that can talk to talk them through the trauma and experiences that they're going through right now.

[00:12:21] Robert Shelly: And what we would just ask the family members to do is don't enable the veteran. If you see that they're having problems please reach out so that they can get the help they need.

[00:12:33] Jeff Thigpen: And Robert, I know this sometimes it's not an easy number to, to, you know, to get it. How many, how many veterans are in Guilford county? Do you have any idea in terms of,  I've heard a lot of different numbers? Um, yeah.

[00:12:43] Robert Shelly: Okay. So that's not an easy number. Um, you know, I kind of have to hesitate when someone asks me that question because I don’t rightly know.

[00:13:20] Jeff Thigpen: But I do know that you all serve them well every day. Um, so with that said, ultimately, what is your vision, um, as Veteran Service Director for the county, how do you, you know, what do you want your organization to be about and how do you want to do it?

[00:13:49] Robert Shelly: Um, I always love to ask that question cause it's a hard question. And I know you have an incredible commitment to veterans. And from the moment I met you, um, I realized that you were special and that you were really committed to your job. And so what, what do you see ultimately, as division knowing that, of course, as a fellow department director, we all have budgets and limitations and the thousand reasons why we can't do what we need to do or want to do at any given time we had. But what's your vision? First of all, the question about the number of veterans that we have in Guilford county roughing. When you look at it, the VA says we have 35,000 plus veterans. Um, our numbers over the past two years have fluctuated due to their incarceration and some of the veterans moving in and out of the local.

[00:14:14] Robert Shelly: Um, you can't look at this position or this job in the sheer aspect of harmony virtual as you have, because we also service the family member. Yeah, so that number can easily double if the veteran is married and then it could triple if you look at a veteran that has a school-age child, then that child grows up at 18 and now they're entitled to a benefit depending on what compensation that veteran was receiving or is receiving.

[00:14:44] Robert Shelly: When we look at the vision, in my insight of where are, want this department to go, and you're correct, we do have budgetary limits. When I first took this position back in October of 2018, I envisioned a place, a building, a facility that our veterans could come to and feel warm and welcome, just first of all from the sheer magnitude of the building.

[00:15:11] Robert Shelly: And then as they entered and met the staff, which currently sits at. In order to do the things that we want to do with the quality of life for our veterans, I need desire an outreach team that can meet these veterans that are armed in the community, because there are many that can't come into the facility and we still need to be able to provide them services.

[00:15:37] Robert Shelly: My passion for this far exceeds whatever you kick it gets, uh, got the understanding. If I was standing in front of the county managers or the county commissioners now I would simply ask for an increase in staff so that we can meet the needs of the veterans and family members of Guilford county.

[00:15:59] Jeff Thigpen: Exactly. Right. And as, as a fellow department director who will look at you and say, you don't have to. But I will say it is that I think that, that, you know, we need you to have a, a very strong staff department. When you talk about 35,000 veterans, at least with their family members with two locations. You know that is a lot of work.

[00:16:22] Jeff Thigpen: I mean, I'm a department that serves a lot of people in Guilford county. And I think that in your situation, it is really important to have adequate staffing levels. And ultimately the community outreach that's needed too, because there's a lot of veteran groups and a lot of people who want to make this county veteran-friendly.

[00:16:39] Jeff Thigpen: And I know you've experienced that in the short time that you've been here. And that staffing would help you to be able to not only serve the veterans well but also do the community outreach, which you were involved in. So, um, if, uh, if the public would like to get in touch with veteran services, I noted that we could get a Guilford county website, um, and we'll have the veteran services website. The direct line. I think you might've mentioned it earlier to veteran services that people would like to contact.

[00:17:07] Robert Shelly: The direct line to me is (336) 641-4684. Um, if you call me after hours, that phone will turn over into my mobile number. So don't hesitate to reach out. We're here to provide a service and it doesn't matter to us what time of day it is.

[00:17:27] Robert Shelly: It's a way of where I, for us in every day, we want to change a veteran's life. So the staff member that I have now, Ms. Tracy Lundy, an outstanding army veteran, their staff completes with two military personnel. Our, we don't just hire military personnel. We are those who have a commitment to serving our veterans and the greater.

[00:17:51] Carly Malcolm: So Robert, could you talk to us a little bit about the culture within the veteran community talking about and dealing with end of life issues?

[00:17:59] Robert Shelly: What happens when our veterans is quite unique, many of these individuals, former soldiers, Marines, airmen, coast, guardmen, they don't share a lot of information with their spouses.

[00:18:13] Robert Shelly: And most of the time the spouse is in the dark about what benefits are out there and what the veteran’s desires for the end of life. So this culture has been worn. Unfortunately, very controlling of information. Time is space and is at that moment when the spouse is going through a traumatic time of losing that individual and have no clue what we're finding out now in the past couple of nights are most veterans aren't preparing their spouses.

[00:18:49] Robert Shelly: They’ve given him that unique information that they need that DD two 14 that shows their service days. If they're receiving disability compensation, they're making sure that they have that relevant information so that this transition is a whole lot smoother for the family. And what we would tell the family is no matter what you're going through we are here for you. We process our applications for you. All we need is to support the documentation and understand that even at the end of life, that the veteran is looking at honor and dignity and commitment.

[00:19:31] Jeff Thigpen: In terms of, um, and I know your veteran services, but when you're dealing with active military, where there is death in combat, does in any way come through veteran services? How has that facilitated within the network of support for armed services families who lose a member of their family in combat?

[00:19:52] Robert Shelly: So on that note, that's mostly handled by our Department of Defense, but what we'll get in our local community is a spouse who lost their veteran, their veteran in combat.

[00:20:02] Robert Shelly: And we're looking at some benefits that they may be entitled to. Educational benefits, hospital benefits from the VA, or if they had strike here. And those are some of the things that we would assist them with. And even the educational benefit, we may not do the initial application for the benefit, but we still assist him in the far walk with other benefits that they qualify for.

[00:20:28] Jeff Thigpen: Okay. Robert Shelley Director of Guilford County Veterans Services. Thank you for being a part of the Good Grief podcast and on behalf of myself and Carly Malcolm thank you.

[00:20:41] Robert Shelly: Thank you for having me.

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

[Intro]

Jeff Thigpen: Hi, this is Jeff Thigpen, Guilford County Register of Deeds, and you’re listening to the podcast Good Grief, where we talk about death, unapologetically. Have you ever lost a loved one and had to figure out what to do? Have you felt alone? Have you had to deal with funeral homes or settle estates? We get into all these issues and more in Good Grief. We bring together community partners in this area to talk about all of these issues. So that number one, we can give our listeners knowledge that they can use in making decisions and also that they know that they have support, that we live in a community that is one where we can not only live and live well, but when we die, we can also die well. So I hope you will join us for this podcast Good Grief, where we get into these issues and more. Thank you for listening.

Jeff Thigpen:  00:00:50  This is Guilford County Register of Deeds with the Good Grief podcast. Really, the Good Grief in the podcast is a lot of times we deal with a lot of issues that are frustrating around end-of-life care. And so we usually use that euphemism good grief, what are we going to do next? On the other hand, we are all dealing with difficult times in our life, and we want to be able to deal with those issues and things that come up in a way that we're supported. and I'm happy to welcome Jim Albright, who is the Director of Guilford County EMS. How are you doing, Jim? 

Jim Albright:  00:01:32    I'm doing well, Jeff. Thank you for having me this morning. 

Jeff Thigpen:  00:01:35    You're Celebrating how many years with EMS?

Jim Albright:  00:01:38    So soon 31 years in Guilford County and, the last seven years or so as the director. 

Jeff Thigpen:  00:01:43    Wow! You’ve been around a long time. I knew you when you weren't a director, and now I know you when we were both in the big league, so to speak in Guilford County government. What I'd like to do is begin by just asking you about the context. I mean, EMS deals with end-of-life issues in the field, and they deal with death as it comes, in many ways all the time. Can you give me some context about how you, in terms of the emergency services, deal with that on a daily basis? 

Jim Albright:  00:02:09    So I think there's a couple of things that people need to understand. First and foremost when we respond, it's a tiered system. So, oftentimes the fire department, arrives first, and then EMS is a close second. We do that because we have emergency medical care available in all the fire trucks in the system. And they provide that initial assessment. That being said, we deal with trying to bring order to chaos every day in people's lives. So when nobody knows what to do, we've trained Americans well to dial 911, and so we get kind of interjected into the midst of their emergency. That could be anything from, something that we consider to be non-urgent, life-threatening all the way up to the death of an individual in our community. 

Jeff Thigpen: 00:02:50    So you deal with acute death, you deal with crimes, you deal with a smorgasbord of things that happen, and you have to clinically be able to respond to a diversity of issues that come up when that call is made. How do y'all think through that and the methodologies that you use and that kind of thing? 

Jim Albright:  00:03:07    So, we have extensive training. It starts with a state credential, but more importantly than that, we spend a very long internship process for our providers; where not only do they have to understand the clinical medicine, but they have to understand the incredible complexity of dealing with people during times of grief and etc. Oftentimes a death is unanticipated and that's a major issue for a family to deal with. So not only do we have to take care of the patient, but we have to know how to interact with that family member as well. 

Jeff Thigpen: 00:03:38   You were talking to me the other day, we were having a conversation about this, and you mentioned MOST documents. We're going to be doing these podcast and putting together information when we start talking about advanced directives, living wills, all these different things. But, I wasn't familiar with the MOST document. Can you explain what that is and the role it has when you're dealing with these kinds of issues at EMS? 

Jim Albright:  00:04:02    Absolutely! So, Guilford County has a long history of dealing specifically with Hospice and other providers in our community, and back in the early nineties, there was a real kind of gap in the law. And that gap was the fact that EMS providers, and fire departments, et cetera, could not accept advanced directives or living wills. That really was a statement by the patient to their healthcare providers of their wishes at end of life. And so we were very fortunate, County attorney, John Maxwell at the time, and others drafted the original, ‘do not resuscitate orders’ that ultimately were then adopted by the North Carolina Medical Society and then the state. So DNRs were a big improvement for us. It was a legal document that was a declaration of your desire not to have a full cardiac resuscitation, cardiopulmonary, CPR, et cetera. But, it left some gaps quite frankly, in defining the level of care that you wanted. 

00:04:58    So several years ago, the Medical Society and the North Carolina Office of EMS came together to develop what was called the MOST form, which stands for Medical Orders for Scope of Treatment. And the beauty of that particular form is that it defines specifically what the patient wants in their end-of-life care. So section A of that particular form handles everything that the DNR form did. So did you want CPR? Did you want to be intubated and put on a ventilator, and et cetera? But more importantly, it started to define other medical interventions. So for instance, did you want full scope of treatment? Do you want a limited scope of treatment or do you just want comfort measures only? And the beauty of the form is that it can move along as a patient's progression of a terminal illness moves along as well. The other nice thing about it is it defined some other very important decisions that people need to make in their end-of-life care.

00:05:52    So specifically, were people interested in IV antibiotics, if they received an infection? Were they interested in tube feedings? Were they interested in sustainment with IV fluids and other issues? And then it allowed an opportunity for the patient to have that conversation, not only with their primary physician but also with their families and it had a signature process. So the patient actually authorizes the level of care that they want. And the beauty for us is that it absolutely eliminates any ambiguity that we would have at the time of someone's death. To obtain the MOST documents, the majority of primary care physicians in the community will have access to them. You ask the physician if they have MOST forms and then the process of going through filling out is done in conjunction with your provider. One of the questions we often answer about the MOST form, what if the patient isn't capable of making the decisions, then that rests with the medical power of attorney for that particular patient and they and the provider can go through the process of completing it. 

Jeff Thigpen:  00:06:54    Yeah. So that's really important when we talk about living wills and all these different things. The goal behind all this is that people, individuals have a right to make their own decisions as much as possible about their medical care and that kind of thing. EMS, you all are put right on the front line of this when it happens. And so the MOST document is something that I, from what I'm hearing you say is really important from the point of view of your ability to both know what the patient needs at the given moment, and also related to your coordination as a medical team with the hospital, and other entities that you're coordinating with throughout the process. 

Jim Albright:  00:07:33    Absolutely. And ultimately our greatest desire is to fulfill the wishes of the patient. And the issue that occurs, particularly when a death occurs, family members, by their very nature, are wrapped up in the emotion of the particular event. Oftentimes they want us to discount what the patient's wishes were, and this provides us that very clear pathway of desires of the patient so that we can fulfill those to the best of our abilities The other opportunity that we have is that we always have online medical direction. So we always do have the ability to contact a local medical control and speak to a physician at one of our respective sponsor hospitals, if there's any kind of issues associated with that particular time of death. 

Jeff Thigpen:  00:08:16  Yeah. You are a clinician, and so you've been trained to enter into these situations and to act. From my knowledge of EMS, it's very regimented, and regimented in the sense of you're trained methodically to work through a number of different possibilities in terms of treatment. But you're a human being and, you know, one of the things about this podcast is the idea of the experiences that people have both as a clinician, but dealing with these kinds of issues on a personal level. Do you have anything you'd like to share related to that in terms of your personal experience in dealing with end-of-life issues?

Jim Albright:  00:08:56   Well, just like any clinician, I have a private life as well. And I had a father with a terminal illness and have gone through the process quite frankly, of doing the MOST form and having clear understanding, I was his medical power of attorney. I knew that I would have to make decisions in his care, but it really allowed us to have a conversation about that, so that I was very clear in the decisions that he made. The other part is that I had to deal with his death in the home as other family members do as well. And, I have to say that it was handled very professionally and we were able to use hospice services within our community and et cetera. We were able to give my dad what his greatest desire was, which was to die at home.  

Jeff Thigpen:   00:09:36   Yeah. And that's important. Being able to deal with these issues, unfortunately, many times people can't necessarily deal with it on their own terms, having the opportunity to do that is really important. 

Jim Albright:  00:09:48    Well, and I think a lot of people don't understand kind of the legal processes that we have to go through at the process of declaration of death. So first and foremost, what we do is that we document the presence of death, but death certificates are signed by medical examiners, by physicians, PAs, nurse practitioners, et cetera. So we do a lot of interface with the medical community during a time of very high anxiety for a family. So for instance, if a patient does not have the MOST form, and even if they do, we still have to have physician authorization to release that body. So we do a lot of interface to the private physician community, into the hospital systems, and then ultimately dealing with the medical examiner's office as well. 

Jeff Thigpen:  00:10:29    In terms of when you're dealing with medical examiners and, autopsies, are there any basic guidelines around when autopsies usually happen or are they requested or how long does it take, do you have any comment related to that?  

Jim Albright: 00:10:43   Yeah, so we work very closely with the office of the Chief Medical Examiner. The medical examiners for Guilford County are actually private contractors of the Office of the Chief Medical Examiner, which is a state office. And generally the rule of thumb is that they take care of unattended deaths and a series of other classified deaths. So obviously suicides, homicides, traumatic deaths, suspected poisonings, and overdoses. Anything of that nature is under the authority of the local medical examiner. What they do is that they oftentimes will come to the scene, they'll have a conversation with the EMS providers as well as with the law enforcement representatives. And then they make a determination whether the death is something that can be ruled on locally or requires a full gross autopsy. So when people think of autopsies, they think of what they've seen on television, CSI type investigations. Those are fairly infrequent and they occur actually in Raleigh. So a deceased person would be transported locally, would be viewed by a local medical examiner and then referred to Raleigh for gross autopsy. The percentage of those is relatively low. 

Jeff Thigpen:  00:11:48    And you mentioned at the beginning usually what happens is the call is made, in many cases, the fire department will show up, then the EMS will show up. Sometimes the police show up, talk to me about how that happens. A lot of people may get nervous. 

Jim Albright:  00:11:59    First and foremost, we respond as a team, and law enforcement is there first and foremost to protect the safety of the providers. If, in fact, it ends up being a crime scene, they have authority over that. So they are there in an investigative component as well. But generally they're there to assist us. They also have medical first aid training. So for instance, if we're dispatched to a cardiac arrest, we notify law enforcement that we're responding to that particular event. And if someone's close, they may stop in, literally to be that first point of care. And really, I always say the first point of care is the 911 telecommunicators that we'll give instructions to folks across the phone to do CPR. But then our next level of care would be in our law enforcement community. They are there again, really primarily to assist us. However, obviously, if there's any indication that there may have been a crime involved, then they have jurisdiction. 

Jeff Thigpen: 00:12:49    I want to thank you for being here to share some good information. And what we'll try to do is on those most important documents and links and things like that, we will try to add that to the podcast. So people can be able to see some of the documents that we’re talking about and anything that would help clarify them. And I just want to say, you know, I've been in several situations where 911 had to be called, where the fire department shows up with the EMS, and Jim and I, we both know of a situation recently in my office. I had someone who was in a very serious medical emergency to see these first responders work, is amazing. And you can tell their commitment to their jobs. You can tell that they are really trying to put the patient first, and they're trying to do the right thing to serve the citizens of Guilford County. 

00:13:37    So you definitely, and your people, your peeps have my appreciation for all the work that you all do. With that said, I wanted to thank you for being a part of this initial podcast.

Jim Albright:    00:13:42   Absolutely. Thank you, Jeff.

[Outro]

Jeff Thigpen: Thank you for listening to this edition of Good Grief. We’d like your feedback, please visit our website at www.guilfordcountryregisterofdeed.com. You can also go to Twitter @guilfordcountyregisterofdeeds or you can email us directly at endoflife@guilfordcountync.gov. And until next time, we hope that you are able to be knowledgeable and have the support you need in dealing with grief.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

[00:01:00] Jeff Thigpen: This is Jeff Thigpen, Guilford County Register of Deeds with Carly Malcolm, NC lead fellow from the North Carolina Institute of Government. This is the Good Grief Podcast where we unapologetically talk about issues of death and dying. Today we're talking with a local author and native Darren Shell. Darren has recently published a new book named 317, a Suicide Loss Survivor Story. Darren is a graduate of Southwest Guilford high school in Guilford county and also a Western Carolina university. As a suicide loss survivor, losing his father in 2006 and his best friend in 2015, Darren has a unique perspective as it relates to these kinds of issues. He's an integrated facilities designer for Cone Health and part of a development team for the peer-to-peer suicide prevention app, We Care. Welcome Darren, glad to have you with us. We're we're talking in September, suicide awareness month. You want to start off by talking a little about that. Yeah, no, 

[00:02:40] Darren Shell: Yeah, thanks for having me this month, especially, I guess. Of course, September will be a year of when I released the book last year. And it'll also be the 15th anniversary of my father's suicide. So, doing this month really makes a big deal out of all of this. So I'm excited to be here. 

[00:03:00] Jeff Thigpen: Yeah. Well, Carly and I really appreciate you being with us. So why did you call the book 317? 

[00:03:09] Darren Shell: 317 was the time in the morning that God woke me up and said, Hey, I want you to write a book. And initially, it was like, you want me to what? And I just kind of ignored it. But for some reason I wrote it down, it was 3:17 in the morning. And as I was looking for a title for the book, I was going back and forth between 10 or 12 different things that it could be. And then I realized, well, my buddy's birthday was March 17th. And then there was something else that was a 317. And then finally I was looking for... at that point, I'd figured out there's some religious element to this and there should be a Bible verse that's going to point me in some direction. And so I just started looking around and I don't know where I'd look. And I went to Ezekiel and Ezekiel 3:17 fit perfectly. And I'm like, okay, that's it. We're going to go with 317. 

[00:04:05] Carly Malcolm: Yeah. That's quite a few signs. Yeah. Now, in the preface of your book, you lay out your approach and you talk about these three main points saying that the book is from your own individual experiences, talking about your family, being an only child, but with a big family. Can you talk about, you know, that you don't necessarily understand what everyone's going through, that it's individual. So, could you talk about why that approach was important to you? 

[00:04:30] Darren Shell: Yeah, I think that's one of the worst things, when it happens to you, there's always somebody that wants to say, “oh, I know how it is.” And even if they do, they don't. Even if you think you do, you don't. Because it's just every person's experiences is different because every reason why somebody commits suicide is different. So I always wanted to get that across to everybody. This is just a story of how it happened to me. And there's probably some similarities, but I can't tell you what you're going to go through. 

[00:04:59] Jeff Thigpen: And one of the things, and I've told you this, I really appreciated your voice in the book, and the language with which you spoke in many ways was just very conversational. And one of the pieces that I identified with is in terms of how you use the term family. That it was, you know, you have a big family, Darren. And I appreciated that. And I know you started talking about the suicide of your childhood friend, Kenny, who you called as your brother, Kenny. Can you talk to us about him in terms of who he was and what he meant to you? 

[00:05:52] Darren Shell: Yeah, like I say, Kenny is probably the closest thing to a brother I ever had. We had actually known each other since we were three years old. He was my first friend on the first day of school. I walked in and, you know, kids running around a thousand miles an hour and he just stops dead in his tracks and says, Hey, I'm Kenny, you want to be my friend. And we were friends for 40 years after that. And you know, like I say, I spend as much time at his house as he did mine. Our parents used to joke around about, you know, should both of them get the claim, both of us, because one was supporting the kid as much as the other. And then, like you said, I say I have a big family because it wasn't just him, there were six or seven of us that ran in and out of one house after another, after another. So yeah, I'm an only child with eight or nine brothers and seven or eight sisters and 12 or 15 sets of grandparents.

[00:06:55] Jeff Thigpen: Yeah, to be an only child, that's a pretty big family.

[00:06:58] Carly Malcolm: Could you share with us what happened when you learned that Kenny had died by suicide? 

[00:07:03] Darren Shell: I think that was weird. My buddy Keith called me and he sent me a message. He said, Hey, you know, call me when you get a chance, which is not normal for him. So I said, well, what would he want? And I started thinking, well, okay, it must be his parents because his parents still live here and he lives out west. So I left and called him and he said, you know, Kenny committed suicide. And it was just like press and pause. Time stopped. I sat in the front seat, I went in the back seat and I could sit and watch everything happen as I just fell apart. So it was strange to experience it and see it, knowing that I couldn't really see it at the same time. But I guess, until you experience that you can't really ever understand what somebody is talking about, but it really is that time just stops. And you kind of see what happens as much as you're feeling it.

[00:08:09] Jeff Thigpen: And there were moments when you reconnected with some of your friends. I think Debra and when you were visiting people, there was an interaction, you know, when you're a person, when I was reading the book, it's kind of like you had the initial experience of building the friendship with Kenny, and all that meant to you with you and your extended family. Then there was the idea that, that both you and your extended family, you know, in many ways, went on when your lives and you went out and were in your own worlds and had your own families and all that. And then there's a part where you come back together and there's some visitation going on. Can you talk about that?

[00:08:56] Darren Shell: Well, yeah, as soon as I heard Kenny had passed and I kinda got past my initial shock and my first thought was I had to get to his mom. And it was, mom would need the rest of us. His sister would need the rest of us. You know, I’m frantically trying to get ahold of somebody and I knew his home phone number by heart, you know, from being a kid. And of course his parents had moved, so that didn't do me any good. And so, yeah, I don't even remember how I got his sister's number. But I finally got a hold of his sister and it was kind of at that point I realized I was now the only one in the group that had experience with this and it was my purpose to help walk his family through what I had already gone through to help kind of cushion the blow. Because if you don't have somebody that's actually gone through it, I mean, you're walking through totally unchartered water all by yourself. 

[00:10:10] Jeff Thigpen: That allowed you to have a little bit of stability in walking into that situation, knowing that you've gone through it before. And I know you mentioned meeting and talking with Kenny's wife and as an aside, I think there was a little mention of the dog that came up.

[00:10:20] Darren Shell: Yeah, he had always had Dalmatians. I think the set he had when he passed was probably number four and five, I think. And I'd never met these two, but the one, I wouldn't say he's not friendly, but he just doesn't like new people. And normally he's all, you know, kind of jumpy, very protective of Kenny's wife. And I sat down at the dog, just came over and sat down and laid his head right in my lap. And just looked up at me, like, are you as confused as I am? And I'm like, yes, I am. And so the dog and I kind of bonded and I guess at that point, the rest of the family was like, okay, you know, the dog likes him. He can't be all bad. 

[00:11:15] Jeff Thigpen: Yeah. That's actually right. And in these situations, so many of us come into them. And there's also this shock of the event. Then there is the idea of reaching out because you immediately, out of compassion and relationship want to connect with people that you know and love. And I think going through these experiences, I know in reading the book, there was kind of this undercurrent that came through, you know, specifically at times and underneath sometimes of your faith tradition and how you are navigating these situations, always with an eye toward deepening and connecting your humanity, and also what that means in terms of faith. And so one of the things I'll ask you about is there's this funny story in the book whenever one of these things started coming through where your faith came into play a little bit about understanding you and your history was this idea of trying to finagle a firetruck? It was, I guess, around the time that you were moving from Virginia to North Carolina and meeting Kenny and I think there was pastor Wallace, the baby Jesus and the firetruck. I thought that was a great story. Can you talk a little bit about that?

[00:12:42] Darren Shell: Yeah, it's my mom's favorite story to tell. And I guess writing the book helped me discover that there's just a series of events that happen through my whole life that kinda got me prepared to write the book. That maybe the book was my end purpose, but all of these other things had to happen to me before then. And so, you know, it's that early religious influence. As a kid, you go to church because mom and dad are dragging you there. I went because I loved our pastor and he loved me. There was another grandparent that wasn't really mine. But he was my first experience, really as a kid, it's Christmas, it's Jesus's birthday, I’m with mom at Kmart and I'm like, you know, we have to get baby Jesus a present. And my mom's like, how do I get out of this? Oh, well, wait a minute. We wouldn't even know what to get him. Of course. I'm three. He's a baby. We should be close to the same age. What did I want? I wanted a firetruck. So, you know, some kids will be throwing a fit about what they want in the store. And I was throwing a fit about no we needed about the baby Jesus a firetruck, and we need to do it right then. And I wouldn't hear any different on it. And so she had, Sunday after church, go sit and talk to pastor Wallace and discuss with him my idea, and he kind of was slowly building up to it and I couldn't wait and I just had to blurt the whole thing out and I’m like it's baby Jesus’ birthday, I want to buy him a firetruck and mom said I can't. And so then he had to convince me that maybe just, you know, throwing $5 in would be a better deal than trying to get a fire truck. But I did get the firetruck for Christmas for myself. So that was kind of cool. So there was some payoff, there was some payoff but I still did get the firetruck I wanted.

[00:14:45] Jeff Thigpen: Yeah. I just thought that interaction that you were having at a young age around, you know, through a child's eyes, well, thinking about another little baby named Jesus and the idea of throughout the book and including, in terms of scriptural references that you use and also just thinking through issues of suicide, how you are led into that space. And it comes through in the book with a deep level of integrity and a sense of faith, a quality faith that I appreciate. 

[00:15:26] Carly Malcolm: Yeah. And one of the things that we talk about pretty frequently on this podcast is how difficult it can be to talk about death. It makes us feel kind of uncomfortable. And I think, you know, particularly with suicide, that's even more so the case. And I've got the quote here when you emailed your friends to let them know what had happened. You said Kenny had lost his battle with depression and we lost him. And that got you some pushback from one of your friends. Can you talk about that? 

[00:15:53] Darren Shell: A couple of my friends actually, I mean, one of my friends, he immediately sent me an email and he goes, you know, I'm just going to assume Kenny committed suicide because I've never really known anybody to die from depression. And I said, well, you know, yeah, you're right. And he's like, look, we're not 12 years old anymore. We're adults. You need to tell us this. He goes, we're not stupid. At the same time, a girl from high school, who I always thought was smarter than me and still proves to be, she's a doctor now. And she called me right away and she said, you know, you need to stop. You can't do this. If you don't talk about it, it just makes it worse. And I knew she was right because I had gone through that with my father for, you know, years. It was like, my dad passed, he died, he was sick, you know, anything but saying that he had died by suicide. And so I knew she was right. And then finally that was really the point where I think I permanently made the change to, you know, okay. Yes. My dad died by suicide. My best friend died by suicide. You know, and then now working at the hospital, you know, you get more into the language of it and you know, it's not committed suicide or a successful attempt and there's nothing successful about it. If anything, you know, it's a failure. So yeah, learning that language has helped me talk about it more, make it a little easier. 

[00:17:30] Carly Malcolm: And one of those terms is suicide loss survivor. And there's some stigma associated with suicide loss. Can you talk about that a bit? 

[00:17:37] Darren Shell: You know, people think of it as, okay. Yes, somebody, you knew died by suicide. My grandma died. Yeah. It's not the same. You knew your grandma was going to die. You might not have known right then, but you didn't have zero warning of it happening. Probably, you know, the closest things are people that have somebody die in a car accident or something like that. I don't know. I've never had that happen. So it's hard to relate to. But just something about losing someone to suicide is just so different than any other death I've experienced in my life. You kind of have to give it its own definition, and suicide loss survivor is just kind of a little different way to explain getting through death, as opposed to just somebody dying.

[00:18:40] Jeff Thigpen: Yeah. And in dealing with it, in a lot of cases, there are these clouds of judgment that sometimes come into play about, you know, how we should morally view it, or should we, and if we should, what should we do? And then we stumble around the words. We don't know what to say. And then a lot of times we say things we don't necessarily know the impact we're having. And at times it creates an unfortunate dance. 

[00:19:10] Darren Shell: Yeah. Because sometimes you say the wrong thing and then other times not saying anything is the wrong thing. So many times, I mean, I remember even with people I knew it's like talk about anything, but you almost feel like people were trying not to talk to you. And then you look back in yourself and you know they're trying not to talk to you because they have no idea what to say, because they don't know what's going to cause you to fall apart because you don't know what's going to cause you to fall apart. You know, and nothing's worse than 35-year old man sitting at his desk in the office crying for no reason. So everybody just tries to avoid that. But then, you know, there are times where you just need a friend. 

[00:20:02] Jeff Thigpen: Yeah. Give me that support. And speaking of the friendship that you had growing up, in reading it, it was the idea that is like 15 year olds. I mean, I remember when I was 15 years old and I remember my friends and I was kind of reflecting on all that when we would come up with, and sometimes I just say dumb agreement, you know how we do, 20 years from now, we're going to get together, do something. But, it was this idea of we're gonna speak at each other's funerals. If something happens to us, we'll take care of our families. And then you find yourself in them moments years later. And I think at one point there's a conversation you have with pastor Scott about God won't give you more than you can handle. And there were points in here where you were clearly processing all this in multiple ways and multiple layers, emotionally, spiritually, practically. And you reach out to a friend named Brian. And can you talk about those two things, I guess, related to pastor Scott? 

[00:21:12] Darren Shell: Yes, like you said, you know, Kenny and I had made a dumb agreement as two stupid teenagers do you know that we had been friends so long, we just assume that, you know, we'll be 85 years old sitting around and talking to each other about how long we've been friends. And one of us, I don't even remember who started made the joke that, well, you know, whoever dies first has to talk in the other one's funeral and we agreed to it. But we were 15. We weren't going to die anytime soon. It's 70 years away and then it turns out it was, you know, it was less than 30 years away. So that was hard, you know, I realized, okay, now I've actually got to speak at his funeral. And so sitting there right before the funeral. I'm sitting here thinking and I've got a regular life going on up in amongst that as well. You sit there and you think, okay, we've been told our whole lives, God won't give you more than you can handle. And I'm sitting there literally thinking you got a whole lot more faith in me than I do. Let me tell you, because I'm about to lose it today. And then just seconds later, the pastor is speaking and he says, you know, well, of course, God will give us more than he can handle, that's why he gave his family and friends. And it's like, so now suddenly I have permission for this to be too much. For some reason that was the biggest relief of anything that day.

[00:22:32] Jeff Thigpen: And I think in there you kind of allude to the idea of, you know, that you both may have not theologically agreed on everything, but it was clear there was a lot of love there. That's awesome. I mean, talk to me about everything in life and we don't agree. And when you bring politics and religion in it, you know, we go off the rails. But the idea of how you say that in that situation underneath, there was a lot of love there that was a powerful statement. 

[00:23:08] Darren Shell: I guess I've had a lot of friends who are pastors and Brian is definitely the first pastor that's been my friend, if that makes any sense at all. He was a youth pastor at our church, but he and I were Marvel movie buddies because neither one of our wives liked them. So he, and I would always go check out the newest Marvel movie and stuff. And so he and I were really, really close. Our kids were in Scouts together, all that. And you know, when Kenny committed suicide, I knew there was nobody else to talk to. Brian was going to be the only person that was going to make it better for me. And we were talking and like you say, you get into that, you kind of try to skirt around a total do not pass, go, do not collect $200 kind of thing for suicide and stuff. And we weren't necessarily on the same side of the coin. And I could tell because I said something to Brian and kind of just raised that one eyebrow as he does. But he never said anything. He’d be like okay, I don't necessarily agree with you, but now it's just really not the time to bring it up. You're in the midst of dumping your soul out to me. Let's continue on with that. And it was just, again, you know, it's the love of a brother to do something like that at that time. 

[00:24:17] Carly Malcolm: Absolutely. And there's a point in the book where you talk about the Kenny, Paul and Darren dynamic. Can you talk about the dynamics of that friendship?     

[00:24:29] Darren Shell: Yeah. That's three things you don't want having in the same place much. 

[00:24:32] Jeff Thigpen: It's an interesting way of saying it.  

[00:24:34] Darren Shell: Yeah. I went to school with Kenny since I was three. About first grade, I left and went to a different school and about sixth grade I came back. So there was about five years there where I guess Paul came in third grade. So they had had three or four years, they were close friends. And he and Paul were as close to friends as Kenny and I were. So when I came back, you know, it was like, as it was our whole life, whenever we found each other again, it was like there was never an empty time between seeing each other. So initially Paul wasn't a real big fan of mine. We had to get used to who was whose friend, and then we've realized, okay, we're all friends. And so, you know, even today, Paul and I, we just had lunch the other day. So, we're always still close, even if we don't see each other. We're almost 50 now. I don't see him for two or three months at a time. And when I do see him, we act like we’re 12 years old and that never changes. 

[00:25:40] Jeff Thigpen: Yeah. That's a very identifiable kind of relationship. We all have these people that we see each other regularly, but we don't see for years and can settle back into a relationship that is sometimes both brutally honest and trusting at the same time. We talked about Kenny and I'm going to transition into what you described in the book is the worst day of your life. The death of your dad. Tell us what happened. 

[00:26:21] Darren Shell: I was at work and we'd just come back from lunch. It was a little after one and I'm sitting there and I just had this ice cold tingle go through my entire body. And I knew something bad had happened. 

[00:26:38] Jeff Thigpen: You said disruption in the forest.  

[00:26:40] Darren Shell: And a buddy of mine was sitting behind me and he's like, I guess I shook it off or whatever. And he was like, what happened there? And I'm like, I don't know, but something bad has happened. And like you said, the only thing I can ever liken it to is, you know, I felt the disruption in the forest kind of thing. But I knew the moment it happened and it was two hours before they got everything straightened out and the police got to mom's house and who to contact. They called work and Tom from HR just came up and he was just standing at my desk and like you know somebody is watching you and you look up and there's Tom, you just look at his face and, you know, okay. I know what's wrong. So I just shut down my computer and I quickly got into the truck and went to mom's house. And they're like, well, how'd you know, and I'm like, I don't know. I just knew. And it was, I guess that's the answer to your question 

[00:27:38] Jeff Thigpen: And when I was reading through your description of it, I want to talk a little bit about the scene where, I mean, because it was really descriptive of the actual interactions with the police detective of the coroner. The crime scene cleaners. And the idea of waiting at the house that afternoon.

[00:27:08] Darren Shell: That all had something, I don't think there's any way to be prepared for. And I guess it's the same. Somebody dies and you have to go through it all, or somebody commits suicide and you have to go through it all. And you don't really think about the things that the family has to deal with in the background. But like you say, I ran to my mom's house. I got there, I headed in the door and this, at least my size man, just steps right in front of me to stop me. And the first thought is I'm like, he's got about two choices and one of them is to get out of my way. And the other is to get out of my way. But fortunately, the greatest thing he could have said was, you know, you don't want to go in there. He's like, he's gone, there are things you cannot unsee. And he stopped me from going in the house and as I look back at it, I'm probably glad of that. But, they were waiting on the coroner. Of course, you know, it had already been two hours by the time I got there and then they're still waiting on the coroner and I think I waited probably another hour, but it felt like about two and a half days. And I'm sitting across the street in the neighbors patio furniture where I used to kind of sit as a kid when I didn't know what to do. I'm feeling like a kid again, actually. And I'm kind of accusing the coroner of still playing golf. Because I'm like, how can it take that long to get from Winston-Salem to Kernersville? There's absolutely no way you can take that long. And of course I had no consideration of, he could have been doing anything else. You know, he might've had another meeting. Somebody else could have died he had to deal with whatever. Now I was just, he was taking too long to get to where I was at. So when he finally came and then they left, the detective had to tell me all the things they had to tell you that they didn't want to tell you. And he's like, well, so here's the list of people who’ll clean these things up and we can't recommend anybody, but I'd start at the top of the list and work down from there, if you had to. Well, at that point, it was just like, well, wait a minute, stop, this isn't my problem to deal with. Isn't this what y'all do? I just had no concept of, I guess I had this CSI image of there should be three people checking for gunshot residue and getting the angles and all this stuff. And then they were supposed to clean that up and leave. It turns out no. It's just like, you know, the police show up and say, yes, there it is. We'll have to call the coroner to confirm he's dead and I’m like, really do we need a medical degree for this? But then, you know, he came and left and now here I am stuck with, how are you going to clean this up? So mom leaves me the checkbook and the guy shows up and she's a woman and she says let me go in and I'll give you a quote and then she comes back out. And I guess somehow, mentally, being an engineer or whatever, I guess I kind of worked out in the math in my head of what I thought it ought to be. Yeah. I wasn't even close. And so for a split second there, your mind is like, there is no way in hell I am paying somebody that much money for this. And then your mind goes, well, there's no way in hell you're going to do it either. 

[00:31:41] Jeff Thigpen: Yeah. And, you know, I was asking you about the scene and all this kind of stuff and you can tell in the language that you're using as you're writing at this moment, in this situation, you're on an emotional roller coaster. And you're about to go off the rails. And on the podcast, we talk a lot about planning for death. A lot of times you can't plan for death, but the idea is that when death happens, what your expectations are, what are the realities that begin happening? And again, we talk about how there are these emotional, spiritual, though, the idea of mourning and what that does to you. And then there's also, you know, what you were getting at is, you know, you want a casket or are you cremating? And I think you're dealing with the emotional roller coaster of the moment that you're in. And quite frankly, at some point you're just mad. But I guess that might be a calm way of saying it, but you're all over the place.

[00:32:56] Darren Shell: It’s like they say, there's five stages of grief and you have to go through them all. You can't skip one. I got anger over, quickly. Like the cleaner left and I stood in an empty house and just cut loose on my father. I cussed him up one side and down the other. I dared him to show himself. It’s like, I don't even believe these guys, but I dare you to come out here and start with me. Just completely illogical anger. And then it just kind of passed. I was just as mad as I could be. I blew off 10,000 pounds of steam. And then I realized, well, that was kind of mean. So I apologized to the house because I felt like, you know, it might've hurt her feelings. For some reason at that point, the house wasn’t hurt. So I apologize to the house. I packed up my stuff and left. But you're right. It just kept coming back, you know? Because then you go to the funeral home and okay. Dad never wanted a big funeral. So we're going to do a cremation. Then you find out what that was going to cost. Well, again, not what I expected, you know? And they're like, do you want to pick a casket? Why would I do that? If we're going to do a cremation, that doesn't make sense. 

[00:34:21] Jeff Thigpen: Yeah. And I think at some point you thought about not having a funeral? 

[00:34:23] Darren Shell: I thought about not having a funeral because dad never wanted one. And then truthfully, we kind of had a funeral out of spite. I was so mad at him. I was going to have a funeral then whether he wanted one or not. Yeah, there was a lot of anger there. But yeah, it's all those things that you just don't think about, you never really plan for. I don't know if it's really just that much more expensive than I ever thought, because I never had any experience with it before. Or if it's just that combined with what had happened, you're just like, how can you charge somebody this much for what this is? 

[00:35:04] Jeff Thigpen: Yeah, I mean, I think I mentioned this to you. I lost my uncle to suicide years ago. And the way you write about this wide array of feelings that you're experiencing and going through, I think is really, I mean, I identify with it. I was reading through that and I remember that after it happened in our situation, the silence of that afternoon after it happened and when people were leaving and the shock, and then the emotional roller coaster you go through. And so the book is not only an exploration of that, an articulation of it, you are involved in a number of other things that, as a result of these experiences in the book, you know, that have connected you with. 

[00:36:13] Carly Malcolm: Particularly there's this connection to veterans and your relationship with Sergeant Q. So could you talk about what that connection is and how you all met?

[00:36:24] Darren Shell: Yeah. When I came to work at Cone, one day I was in a meeting at the behavioral health hospital. And I don't know, it just felt like the right place, right time. It had been about 12 years since dad had passed and I’m like okay. I was really starting to feel it was time for me to do something for somebody else. And so I started talking to one of the doctors there and I’m like really, what could I do and this and that. So she had some ideas and we had some, and we were talking about possibly doing a walk when this new behavioral health urgent care opens up here in Guilford County. And so I ran off to some ideas and I called some people I knew through like the mission 22 and till Valhalla kind of thing, because that was some stuff Kenny had supported before he had died. So when I got a hold of the guys from till Valhalla, they're like, you know, they were just way too busy to get up there. Their business was booming and he was growing faster than he had space for. And just didn't know if it was going to work out. But a couple months later he sent me a video of Sergeant Q who was a Marine that had battled PTSD and actually almost committed suicide himself. And had started to develop an app for peer to peer suicide prevention in the veteran community while working at the hospital. Now it just, to me it hit me like, Hey, this is a good idea. This is how we reach out into the community, not just veterans or whatever, but this is something that would apply to just everyday people. So I called him and he came out here and we went to our behavioral health group and our Cone ventures group, and everybody really thought it was a good idea. And so we started working on how we would roll this out into the community. And in the midst of working on that, COVID hit. So COVID-19 hit, he was supposed to come out the next week. Of course he was in King County, Washington state, which was like the second worst place to be. So, we said you stay there, we'll stay here. And so we started doing a lot of stuff over the internet and that stuff and starting to plan for, you know, what we would do. Oddly enough, at the same time, one of our doctors happened to know a doctor. He had gone to school with her who made the news because she was an ER doctor. She had gotten COVID. She had gotten over it, went back to work and was just so stressed, she ended up committing suicide. And so I read the comments in his post, seeing other doctors saying, yeah, this is what we're fighting. We don't have anywhere to go. Yeah, who helps the helper kind of thing. And so, you know, I called Aaron the next morning and I'm like, we're six months away from a disaster. We've got to do something. Not knowing what was going to happen here, because it hadn't really started to hit here. All we could see was what was going on was in New York and look into that. Like it was going to be the worst thing we could imagine. And so we were trying to prepare for that as a hospital. So I started trying to prepare for that for our staff, knowing people can't take that much at once and it's not when it happens, cause you always get through it. Once it's over, it starts to crumble. And of course they were saying, we just need to be home for two weeks and it'll come off and all that. So I knew we had a very short period of time. And so Aaron and I convinced a kind of venture group to let's rephrase what we have. Let's work this thing out and get it to our staff. And we launched what we're calling We Care now. It’s still been in the test phase for a while, but it has been positive enough that we know we've had at least three people in the app reach out to the suicide hotline. So from our world, we know we've saved three people's lives with the app, which is well worth whatever we put into it. and it has since rolled into a clinical trial, which they're now actually working on the community app that we had originally planned.  

[00:40:56] Jeff Thigpen: That’s great. I think you mentioned veteran culture and I guess Sergeant Q or Erin, right. The idea of the app really being intuitive to active military and veteran culture about leaving no one behind in how, you know, you've got companies of people that are together and the ability to be able to check in and follow up.

[00:41:25] Darren Shell: And he made such a stupid, simple point. You know, the whole strength of our military relies on the squad mentality. You know, the no man left behind. You’re five guys and the only people you have to rely on to protect you and save your life are the other four. As he designed the app, it's designed around that mentality of you trying to keep groups of four or five people. And they are people you know and trust and it's a three second push of a button and the signal goes out to your group and then throws you into grounding techniques to mentally kind of restore that cognitive thought that you need. Because when you lose cognitive thought, that's when we make bad decisions because you lose the connection to the frontal cortex. So it starts asking you questions, you know, what are three things you see? What are two things you smell? And it's really just to slow your brain down to make you try to get an answer and wait out your team comment. And, you know, the military has proven, you're more apt to hold on because you know somebody's coming. And that's just the premise behind the app. And when we tried to roll that into healthcare, it works the same way and it made the same sense because, especially in the ER departments and stuff. These people rely on each other every day to be there for one another, you know. You get to the point where this type of thing comes in, everybody knows what to do. I need a scalpel, if I've reached out my right hand there's just instinctively somebody there handing me the scalpel. And it's exactly the way the military works. And so it was a very convenient way to roll it over into the health care app. 

[00:43:11] Carly Malcolm: And then there's also the out of the darkness walk. Can you talk about what that is and what that's like? 

[00:43:18] Darren Shell: It's sponsored by the American foundation for suicide prevention or AFSP as a lot of people call it. Their little walks in every little town or major city all around the United States. And it's just a group of people who've been touched by suicide who get together to kind of recognize everyone they've all lost and be around people who have experienced the same thing. It's kind of like me being with Kenny’s family on a grander scale. The big thing I really liked about it was, everybody, when you first get there, you pick these colors of beads and the colors represent different things. You know, there's a color for a spouse. A color for losing a family member. A color for losing a child. And after they do the walk, then everybody's in a big group and they'll say, you know, here's this person and they're honoring everyone who lost a child and they're holding up the color of bead and then every other person in that group that's lost a child is holding up that same color. And now if you're new to that, if that’s your first walk, you realize you're not the only person that's lost a child. I mean, you knew that, but then you kind of realize here you are in your little town in a group of eight or 900 people, there's 50 other people who've gone through what you've gone through, and you never knew that. And sometimes you might see somebody you knew that you never knew went through it. And it's just really, again, it's just kind of refreshing because it kind of lets you realize it's okay to not be okay with what happened. And there are other people there that can help you through it. 

[00:45:02] Carly Malcolm: And that kind of gives you the sense of community and of support that's so important. Now where can people find and buy your book? 

[00:44:16] Darren Shell: The book’s on Amazon. It’s probably the easiest place to get it. I do have a website which is 317TheBook.com. It's also on sale there. I prefer you buy it from there because I make a few cents more from there than I do Amazon. But as long as you buy it, that's all that matters.

[00:45:33] Jeff Thigpen: Yeah. Well, thank you very much for being with us today, Darren. 317, a suicide loss survivors story, talking with you in September, the first anniversary of the release of the book. Thank you for running through different pieces of your experience through the book and some of the community initiatives that you were involved in. You are a local author and we really appreciate you not only being local, being a triad native and your courage and your commitment and stepping out related to the story. So Darren, on behalf of Carly and myself, thank you for being with us today. I appreciate you.  

[00:46:19] Darren Shell: Thank you for having me and giving me the opportunity to, you know, again, get out the word about suicide prevention and mental health recovery, both for the sick and the effected.

[00:46:37] Jeff Thigpen: All right. Well, thank you very much. And thank you for being a part of the Good Grief Podcast. 

Thanks.

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

[00:01:25] Jeff Thigpen: Hello, this is Jeff Thigpen, Guilford County Register of Deeds. And I'm here with Carly Malcolm, who is the NC league fellow from North Carolina Institute of Government who's with us this year. Usually, we have special guests, but for me, I'm going to [unintelligible] Chase Holleman. Chase, I told you I really just appreciated seeing you. And Chase is the program director for GC Stop, an acronym for Guilford County Solution to the Opioid Problem. He has a master's degree in social work from the University of North Carolina, Chapel Hill. Chase has had an incredible personal journey and an incredible professional one too, in terms of the work that he does in the Guilford County community. We're gonna talk about that today. I kinda say Chase, in a lot of ways, you're no-nonsense, down to earth, and keep it real. Today we'll talk about family because you've had to deal with end-of-life issues as it relates to your family and in the world of end-of-life care, as well as the world of opioids and dealing with opioid abuse disorder and your work with GC Stop. So thank you very much for being here. 

[00:02:52] Chase Holleman: Absolutely. 

[00:02:54] Jeff Thigpen: And as I say that, I'm going to take a minute and say, I really think you are an incredible person. As you know, I knew your dad very well as a fellow register of deeds and I see a community of support that's developed around you in the work you're doing. And I think it's such a gift and I recognize it and I think there are a lot of people around you that do. And so, as we get into some of these points may be just tough discussions around life and death and recovery, I just want you to know that I think you're doing an incredible job, and I think that there again are a huge number of people around here that support what you're doing. So, just getting into it is, your mom and dad, both suffered through terminal illness, right. How did end-of-life life issues come into play as it related to you dealing with that? 

[00:04:01] Chase Holleman: I think my entire life was enveloped in that. My mom worked in hospice for 23 years and she started there as a social worker and how she got into it was that she lost her parents at a young age. One of them to early-onset Alzheimer's and the other to lung cancer. She was in her mid-twenties and going around and talking about her experience and a nurse from hospice heard her story and said, come work for us. So I grew up around that and volunteering there. And then when I was 18 years old, I had just gone off to college and my mom was diagnosed with early-onset Alzheimer's, a familial gene. And that was my first experience dealing with death and dying personally. 

[00:04:48] Jeff Thigpen: I want to go back because I screwed up when I said that we'll talk about your family, your journey, and intellect. I used opioid abuse disorder. Okay. I need to use opioid use disorder.

We'll talk about his family, his journey in the world of end-of-life care and deal with the world of opioids use disorder, and his work with GC Stop. Okay. Got that. 

So when you were dealing with your mom and dad's situations, did you use the bureaucracy much at all in terms of having to deal with advanced care directives and things like that and the clerk's office and, you know, how did all that come to play? I guess, you know, from what I remember is that you and your dad were caregiving for your mother, and also your dad had cancer, right? And so he was dealing with that terminal illness and your mom was dealing with Alzheimer's. And how did that play in, in terms of just working through the things that come up that you may not expect? Because you were dealing with that, you know, you were exposed to that as a teenager, right? 

[00:06:27] Chase Holleman: Absolutely. And despite my mom working for hospice and despite having that language used around me my entire life, I was 18 years old when it happened. and this is where this intersection is interesting to talk about opioid use and death and dying. I'd grown up with undiagnosed and unrecognized, untreated mental illness, and using illicit drugs in my life. Because they helped me cope with that. So by 18, I was well on my way to that and not really in a place to be thinking about advanced directives or living wills or all of these things and, you know, the diagnosis of my mom really skyrocketed my use because I did not know how to deal with that. In a way it amplified the symptoms I was already feeling. And you know, a year and a half later, my dad was diagnosed with renal cancer. And then I really had no idea what to do. 

[00:07:22] Jeff Thigpen: So you had all these things, you're an 18-year-old with these undiagnosed conditions. You're dealing with family members that are diagnosed with terminal illnesses, you have those things that you can use. And the way you describe it there is that it saved your life and then you had to deal with the addictive nature of it. Talk us through that a little more. 

[00:07:47] Chase Holleman: Absolutely. So I think at first they saved my life just by me being able to cope and live the everyday reality that a lot of us do. And at some point, my use became problematic and chaotic. Speaking of death and dying, you know, I ended up overdosing more than once a few times on opioids when I came to the brink of that. I got arrested a few times, I put my parents through what I hope I never have to experience, all while they were dealing with that. And the subsequent shame and cycle of use that happened as a result of that. 

[00:08:28] Carly Malcolm: Yeah. And there's a lot of stigma that comes with your field of work. Can you talk about how that comes into play? 

[00:08:34] Chase Holleman: Absolutely. I'd love to. I think stigma kills more people than drugs do. I know that 10% of people that will seek help for their opioid use disorder this year will receive it, it’s only 10%, there's not a lot of options. People don't want to tell you that they use drugs because they're used to being scolded or told that they're bad or worse, put in a cage for their drug use. And it's worth mentioning that our friends and loved ones who are black and brown are put into cages for their substance use far more often than their white counterparts.

[00:09:12] Jeff Thigpen: And sometimes, as someone who's using drugs, the only people you can trust, you feel like maybe they’re other people using, right. Sometimes. And so you've got systems in place and culture that make it really hard to talk about this. And our inability to not only talk about it in a way that we can understand it and develop strategies and approaches that are effective, create cycles, not just individual cycles, but as what you alluding to is when that is put into policies, practices, and procedures within systems in that culture, we're really in a bad place. We really are. And I think that what you bring to the table is not only your personal experience, but the heart to understand those things. And within that system, work to push it to be better. 

[00:10:05] Carly Malcolm: Would you talk a little bit about how you got started in this line of work, like how you got set on the path of helping other people recover?

[00:08:57] Chase Holleman: Absolutely. I moved to Greensboro in 2013. I went to treatment here in Greensboro, and I was so fortunate and privileged to be offered a chance to go to treatment instead of jail because of my privilege. And I had health insurance and my parents had access to resources to help pay for it. I did well here. I had a community of people willing to support me and help me. And then I was kind of like what now? And at first, I'd considered going to a trade school doing electrician work. And I didn't think college was an option for me because of my criminal history. And because I had been invited to leave my former university. But I applied anyway, due to the encouragement of some of my friends. And after a long arduous process of arguing my character, they let me in. 

[00:11:10] Jeff Thigpen: Okay, alright. You got there. And one of the things that I think about a lot is back when you were in the midst of a lot of those transitions, I had the opportunity to meet you in my office. And I remember our conversation. I can't remember all the details, but when I was done, I had this feeling that you were going to do something unique and special. I had no idea what it was, but I think I do know a little bit of that now because the work that you're doing right now with GC Stop is incredibly unique. And can you talk to us about what GC stop is and what it does and what your role is? 

[00:12:06] Chase Holleman: Yeah, absolutely. So my role is I'm the program director there. They let me have some credentials. So I'm a licensed clinical social worker and licensed clinical addiction specialist. And at GC Stop, we spend a lot of time addressing the systems that you had mentioned earlier, Jeff, at critical touchpoints. I remember a time when I overdosed and was revived by EMS. And I took off running because I was afraid. And that was a medical touchpoint that someone could have offered me help and care. But I saw someone in a uniform and ran off. So what we do is we've worked with Jim Albright, the director of emergency services here in Guilford County, who you introduced me to, Jeff and I appreciate that. And he helped found this program.  

[00:12:57] Jeff Thigpen: I found that email, it was like 2016. And I remember when you contacted me, it was like in November and we had a brief conversation. And Jim, as I was mentioning before, thinks the world of you. I mean, he really does and is so appreciative of the role that you're playing right now in the community related to this. I think you started out, I mean, what I remember about the context of that time, and you can help me, you are doing a lot of community meetings, right? Tell me a little bit about that. You were just trying to raise the issues, something that was really important and you were working at the time with an organization locally, right?

[00:13:35] Chase Holleman: Absolutely. While getting my master's at Chapel Hill, I was running a program in High Point that distributed Naloxone, which is the drug that reverses an opioid overdose to the community lay people or people who use drugs, who are often the real first responders to an overdose. And I really wanted to raise awareness and I kept seeing the barriers and the systems you've talked about. And I reached out to my dad and said, I'm having this training. And I want some people from Guilford county that have power and resources to be there. They might be able to help us. And he said, well, I know one called Jeff. 

[00:12:55] Jeff Thigpen: I don't have actual, well, actually, Brody understands, today I don't have a lot of money in my wallet. But I have friends and in that situation, I just remember that when I talked to you, I was like, I got to talk to Jim and he had known of you and you all made that connection. And then from just, you know, a lot of times we think about all these wonderful things that we do in life and you know, all these accomplishments, but sometimes it's just hearing from a friend and passing it on. And that for me has been a huge gift because it's kind of like in some small way, I have a connection to you and your dad and Jim and as that started working, we're dealing with the reality in Guilford county where, when you're looking at, you know, we were losing people, a lot of people. And I think Jim says like one in five. When it was going on 20%, we were losing people based on not being able to reverse it and to be able to have a strategy to deal with it. And what you've been doing has been incredibly helpful because you help in a way, make relational connections. You're pushing the discussion around treatment options, and you're looking at how organizations and institutions can be in the middle of this and actually work. And so it's interesting because I talked to Jim a little bit about the funding for GC stop and it definitely is bi-partisan and we talked about this with former Senator Trudy Wade, he found some money in the state budget that got connected locally and helped you all get going. And now you're located in the school of social work, right? Yeah, talk to us a little bit about that in terms of how, in dealing with GC stop, what some of the successes have been. We'll just start there. Because it sounds like you came up, you got an idea, and then it's developed into an organization and an approach, you know, how has that all developed from, I guess it was from 2017 to now, right? 

[00:16:25] Chase Holleman: Absolutely. It's been a wild ride, to say the least. While we started with just referrals from emergency services that people who had overdosed and visiting them, we realized that that was helpful and a lot of those folks were able to navigate to treatment. We also realized that there was a need for more syringe services in Guilford County. And we have the urban survivors union here in Greensboro. It's been doing syringe exchange for a long time. 

[00:16:55] Jeff Thigpen: Talk to me about that because there are people who say, no, you shouldn't do that. No. Why are you giving junkies syringes? Why are you doing all this? And as a part of the stigma too, why is it so important to have an approach around syringe exchange? 

[00:17:05] Chase Holleman: Absolutely. I get that all the time and I love talking with folks about it. And I think I'll just share a story about that. And that's, when we first started doing this syringe service program, it was delivery and I got a text to the GC Stop line, and it said, you know, is this the exchange? And I said, yeah, can I help you with something? And they said, yeah, I'm over here at this motel. If you could come meet me. Now, at the time we were just getting going. So I just hopped in the truck and went over there. And I get there and call. And of course, as soon as I get there. No one picks up the phone. I'm like, okay, great. So I see someone that I know from an EMS referral actually, and I go over and say hello to him. I get him some supplies and actually make a referral for him to go to treatment. I think, well, maybe it's a good idea for me to just stick around. So I go and park and there's a young woman outside and her and I tried glances and she walks over to the window. And I rolled it down and I said, “are you the person that I'm looking for?” And she said, no, but I can be. And I said, no, no, no, no, no, I'm not here for that. And I said, “I’m actually here to do syringe exchange.” And she was like, well, honey, I don't do that. And I said, oh, well, I've got some condoms, would you like some of those? And she said, yeah, sure. And we'd go to the back of the truck and I get her this big bag of condoms and we're just talking and building rapport and being kind to her, you know, something that I don't imagine she's experienced in a while. And after a little bit, she says, hold on a second. She goes and knocks on doors and within about 10 minutes, I've got five people out there, all getting supplies about three of them went to treatment in the coming weeks. And that's why we do syringe services. It's an opportunity to be kind and listen to people. 

[00:19:05] Carly Malcolm: Yeah. And that's really just one of the ways that stigma can kind of get in the way of the best treatment that you can offer. Can you talk about other places where that shows up? 

[00:19:10] Chase Holleman: Absolutely. I think it shows up everywhere. I talked about medical touchpoints, like with EMS. I think it's important to know that when someone goes to the hospital and they’re there to detox from opioids, they'll be turned away because it's not life-threatening. It's also important to know the stigma that’s ingrained into the treatment system, the very healthcare professionals we trust with our loved ones, there are only two evidence-based treatments for opioid use disorder that are shown to decrease the overdose death rate. And those are methadone and buprenorphine yet only a third of opioid treatment programs nationwide, even offer these medications. 

[00:20:08] Jeff Thigpen: So, sometimes we come at this issue of like, oh no, you shouldn't deal with the needle issue. Or we say, everybody's got to go cold Turkey, you know, gotta stop it and quit it. But it's more complicated than that. And I think that you not only understand on a personal level, the idea of the work you do, why I'm such a proponent of it is what you just said, you have an opportunity in interaction to build rapport, to build relationships where people are in some spaces, dealing with a disease. I mean, they're dealing with the need to be able for it to be treated, not only effectively in terms of the chemical components of dealing with it, but humanly and at least in terms of what I've learned about the work that y'all are involved in is that you take that head-on and you know there's no separation, at least I think, between the street and the program in terms of really trying to be there for people who are struggling through this.

[00:20:53] Carly Malcolm: Certainly on the personal level, you've touched on some successes, but in a sort of broader scheme of things, what sort of successes and challenges have you seen in this program? 

[00:21:03] Chase Holleman: Well, I think our favorite output currently would be that from July of last year to July of this year, we heard 1,006 times that someone in Guilford county used our Naloxone that we distributed to save someone's life. We're really happy about that. And it's hard to think about the significance of that, you know, 1,006 families that didn't have to bury their loved ones. And to put it into perspective, you know, if those were all different individuals, that means one out of 500 Guilford county residents would have been revived with our naloxone.

[00:21:45] Jeff Thigpen: That's incredible. And you lose people? 

[00:21:47] Chase Holleman: Absolutely. More and more often now with COVID, we're seeing some significant increases in overdose fatality with returns to use of people who are abstinent. A lot of times people coming back from abstinence-based treatment, come back to the community from which they came, they have no tolerance. And the drug supply is essentially poisoned because it's all fentanyl now, COVID has not only affected regular above-ground supply chains but has also affected underground supply chains. And it's made the drug supply very, very dangerous. 

[00:22:21] Jeff Thigpen: Yeah. And so in terms of COVID, you've got the realities, and I'm sure you see this a lot, you know, how are the NA meetings going? How are the counseling sessions and the treatment opportunities working? How is that system already, probably with all due respect to some really good people, working in it, dealing with overwhelming challenges to respond to this, COVID makes it that much more worse? Have you seen, I mean, how has COVID impacted your work?

[00:23:03] Chase Holleman: For us, we’re still out in the community and we spend a lot of time in motel parking lots and on the streets. So we just mask up and give out sanitizer and mask and try and help folks. However, I'm referring folks to different levels of care. You know, most organizations are inside. A lot of places shut down, everywhere has reduced capacity. The challenges are just that much harder. We know that folks need work to sustain recovery. We know folks need resources to sustain recovery and all of those things are gone. I think it's important to mention too, from a prevention side of things, and it's all interconnected. We talk about recovery capital, which is resources or the things that enable us to do well. And a lot of those things are gone for folks. In fact, the biggest one, which would be connectedness to others is incredibly damaged and it is ravaging the recovery community and the community in general. Alcohol sales are through the roof. I imagine we'll see a surge in new diagnoses of substance abuse disorders.  

[00:24:11] Jeff Thigpen: Can I cut for a second? Did I say, I said disease a minute ago. Was that appropriate? 

[00:24:18] Chase Holleman: That's fine. I don't touch it. The medical association would agree with you. 

[00:24:25] Carly Malcolm: I guess. Do you see any sort of solution for while we're still dealing with COVID like, what can we do to support that community?

[00:24:28] Chase Holleman: That's a tough question. I'm a big idea person, an ideal person, so my mind immediately goes to that. So I always try to say that we have a poison drug supply and it is completely because of an illicit market where we're unable to regulate what is out there. And until we have safe supply at the bare minimum accessible buprenorphine and methadone, which are the effective treatments I talked about before, we'll continue to see overdose deaths because people need safe supply and people are going to do what they're going to do.

[00:25:05] Jeff Thigpen: And I'm good friends with former judge Lawrence McSwain. And he would talk about with the drug treatment courts, people who are struggling with addictions, is that the idea of working through the addiction and dealing with failure, is it if you're addicted, I mean, he was saying on average 13 or 14 times, breaking through that is incredibly complex. And a lot of times we come at it from a one way fits all mentality, absent a relationship to the problem. And I think that's part of the problem. We end up, most of us get into it through our family. We don't really think about it until something happens that affects us personally, that affects our families, and we have a relationship to understanding the complexities that addiction brings into our lives and, and how you not only treat it and how the recovery process works. And it's not, in any way, a straight line 

[00:26:16] Chase Holleman: No, absolutely not. And I think in the context of the illicit drug supply, the way it is, and the fact that we know that 90% of people that are going to go to abstinence-based treatment, which is the main treatment modality in the United States, will return to use. Now, we've been doing this for a hundred years and this has helped a lot of people. My pathway was abstinence-based recovery when I got here in Greensboro. And it did help me. However, what we know is that the vast majority of people are not going to do well with this. So we know that 90% of people are going to have no tolerance and return to use with a dangerous drug supply and likely overdose.

[00:26:59] Carly Malcolm: Yeah, it seems unfair to paint that as a personal failure, when it's so many people that the system isn't helping. So I think you bring up some really good points about how that system can change to better support people. 

[00:27:12] Jeff Thigpen: And when you were going through your own addiction and recovery and in 2013, you attended fellowship hall, right. There was a mother, there were some different ways in which you were trying to work through the addiction and also find support that you would need. 

You've talked about naloxone and you can say buprenorphine, as a part of this concept called medical assistance therapy, I guess MAT is what Jim refers to it. That to me, shouldn't be controversial. 

[00:28:05] Chase Holleman: It shouldn't be, and it's interesting. And you saw the TEDx talk that I did, and it was about this because it's a curious subject because you can review the literature and we have decades and decades of literature that speaks to how effective methadone and buprenorphine are and how ineffective abstinence-based treatment is. And yet it's still the slim minority of treatment options available to folks and a lot of it really is that stigma. 

[00:28:39] Jeff Thigpen: Yeah. I mean, you can look at this at least the way I see it is you cannot agree with drug use but we can agree on how to treat addiction in ways that actually are effective. And sometimes you've got to be able to have these kinds of strategies that utilize drugs like this to help you. And again, it's the idea of harm reduction, to some extent. It's throwing everything at it. You're not only throwing your money and soul and treatment philosophy to it, you're coming up with practical tools that can help people in very difficult spaces. We're already failing by the way. And I know that you can kind of talk about the systems at play. And I mean, there have been investigations, there are lawsuits with drug companies around opioids right now. I mean, that's something that we all shouldn't be afraid to talk about. And I think that again for us, these end up in many cases being life or death issues. 

[00:29:47] Chase Holleman: Absolutely. Yeah. 

[00:29:51] Jeff Thigpen: You are a professor. Professor Holleman. I keep going back to Jim, he's the EMS director. And he goes, yeah. When I met Chase, he was this dude with long blonde hair who came in who was always rocking the boat and wanting us to do different things. And he goes, now he's over there at the college and he's teaching courses. I love it. Talk to me about some of the teaching that you're doing right now. 

[00:30:18] Chase Holleman: Absolutely. So I got to teach my first class at UNCG social work program last spring, which is awesome because that's where I went for my undergrad and I taught a class that I'd taken. And the professor that I took it with got to help me teach the class. I would go to him before class so they could teach me what I was about to teach. And this semester I'm teaching a social work seminar, which is a class that all seniors in the program take. And what it is, is it goes with their field placement, where they do two days a week in the field doing social work and we talk about what they're learning there and the theory behind it, and really connect the practice. And I love it. 

[00:30:40] Jeff Thigpen: So, and you've been able to become the director of the program over at UNCG. You're teaching over there and you also get to utilize interns to help support your work. And so they're getting good clinical experience and you're being able to leverage the college in a way that helps the community. And I think that's incredible. And I think that's one thing that makes this program very unique. Is there anything you want to talk about? 

[00:31:35] Chase Holleman: I think I'd just like to expand on that or everything they've helped build our program. I mean, I've got 10 interns right now. Eight of them are graduate students from various social work programs. And from the beginning, I've told people like, this is your program too, there are no ceilings. I want you to help develop this. And it's because of the interns that we've had, why we've had so much success. 

[00:31:09] Jeff Thigpen: How many people do you serve in a year? Do you have those numbers? Of course, let me say that this kind of work is something that you don't necessarily gauge the success off of numbers. So I'll go ahead and disarm that, but in terms of how you equate success. 

[00:32:28] Chase Holleman: Since we started, we've been referred to by close to 2000 people. So that includes people out of the county as well. And we see anywhere from 40 to 70 unique individuals each week. And those are the only stats that I'm confident about. And I mean, really for us, we have an evaluator and we have data that we keep, you know, and what we want to see is fewer deaths. That's the main thing. But what I see as success is the students that learn how to engage with folks who use drugs and will go on to be great social workers. Because who knows the impact of that. And the little times that I'm just with someone and maybe it's the first time. And like I had mentioned earlier, you can just tell it's the first time that anyone has been kind to them or listened to what they had to say in a very long time. 

[00:33:15] Jeff Thigpen: That is incredibly important and it makes a huge difference. And Chase, I just really appreciate the opportunity to have you come in and be a part of the Good Grief Podcast. And just talking about your family, talking about your journey, and in terms of just life journey, recovery journey, the work that you're doing in Guilford county with GC Stop. And so as we kind of closeout, I want to encourage people if they want to get more information about GC Stop to go to G-C S-T-O-P dot UNCG dot E-D-U. And Chase mentioned that he is fresh off of a Ted talk. And if you want to go onto YouTube and get some knowledge dropped on you, put in the search engine, Chase Holleman, Chase and then H O L L E M A N, Ted X Greensboro, and listen to his topic about why aren't we using the most effective addiction treatments? An incredibly important question and one that I think that, not only Chase but we as a community ought to be gathered around and learn from his experience and come up with community strategies to support these efforts. With that said, Chase, thank you for being a part of the Good Grief Podcast. 

[00:34:45] Chase Holleman: If anyone wants to be referred to a GC Stop, which would mean healthcare for anyone who uses drugs or access to healthcare, they can call or text (336) 505-8122. 

[00:35:02] Jeff Thigpen: All right. Thank you very much. 

[00:35:03] Chase Holleman: Thank you.

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

[00:01:36] Jeff Thigpen: This is Jeff Thigpen, Guilford County Register of Deeds, and Carly Malcolm, NC lead fellow from the UNC Institute of government. And welcome to the Good Grief Podcast. Today, we're talking with Sarah Williams. Sarah is president of the Funeral Consumers Alliance in North Carolina and she started Death Cafe in Mebane in 2014. She says that even from a young age, she had been interested and fascinated by these issues related to death and that she knows, death at times is uncomfortable to talk about, but through her work and her passion, she tries to change those negative feelings and move them toward reclaiming a sacred tradition of caring for our own dead and by extension caring for each other. She's a trained home funeral guide and a hospice volunteer. Sarah, welcome.  

[00:02:48] Sara Williams: Thank you, Jeff and Carly, it's really good to be here.  

[00:02:53] Jeff Thigpen: Where did this interest and passion around death come from? 

[00:02:55] Sara Williams: Well, I think maybe one of my first and earliest memories, and I think anybody listening to the show has a horrible funeral experience where they will have walked away and said, “I never want that to happen to me.” And when I was in middle school, a young fellow student died from his cerebral palsy and we were told we had to go to the funeral home. And when I saw Lewis in the casket, it was not Louis. It was not the Lewis I knew in his wheelchair, on the playground. They let him always be the general on the playground. And I just knew death could be done better and years later, I discovered that in fact, that was the truth. 

[00:03:55] Jeff Thigpen: So, you had this really impactful experience as a teen or early teen?

[00:03:57] Sara Williams: Yeah, I think I must've been 12 or 13. Yeah. 

[00:04:01] Jeff Thigpen: And that's kind of led you into the field of advocacy in a lot of ways through your work? 

[00:04:03] Sara Williams: Definitely 

[00:04:05] Carly Malcolm: Talk to us about the Funeral Consumers Alliance. What is that organization and why is it important? 

[00:04:10] Sara Williams: Well, Funeral Consumers Alliance, North Carolina is one of more than 70 funeral Advocacy and education groups across the United States. And we are affiliated with the National Funeral Consumers Alliance. We help people across the state become more knowledgeable as a consumer when they're planning a funeral or purchasing funeral goods and services. 

[00:04:43] Jeff Thigpen: A lot of times what we're learning through the podcast series is that, number one, a lot of folks are unprepared for these decisions. And a lot of times they have no idea how much this stuff costs and what they should expect. And so you have some regular funeral homes that will give you 18,000, $20,000 funerals, when a family can't afford it. And as Randall Keeney in one of our podcasts mentioned, we ought to live in a society where the people shouldn't go bankrupt burying their loved ones, right.

[00:05:21] Sara Williams: Or putting into the ground better furniture than what you lived on and with while you were still alive.  

[00:05:30] Jeff Thigpen: And so the Funeral Consumers Alliance really gets into that space as an advocate for people.

[00:05:35] Sara Williams: Right. And we try to urge people to plan ahead, that doesn't necessarily mean pre-pay, just preplan. Tell people what you want and set aside some money. You know, every week we get phone calls, I think in our organization, which is just a nonprofit. I mean, I wish we did have money, lots of money to help people bury aunt Bessie because aunt Bessie didn't plan and they're stuck now not knowing what to do.

[00:06:14] Carly Malcolm: Yeah. And that planning is so important. Like everyone wants to honor their loved ones, the way that they would want it to be honored and that's really what we're finding is that it can be hard to do that if you have somebody who didn't make those arrangements while they were living. So when you're advocating on behalf of consumers, what's the goal?

[00:06:23] Sara Williams: Well, we make sure all your rights are protected under the Federal Trade Commission's Funeral Rule. That was a rule that came about in 1984. And part of that law gives you the right, if you purchase a coffin elsewhere, a funeral home has to use it. If you walk in and want to see a price list, what we refer to as a GPL, a general price list, they have to give it to you. If you call them on the telephone, they have to give you prices over the phone. And the other really important thing about the funeral rule, you do not have to buy a package. Sometimes they're presented as like here's our package that includes X, Y, and Z. You can just purchase services or funeral goods. 

[00:07:44] Carly Malcolm: Yeah. Well, and that's really important to know. I feel like a lot of people wouldn't think to ask those questions. Now the FCA, NC is a pretty new organization formed in January of 2020. And it was when the funeral consumers Alliance of Coastal Carolina, Western North Carolina, and the Piedmont merged together, right? Why did that happen? Like why did these chapters decide to merge and what's been the benefit of that merge? 

[00:07:54] Sara Williams: Well, all of these chapters were coming up with an aging membership. So we hoped through getting bigger and better, you know, strength in numbers that we could attract a younger population to see what it was that we were actually attempting to accomplish. We were able to pull our financial resources, so that gave us more money to work with so we can, in the future, when we're past this pandemic, hold some really exciting big programs with well-known keynote speakers. And also we got a fabulous new website. And I'd like everybody to know about that website, which is FuneralsNC.org. And it's just loaded with information, which I think, for your listening audience, would be very helpful actually. 

[00:09:02] Carly Malcolm: Absolutely, yeah. And we'll link to that in the description of the podcast and in the transcript too. 

[00:09:09] Jeff Thigpen: One of the reasons, you know, while we thought it was really important to have you with us is one based on the work you do with The Funeral Consumers Alliance, but it was also about the death cafes. And as I mention a lot of times, we don’t like talking about death and dying and then the idea of providing support when you need it. And talk to us about the concept of death cafes. And I think I told you before the interview that I found the concept in London on the internet, so to speak, in terms of looking for support networks and I thought that was a really direct and very catchy phrase, death cafes. Can you talk to us about what they are? 

[00:09:57] Sara Williams: Absolutely. At this point in time, it is an international movement. I think the housings have been hailed in like 80 countries across the world. And it was a concept that did originate in London via Switzerland. But I want to give the credit to John Underwood, who unfortunately died just a few years ago, unexpectedly. I mean, how ironic is that? And he was a lovely man who with his mom held the first death cafe, I believe in 2011. And the movement caught on with a social worker in Columbus, Ohio, Lizzy miles. And she brought the concept to the United States in 2012. So I was aware that this movement was going on. And to tell you the truth, at the time I was working at UNC Chapel Hill, I couldn't believe that nobody had started a death cafe. Here was this forward-thinking innovative intellectual community, where the heck was the death cafe. And I just got tired of waiting. So I said, I can do this. And so in July of 2014, boom, we started death cafe Mebane, and we are still going strong today 

[00:11:24] Jeff Thigpen: I think I was looking at your website and on the death cafe that you, as a particular person, self-described yourself at certain points as obsessed with death. And I think that's a good thing. I mean, depending upon what you're thinking about it, maybe it could be unhealthy. But the idea that we need to spend really thoughtful time around issues of death, what are some of the issues and feelings and things that come up in these cafes that you see and are impactful to you? 

[00:12:00] Sara Williams: Yeah. There are so many. First I'm going to address the obsession with death. Apparently that is my claim to fame, but it's a true story. It was honors English in my senior year in high school and we were going through Dante's Inferno and I was raising my hand constantly. And I could hear these sighs behind me, like shut up. And then when the class was over, Tom came up to me and said, you know Sarah, you're obsessed with death. It was one of the defining moments in my life. I guess I was. But not in a Blair witch project kind of way. It's like this interests me. I mean, the last time I checked the mortality rate for the human race was a hundred percent.

[00:12:57] Jeff Thigpen: Yeah. A hundred percent. That's pretty high. 

[00:12:58] Sarah Williams: And to me, if we acknowledge that we're going to die, we live our lives more fully. And in death cafe, that's exactly what we do. Don't I look like this sad person? We spend so much time laughing and just going down rabbit holes. If someone asks a question and I can't answer it, I promise them, I'll find the answer. And that's how questions come up like, can I bury aunt Bessie in my backyard, what is a home funeral? What is a green burial, you know, all these types of things. What's a vault for, in a cemetery, right? 

[00:13:44] Carly Malcolm: Why don't you go ahead and answer some of those things? Can you bury aunt Bessie in the backyard?

[00:13:50] Sarah Williams: You can. If you contact all the right county people and follow setback rules, it absolutely allows you to. And I'm sure you and our listening audience has no doubt seen little family cemeteries as you travel across the state. And some of that land is abandoned sadly, but no, you’re permitted to do that as long as you follow rules and regs of the county health department and you do all your filing of papers correctly. 

[00:14:31] Carly Malcolm: You mentioned home funerals too. What does that mean? 

[00:14:34] Sara Williams: Well, a home funeral is where we care for the loved one in the home, and it is legal. It's safe. Bodies don't stink or rot, despite what people may think. And it's really how we used to do things. So there is a movement now in this country and it's gaining strength and popularity where people like me, a trained home funeral guide, helps the family care for aunt Bessie at home. We wash the body, anoint the body, dress the body. If they want aunt Bessie to lay there for three days, we have a way to keep her cool. And then the final body disposition is up to the family. I mean, whether she's being cremated or buried. But it's a lovely organic movement. I mean, I cannot tell you, like I mentioned early on, everybody's been to a funeral where they've come out and said, oh God, I never want that to happen to me. You'll never hear anybody come away from a home funeral saying those words. It's just too beautiful, too moving. And it is safe and legal. And we are a home funeral-friendly state. I do want to point that out. There are nine states now in this country where you're required by law to use the services of a licensed funeral director. And that's usually either to witness the burial or to help with paperwork. But here in North Carolina, we can do everything ourselves. 

[00:16:32] Jeff Thigpen: Yeah. Well, it's good to hear that we're a home funeral-friendly state. One of the things I was going to ask you is the idea of COVID 19 and the impact it's had on that. And you were talking to me a little bit before we started, but what do you see as the impact, at this point? 

[00:16:50] Sara Williams: Well, it's changed how we lived, how we live, and it has definitely changed how we die. And I can't believe over the past 10 months, if you have not, you must be in a bubble. If we've got death staring us in the face every day from our television, from our radio, from our cell phone. I think it's given us pause to say, “Hey, this is happening to people. Thousands of people, every day, it could happen to me.” So I think number one, unless you really are living in a bubble, it has caused people to reflect on their mortality. Secondly, for me, as a home funeral guide and as a funeral celebrant, it's changed the way people are having funerals and memorial services and celebrations of life. So I have not really been called upon to do a service or a home funeral in a while. Although I would not be afraid to take part and to help celebrate. It’s just that now things are different. I think this is because so many people are dying in the hospital. 

[00:18:35] Jeff Thigpen: I mean, it's amazing to me when I look at the work that you are doing in multiple spaces, right. Because you put a hospice volunteer as well, I mean, and so you really are in the thick of it, you really do see how death manifests itself in people's lives in so many ways. I think the question I want to ask you is how has this work impacted you?

[00:19:04] Sara Williams: Well, I think it's a calling. It's a ministry. I mean, not everybody is going to be obsessed with death in a way that brings them joy. I mean, it's sad when people die. It's sad when people die in my family or close friends, and yet to help that family through that journey, the natural way, the organic way is just fulfilling. I mean, I don't know how else to say it. 

[00:19:51] Jeff Thigpen: Yeah. I mean, some of the things that come up in the podcast series is, I think, the way I started these podcasts, I was going, “you know, there's this way that people are buried, you know, there's the funeral home, there's this and that. And then when we get into it, I’ve come to understand, well, you know, back in the 1860s, they had a way of burying people. You know, people didn't just start dying when funeral homes were created, for example. But it's this idea of, in celebrating the life of an individual and dealing with death, there is our perceptions of how we talk about death and our perceptions of how we talk about burials and things like that. But then there's the actual on the ground experience of having to go through it and developing the understanding, both in the Consumer's Alliance, is being able to make sure that you're advocating for people who, when they're dealing with the practical issues of costs and what is culturally appropriate and acceptable and those kinds of things, that you have the right support mechanisms in place to be able to reflect the care and appreciation you had for that life. And I think that what I sense in you is it as you're doing this work, it's probably helped you appreciate yourself in ways that you probably didn't know. And maybe that's why you stayed in the work and the reason why you're so passionate for it. So I appreciate you. 

[00:20:57] Sara Williams: Thank you. And I always say, people can't know what they don't know. So when they hear the word natural burial and we explain what that is and you mean embalming is not required by law? No, it is not. I could do everything at home and never go to a funeral home. Yes, you could. So we just want to educate and make sure that people get what they want or think about the whole mosaic, the whole pie. 

[00:21:55] Jeff Thigpen: Well, we appreciate you again and appreciate you coming in and talking about the Alliance, the death cafes and what the impact of this work has had on you. And with that said, again, I want to appreciate you for being a part of this podcast and on behalf of Carly and myself we'd like to thank you for being a part of the Good Grief Podcast. 

[00:22:21] Sara Williams: Thank you so much, Jeff and Carly for what you do. 

[00:22:28] Jeff Thigpen: Thank you. 

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well because we care. So we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:00:58] Good afternoon. It's Jeff Thigpen and this is the Good Grief Podcast. I'm the Guilford County Register of Deeds. Today I've got, with me, Carly Malcolm, who's going to be asking some questions. She is the NC lead fellow for the North Carolina Institute of Government, who's working with us on special projects and end of life issues. And today we’ve got very special guests, Randall Keeney. And Randall's a good friend of mine. And he's the pastor of St. Barnabas Episcopal church in Greensboro. He's somebody I've known and respected for a long time. I think you’ve served that congregation since 2006, right? 

Randall Keeney: [00:01:43] Yes.

Jeff Thigpen: [00:01:41] Okay, that's where I hit it. On your episcopal site, it says all are welcome at St. Barnabas. You go through, all are welcomed and loved without regard to race, nationality, economic status, language, gender, sexual orientation, marital status, age, political theological status, and you don't ask people to check their brains at the door. Well, that's actually a good thing cause I've been there a couple of times and I'm glad they didn't check mine. You know, and what I can say this about you Randall is that, you know, in so many ways, because I've respected you, you've sought to live out many ways in the community, what I would consider the gospel around issues and concerns where people are at a crossroads. And sometimes in the street related to everything from race to immigration, to the need to offer hospitality and sometimes justice for people and living it out as a part of your faith tradition. And I've really appreciated that about you. 

Randal Keeney: [00:02:40] Thank you. 

Jeff Thigpen: [00:02:41] And today, of course, we are here to talk about something really important that we, a lot of times in this culture, don't like to talk about and that's death. Death and dying. And so today we've got you on to talk a little bit about your faith tradition and you know, how you came to it and how it influences you as it relates to death and dying, but also about All Souls Burial Association, which is new to this area and we want to give you the opportunity to share about what that is and why it came to be. But first I want to kick it off and just get to know you a little better. Where'd you grow up Randall? 

Randall Keeney: [00:03:16] In central Georgia in a little town called Cochran 

Jeff Thigpen: [00:03:23] Cochran, Georgia. Where is that at?

RandalL Keenye: [00:03:26] That's about 40 miles south of Maine. About 10 miles north of Eastman, you know, Hawkinsville, Dublin, you know all these places.

[00:03:33] Jeff Thigpen: [00:03:33] Yeah, absolutely. I went through Dublin on my way to Ashton Crossroads in Burgaw, North Carolina. I'm sure you know where Burgaw is. And so, hopefully we're both folks who come from humble backgrounds and they've led their greatness here in Greensboro. But that's good to know. How did you come to your faith? 

Randall Keeney: [00:03:56] Well, I was reared or raised in it. However you want to say it. My parents were church going people from the time I was born and before. So I remember being in church as a little bitty guy and, you know, bored out of my mind and falling asleep and kicking the pew in front of me and all those sorts of things. So I grew up in it. 

Jeff Thigpen: [00:04:23] Well, my son's going to be a pastor then. Where'd you go to seminary and all that?

Randall Keeney: [00:04:29] Well, sometimes I don't like to say that. I went to a seminary in Wisconsin called Nashotah House Theological Seminary. And when I was there, it was pretty broad. The theologians and administration was pretty middle of the road and included conservative, you know, liberal ideas. Sort of after I left, there was a takeover by the evangelical right. So, you know, I hesitate to say Nashotah House because some folks think that the Episcopal Center for the He-Man Woman haters club.

Jeff Thigpen: [00:05:10] Well, you know, we have not shied away from different faith traditions and you know, I’m finding that there is a spectrum of belief within your denominational structures in faith tradition. So what got you to St. Barnabas? 

Randall Keeney: [00:05:26] I was pastor at a church in Clemens. And just like a lot of folks, I went through a divorce. I was so depressed, I just kind of didn't do anything for about three years. And during that time, finally, I just decided I am going to go back. And so I started interviewing with St. Barnabas. They had an opening and we went through dinners and conversations and phone calls and eventually they called me to be their new rector.

Jeff Thigpen: [00:05:59] You were taking over from Jim Cravat?

Randall Keeney: [00:06:01] Yeah. He retired about six years before I came. 

Jeff Thigpen: [00:06:07] Okay. So, St. Barnabas is a smaller congregation, I would guess, overall for Jefferson Road in Greensboro. And so, Carly, you probably want to help. I've been sitting here doing small talk with you, Randall, which is all good. We can keep going. But, I guess we're gonna talk a little bit about the issues of death and dying and ease into that.  

Carly Malcolm: [00:06:28] Yeah, we'll just dive right in. Could you speak generally, just about like how the Christian faith deals with issues of death?

Randall Keeney: [00:06:34] I think, you know, depending on which Christians you are talking to, you know. But overall I think I can be pretty sure of saying that we see death as a part of life. That it's not an end to anything. It is an event, an occurrence, a process through which we go in our existence, in our lives. You know, the God we believe in is eternal and we believe we live in that eternity, which is to say, eternity is different from the notion of immortality. Eternity exists outside of time, that it is simply existence when God said I am that I am. So we believe mortal life and death are a part of eternity, in which there are transitions and death is one of those transitions. 

Carly Malcolm: [00:07:33] And so that idea maybe brings people some comfort as they're grieving? 

Randall Keeney: [00:07:36] I would hope so. I would hope so.  

Carly Malcolm: [00:07:39] So then specifically as an Episcopal pastor, what's your approach to spiritual care when you're dealing with people who are suffering from grief and loss?

Randall Keeney: [00:07:46] First is to respect that grief and loss, completely. Whatever we do, we don't dismiss that and we don't try to talk people out of being grieved, out of feeling loss. That is a part of their lives as well. You know, in as much as it's desperately important to the person who passed, it's equally important to those who survive. So we try to talk people through that process of learning to live in a space without the physical presence of the one that they loved. Continuing on the life that they had with that person while they were with them.  

Jeff Thigpen: [00:08:29] I remember I had the honor of speaking at a funeral at St. Barnabas a few years ago. Burl Brynn. I remember looking out into the people who were attending and there was a significant number of people who were wheelchair bound and had very special needs. And so I'd expect that in your support for that community, it comes with a lot of nuances. 

Randall Keeney: [00:08:55] It does. Those folks are used to celebrating joy, you know, in a profound way and also living with some grief throughout a lot of their lives and losing their independence, losing the ability to do something. But at the same time, depending upon one another, you know, to lift one another up emotionally and spiritually. So they have a profound spirituality. 

Jeff Thigpen: [00:09:24] In terms of the actual funeral service, you know, you usually have like old Testament readings and new Testament readings. We've done a podcast with a member of the Jewish community who was going through how they do the actual services. Can you kind of just speak to, you know, the 101 of Episcaple funeral services, just to share that. 

Randall Keeney: [00:09:53] Well, there's a basic understanding that you received the remains of those who have died. You received them into the church where their spiritual foundation has been built. As a part of that worshiping community, you receive them for the last time. You welcome them through the doors, you say prayers for the reception of the body. And you bring them in and you surround them with the people who loved them and cared for them and were members of that community. And you read from scripture and you sing hymns, most of which express an idea of resurrection. A funeral service for us is a resurrection story. It's an Easter service. It's not a good Friday service. And you bring them and you sing and you tell stories. And at most of them, or a lot of them, one of the central acts is that we celebrate the Eucharist, the offering of Christ of his body and his blood. And we welcome people to that table, that feasting table. We bring with us, in our spirits and our minds, the person who has gone away. And it's a way that we, you know, celebrate their lives and their presence with us before we commend them into the hands of God. 

Jeff Thigpen: [00:11:14] In terms of that leading to the burial portion of that celebration of life, so it leads us into All Souls Natural Burial Association. Where did that concept come from and how did it start here, and how were you a part of that? 

Randall Keeney: [00:11:32] There's a group in town that has been talking about death and dying for a long time. And it was an organization called The Funeral Consumers Alliance of the Piedmont. And it's sort of grown and developed and changed. But I was a part of that group for quite a while and it had pastors in it, late people in it, funeral folks in it, Christians agnostics, all sorts of folks who just wanted to be able to talk about death and dying. You know, they had questions, they knew people that had questions, but we've been sort of taught that it's one of those forbidden subjects. The Funeral Consumers Alliance is a group that tries to teach about death and dying and also hold the funeral industry to a place of responsibility. So when people die, the family doesn't go bankrupt trying to celebrate their lives.  

Jeff Thigpen: [00:12:31] And we're working to get someone within that group to be a part of the podcast.

Randall Keeney: [00:12:35] Just an offshoot of that they were a group of people that brought up this whole idea of natural burial and it was new to me. So I was part of a group that continued to discuss it. And what natural burial is, basically, is going back. It's not a new thing. It's going back to treating death and dying and the way families and communities respond to it and the way that families responded to it before the advent of embalming and a developing sort of technological practice that came to exist within the funeral industry. Where families and worshiping communities take responsibility and take care of their own people. And also the recognition that the way we were doing burial was, in the eyes of many, an insult to the creation. Not only the person who had died with chemical treatments and all those sorts of things, but also to the environment. We're burying tons and tons of concrete and steel and toxic chemicals and all sorts of things. And basically what we're doing is trying to avoid the real consequences of death, you know, to push off the decomposition of the body, to make people up to look like they're alive, put AstroTurf around the grave so it doesn't even look like there's a hole in the ground. You know, all these little things that we do to sort of push away the whole idea of death. But instead to embrace it and to see it as a part of our loving relationships with those who go before us. 

Jeff Thigpen: [00:14:23] So they are the ecological piece of it, there is the cost of funerals that, you know, in terms of looking at, if you get a casket burial, if you get cremated, the whole economic models around death and dying. You know, one of the things that I told you when we talked a couple days ago, I was like, you know, somebody did tell me that a family shouldn't go bankrupt because they lose someone they love. And that's a powerful statement. And I also see there's this similarity in approach around the all natural funeral concept with other faith traditions. The Jewish and Muslim faith traditions, as well as kind of what you're saying historically is that there was a time where we didn't do all this. 

Randall Keeney: [00:15:13] Jewish and Muslim folk have been doing natural burials since day one. Most of them have not succumbed to, you know, all the trappings that developed around funeral practices, which actually sort of started in the early to mid 18 hundreds, and then really didn't get passed on to the wider public until the civil war and afterwards, when they began to embalm bodies in far away battlefields in order to ship the remains back. And right after that, embalming became almost a sign of affluence for people. And then a sign of, you know, the more you spend, the more you loved them. You know, you don't want to deny them the best send off you can give them, sort of thing. And, you know, then it developed into all sorts of bizarre ideas. 

Jeff Thigpen: [00:16:15] When did it open? 

Randall Keeney: [00:16:16] When did what open?  

Jeff Thigpen: [00:16:17] The burial sessions. Like open for business. So, where is it located? 

Randall Keeney: [00:16:24] It is in the wooded area behind St. Barnabas, the Episcopal church on Jefferson road. We have about 3, 4, 5 acres down there next to a Creek. And we were looking for a way to use that property and this group that started talking about natural burial was looking for a place to do it. They thought they had two or three places in the region and every one of them fell through. And then finally, they came to us and said, what are you doing with all that property back there? So we started talking about it. 

Carly Malcolm: [00:16:54] So now when I think of sort of like a typical funeral, the kind I'm most familiar with would be, you know, there's a service, there's a wake, and then maybe a casket or an Earn in the burial. So how does that look similar and different from a natural burial? 

Randall Keeney: [00:17:10] Well, in a natural burial there's, first, no embalming, okay. There's nothing non-biodegradable put in the ground. So typically when someone is given a natural burial, they're wrapped simply in a shroud and they're taken and they're buried in the ground, probably four feet deep. The whole notion of six feet deep was created to have space for, you know, involve big caskets and all of that. And you bury them a little bit more shallowly because that allows the body to decompose. And it's just sort of, you know, going back to doing things the way they were before embalming and before all the trappings that were put on that lead, you know, full-blown quote traditional funeral to be 10, 12, $14,000. And this is pretty inexpensive and it's also the way families and faith traditions did burial for thousands of years before embalming and caskets and balls and all those things became normative. 

Carly Malcolm: [00:18:19] So, you mention the economic, the ecological aspects there. Are there any other factors that folks should think about when they're considering if a natural burial is the right thing for them or their loved one?

Randall Keeney: [00:18:29]Well, natural burial sort of respects the environment in that, we're not taking a space of ground on the earth for one person to own in perpetuity, forever. You know, you go back to the ground, you return to the earth and you become a part of the recreation of the world. As much as the earth gave the gift of life, even in the scripture, Genesis talks about God taking mud, dirt, and out of the dust, forming people, that we come from that. We come from this wonderful creation and then we are returned to it. To me, that's one of the most profound things. Is that we're not separating ourselves from the creation. We're actually gifting ourselves back to it. 

Jeff Thigpen: [00:19:22] Yeah. And you and I share a couple of friends that transitioned a few years ago. Two of them in particular, Loki Meacham, the blues folk singer. And we both spent time with him nearing the end of that time. And I'm just trying to come up with words to describe the former Bishop of the Episcopal church in the state of Mississippi, Chip Marvel, who was a dear friend, I think to both of us. And I actually remember being at a facility where Chip was in the last few weeks of his life. And I think I was leaving and you were coming in. I don't know if you remember that. What I'm getting at is, you know, we live in a society where talking about death and dying is elusive and it's hard. And sometimes people don't want to talk about it. And you know, how do we create a culture where we have more meaningful conversations about death and dying? I mean, I think it involves individuals. I mean, people as groups need to support that. We need to have systems and culture that makes for that. What do you see? I mean, you know, in terms of the faith tradition and practically, as you kind of say, a lot of times in the burial process, we try to ignore death in some ways, or we try to seek comfort in ways that may give us some comfort. But we could probably have more openness, not only in preparing for it, but understanding death is a part of life. What do you think about all that? How do we talk about it? How do we create a culture that views this as okay? 

Randall Keeney: [00:21:00] Hopefully, those of us who are not particularly afraid of talking about it, just continue talking about it. There are those groups around that bring the idea up, you know, but ultimately there is no avoidance of the conversation. It's just when you have it. It's just when you have it. And I think there's a powerful place where you can have that conversation with someone who's about to go through it, who sort of embraces that whole idea and giving people permission to talk about it. A lot of folks just don't feel like they can or should. I think we need to invite people to those conversations. I went with my sister for about two years, living with us and going through a process of dying. She was diagnosed with a particularly ugly thing called multiple system atrophy. And she's living in Colorado, doing wonderfully, having a great life and then that hit and she came to live with us. And that whole process of going through grief and dealing with the reality of a pending death for a couple of years was such a wonderful opportunity for the two of us to talk about things that we hadn't talked about. Because it meant that the moment was quite precious.When certain tragedies happen, we’re sometimes robbed of that. We don't have that opportunity, at least with the person who passed away. But the people who survive, you know, sit around and tell stories, you know, cry with one another and have those conversations then. So the conversations are happening. It's just a matter of when they happen, in a lot of ways. And one of the groups that was meeting down at Scuppernong Books, I think it was called Cafe Mortal or something. And there was a gentleman in Greensboro who was dying and wanted to have natural burial. And they went through all sorts of conversations and they actually had a party for him before he died. And they brought in a cardboard casket that you can get from funeral homes that are pretty cheap, maybe free. And they brought it in and set it down and his grandchildren and children and friends got magic markers and crayons and colored it and decorated it and wrote things on it. And it became a way for them to sort of cope with his impending death and then his death. And his life was celebrated not only after he died, but before he died. And from what I understand, he had a wonderful time there. And so, you know, the more we're willing and able to talk about it, the more able we are to embrace the preciousness of the moment. 

Jeff Thigpen: [00:23:58] That is an incredible articulation of celebrating life in death in a way that affirms the individual. It also is the context of having a discussion around these things that are really hard to talk about. And that's why we're doing these podcasts. It’s to put it on the table and a lot of this is going to be informational. And we know that in Greensboro and in this area, we have a lot of people every single day who go to work and try to help create a context for an environment where we can have these discussions. And I think we want to be able to put it out there and help people get good information. And also think about these things in ways that lift up the quality of our discussions and our interactions around issues of death and dying and end of life. And so it was really good to have you in here both to talk about your faith tradition and why talking about these things are really important and looking at All Souls as an option for folks to consider and why it is so important to put that on the table. 

Randall Keeney: [00:25:08] And it doesn't just have to be All Souls quite frankly, we would love to talk to folks, but you know, there's a natural burial, green burial place outside of Asheville called Carolina Sanctuary, I think. There's one in South Carolina called Ramsey Creek and they're popping up because a lot of folks are simply beginning to embrace this whole idea. 

Jeff Thigpen: [00:25:32] Well, thank you for coming in and talking about it. And if folks want to learn more about this, they can, I guess Google All Souls Natural Burial Association. You can go online and get more information. And Randall, I really appreciate you coming in and talking about it. 

Randall Keeney: [00:25:48] You're more than welcome. I appreciate the invitation. 

Jeff Thigpen: [00:25:50] On behalf of myself and my stellar assistant Carly Malcolm, thank you for coming in to the Good Grief Podcast.

Outro

Thank you for listening to this episode of the good grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndofLife@GuilfordcountyNC.gov, or find us on Twitter with the handle @Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm Lead for North Carolina fellow for Guilford County from the UNC School of Government. And welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So, we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

Jeff Thigpen: [00:00:59] This is the Good Grief podcast. I'm Jeff Thigpen, Guilford County Register of Deeds with Carly Malcolm, Lead for NC Fellow from the North Carolina Institute of Government. Today our guest is Diane Person, the founding director of the Elon University Anatomical Gift Program, AGP. As a willed body program, the anatomical gift program was launched in 2017 and aids students in the fiscal therapy and physician assistant programs in learning about anatomy and physiology of the human body. Diane’s task has been to inform the public about the program and increase the number of registered donors per special gift. She appears to be dealing with end-of-life issues and in some cases, spending many hours with potential donors and their families and providing a great deal of care for that program. She is currently an ad hoc member of the North Carolina commission on anatomy and was recently awarded, congratulations, the 2020 Phoenix rising award, which goes to an employee who has risen to the top and contributed to the Elon community in a dynamic way. She's got a national reputation for her contributions in the field of anatomy and willed body programs. And I was listening to one of your interviews and I heard one of your quotes and it said, what we know matters, but I think who we are matters more. And I think that based on my conversation with you a few weeks ago, I think that you bring that to your work. And so on behalf of Good Grief and Carly we want to welcome you. 

Dianne Person: [00:02:35] Thank you. Thank you so much for your kind words. I appreciate that. 

Jeff Thigpen: [00:02:38] Yeah. So what brought you to Elon University? I think you came from Massachusetts. How did you get from Massachusetts to Elon? 

Dianne Person: [00:02:51] I get that question often, and I love to tell the story because I’m, yes, Massachusetts born and raised. And part of my background involves the work that I did at UMass medical school in the same capacity as the director of their anatomical gift program. The difference being, theirs was already established. So, I walked into a program that was already established. But yeah, national organizations and reputation, you know, grew over that 16 years. Part of what I do is interact with the anatomy space and teaching human anatomy to medical students. And that is where I met a colleague by the name of Dr. Janet Co. We established a relationship, a collegiality and a friendship. And little did I know that, and this was back in the early 1990s, little did I know that about 10, 12 years later, that our paths would cross again. So in 2012, she came back to UMass medical school and said, I'm thinking about ramping up a program at Elon School of Health Sciences, what do you think about that? And I said, oh my goodness. Unaffiliated with a medical school, that's a pretty daunting task. But it sounds like it's feasible. Good. Will you serve as a consultant to a feasibility study? And I said, yeah, sure. So I didn't know what that would entail, but I said yes, because I wanted to be helpful. And Janet was a friend and a great working colleague. So I began as a consultant. So using vacation and personal time to fly to Elon to serve as a consultant to a feasibility committee. And that led into the offer of the post of founding director. They liked me a little bit on the committee and they made the offer after we submitted our report to the trustees in January of 2016 and the offer was made in March of 2016. And I readily accepted because I just fell in love with North Carolina, the people, the culture, and the opportunity to build a program the way I wanted to build it. So that's how I came to North Carolina

Jeff Thigpen: [00:05:05] And it's amazing that this is an undergraduate program and usually these kinds of programs are associated with medical schools. And so it makes it unique. And this is the first one of this kind in North Carolina, right? 

Dianne Person: [00:05:15] Yes, that's true. We are the first of its kind being unassociated with a medical school. So yes, that is our claim to fame and, you know, we've made history in that way. I'm not sure about nationally. I don't believe there is some completed data on that. But, we’re doing that investigation currently to see if we are the first in the country. 

Jeff Thigpen: [00:05:39] Yeah, and I was just kind of joking with you on the phone when we talked. I was like, I worked at an undergraduate college who had, you know, donors and gifts, which was different to this program. It’s a whole nother kind of approach to donors and gift programs. But tell us about what the anatomical gift program is and how you became involved with it. 

Dianne Person: [00:06:02] So, to that type of gift that you're talking about, Jeff, that's exactly what I thought I was interviewing for at UMass medical school. Yes. I thought it was something philanthropic and, you know, totally unrelated to my background. By the third round of interviews, I was ready to walk out the door, you know. I said, dead bodies, get me out of here. So, my mentor who was my last interviewer, Dr. Sandy Marks, who was the founding director of the UMass program, which he developed in 1970. He said, no kid, I see something in you. You've got to give us a chance. And so he won me over and he knew more than I knew about myself at that time, because I just completely fell head over heels in love with this field of end of life and anatomical gifting. So, that's how I became involved with it. And so in order to become an anatomical donor, one must sign the consent paperwork at Elon university because we are a first consent only program. We are governed under the uniform anatomical gift act, which is a national uniform law that is adopted by state laws. So, we are under the direction of the state laws for willed body programs and cremation. And those are the laws that we are bound to. However, they're sort of ambiguous in that each willed body program has the authority to determine their own program. And so we built our program as it aligned with the mission and vision statement of Elon university. 

Carly Malcolm: [00:07:46] So, for somebody who's interested in making the decision to donate their body, who would they get in contact with? 

Dianne Person: [00:07:51] They would contact me. We have a website that I helped develop and the website really tells our stories. So, I will share with people that if you're interested in anatomical donation at Elon, that you should check out our website. It gives you an opportunity to look at the consent forms that are required for registration with our program. And there are also some videos that I would encourage people to take a look at. There's a student testimonial video. So, earlier on when I was developing the program for Elon and going out and conducting educational outreach throughout the entire state of North Carolina, I would ask some of the graduate students to come with me because their words, their testimonials really empower the definition of anatomical donation and the value as it's attributed to healthcare education and eventually help them as a healthcare provider. But I ran into a little bit of trouble with faculty who said, academics first and then this later. So, I thought, well, gee, how can I get around that and I came up with an idea to record their testimonials. And so that's the video of student testimonials that you'll see on the anatomical gift program website. And they really do endorse who we are and they endorse the reason for anatomical donation. 

Carly Malcolm: [00:09:16] Yeah. And I saw on the website that you recently had a virtual donor Memorial service. Could you talk about that? 

Dianne Person: [00:09:21] Sure. So, because of COVID and the restrictions, social distancing, and because we were not allowing, at that time, any outside visitors to come to campus, we thought, well, how are we going to include the family members because that's part of what we do and our offerings of an annual memorial service. We invite the family members and we ask them to contribute with photos, with, you know, their written testimonials or their spoken testimonials about their loved one. And that just, I think it's empowering for the students. It's also very affirming for the students to know, you know, who these people were in real life and that they really truly did want to make the decision and contribute further by donating their body toward healthcare education. So, to encompass that, I thought, well, let's invite the family members to do video clips or to send in photos. And so, most of them complied. So it was a major production. It was still produced, video at the sacred space in the Newman lumen pavilion. We had student participation, we had faculty participation. I spoke to the Dean of the school of health sciences, Dr. Becky spoke. So we had many verbal offerings. You know, people who put together their words to express the importance of anatomical donation and to show our thanks for what we consider to be the ultimate gift toward a healthcare education. 

Carly Malcolm: [00:10:58] I was really struck by just the gratitude that was expressed by the students for that contribution to their education. Could you talk about the process that follows donation? Like how the body is utilized and treated and eventually laid to rest. 

Dianne Person: Yes. So I will go back to being first person consent. We feel very strongly about that. We feel that the individuals themselves are really the ones who should make the decision to donate his or her own body. We do not accept next of kin donations. We do not utilize the unclaimed dead. We deal only with individuals who themselves decide, make the decision to donate their bodies. So in that regard, it is honoring the individual's choice, and in that regard, when it comes time to orient the students prior to them meeting their first donor, we call them their silent teacher. I think that's just such a beautiful language that is synonymous with willed body programs. And that's one of the terms that we use. And when we introduce the students to the notion of them meeting their first silent teacher, we can say with assurance that they are here because they chose to be here. This was their decision. And that really does remove some ambiguity, you know, some hesitation for the students to go in and to actually meet their silent teacher because they're, you know, they're a little nervous about that. Some of them have never seen, you know, a dead person before them before, and this is an opportunity for them to embrace that experiential learning. And in our anatomy space, we pride ourselves with compassion, with dignity, with reference. And I recall my mentor from the UMass days saying to me that the way a student conducts himself or herself in the anatomy space will certainly determine how he or she will be as a healthcare provider. So that respect, that dignity and that compassion is a common thread, you know, throughout the entire anatomy course. 

Carly Malcolm: [00:13:07] Have you ever encountered family members who maybe don't understand or don't fully agree with their loved one's decision to donate their body? 

Dianne Person: [00:13:15] Yes. And, that's a great question. Part of the educational outreach is to invite family members to attend that educational outreach session or to invite our potential donor registrant's to include their family members. Another UMass story, that was a lesson learned the hard way. Earlier on in my career, I walked into my office one morning and my assistant said to me, there's an urgent call for you. The night before I had accepted my first donor. And so the call was from the donor's daughter and she said, there's no way that you're keeping my mother.

She never told any of us. She was calling from out of state and she had siblings who were also living out of state. The mother had made the decision to donate her body to UMass anatomical gift program without telling any of her family members. So that was a policy change for us. In terms of, within educational outreach, making sure that potential donor registrants include their families in this decision-making process so that they can support them because they're, after all, going to be the ones to facilitate at the end of life. So to finish the UMass story, I said to Dr. Marks, I said, you know, we really have to deal with the living. So we invited the family to come to the school and take their mother back, which they did. But it was a policy changer and so when I was developing the program at Elon, I made sure that we were first person consent and that the families would know. So yes, it's all about educating the family and bringing them into the fold. 

Jeff Thigpen: [00:14:53] Yeah. And when we were researching the program, I think we were struck with the language. It was a very compassionate language. It was a caring language. It was not just about a body. It was about the whole person. It was about the family. It was about the idea that, you know, as you say, silent teachers, is that in death, these people whose bodies are donated continue to have a huge impact on students in terms of their knowledge, and that knowledge goes out into the world. When you're looking to the future, what is your hope for the program and how would you like to see it grow and evolve in the years to come? 

Dianne Person: [00:15:35] So before I answer that question, may I speak to what you just said? Because I just love the way you summarize that. I asked a student if they would calculate how many potential people they would affect by one donor, by one silent teacher. So when you take the number of cohorts, the number of students who will actually learn from one donor, because it's a shared experiential learning experience in the anatomy space. And as they go out as healthcare providers and treat all of their patients, they will have made a difference, made an impact. One donor will have made an impact on over 600,000 patients. To me, that is mind boggling. That is just a staggering number calculated by our school of health sciences students. And in that way, death is not final. And in that way, they are creating a legacy for themselves. So that's very impactful on healthcare education and healthcare providers.

Jeff Thigpen: [00:16:35] Yeah. And that's great. I mean, in terms of our podcasts, we have these podcasts in order to be able to understand the issues of death and dying and to talk about a part of our lives and death that sometimes we don't like to talk about and you all have done such a wonderful job of this program that definitely, the more I learn about it, the more I'm a proponent of it and think that what you're doing is just wonderful. And again, it's not just what you're doing, it's how you're doing it. 

Dianne Person: [00:17:04] So to your question about what I have in mind for the future of the anatomical gift program at the school of health science. I think we're already on our way to establishing that it has always been my dream to establish a gold standard willed body program, uniquely and it's in our own way, aligned with our policies and procedures as a first person consent only program, and to set that gold standard for other willed body programs nationally. I think that we're well on our way to doing that. I think that we have established ourselves in that way. And I also want our reputation to be known as being those compassionate end of life options. We are an end of life option. So anatomical gifting is not for everyone, but for those who decide that this is what they wish to do with their end of life, we hope that they'll consider Elon. And I’d like to add to that a common thread in educational outreach was the struggles that people have in initiating these difficult end of life conversations with their family members. So that was sort of a common thread. So, I've also done some work on behalf of Elon's anatomical gift program in helping people initiate those crucial conversations, those difficult end-of-life conversations. So that has been mutually beneficial. 

Carly Malcolm: [00:18:31] So, what would you tell somebody who's considering donating their body but doesn't really know what all that entails. You know, my conception was just this vague, you can donate your body to science. What factors go into play there?

Dianne Person: [00:18:43] So I would invite people to think about why they want to donate their body, to think about that because that's a conversation that I will emphatically suggest that they have with their family members. I would ask them to think about doing that and they can do that in a number of ways. I could offer a zoom session with them now. Whereas I would make a one-on-one appointment with them, but hopefully we'll get to that one day, but for now it would be a zoom session to include their family. I would invite them to visit our website because it really tells our story and it gives them the opportunity to look at the paperwork. I would also ask them to be prepared to make a commitment. This is for their family members because the individual, their loved one is going to be with us for up to two years. It could be a year, but it's up to two years. So they have to really prepare themselves and to be ready for that. Some family members will comment and say, well, how do I have closure? I will say, think about that. You know, everybody has their own definition of closure. Some folks, myself included, do not like the word closure. You know, I always want to keep the people who I loved and lost in my heart forever. I don't want closure. But for those who do, I would invite them to get creative about a memorial service. And they would have to do it, of course, without the presence of their loved one, but they could do that earlier on. And then I would also let them know that we are a very transparent program at any given time they can call us and inquire on where studies are. When will they be concluded? So, there's an open line of communication. I would tell them that. And then I would also let them know that at the end of life, at the end of studies, rather that we will be celebrating not only their loved one, but celebrating them for supporting their loved one in this end of life decision with a memorial service that will include their contributions and our students expressing their very deep and profound gratitude for the ultimate gift toward their healthcare education. That would be the comprehensive answer. That's great. Thank you. You're welcome.

Jeff Thigpen: [00:21:01] Dianne. Thank you so much for being with us today on the Good Grief Podcast. Dianne Person, the founding director of the Elon university's anatomical gift program, AGP program. We will have the links to the program and information, which will adjoin the podcast. And again, Dianne, on behalf of Carly and myself, we want to thank you for being with us today.

Dianne Person: [00:21:25] Thank you everyone. Thank you for this opportunity. It has really been my pleasure.  

Jeff Thigpen: [00:21:30] And so, we really appreciate you being here with us. We've come near the end of our time. And what I would like to do is thank you on behalf of Carly and myself. Thank you for being a part of the Good Grief Podcast.

Dianne Person: [00:21:47] You're very welcome, Jeff. It has been my pleasure 

Outro

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm Lead for North Carolina fellow for Guilford County from the UNC School of Government. And welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is also complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So, we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end-of-life challenges.

Jeff Thigpen: [00:01:01] This is Jeff Thigpen, Guilford County Register of Deeds with Carly Malcolm, who is the NC Lead Fellow with the UNC Institute of Government, who's here and welcome to the Good Grief Podcast. Today we have Al Lineberry Jr, chair of Meredith of Hanes Lineberry Funeral Home. Hanes Lineberry has been a staple within the Greensboro community and traces its lineage back a long way from Hanes funeral home that opened in, I think, 1919 and celebrated its 100th birthday last year to the services that they're offering today. Al is a graduate of both Wake Forest and Winget and he's been involved with any number of community leadership roles in Greensboro. He has been former chairman of the Greensboro Chamber of Commerce, chair of the Greensboro Merchants Association, has been a part of the Community Foundation. And Al, there's just too many things. But we really appreciate what you do in the city of Greensboro and also what you do for families that are going through tough times. And so on this podcast, we'd like to unapologetically talk about the issues that deal with death and dying and end of life issues. So, thank you for being with us. 

Al Lineberry: [00:02:22] I’m honored. Thank you for inviting me.  

Jeff Thigpen: [00:02:24] Okay. Can you talk to us and describe your background? I know that's a big question. You know, how you grew up and how you led into the role that you've had here both in Greensboro and in the business.  

Al Lineberry: [00:02:35] Well, I grew up in Greensboro and went to Lindley Elementary School, Kiser Middle School, and Grimsley High School. From there, went to Wingate University, Wake Forest University and got a business degree from there. I was looking for some work and of course, having grown up in my father's world, I think it was kind of a go-to. And so I started working with him in about 1968. And then, actually, he does not encourage me or discourage me from coming into the business. I actually got more of an idea of what work he was doing actually from my grandmother’s funeral, which was when I was 16.  

Jeff Thigpen: [00:03:21] Your dad, was he a part of the original purchase of it becoming Hanes Lineberry? 

Al Lineberry: [00:03:28] Well, he bought the controlling shares in 1955. 

Jeff Thigpen: Okay, in 55.

Al Lineberry: [00:03:33] So I mean, I was in elementary school at the time. 

Jeff Thigpen: [00:03:39] Was that when your grandmother passed away? You were 16?

Al Lineberry: [00:03:42] Yeah, I was 16. And I didn't pay any attention to what he did. He was just gone from the house, growing a business and staying active in his work. And then my grandmother had been dying for seven years in the nursing home. I just remember seeing her in the casket. She's like 15 years younger. And really, like I knew her growing up. It started me thinking differently about this kind of work. I loved the idea of law, but I didn’t like the idea of going back to school a lot more. So that's kind of how I wound up with that.  

Jeff Thigpen: [00:04:15] Was that one of the first times you experienced death in a close way within your family? 

Al Lineberry: [00:04:20] Well, it was a family member, you know, you have your animals die and that can be pretty traumatic. But that's the first real family member that I can remember that made a heavy impression. And it turns out to be important for us to confront death face to face and seeing the person who has died, that they have died. It’s the same person instead of being a myth out there.

Carly Malcolm: [00:04:51] So, what do you remember about growing up with a father that managed a funeral home? Did that affect your perception of death at all, do you think? 

Al Lineberry: [00:05:00] I don't think so. I think that my perception grew. I mean, I had the same issues that almost every other child does with the scary part of death. You know, ghosts and goblins were on TV and I was not immune to that. But I never thought about it. And you know, my friends would say your dad does what? And they’d look at me crosseyed a little bit, but it wasn't really overwhelming to me. 

Carly Malcolm: [00:05:31] So then how'd you go from there to wanting to become a funeral director? 

Al Lineberry: [00:05:35] As I said earlier, I really wanted to go to law school and I was just full up on my neck with education. And I just asked my dad one day, I said, you know, I need to get out of your house and start my own life. And he said, well, you can start from the very bottom like everybody else does. And he paid me a hundred dollars a month, less than uncle Sam was going to pay me to go into the military. Anyway, it turned out to be a good decision.

Jeff Thigpen: [00:06:06] So when you went from the bottom through the organization, what did that mean? What were some of the responsibilities that you had when you started? 

Al Lineberry: [00:06:16] My first memory was washing the walls down a corridor where we had a ramp. And, you know, washing cars, putting up tents. I never dug a grave, but came close. I never became an embalmer. Now I can explain all that a little bit later. But funeral service, funeral directing seemed to be where I was being directed. And you would serve an apprenticeship under a licensed person and learn what legal things we have to go through and then learn to listen to what people are telling you and what you’re hearing. And you're a counselor, in a lot of ways.  

Carly Malcolm: [00:06:59] So other than that apprenticeship, what education requirements are there for becoming a funeral director? 

Al Lineberry: [00:07:04] Well, there's a year of apprenticeship and then two years of mortuary school, and that's 24 months. And then you take a national exam and a state law exam to become licensed.

Carly Malcolm: [00:07:17] And what kinds of things do you learn in mortuary school? 

Al Lineberry: [00:07:20] What they learn is an awful lot about is science, our bodies. And then disease. What we need to be prepared for at certain times, and the preservation and sanitization of bodies. 

Jeff Thigpen: [00:07:37] When you have, you know, potential clients, people come to see you, what are the realities in a lot of cases that they're dealing with and how do you, you know, within the funeral services realms help them navigate that? 

Al Lineberry: [00:07:55] We ask open-ended questions a lot of times to get their lines going. The first part is we need to get biographical information that we have to use for legal documentation, being social security or cremation rules or burial rules. Many people today are pre-arranging their funerals and the good thing about that is they're not having to make pretty traumatic decisions right at the time of death because we already discussed that. And a lot of people come to us when they know that their loved one is kind of reaching those final weeks and months. I think we've got quite a few pre-arrangements of over 12 years old. So it's a really smart thing to do.

Jeff Thigpen: [00:08:46] We went over and spent some time with you about a year ago, and I'm wondering if you made the comment about, there are approximately 152 things you have to do around the time of death. Does that sound familiar? 

Al Lineberry: [00:08:59] I don't even know why I did it, it was about 1966. He said, son, I never thought about this, but I went and listed everything that we do. There’s a 157, actually. And he wrote a little pamphlet but I’ve not been able to find it. 

Jeff Thigpen: [00:09:16] Yeah. And that's part of the reason why we're doing the podcast is one part of this is, you know, for us at the registry, its web-based resources and connections to people and organizations in the bureaucracy around death and dying that people can understand. And I remembered that because, you know, we don't, in a lot of cases, like to talk about death and dying and certainly planning for it. There's certain folks that do pre-plan for it and a lot that don't, and there's a lot of reasons why they don't. Some of it is stigma. Some of it is you never think you're going to have to deal with it and then it's right in front of you. But when it is, there's a lot to do. 

Al Lineberry: [00:09:58] Yeah. And it's under some sort of a duress, our brains are in that grief mode and a lot of it. And I'm one of those persons that went through a death but I don't remember four days after my daughter died, I just don't. And everything went fine, you know, the service and everything, but you just get blank sometimes, especially when it's really unplanned for and you just need to have an incredible support system around you and you need to.

Jeff Thigpen: [00:10:28] Yeah, and we did the podcast with kids path locally and part of the discussion was around, you know, children who are terminally ill. And also children that are dealing with the terminal illness of their loved ones. And you know, that is a kind of trauma that a lot of times we can't imagine, but is there. And in many situations when people are losing their loved ones, they're balancing, as you know, the loss with, okay, where does the body go? Or, you know, what funeral home are we going to use, or these bills that are there that we have to pay and why do we need so many death certificates? And by the way, Gilford County is going to be a pilot county on electronic death certificates.  

Al Lineberry: [00:11:23] I’m looking forward to the next week’s learning experience. 

Jeff Thigpen: [00:11:26] There you go. So that's something that's happening now. North Carolina general statutes that deal with funeral homes. Tell us about that. How are funeral homes either supported, regulated, guided in statutes? 

Al Lineberry: [00:11:42] The first regulations that I'm aware of started in 1901 and it was based primarily on embalming, which was actually invented by medical doctors for research. So, they could do research for a longer period of time in the mid-1400s. Then the civil war came and they needed to transport people who were killed back to their homes. And so, there were not enough surgeons or medical people to do all the embalming. So, they started training these other folks. And so, in 1901, they decided to license them and over the years the decades have changed the rules and funeral directing and embalming became under one roof, if you will, probably in the sixties. And it’s advanced as we've gone into cremation. It’s all part of section 13A. And I brought my little book with me which is pretty long and detailed. But it goes for the licensure, the training, the apprenticeship program and the vows that you have to keep.

Jeff Thigpen: [00:12:47] And more people are choosing cremation these days, right? 

Al Lineberry: [00:12:50] It seems to be, yeah. It's about, I will say a little over 50% in Guilford County. And when I started some years ago, it was zero. So, it's changed quite a bit and I like that. 

Jeff Thigpen: [00:13:04] So, when folks are pre-planning and trying to figure out cost factors, can you tell us a little bit about how y'all are guided around all that?

Al Lineberry: [00:13:14] Well, the first thing you need to determine is what the family’s thoughts are. Do you want to have a burial or do you want to have the person cremated? The object of the funeral is taking care of somebody who's died in some systematic way. And we, human beings, have designed funeral services, which is another reason. I'm giving you too much history on this, but there weren't funeral directors in the 18, mid-1800s. There were hardware dealers, furniture dealers, and they kept being asked to do something else in regard to a service. So they started undertaking tasks, eventually the word undertaker became the word before funeral director. So that's the undertaking stuff. So anyway, I'm not sure where that went with that question, Jeff.

Jeff Thigpen: [00:14:01] Well, just the cost factors that go on that people have to consider.

Al Lineberry: [00:14:04] First of all, I don't think, cost is not up there on the top rank. It's what are we going to do? How do we want to look out for our loved one? It turns out there's less person power in a cremation service than there is on a traditional funeral. So, that's going to affect your cost basis there. It's not like we’re providing the same type of service from the governmental standpoint, trying to get all the records together. A cremation has a lot more paperwork to it than does a regular burial day. 

Jeff Thigpen: [00:14:44] Really? 

Al Lineberry: [00:14:50] Yeah. And it's really governed by the state of North Carolina, cremation is. And the less manpower person power we have to use, you know, that affects the bottom line of the cost. 

Jeff Thigpen: [00:14:53] And the state audits funerals? 

Al Lineberry: [00:14:55] The pre-need program is audited very strongly in March of each year. We have regulators that come in and visit our funeral homes and inspect them, but I don't know what you mean by audit. We don't have a financial audit.

Jeff Thigpen: [00:15:11] Financial auditor or anything like that. 

Carly Malcolm: [00:15:16] So you spoke earlier about embalming. Could you talk about the education that goes into that and why you ultimately didn't choose to become an embalmer? 

Al Lineberry: [00:15:23] I didn't want to become an embalmer because I didn’t want to go back to school. And we had, at that time, enough folks to really look after our client families. And being from a business background, I got more involved in the business side of it and then into the social side of it, of helping families in their despair. The embalming is pretty much the same rules as far as you’ve got to go to a mortuary school for two years, you’ve got to go for an apprenticeship program for a year and then take the exams. The funeral director does not have to take a national exam, they have to take a state exam about the laws that govern our profession. 

Jeff Thigpen: [00:16:10] You all are, in terms of your business have been, and you have, have been really involved in the Greensboro community over the years. Can you talk about some of the things that you've done and been a part of? 

Al Lineberry: [00:16:24] My dad was a role model for me. He was incredibly active in everything he ever did.

Jeff Thigpen: [00:16:30] Was he in the state Senate or the house? 

Al Lineberry: [00:16:32] He was in the house for three terms. And that’s one of the reasons I’m maybe not running for public office. But he set a mark really high and I just thought that was the way you're supposed to live, the community has been giving to you, you give back to the community the best you can. It's not necessarily a financial give back. But the least is blood, sweat, and tears sometimes. And I think that’s important that we help each other survive the best we can. So, that's kind of where that comes from. And then most of our family still does the same things too. 

Jeff Thigpen: [00:17:13] You mentioned that you lost your daughter. Can you tell us a little bit about that and what happened and what you went through? 

Al Lineberry: [00:17:21] She had a disease, which is called osteonecrosis, which is the dying of the joints. And I always thought joints was a knee replacement or a hip replacement or something like that. But we're talking about joints, little fingers, little toes, big toes, every joint in your body that has a joint was dying. And just about that, which is excruciatingly hard of pain. 

Jeff Thigpen: [00:17:35] How old was she? 

Al Lineberry: [00:17:40] She was 37 when she died and it was a heart attack. But it was caused more from the medicine she was taking that created a linear blood clot. And Janie and I were going to see her for lunch after church one Sunday, and just found her that way. And it's traumatic. 

Jeff Thigpen: [00:18:10] Yeah. So you, you actually, you know, have a family that has been a part of the funeral services industry for your lifetime. To have a personal experience like that in your family, I think probably informs what you do in an incredibly personal way.

Al Lineberry: [00:18:32] Well, it has. I mean, it makes me look back and say, hey, what we do really is important for people. And if we can do the right things and work the right way, you're helping people get over a crisis. And Kubler Ross wrote the book that there's four stages of grief, diverse stages of grief. And there's a sixth one that just came on about three years ago. I helped her write the book. I'm not going to go into that. But, you know, the cycle of grieving is a cycle of middle schoolers in their growing up process, it’s the same things we go through. And our lives get accustomed to these cycles, but we've never put a name to them and identify them like Dr. Kubler Ross did. And I had the pleasure of studying under her in the North American University.

Jeff Thigpen: [00:19:30] And we can add a link and all that.

Al Lineberry: [00:19:35] That’s good. The American Way of Dying.

Jeff Thigpen: [00:19:38] Well, we really appreciate that you're part of this community. And if folks want to learn more about the services you offer and everything, how would they do that? 

Al Lineberry: [00:19:46] Our office phone number is (336) 272-5157. Or they can go to our website, which is Hanes Lineberry Funeral Homes dot com and get additional information.

Jeff Thigpen: [00:20:02] All right. Well, thank you very much for being with us Al. On behalf of Carly and myself, thank you for being a part of the Good Grief Podcast. 

Al Lineberry: [00:20:10] Thank you Jeff and Carly. It was good to see you and best of success in your work. 

Thank you. 

Outro

Thank you for listening to this episode of the Good Grief Podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com.You can also email us at EndofLife@Guilfordcounty.nc.gov, or find us on Twitter with the handle at Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

[Intro] 

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is also complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So, we thank you for joining us for the Good Grief Podcast and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:01:00] Welcome to the Good Grief Podcast. I'm Jeff Thigpen, Guilford County register of deeds. I’m with Carly Malcolm, who is the lead for NC fellow with us this year through the North Carolina institute of government. She's working on special projects for us through the registered deeds office. And today we have a special guest, the Reverend C. Bradley Hunt II is here with us today. Welcome Bradley. 

Bradley Hunt: [00:01:26] Thank you. 

Jeff Thigpen: [00:01:17] Bradley is the pastor at New Light Missionary Baptist church where he’s a youth pastor, and he's a community leader. He's been involved in a number of community organizations, dealing with everything from race equity policing in communities of color. And he's active very much in the pulpit forum here in town, as well as the Greensboro and North Carolina NAACP. We are thankful Bradley to have you here today because these podcasts are put in place to talk about issues of death and dying. And we are really interested in having a conversation and learning more about death, dying and end of life concerns and issues as it particularly relates to the African-American community. So, welcome. 

Bradley Hunt: [00:02:05] Thank you. Thank you, Jeff.

Jeff Thigpen: [00:02:01] So, where did you grow up? Are you from Greensboro originally? 

Bradley Hunt: [00:02:08] Right. So, I did. I grew up in Greensboro. I like to say that I'm straight out of Moses Cone, born and raised here. My mother was a school teacher at Jackson Middle School. She taught there for 23 years and we grew up all around in south Greensboro. She was a single parent. I watched her provide for my sister and I by any means necessary, Jeff. She worked two or three jobs and really that instilled in me early on how important it is to work hard and to be determined and dedicated to your family and to whatever you put your mind to. And I also learned early on that, you know, my mother had a professional college degree, a school teacher. She taught NFL players, successful business people. But we still had to struggle to make ends meet. And so it just taught me that it's not always necessarily about credentials, but it's about, you know, hard work, dedication, that's how I was able to become the man that I am today, by watching my mother.

Jeff Thigpen: [00:03:08] Wow! Sounds like your mom was an incredible role model. Now you are over at New Light. You know, did you grow up within a faith community or did you grab onto the faith later on in life, or how did that journey start for you and lead you to where you are now?

Bradley Hunt: [00:03:21] Right. So, you know, growing up, I always thought that, you know, my mother had a drag problem because every time the church would open, she would always drag us to church. And so we were dragged to church all the time. And so, you know, faith has always been a part of our family structure and our belief system, and my mother thought it was important to instill in us some foundation and some sense of something that is greater than you. Something that has to do more with what you believe and not necessarily who you are, but what do you believe and what do you stand for? And who are you in times of adversity? And I believe it’s those values that allowed me to continue to stay in church. Because it has been tough to stay committed to the black church because we have a number of challenges. People come to church expecting perfect people, and if you're not careful you will believe that everyone that is in church has no faults. And navigating the fact that the church is certainly a hospital for the sick, it presents challenges almost daily for me as a pastor, as a youth pastor. Imagine what it's like to minister to young people at this time. And so, you know, I’ve been in church all my life, still struggling to understand what is my purpose being a young person accepting the calling early on in life, relatively early. I have peers that started, you know, way younger than I am or that I was when I started. So just trying to understand, you know, how to navigate the challenges, how to expose the classic Jesus, not the one that we will romanticize and make fit our lifestyle. But the classic Jesus that fought for the poor, the least, the left out, the lost. And so that has been something that I found to be most important to me that Jesus, in fact, was a social reformist. Let’s take away all of the tradition and the customs that come along with the black church and let's really try to define how we're supposed to live in a way that will be pleasing to our Creator.

Jeff Thigpen: [00:05:36] And Bradley, I will say this, in knowing you, what I feel from you is that when the community is hurting, you're hurting. I think in the settings that I've known you, there is a faith tradition that connects to those people who are excluded from systems and culture and in society. And I feel that there's a piece of you in all the environments I've been around, where you take that in and at times be very powerful, lead to it. And that's, I will say, I really appreciate that about you and it sounds like your mother taught you well. And of course, you get none of that at New Light, right? That's a joke, you know. The New Light community is very active in the community. And so, in terms of your approach as an assistant pastor, youth pastor dealing with grief and other issues like that, how does that come into your world, into your ministry? How do you see it where you are particularly within the black community?

Bradley Hunt: [00:06:33] Right. So, I think for me and for the believers, those that I'm connected to, our understanding of life, right? Because I think you have to have some basic understanding of life in order to understand death. And our understanding is that we're here for a little while to live. If I could use an analogy, many cemeteries have someone's date that they were born and someone's date that they died and in between is that dash, right. That dash which tells all of the story. That's really what it's about. And for us, you know, understanding that dash and understanding what it means to live and take full advantage of life. Understanding that at some point, life, as we know it, will come to an end. We also understand that it doesn't necessarily mean for us the ending, it’s the end of our earthly existence, but we also believe that there's something greater to come. And so grief for me is the understanding that to be absent of life to me is not necessarily death, to be absent from the body is to be present with God, that's what our texts teach us. And so understanding that there are cycles of life, how you live will be judged and determined by the creator, and then you die. As a youth pastor, I've had many experiences. I've had young people that tried to commit suicide. I've had young people that could not understand why God, in their opinion, would take their loved ones. Why would God take my mother? Why would God take my father? These are the probing questions that we deal with as youth ministers. And for me, first of all, understanding that I may not have all the answers. And I think a lot of times pastors and preachers, we want to, you know, we want to have all the answers. And what I found with generation Z, millennials, we are more connected to relationships and not necessarily, you know, the wisdom that I believe other generations have been connected to meaning that it's not really important that you're interested in me or my wellbeing, but that you are thoughtful and that you are, you know, knowledgeable, that seems to be inefficient. But for this new generation, it's more about relationships. And so being able to sit with them, you know, not really responding, but making sure that they understand that I understand where they are and giving them an opportunity to grieve and to deal with loss has been my approach to addressing some of the issues and some of the questions that have come up with, especially young people around death and dying.

Jeff Thigpen: [00:09:12] And death and dying issues can be incredibly painful. And the idea of being present, which I hear you saying, sometimes you don't have the answers and it's about being with, and being in relationship to people who are struggling and try to help support them. I know within a number of African Americans that I've known, celebrating their lives through funerals in the black church, there's a special quality to that experience that is almost indescribable. It's incredibly powerful. In many situations it has been incredibly powerful and moving for me. And one of the things that we really wanted to talk to you about was that culture and the traditions that go along with that when celebrating a life. So, we talked about that a little bit on the phone and I think you’ve got a word to that. 

 Bradley Hunt: [00:10:00] Absolutely. I get chills, Jeff, when I think about the black church experience, as it relates to our Homegoing tradition and our celebrations and what we have done since we entered these shores. And, you know, I think about, recently George Floyd, his funeral, and you think about all of the funerals of those who have died by the hands of police, black folks, unarmed. Our community has had to mourn and it's been public. You know, these are public funerals and deaths and services. And I think about some of the icons, Whitney Houston’s funeral, and some of the folks, John Lewis, that even, you know, people that have lived and led amazing lives, the truth is they all come back to the same place. As you know, George Floyd is, you know, at his funeral, many of the same elements were there for Whitney Houston and John Lewis. And so, to me that suggests that no matter how you lived, no matter who you were or your contributions to society, the black church, the black community has a way of celebrating you, right. And doing that in a way that you receive the commendation that we believe that you deserve simply by being a human, simply by being one who was a part of our community. And I think that's something beautiful about the experience. And there is no other experience like a black funeral. When you think about the elements WEB Dubois in his book, Souls of Black Folks talks about the three elements of black worship. And he talks about, you know, of course there is singing and then of course there is the preaching. But lastly, he talks about what he calls the frenzy. And that is what we believe to be the Holy Spirit moving and giving credibility to our gathering. And a lot of times in Black Homegoing celebrations, what you're able to experience is that frenzy that people are gathered in one place like minded and celebrating the life of one who has passed on. Understanding, and Jeff, this is important because we really believe in our tradition that one day, we'll see you again. And I think that really speaks to who we are as a people. Resilience is one of the things that I appreciate about our community is that we have this faith that says, hallelujah, anyhow, no matter what happens to us, we have found a way to rejoice even in difficult times. And that has been our plight, that has been something that we have done consistently. And I just rejoice when we have an opportunity to see black church on display. When the world can get just a glimpse of what I'm able to receive every week, you know, pre-COVID. And so we're thankful for the witness and what it means to our community to experience a homegoing celebration. We don't say that lightly. We mean that. This is a tradition that we believe is one that allows us to really celebrate the existential, the essential being of a person that is a part of our community.  

Jeff Thigpen: [00:13:18] When I talked to you on the phone, you said that there is a quality within these services and in the belief that death is not the end. And I've been to a lot of funerals and I've been, you know, there's some finality there, right. But I know I've been to a number of African-American churches, where when I walked out, death was not the end. The spirit is alive and moving in the soul, the music that comes through. And for me, I can see that within the DNA of a people that has struggled for hundreds of years and overcome enormous hardship, bigotry and discrimination, institutionalized racism, slavery, Jim Crow, all of these things that would crush people. Yet, I guess, they rise. This is what a very powerful woman once said. And so I know it's been touching to me and Carly is going to get some questions in here. So, she's been anxiously waiting. She got a couple questions she wants to throw out. 

Bradley Hunt: [00:14:30] Let's do it, Carly. Let’s roll.

Jeff Thigpen: [00: 14:54] I give it up. 

Carly Malcolm: [00:14:36] Yeah. So, I was wondering if you could talk about, you know, there are segments of our society that are still more or less segregated by race. I wanted to know how that shows up in your work. How do you encounter that?

Bradley Hunt: [00:14:45] Absolutely. So, we know that it's no secret that Sunday mornings, you know, pre-COVID, that was a segregated time that, you know, for society. Black people go to black churches more or less, and white people go to white churches. And we know that to be the case. I like to believe that there are not two different messages. But it's always something that intrigues my intellect. Why is it that there is this separation in worship? If we all are indeed worshiping the same God, why is there a distinction? I think that speaks more to our struggles and challenges as a society. It certainly speaks to institutional racism. I think it also speaks to this other ring that happens in society where our faith practices have yet to be validated by the dominant culture and seen as something that is real. And so, I think we have some ways to go in that. But I also see the value in black folks having a space that they can say is theirs. When you think about our communities and you think about the value of our communities, property value, for instance, in America and your black community, the highest value properties are going to be your churches, right? And when you think about a black community, the value will be in the Black church. And so, I see that as an indication that the church is the cornerstone of our community, and it is a place where we feel that we can be ourselves, that we are able to express ourselves in a way that we can't do anywhere else. And so, I think that, although I would hope that at some point, we'll be able to integrate in a sense, come together, I also see great value and what we have been able to accomplish separately. But certainly, to your point that not only in the black church is there separation, but in funeral service, right. You know, you have your black funeral homes, you have your white funeral homes and even someplace it's Hispanic and Jewish, depending on where you are. In the south, it's pretty much black and white, right. And so, I think that's also with reason, a lot of your funeral homes, especially in this area, black funeral homes have been in business for quite some time. Harget funeral service here in Greensboro is I believe the fourth oldest funeral home in the country. The oldest here in North Carolina, the fourth oldest in the country. They go back to the 1800s. And I believe that black people have always connected to those funeral homes that have been here for a while. And so, I think that's the affinity that blacks have with black funeral homes. But I also see where at this time of arising cremations that there are more options. And so, I'm seeing now that where you have blacks going to the many different establishments and it's not as cut and dry as it once was. And so, I think that at some point, as I said, I would love to see us come together. I would love to see us value each space equally, but until that time I have been impressed by the service that I've seen that black funeral homes provide to those grieving families. And I think that resonates with our community, being able to relate to someone. And then there's also this piece, Jeff, where we, I believe that black embalmers have a way of understanding our features, our anatomy, our biology. So, a black embalmer is able to bring the loved one to a place where they are presentable and recognizable and we are also able to connect in that way.

Carly Malcolm: [00:18:41] Absolutely. And I mean, in addition to issues that affect the black community in ways that it doesn't affect white people. So when we're thinking about institutional racism, you know, you're an activist for justice and for health equity, how does that all affect the black community in terms of mortality? What effect does that have, that inequality on the grieving process? 

Bradley Hunt: [00:18:59] Right. So, and it's all connected. It's all connected very much. When we think about this pandemic 200,000 Americans dead, we know a large proportion of that number is black and brown people. And what we also know, this is undebatable, we know this is due to issues that were pre-existing before COVID. And so, when you have the lack of adequate healthcare, when there is, in the state of North Carolina, where our general assembly has decided to deny Medicaid expansion to 500,000 North Carolinians, the poorest among us. We know that has an impact on COVID numbers and mortality in our community. We also know that we have issues with food deserts and nutrition. Thinking about the number of black students that would be missing meals if we hadn't put things in place to make sure that their school lunches were still being provided, which we had to fight for it to be continued until the end of the year. There's always a continuous move to make sure that our community has what we need. Black mortality is connected to social issues because we are given these circumstances. And I don't say given lightly, because I believe that these are systems that, you know, our economic system, law enforcement, criminal justice system, education, I believe that these are systems that intentionally put black folks in a position where we have to fight for the most basic rights. That has been something that I have watched over and over again. Crowdfunding, for instance, for black folks, young people who didn't have insurance. And now they have to go to fund me and try to figure out a way to pay funeral expenses because we live in a community that is riddled with violence. And not that black people are prone to criminality, but we live in a society that says, put all of the black people in a certain space and allow them to fend for themselves. And if the violence does not come to where we live, then there's no issue, right. And so, we've seen that perpetual cycle of poverty and generationally, we have not been able to avoid those same circumstances of those that came before us. And so, I think it's certainly vitally important to consider our social standing in society and how it weaves with the death and dying process. So, you can't really separate the two, they are joined at the hip. And I think if we can address some of the things that are plaguing our community, then there would be a different way that we would look at how death and dying affects our community.

Carly Malcolm: [00:21:55] Yeah. And that's really the systemic piece, right. Of systemic racism. A lot of times we see things as individual choices, individual circumstances. But you can't really ignore the structural barriers in place that affect health and that affect the death and dying process as well. 

 Jeff Thigpen: [00:22:11] And Carly, you’ve been working on this. Some of the statistics, infant mortality rates are higher for black babies than any other racial category, more than twice that of whites. When you look at maternal mortality rates for black women, three times that of white women. Black folks are more than four times likely to die by homicide as white folks. You couple that with unemployment rates, education achievement levels, lack of opportunity, basic fairness, systemically. I was looking at something from Wisconsin and they were talking about differences between African-Americans and whites, as it relates to pain management. If you enter, you know, are African-Americans adequately assessed and treated across care settings. Communication, the idea of African Americans reporting poor communication and lack of satisfaction at times with quality end of life care. The whole idea of culturally talking about advanced care planning and being prepared and having the support around doing that. And also hospice care bleeds into this in terms of not only just having knowledge about hospice, but the availability and opportunities for it, especially when you're dealing with the level of economic stress that in many cases are happening in the black community. It's not just happening. You know, it didn't just happen yesterday, right. It's something that when we talk about issues of systemic racism, we see it across the generations. And if you look at, Bradley, you and I were part of a discussion a year or so ago about policing in communities of color. And one of the things that we talk about is if you polled 80% of the people in the white community, that if there was police abuse of power, they would say no. 80% of the African-American community would say there was. And what that presents is a tremendous challenge for our community to be able to walk into sometimes very difficult discussions, you know, not only in terms of race and policing, you've also got these health issues that can be incredibly personal. And people don't, in general, like to talk about death and dying and we find so many ways to avoid it. So, we see that while we have these issues that cut across race when you look at the African-American community, you can't deny that those issues are endemic in there and have to be addressed in a unique way. We know that you have a background in funeral and cremation services. Okay. Tell us about how that all came to be. 

Bradley Hunt: [00:24:38] Yeah, so I've always had an interest in the death care industry and it goes back, Jeff. There's a thing in the black community around funeral programs, right. And even more than that, I watched my grandmother in Charleston, South Carolina. My family is from Charleston, South Carolina, downtown Charleston, America Street. And I watched my grandmother go to the funeral home and view the remains of people that she may or may not have known. And that was something that she did and that others did. And a lot of times she would go there and realize that she knew the person once she got there. So, I watched my grandmother do that. And then I also watched her collect funeral programs, right. She'd go to a funeral and there's a program, she takes that, she brings it back home and she puts it in a location where she has other funeral programs stashed. You know when she passed, we were going through her things and just found boxes of funeral programs. And so, I believe my grandmother actually gave me this desire to want to work with, and for me, I see myself as one who it's important for me to be present. And Jeff, I found myself having to be present quite a bit in crisis, right. I find myself people want me around when things are not the best, which is taxing on me, but I have accepted that. And so, I find that really what drives me to the death care industry is not necessarily the industry itself. But it's the ability to be there for a grieving family and to celebrate that person who has passed on to celebrate their life and to also be their ears and their eyes, and to be able to work on their behalf has been what has been most gratifying for me. And so, I believe that I've been called to the funeral service all my life. I started right out of high school. The first job I ever had was at a funeral home. I did that for a little while. And in funeral service, it has its highs and lows, right. So, you have a time where people are dying, business is booming for the funeral establishment. And then there are other times where it's slow, you know, there's not much going on. And so, a lot of times you have funeral homes or small businesses that, you know, have to operate with tight budgets. And so, I realized that I was there during a slow time, you know, a brother couldn't go out like that, Jeff. So, I had to figure something out. And so, I said, I just go to ANT and then I'll be an attorney. The whole attorney thing didn't work out for me. I didn't want to prosecute or defend anyone, and that whole process was weird for me. During that time, I accepted a call to ministry. Completed a degree in political science from ANT attended Wake Forest Divinity. Now coming back now to 2013, I had a very close friend, Jeff, who was a preacher pastor and he had sickle cell. And he was 10 years older than I. He would always talk about his death, not only death in general, but he would talk about his death as a young person. And I always connected to him, and we would talk about death together. I know, it's weird, but this is how I got here. And so we would talk about death and one night a friend called me and said, I think that something is wrong. I can't wake him up. And I went over to his home and there he was, my best friend lying on his bed, dead. And I was not surprised that I was in that situation. I was not surprised by that. I almost expected it, Jeff. I did. I expected it.  

Jeff Thigpen: [00:29:12] Was it just from your conversations?

Bradley Hunt: [0029:14] It was from our conversations. Once again, he had sickle cell, so he was always hyper aware of that, right. That he understood that people with sickle cell don't live long and that he wanted to make the best of the time that he was given. That was his understanding. And so, you know, he lived his life that way. And, you know, I found him and during that same time, my wife and I were about to give birth to our first child. And I was certainly in a time of transition. And one day I just happened to walk into Serenity funeral home and I felt that I was connected immediately and I just began to do the work and Reginald Woodit was there. He has passed on now. He was a mentor for me, someone that allowed me to understand what it really took to work in funeral service, to love families, to really lean in and get in the trenches with them and to make sure that they had everything they needed. And so that was 2013. I've been working in funeral service mostly ever since that time. I've completed the funeral director license educational requirements through Forsyth technical community college. And I'm now waiting for the right opportunity to pursue an apprenticeship. And so that's sort of how I got involved. I started right at the high school and then the opportunity presented itself later on in life. 

Carly Malcolm: [00:30:06] What have you learned from the funeral director’s program? What's that like?

Bradley Hunt: [00:30:08] So they have, in the state of North Carolina, you have two different licenses. You can be the funeral director, which means that you don't embalm, basically. You do everything else, but embalm. Then you have a funeral service licensee. That means that you're both a director and embalmer, or you can actually do just the embalmer. So it's actually three: funeral director, funeral service licensee, and then embalmer. So, I elected to go through the funeral directing program. I've never felt like I had enough time to embalm. That is very demanding work, as you would imagine, right. A lot of time at night, early morning, and I just didn't want to be away from my family, not at this point during those times. And so I thought it was better for me to pursue the funeral director. You take a number of courses in biology, accounting, business management, and then you have some of your core classes, English, math, basic, you know, fundamental courses. And that was the most challenging course for me, a course that dealt with the different diseases of the body. And what we were asked to do was to go through a number of case studies and to determine based on the case study, the cause of death, how do you sign the death certificate, what terminology do you use for that. That instructor, he took that part of funeral directing very seriously. And I spoke to him about it, I said, why is your course so difficult? And he says, I want, if you can get through my course, then you can handle being a funeral director. And that's important for me that, you know, people are not just skating through, but that you actually are being challenged. 

Jeff Thigpen: [00:31:56] You mentioned, when we were talking on the phone, that you felt like more and more African-Americans were choosing cremation as an option. Can you talk about that? 

Bradley Hunt: [00:32:03] Absolutely. So, I think that everybody is choosing cremation more at this point, because it's just a way more affordable option. And for black people, what I found is that they want to be able to have that church experience. They want the body present. That's important for most black people. There's also a stigma in our community that if you get cremated, you didn't have any money. So, the body is not present for black people, that means there was a financial issue. So, for many black people, they want to have the body present at the service in a casket dressed the whole nine, everything flowers, preachers, they want the whole nine. But instead of going to the cemetery, they want the remains to go to the crematory. And that decision in itself saves them a lot of money.

Jeff Thigpen: [00:32:56] I think a part of it is economic now across the board. I mean, I know friends who've lost loved ones and it becomes an economic decision. I think I mentioned to you Randall Keeney, who's been interviewed. I mean, one of his comments was, you know, a family should not go bankrupt trying to bury their loved ones. And I think that's real.

Bradley Hunt: [00:33:11] No, it's definitely real, Jeff. I get into some spaces and I turn into a reformist. And it's like, you put me somewhere, I want to try to change it. It's just something about me. And so what I found in funeral service is like really the way that, you know, the funeral homes arrive at the bottom line, doesn't really keep the consumer in mind. It's all about profit, to me. And I think that I pushed back on the notion that funeral services, you know, I understand that you have to pay your bills. But to be profit driven in that way, to me, is almost immoral. To have a grieving family come and to place that burden on them at that time. Now if there's insurance, then I think that should be taken into consideration. But a lot of times in our community there may not be insurance. And to not be flexible in, you know, what you're able to do and to provide, and at what price point, to me, I have a serious issue with. And so that was one of the things for me, like, listen, I know what the markup is, and I know that I can give you what you would pay $10,000 for, I can give that to you for half, and still make money off of that. And I think that's something that I've always considered to be important. Yes, value. Yes, we want a professional service, but it has to be affordable. 

 Jeff Thigpen: [00:34:35] Yeah. It's not what it says about the family, struggling with these decisions. For me, it's a cultural question. It's about us. It's about a community. I mean, how are people able to bury their loved ones with dignity and respect and focus on remembering and celebrating their lives, then have to worry about so many different other questions. And that's part of why we do the podcast, because part of this is about grieving and part of it's about the bureaucracy. Part of it is about the systems and the opportunities to be able to bury people affordably, and also to be able to settle estates and do all these other things in a way that people have good information and they have support. I've got one more question that I want to ask you as I’m winding down. Are there common questions that you find when you're dealing with African-American families that are in mourning that come to you as a part of your role, either pastorally and the practical questions of burial?

Bradley Hunt: [00:35:25] One of the most consistent questions Jeff is why? That's always a part of the discussion, especially in my role as associate pastor, youth pastor, why did this happen? Certainly the scripture gives us enough that we can deal from a biblical perspective, but that doesn't really speak to their question of why. That why is a question that they have to find the answer to. Well, you know what I've also found Jeff, there is one demographic in particular that I found consistently and that's a black man. When black men are dealing with grief, they normally respond with anger, which is certainly a part of the grieving process. We all do. You're going to go through anger and regret. You're going to have all of those emotions. Sometimes you will find yourself feeling good. There's an imbalance in your emotional state, but for black men, it is always this aggression, this microaggression towards funeral home staff. And I've come to embrace that because I know even for me as a black man, I know that when someone is taken, that is close to us in our frustration, because you're talking about a black man that has to struggle. And that's normative that, you know, you’re talking about the same black man, that may be pulled over for driving while black, and they may be followed in a convenience store. These same lived experiences carry on even with our grief and even at the end of life, when we have to deal with someone that we love. And so it's very interesting, but even in that, I found that that's why I said it's so important for someone like me to be there, to understand, to have that understanding, and to diffuse them in a way that I know will be meaningful because you can't push back with anger. That's not the way to do it, but to push back with love and compassion and understanding, because really that's what they're saying. It's happening again. I feel isolated again. And so that's been something that I've enjoyed doing. But the question of why is really that question that's always thought provoking for me.  

Jeff Thigpen: [00:37:48] Well, Bradley, we really appreciate you there, and I'm glad that you're here with us today. As we get ready to close, I’m going to put you on the spot. If somebody is listening to this podcast and there was one YouTube hymn out of the black church that you would recommend it be Googled, what would it be?

Bradley Hunt: [00:38:08] Hold to God's unchanging hand. And it says the time is filled with swift transitions, not on earth unmoved, one can stand. You have to build your hope on things eternal and hold to God’s unchanging hand. That has been the most powerful hymn for me.

Jeff Thigpen: [00:38:33] All right. I almost said amen. Bradley, man. We really appreciate you being here on the podcast talking to us about the African-American church, the richness of it about your experience working through issues within the black community, and also your experience in the funeral home ministries, real insightful. On behalf of Carly Malcolm, and myself, we really appreciate you being here on the Good Grief Podcast. 

 Bradley Hunt: [00:39:00] Jeff, I really appreciate you doing this. 

All right. Thank you very much. 

[Outro] 

Thank you for listening to this episode of the Good Grief podca st. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[Intro] 

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is also complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more, to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:00:59] Welcome to the good grief podcast. This is Jeff Thigpen Guilford County register of deeds. Today we have a guest with us. Her name is Betsy Gamburg. Betsy is the director of Jewish family services. Welcome, Betsy

Betsy Gamburg: [00:01:13] My pleasure. 

Jeff Thigpen: [00:01:16] Yeah. Can you talk to us about Jewish family services and what you all offer through that organization in, I guess, probably Greensboro and Guilford county community.

Betsy Gamburg: [00:01:23] Yes. I'd be very happy to. Jewish Family Services here in Greensboro serves primarily the Jewish community in Greensboro. But our mission also includes, you know, being good citizens and promoting the wellbeing of all citizens of Greensboro. So, while many of our programs are directed to the Jewish community and like most Jewish family services around the country, of which there are many, you know, we offer such services as case management, counseling, programming for children and families, senior services, and some nursing services. We try to be a traditional family service agency reaching out into our community to try to help people make the most of their lives and be there when times get challenging for them. So that's our primary focus. We have emergency financial assistance, we run a food pantry, we have some employment services, we have a large volunteer part of our organization, and some of those services are for the general community. For instance, our food pantry, anybody who's in need of food is welcome to call us and can come and get food. Our employment services are open to everybody. So, while our focus, as I said, is on the Jewish community, we really want to be good citizens of Greensboro, and we do participate and work in a very collegial fashion with many organizations all over Greensboro. 

Jeff Thigpen: [00:02:49] So, I can imagine with COVID-19 over the past several months in terms of, it’s probably been really busy with the food bank. And I know with unemployment increasing and things like that in general, probably been impacted by that.

 Betsy Gamburg: [00:03:02] Yeah, absolutely. I think all family service agencies, all nonprofit agencies right now, certainly us among them, you know, are really working very hard to try to meet the needs of their constituents and their clients, and have to think fast. I think one of the big challenges is re-imagining, is the word I keep using over and over, re-imagining how we do everything. So even the simplest thing, you have to think of a different way to do it when somebody can't come to your office or you can't make a home visit. And that's the challenge and it's the opportunity to be creative.  

Jeff Thigpen: [00:03:37] Yeah. What led you to Jewish Family Services? 

Betsy Gamburg: [00:03:39] Well, I am Jewish and I was raised in a Jewish home and I always felt that helping people was the way to go, the most satisfying thing. My parents were very strong supporters of that idea and always felt that they were supposed to help make the world a better place, which is a very strong belief in Judaism. It's called Tikkun Olam, which means repairing the world. And it means that we have an obligation to make the world a better place. And certainly, we can't fix the whole world, but wherever we find ourselves, we make that little piece of the world a better place. So, I was kind of raised with that, and that led me to become a social worker and I have a master's in social work. And I have spent most of my career working in the nonprofit world, some of it in the Jewish nonprofit world and some of it, you know, outside that particular religious community. I've worked in the Episcopal diocese for instance, and in some other kinds of organizations. But my husband is a Rabbi and I just found that I gravitated towards working with the Jewish population. I was very comfortable with it, and I thought my skills could really be put to good use there. So, actually my first job after getting my MSW was with Jewish family services in Boston. 

Jeff Thigpen: [00:04:57] Oh, really.

Betsy Gamburg: [00:0458] Yeah, it's really funny. Life is kind of a full circle because my job here in Greensboro will probably be my last job. I feel like, you know, in between we all travel many different paths and experience many different things, but it's nice to work in a faith community and it's nice to work in your own faith community. And the Jewish community here is very strong. It's very caring. It's very supportive of its own membership and it, as I said, is a good member of the larger community as well, I think. I feel very comfortable working there and trying to make our little corner here in Greensboro, Guilford County, you know, just a little, but better. 

Jeff Thigpen: [00:05:30] So Jewish family services, you've got services that help children and families, adults, seniors, you have a network of volunteers. I know in terms of synagogues, there's the ones that I know of, Temple Emanuel, Beth David, there's the Jewish Federation. So, there's a network and community within a community within the Jewish community that has done a lot of good work in terms of serving this area.

Betsy Gamburg: [00:05:53] Let me just say that we actually, when it comes to children, our focus with children really is on programming for children. We don't provide clinical services for children. We usually refer out because we have a lot of good services in the larger community. And our focus has been on adults and older adults. There are any number of Jewish organizations and institutions in Greensboro, as you were saying. There's the temple Emanuel, Beth David's synagogue. We also have a Chabad center here in Greensboro. We have a day school here and other organizations as well that are all, you know, very involved in, you know, taking care of the Jewish community and also, you know, making liaisons and being part of the larger community as well.

Jeff Thigpen: [00:06:37] Yeah, a part of the podcast today that I really wanted to drill down into, well, twofold. One is, you know, you're the director of Jewish family services, how does your organization deal with issues of death and dying on your own and how you see it. And also from the faith perspective, in terms of, you know, how the Jewish community or the Jewish faith approach, culturally, I guess in terms of a faith tradition to death and how that impacts what you do. You deal with an adult senior population, for example, that would probably be one venue into that issue of end of life. Can you talk a little bit about that? 

Betsy Gamburg: [00:07:12] Sure. Well, the first thing I would say is Judaism's primary focus is on the sanctity of life. Even in our prayer for the dead that’s said at every service, that prayer doesn't mention anything about death. The whole idea in Judaism is to celebrate and protect life. Which doesn't mean that death is dismissed. Death is seen as an integral part of life. And when somebody is dying, it is a very important belief and practice to be with that person, to never leave a dying person alone and to be there for them. Taking care of the dead and the dying is so important in Judaism that when Jewish communities are set up, the first thing that's set up, always, is what's called a Chevra Kadisha. And the Chevra Kadisha is the group of people that takes care of the people who have died. And it's considered just a very great mitzvah, a mitzvah being a good deed. The greatest mitzvah you can do is the mitzvah for which you can't be thanked. And therefore, taking care of someone who has died, preparing the body. And there's a whole lot of rituals about that, which I can talk about, is really considered very holy because the person that you're doing these rights, these kind of last rights with taking care of their body and making sure their soul goes to God for eternal life, they can't thank you. And so, the first thing was always set up, you know, before the school, before the synagogue is traditionally, this group called the Chevra Kadisha. So that's really important and says a lot about how the Jewish faith feels about death and taking care of the person who has died as well as the mourners.

So, Judaism has some very specific tasks that have to be done. And again, this is traditionally, Judaism, I should say, it's hard to talk about Judaism in one swoop, because there are many different ways of being Jewish from very Orthodox to conservative, to reform, to reconstructionist. There are just a lot of different paths, and traditions have changed over the years and different groups of people will do different things. In general, some of the main things that happen when somebody dies, when somebody is dying, you know, it's really a great mitzvah, a great blessing to try to be with them, to never leave them alone. Not that you have to talk their ear off or be doing things necessarily, but just to be a presence with them. And if they want to talk, you can listen, and if they want you to talk, you can talk, but it's just to be with the person. Once death has happened. One of the things about Judaism is that we bury people very fast. So usually within three days is the funeral. And during that period, those first three days, the family's focus is really just on making the arrangements that they want or that the person, the deceased person has asked for, and that's the primary focus. While many people can mourn and, you know, friends and relatives all may mourn and generally do mourn in the passing of somebody, in Judaism, there are official mourners and those people are the children of the deceased person, sons and daughters, sisters, and brothers of the deceased person, the mother and father, if they're still living of the deceased person and the spouse. Those are the official kind of designated mourners. Which, as I said, doesn't mean that lots of other people aren't actively mourning. But after those first, you know, few days where you're making the preparations, most people have heard, I think of Shivah, which is a uniquely Jewish event. Shivah is seven days, and Jeff, if you want to interrupt me at any point, please do.

Jeff Thigpen: [00:11:07] I was going to interrupt you and say, I knew it was seven. I know that word. But yeah, you can explain more about that. And I'm just going to let you go because I'm learning all this as you're speaking. So, I'm taking all this in. You know, I really appreciate it because not many people know a lot of these details. And it's so important when we're talking about issues of death and dying to be able to understand our different traditions and our different cultures and how our approach to dealing with death and dying. And even within the Jewish faith tradition, as you're saying, they're, you know, they're different groups within that subgroup that mourn differently in terms of culture and in terms of process. Of course, I find that, you know, the psychological, emotional issues that come with death and dying in a lot of cases, transcend all kinds of boundaries, and there are a lot of similarities that we all either have to deal with internally or dealing with externally institutions and organizations in our community as a result of that. So, yeah. I want to turn you lose as much as I can to get into this. But I want to come back to Shivah and the seventh. So go back into that in terms of the seven days of mourning.

Betsy Gamburg: [00:12:20] Okay, well, and I also would like to say that, you know, death is universal. So, the Jewish practices I think are modelled that the Jewish practices around death and dying really take in the whole first year. But because death is a universal thing that happens to every human being. There are so many, I think, very beautiful ways besides the Jewish way. That's just my way. But there's so many beautiful and touching and meaningful traditions in all faiths that it's quite profound, I think. But going back to Shivah, actually, I'm going to take a step before Shivah because I want to say something about how the Jewish tradition prepares the body to be buried before we even get to mourning. There's some very specific things and not every Jewish person will do this, but traditionally, after a person has died, you know, the arrangements are made, the body goes generally to a funeral home. And there, that group that I mentioned earlier, the Chevra Kadisha, these are people who are going to care for the body in a hands-on way before burial. It will take place at a funeral home and some funeral homes have special rooms for this to happen in. But basically, the body is lovingly and carefully and thoroughly washed by these members of the community. Men for men and women for women. And there are certain prayers that you say over the body and you ask forgiveness of the body if you do anything to harm it in any way. It's a very beautiful and loving thing, and it ends with the person being dressed in a white shroud. Not everybody wants this, but many Jewish people do. From the moment of death, also there's something called Shemira, which comes from the root meaning to guard. It’s also the idea that we don't leave the body alone. And so, again, not everybody will do this, but in Greensboro we do have Chevra Kadishas and there are people who do all of this and they will stand guard usually like in two hour shifts and stay with the body in the casket until the funeral actually happens. So as I said, the body is washed and that's called Tahara and then dressed in the shroud. And then, you know, there are people who stand guard. I mean, they sit, they can be comfortable, but they stay with the body until burial. Then the funeral happens and then Shivah starts. Shivah is seven days from the funeral, and people stay at home. People who want to observe this stay at home for seven days. And basically, they're cared for by the community. Meals are brought, if there are errands or things that have to be done, children to be cared for, you know, friends and families to the best of their ability, help the family do all of this. And every day you would say Kaddish, which is the prayer that we say for the deceased. And you would say Kaddish for the deceased person. And some people traditionally, when they're in mourning for these seven days, the mourners will sit on stools as a kind of a sign of humility and of loss. Again, not everybody does that. Sometimes people have a bowl of water outside their house and they wash their hands to kind of cleanse and purify themselves before coming into a house of mourning. And some people will also do things like cover their mirrors. Not a hundred percent sure why that is, but maybe it has something to do with not being vain during this period that you were thinking about the larger issues of life.

 Jeff Thigpen: [00:15:59] So we have the Shivah, the Chevra Kadisha, which is the community of mourners and the Kaddish, the mourner's prayer, right? 

Betsy Gamburg: [00:16:00] Yeah. Okay. I'm following.

Betsy Gamburg: [00:16:08] Let me go through the year real quick and then I'll come to Kaddish and what happens. So then after Shivah there's another period, it's called shloshim, which means 30, the number 30. And for the next 30 days, the mourners, they can go back to work, but they kind of keep a lower profile. They, you know, don't party or go out to dinner. It's just kind of, you know, you're transitioning. And then for the next year you are considered, at least for 11 months, you are considered that you're still in mourning. But most people these days, you know, resume most of their normal activities at about 11 months. And there's some variation. It could happen a little earlier. It could happen later. There is a ceremony called having an unveiling. And at that point, you call together, usually close friends and family members come together. And this is the point where, you know, the stone that you have decided to erect or lay on the ground for your loved one, it's been put up. The name and dates of the deceased have been put on there. And it's covered with just a kind of symbolic covering before you get there. And the rabbi would usually join you and you unveil it. You take the cover over and you say a few prayers and that's kind of the end of your year of mourning.

Jeff Thigpen: [00:17:29] So, what I'm hearing is you're saying the tombstone, for example, I guess, it gets placed about a year after. And of course, Christian faith tradition usually happens soon after the burial. So that's a clear difference. And it sounds like there's a number of similarities as you're going through this to the Islamic tradition in some ways. And we'll have, you know, we're going to have Christian faith, Islamic faith, you know, talk about their customs. It's interesting how you lay this out in terms of how the Jewish faith tradition approaches these. Of course, with some differences and similarities. So, going back to near the end of the first year, you'd then have a ceremony consecrating 

Betsy Gamburg: [00:18:11] Right. So just a brief ceremony. So Kaddish prayer is set after every service and it is a prayer for the dead. And it's a moment for everybody in the congregation, really to remember their loved ones. But if it's the yahrzeit, that means a year. If it's a year from the death of your loved one, in some traditions, and this varies, you might stand because it's your loved ones one year or two year or five-year or whatever anniversary, and you might rise, that's the tradition, for instance, in the conservative movement. In the reform movement, everybody rises. And that's based on the idea that everybody wants to be with the mourners and there might be other traditions too. But it's a moment to remember. The yahrzeit, if it's my mother's yahrzeit, then I am saying that prayer specifically for my mother, with her in mind and her name is read out in the congregation that this is an, you know, an annual anniversary of her death so that we remember. And then as if that's not enough, four times a year, we have a special prayer called Yizkor which again, is a moment to remember all of your loved ones. And that happens like at Yom Kippur, during Sukkot, during Passover and during Shavuot, which are major Jewish holidays. So I think the point I want to make about all of this is that we have, you know, Judaism is very much about remembering. Remembering our history so that we can learn from it and we can make the world a better place. I mean, that's what Passover is all about. And we remember the people that we have loved or sometimes don't even know, but we remember the deceased. And when I say the people we don't know, I'm kind of referring to Holocaust victims who may not have people to remember them. But we're remembering the people who have made us who we are, we're remembering the people who we loved, because that's just so important in Judaism that we celebrate their lives. That Kaddish prayer, which we say, you know, at every service, you know, for the deceased, doesn't say one thing about death in it. All of this is not set up to be morbid and to hold you back into the past, it's really to celebrate life. That's the point of view that this comes from. To celebrate life, to remember an honor and value and love those people who've been important to us. And to feel very grateful that they've given us life and we can go on and make them proud. We often say when someone's deceased that their name or their memory should always be a blessing, meaning that we want to be a blessing to them. We want to bring honor to their name, and that's how we look at it. That's the whole cycle. 

 Jeff Thigpen: [00:21:05] Thank you so much for sharing that.

Betsy Gamburg: [00:21:07] You’re very welcome.

Jeff Thigpen: [00:21:09] It's incredibly informative on the one hand, and also it points out the incredibly rich tradition within the Jewish faith around care. Taking great care in remembering life. And so I appreciate you going through all these things, because from an informational standpoint, you know, jokingly as I was going through trying to get the tone right on some of these, I guess, Hebrew words, but they symbolize the appreciation for life as it is transitioning, the immediate time after that, and then also the period of mourning that people go through. And, you know, in a lot of circles, people say, yeah, you know, when you lose a loved one, we typically mourn in certain ways throughout a year. And I appreciate, again, the tradition around how this works within the Jewish community. You know, is there anything that you think that the broader community in Greensboro should understand about the Jewish community? I can say that I think it's a wonderful community I've met and have a great appreciation for a number of my friends here who are a part of that. I've loved and visited temple Emanuel on a number of occasions, and I have such a great appreciation for what you bring to this community. But yeah, I mean, are there specific things you'd want people to know about the Jewish community? 

Betsy Gamburg: [00:22:38] Well, it's a very caring community. It's a strong community. I think that, you know, one of the major underpinnings in my mind anyway about Judaism is its commitment to social justice. You know, justice, justice shall you pursue. The fact that, you know, I don't usually go around quoting Biblical texts, but you know, when the Bible repeats a word, it's because it's so important. And justice is a very important piece of Judaism and making the world a better place. And, you know, obviously we're committed to fighting antisemitism. We want, you know, Jewish life to thrive and Jewish individuals to be safe and healthy, but we really want that for everybody. You know, we really want to work with the community for social justice whether it’s combating anti-racism and learning, you know, from others in our community, how we've brought harm and things that we've done and how we can repair that. I think we have to educate ourselves. And I think our community is trying to do that through a number of programs that our Federation has held and trips that we've looked into with other congregations and interfaith missions that our rabbis and our federation have gone on together with other congregations. Non-Jewish, you know, church groups and other groups to go to Israel and to study together and to learn together. I think, you know, the Jewish community really wants to build bridges. So that we all respect and care for each other, regardless, you know, of our color or our sexual orientation or our abilities. So I think you will always find friends in the Jewish community around those issues. 

Jeff Thigpen: [00:24:24] So let me ask you, you know, when you are dealing with death and dying within the Jewish community, are there any structural challenges that you see related to dealing with the loss of a loved one? 

 Betsy Gamburg: [00:24:35] Well, that was an invitation to me to think about some specific things that might be misunderstood about Jewish practices. Because we are a small minority, we’re really a very tiny part of the Greensboro community. And these are kind of just very, in some ways superficial things, but I think people might not always understand. For instance, in Judaism, there is no viewing and I've had friends say to me, well, when will the viewing be? And we do not believe in viewing. So, it's not because we don't love the person. It's just one of the practices. We don't show the deceased. That's just not part of things. In most Jewish traditions, flowers are not necessary or desired now that's not true in every Jewish tradition, but for the most part in the American Jewish tradition, we don't send flowers. People might do it now and then, but it's generally not a traditional practice. Again, not for any reason. It's just, hasn't developed that that's something you do. When we go to visit a grave, like if you go to visit your mother or father's grave, we pick up stones and we put stones, rather than putting flowers down, we put stones on the grave and that's a symbol that somebody has been there and remembered that person. So sometimes somebody might go to a Jewish grave site, you know, to a cemetery and there's no flowers. It could be really misunderstood that people don't care about their relatives. But if you look for the stones, you would have a different story. I just find these very interesting, you know, because we get used to sort of certain ways of doing things. And the other thing is if you ever go to a Jewish funeral, you will see that the traditional Jewish casket is supposed to be a very simple pine box. And so I've also had people kind of raise their eyebrows at a Jewish funeral and go like, that's not very respectful that they're in just such a simple box. Because, you know, caskets can be, you know, very, very elaborate. And it has nothing to do with cost or respect or anything like that. And I don't really know why. Maybe because people didn't have money at that time for, you know, things like this. But the tradition is the simplest casket you can get, which today can still be pretty nice looking. I mean, they're not always plain simple pine boxes, but the simplest casket is the one that the Jewish tradition says we should choose. Yeah, these are just very interesting. And the other thing is that giving to charity in the person's name is a very big thing. In the Jewish world it is called giving Sadaka. Sadak is from the Jewish word that means justice. You know, making the world better, trying to, you know, through making a donation is a really important way to honor the deceased. So I just wanted to mention those things. Because I think that they are misunderstood sometimes. And sometimes the other thing is that, you know, Shivah lasts seven days and just, you know, most employers will give you three days off for bereavement, which is very good and very appreciated, but a Jewish person in mourning might be off for seven days. And it doesn't make them better than anybody else, it's just that the tradition says that Shivah is seven days. So they might do that. So those are some of the differences I think that you would find that might be misunderstood.

Jeff Thigpen: [00:28:11] Well, if somebody wants to respect the faith and traditions, that's really important to know. And in terms of misconceptions, in terms of where we might get stumbled up as people who may not understand those traditions, and we still, you know, we want to be supportive. So thank you for sharing that because that's really important to know. I'll remember that and I'm better for it. And so I'll make sure I'm mindful of that, going forward. I think that's a wonderful thing to understand. If people wanted to learn more about Jewish family services, where would they go? Do you have a website? Yeah. 

Betsy Gamburg: [00:28:43] Yeah, we do www.JFS.greensborough.org 

Jeff Thigpen: [00:28:47] Okay, well, thank you very much for spending this time with us and we're going to log this and we'll probably have, you know, we'll be translating all this. We'll probably have some web links that'll go along with all this to give our listeners more information about what you do and probably add some additional information related to the religion, culture and traditions so that we can be mindful of it. I think this is an outstanding conversation and I really appreciate you making time in your day to be a part of the podcast.

 Betsy Gamburg: [00:29:14] Well, Jeff, thank you very much. I think this is a wonderful project that you're doing. And I really look forward to it. I thank you for asking me and for the opportunity to do this. And I really look forward to listening to some of the other interviews that you're doing, because they'll be great. They'll be really great. And, you know, I'll stay tuned for those 

Jeff Thigpen: [00:29:34] Yeah, we’ve got lots of good interviews and you are definitely one of them. You had a Hebrew word for gift didn’t you? 

Betsy Gamburg: [00:29:40] For a gift in Hebrew. I'm not fluent by any means in Hebrew, but I know the word for gift and Hebrew is Mattena But I don't know that I mentioned that in the course of this.

Jeff Thigpen: [00:29:51] Okay. Well, I'll just end by saying you are a Mattena to me today. I really appreciate you and your gift. Yeah. 

Betsy Gamburg: [00:29:59] Thank you so much. I’m glad I had the opportunity to get to meet you and talk with you. And I hope our paths will cross again. ? Well, thank 

Jeff Thigpen: [00:30:06] Alright. Well, thank you for being a part of the Good Grief Podcast. 

 Betsy Gamburg: [00:30:09]Take care and stay well.

[Outro] 

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen Guilford county register deeds. And I’m Charlie Malcolm Lead for North Carolina fellow for Guilford county from the UNC School of Government and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford county to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Podcast Podcast and for taking this step to be better prepared for end-of-life challenges.

Jeff Thigpen: [00:01:01] Welcome to the Good Grief Podcast. I'm Jeff Thigpen, Guilford county register of deeds with Carly Malcolm, lead for NC fellow from the UNC Institute of Government. Today, we have Lisa Lundeen. She is a chaplain at Moses Cone Cancer Center here in Greensboro. Lisa is a board-certified chaplain originally from chapel hill and she's lived in Greensboro for about 20 years now. She graduated from Guilford College with majors in environmental studies and German and earned her master's in divinity from Earlham school of religion in Richmond, Indiana. Prior to becoming a chaplain, she held several informal educational roles from public school outreach to parent and child care provider education. She did two chaplain residencies at Moses Cone then worked for three years at Women's hospital and has been a lead chaplain at the Cone Health Cancer Center for almost five years. Welcome Lisa, glad to have you with us today.  

Lisa Lundeen:[00:02:00] Thank you. I'm so grateful to get to be here with you.

Jeff Thigpen: [00:02:03] Lisa, what inspired you to become a chaplain and specifically working in the cancer center?

Lisa Lundeen:[00:02:07] Well, that's a funny question because inwardly, it felt a bit like an accident. And I'll say more about that. When I went to seminary, I knew that I was really drawn to supporting people through spiritual growth and reflection and also hard times in their lives. But the reason I did two chaplain residencies was really for personal and pastoral and professional formation. That is to go deeper into how to care for people well. And even after the second residency, I still wasn't specifically planning to be a chaplain, but as it turns out, my experience of practicing hands-on ministry in lots of really challenging situations throughout the health system really formed me into a chaplain. And so later when the Women's hospital chaplain retired, it was clear to me that I was called to apply to do this professionally. And so it continued from there. Now I switched to the cancer center in part because the position was full time and in a deeper part because it allows me to have longer ongoing relationships with patients and families. In many other settings within the health system, they are event-based encounters. Someone has been admitted to the hospital because they have a need. And in the cancer center, it's a long-term process of coping and healing and managing, and I just really value getting to know people over time. 

Jeff Thigpen:[00:03:54] How does end of life issues factor into your job? 

Lisa Lundeen:[00:03:59] Well in lots of ways. We all know that cancer diagnosis can take a lot of different paths and different paths over time from this is early stage and we're on a curative track and think we can get rid of this thing, to this particular diagnosis isn't curable, this is a kind of disease we don't have a cure for. And so it's a matter of learning to live with either through treatment or through watch and wait. And then there are cancer experiences that involve a spread of cancer in a situation that can be treated palliatively as we say, which is managing symptoms to promote the best quality of life. And there are times when a diagnosis either starts out or eventually becomes a terminal situation. And so end of life could get stirred up still in a lot of ways because anyone who gets a cancer diagnosis runs smack into their mortality. The C-word is a game-changer and how people think about life and living. And so regardless of what their clinical outcome may be, the questions about how am I living and what's important to me and will this take my life, are all out there. 

Jeff Thigpen:[00:05:25] Yeah, there's the psychological impact of the C-word, then there's the, you know, the assessment and then, you know, you're dealing with the emotional weight of that and the psychological weight and almost the stigma in many cases. And then you practically have to settle into, okay, is this immediate surgery? You know, how's the treatment plan going along with this and I totally appreciate that idea of going into that field in terms of building a relationship with people who are dealing with this, because in many cases, there are many different places in the continuum of management of care, and they do need that support, you know, in terms of navigating through, it's really interesting about you being in there as the clinical chaplain there. I had a member of my family who actually went through there. We got a great deal of support. I don't think we ever met, from the nursing staff, from the doctors and people who were there, really supported our family in a way that we really appreciated it.

Lisa Lundeen:[00:06:22] I'm grateful that you had that support and that's really important to us as a team. And that's why we're so lucky that we have people from so many different disciplines who work at the cancer center. So that together we can be the village that a family may need to move through whatever their particular experiences will turn out to be. In terms of end of life, there are times when I walk with people through the end and I see people as they make different choices in their treatment, or they find that treatment isn't working anymore. I sometimes help people with advanced care planning and advanced directives specifically. The legal pieces of making arrangements and saying what's important to me and my end of life care and who might speak for me if needed. And there are times when I have visited people, even in a hospice home, because I have become their clergy. They may not have their own clergy and I have become their person. And maintaining that relationship is really important, especially at the end of life. And there are times when I help people plan memorial services for themselves or others. In the times of COVID, I have been involved in a Zoom Memorial service. I have done socially distanced mass to graveside service. There are lots of ways and layers that I might plug into. 

Carly Malcolm:[00:07:48] Yeah. And so when you walk, you know, all the way through that journey with someone, what has that taught you about the process of grieving and how to help folks through their grief?

Lisa Lundeen:[00:07:57] Well, you know, it used to be standard that we talked about stages of grief, and now we really understand that grieving doesn't follow a single line. Grieving is messy and complicated. I think of it as coming in waves, like at the ocean. So, you know, you may be carrying along just fine and feeling like, okay, I'm having a good day and then push, you know, you're suddenly underwater with sand in your mouth. That's some of my personal experience with grieving. So really honoring that, honoring the variability, honoring that different feelings, anger, frustration, hurt, betrayal, all kinds of things come out. All our unresolved issues can come out. We as humans need a lot of gentleness and care through grief. I think the biggest thing that we can really do is sit down beside someone and ask, how are you holding up? What I'm really driving at is how is it with your soul? That may feel like an awfully big question to people. Our temptation culturally is to try to fix it. You know, we want to make people feel better. We want to cheer them up. So people in the thick of grief don't want to be cheered up. In fact, they can't be cheered up. And so rather than doing what I have started to call fluffing, which is when people kind of pat at you and they say, honey, baby sugar, darlin, you're going to be fine, rather than doing that sitting and just saying, how's it going? Or saying, you know, I remember something about your loved one that was really special to me. Can I tell you about it. Asking that permission is helpful because a person may want to say yes later or may say, of course, that would be so helpful to me.  

Carly Malcolm: [00:09:56] So what would you say to somebody who's facing a terminal cancer diagnosis either for themselves or maybe for a loved one?

Lisa Lundeen:[00:10:04] That's a good question, because I think my first response would be not to say something, but to ask something. Again, that feels really big. How is that sitting with you right now? What are you doing with that? How do you feel? And if it's a new diagnosis or a new change in their path, numbness is really common. It feels surreal. I can't really wrap my mind around it. I can't believe it's actually happening, are all common responses. And then later on, as it becomes more familiar and we have more time to digest, then people get to some more of the feelings and the questions about what am I going to do and how am I going to live and how am I going to say goodbye? And so as I become more aware of where someone is in their particular process, then I may come alongside them with some of those other questions. One of the big things that I think about related to a cancer diagnosis, especially when it becomes terminal is where is hope and what are you hoping in, what are you hoping for? And in cancer, we tend to think about hope as hope for a cure. But there are times when it's not curable. And so hope becomes a moving target, hope may become I really want to participate in this life event of someone who's important to me. I want to be present for a wedding or a graduation or another milestone. Hope might be, I have a peaceful death and I want to be comfortable. Hope might be, I want to reconcile with someone I've had a conflict with and really tell them that they're important to me and I'm sorry. 

Jeff Thigpen: [00:12:02] Well, yeah, I mean, it's like your role in a way is helping to support and facilitate helping them be fully present into themselves and then being present to what they see as the reality of the situation they're in and seeing that soberly and also be supported. And I appreciate the idea of you asking the questions and especially it's kind of what are you hoping into. I think that is a powerful question because so often in these situations, people can so easily feel alone and afraid and not knowing and unsupported. And what counseling and support group services are available to the patients and their families.

Lisa Lundeen: [00:12:48] Ooh, we have several different layers of support available. We have a whole patient and family support center downstairs at the cancer center, and we have several teammates who are part of that work group. I'm the chaplain. So I provide spiritual and emotional support. We have social workers who are really good with helping with practical problems and also providing emotional care. We have registered dieticians who specifically focus on Oncology and needs that come up within the cancer experience. We have genetic counselors who help people with genetic testing and understanding their results. And we have an amazing relationship with UNCG's counseling and education program. And usually each year we have one or two counseling interns who are finishing their masters or a doctorate and provide free counseling for individuals or for couples or for families. There's no cost for our counseling. There's no cost for spiritual care that people are able to receive these appointments regardless of ability to pay, and that can make a tremendous difference in accessibility, especially because cancer treatment is just so expensive. And I want to highlight a couple other pieces of what you're asking too. That's our support team, but we also have a number of support groups. We have some that are based on particular types of cancer like prostate cancer, breast cancer, blood cancer, gynecological cancer, gastrointestinal cancer and those tend to be closed groups just for patients. We also have, especially in a time of COVID when life is so isolating and a cancer diagnosis is extra isolating because folks often have compromised immune systems due to their treatment. We have found that to breach that isolation offering some discussion-based support groups is very valuable. Because people just want to share and connect, and sometimes it's nice to talk about meaningful things that aren't specifically cancer, but within a framework of people who understand what some of the underlying issues or concerns might be. And those support groups are all free as well. And finally we have an utterly awesome relationship with a community partner organization called Hersh wellness that has an office and a studio at revolution mill. And although we are not meeting in person right now, they are still providing via zoom classes in tai chi, in yoga, in lots of different visual arts, in poetry writing, in book studies. And I can't tell you how rewarding it is to have someone say, oh, I don't want to participate in a healing arts group. I'm a stick figure person, that's not my thing. And then they brave it, and then they hold up this thing that they made with such pride, “look what I created.” And that matters so much because loss of control is such a stressor, particularly in the cancer experience. And so to be able to see I created something in my own power goes a long way toward healing and inspiring people.

Carly Malcolm:[00:16:12] Absolutely. Yeah, that's a lot of different kinds of resources for people to choose from. How can somebody get connected with those resources? 

Lisa Lundeen:[00:16:19]  Lots of different ways. Our nurses and physicians encourage and make referrals. We have a big mailing list that we're always adding to, to make sure that folks are getting this updated information each month. We in the support center make referrals to our own programs. We have flyers and other information posted throughout the center. So lots of different ways. One of my colleagues was saying, be sure to include that list. When I'm trying to encourage someone to be brave and try things out, I describe the support center and its programs as like a runaway truck ramp in the mountains. Are you both familiar with those, with the big berms of sand so that if a truck is careening out of control or it's briggs or super hot, there's a place for the driver to pull off the gun to slow it down. And I think, know that we're here because there may come a time when you need some help slowing down. There may come a time when it's meaningful to try something new or different. So if nothing else, think of us as a runaway truck ramp.  

Jeff Thigpen:[00:17:28] That is a good way to look at it. Yeah, that was a great way to look at it. And as you know this ramp and truck has, you know, many different tires and models and the speeds that come at us. And a lot of times how we do a death and dying and serious illness depends upon, you know, how we see it, where we are, where we stand. And we come from different backgrounds and beliefs, socioeconomic areas. We deal with different faiths and cultures as it relates to that. And you had some work where you were helping educate staff around end of life issues in terms of how they interact with it. Can you talk with us about that training and some of the takeaways that you had from it. 

Lisa Lundeen: [00:18:15] Sure. And I'm really glad you asked that question because you're right. There is so much variety in the human experience and there's no way we can possibly know where someone else is, especially if we're basing our assumption on a piece of information about the person. For example, we may know that they are Jewish. We may know that they're Muslim. We may know that they're a Christian or even specifically that they're Catholic or Presbyterian, but we don't know what that means for them. We don't know if they're tied into a faith community, we don't know what their particular rites and rituals might be and what their individual preferences are. So I would say the biggest tool is curiosity. It's learning how to ask questions and what kinds of questions we might ask about. That is, tell me more about who should be at the bedside? Who do you need to have here? Is it close family, does gender matter? Is it clergy? Could we talk for a few minutes about arrangements? Is there a particular timeframe that we need to be working in according to your faith tradition? For example, some people may need to be buried by sundown, but that may not be the timeframe that hospital staff is used to performing all the tasks in. And so knowing what is dear as the family helps the staff reframe, how do we provide all the care steps that we need to provide here? And it may be that certain people need to be involved in the care of a body after death. It may be that certain prayers need to be said, or that certain people need to be present or not present that this is something that this particular subgroup of people tends to. But we don't know unless we ask. So again, knowing time frames, knowing who should be involved, knowing is there clergy we might contact, are there important people in your life that you would like to have here present? Knowing how to ask those kinds of questions gets us information that is specific to that patient and family so that we really can meet them where they are and honor what Cone health kind of mission and brand promises right now to be right here with you. 

Jeff Thigpen:[00:20:46]  And that is so important. And one of the things that I had not planned to ask, but I'm going to just ask you, you know, we talked about families and patients who have support. How do you provide support to staff who are doctors and nurses and caregivers within Cone health cancer center?

Lisa Lundeen:[00:21:07] Oh, I love that you're thinking about staff because in some ways I think my role as a chaplain is even more focused on staff care than many other positions are able to be. So lots of different ways. You know, in non COVID times, I would round on staff and just check in with people and say hi and see how they're doing. And as I build relationships, people then feel free when they're having a bad day or they stumbled into something rough or, you know, something with someone they've been close to has changed recently. Then they feel free to say, oh man, Lisa, let me tell you what's going on. With COVID, it looks a little bit different, but when COVID first started, I created an online series. I sent out a kind of a caring email every week and I used a quote and a photograph or a silly illustration that I did, something that would be inspiring and would demonstrate to people, to our staff, I'm right here with you too. And so that was great because people would respond by email. You know, I was fine about the pandemic until I couldn't find any toilet paper and then I lost my mind. You know, now we're getting serious and it's so helpful to have that person you can get serious with. It's also so helpful to have that person you can laugh with and be goofy with. And so I try to straddle that line because tears and laughter are both so essential in life and in coping, especially within the really high contact, high touch world of healthcare.

Jeff Thigpen:[00:22:48]  Yeah, and as we're taping this, we're going through COVID. And as you have been alluding to, is that it's impacting us in so many different ways in terms of not only service delivery, but our personal interactions in terms of our anxiety levels and our hopes and aspirations along with having to deal in some cases with significant health issues and health crisis in a way that we all need to be there for each other. And so I appreciate the fact that you've laid out some of these things in terms of what the cancer center does and your role as a clinical chaplain. And we definitely appreciate the idea of the support network that you have there at Cone in terms of supporting families and patients and staff, and the role that the chaplaincy program plays there at the hospital. If the public wanted to get more information about the chaplaincy program or if they were at the cancer center, for example, and they needed or wanted to reach out to you all, what would be the best way to do that? 

Lisa Lundeen: [00:23:50] If they're at the cancer center, that's really easy. They can ask any staff to page the chaplain. And I always have a pager on me, so I'm easy to reach anywhere I am. If someone is out in the community, it's easy to call the main cancer center number and ask for the chaplain and their call will get routed straight to my desk phone. And then if I'm not available, people can leave me a private message. I’m the only one who listens to it. And that can bring a little comfort too when people are being brave. 

Jeff Thigpen:[00:24:20] We'll have show notes and translations of the podcast and have all that additional information linked in for the public. Lisa, thank you so much for what you do and who you are. And thank you for for being here on behalf of Carly and myself, we would like to appreciate you for being a part of the Good Grief Podcast

Lisa Lundeen:[00:24:39] Thank you so much. And as listeners are sitting with all that we've discussed today, I just wish them every blessing in their process and want to say that no matter how it feels today, it won't always feel that way. And we stand in the place of hope. It will continue to get different and you will continue to heal over time and your load will lighten, and we're right here with you.

Outro

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.GuilfordDeeds.com. You can also email us at EndOfLife@Guilford CountyNC.gov, or find us on Twitter with the handle at Guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

[Intro] 

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief Podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is also complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more, to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

[00:00:50] Well, welcome to the good grief podcast. I'm Jeff they've been Guilford county rates through dates today. We have a very special guest, Mr. Brooks Johnson, who is the clinical chaplain at wake forest Baptist health.

[00:01:11] The high point medical center over in high point also have Carly Malcolm who's with me today. She is with the lead forensics. Program's going to be working with registered deeds over the year for special projects. She's done a lot of work on the end of the life program, graduate of Clemson university.

[00:01:26] She's going to be chiming in with some questions as we go along. And so I want to welcome Carly in terms of being part of the podcast and Brooks Johnson. Jeff. Good to see ya. Good to see you. Brooks is, uh, I was joking with him earlier. He's a little bit of a second fiddle. His wife, Katherine Johnson is a fellow Guilford county department director, uh, with the family justice center does a outstanding job there.

[00:01:53] And, uh, as, as I have my wife who is a principal and doing an outstanding job too. So we share that in common. We have very strong wives. Yes, yes we do. Yeah. So, um, We thought it would be a good idea to get a, a voice who is kind of on the ground in one of the hospitals, in the chaplaincy program. And it was great to be able to connect with you Brooks.

[00:02:17] And so today I think what we're just going to do is get to know you a little better and talk about what influenced you in pursuing Champsi program. Some of the things that you do over at the high point medical center and, uh, you know, talk about end of life issues. And so, again,

[00:02:33] Brooks Johnson: [00:02:33] Thank you, Jeff. It's a pleasure to be here.

[00:02:36] And I appreciate continuing the conversation that we started. Quite candidly. I don't remember how long ago it was since a lot has happened between that conversation. And now yeah, we've got

[00:02:47] Jeff Thigpen: that COVID reality going on. Yes, we do. And I'm sure

[00:02:50] Brooks Johnson: that's impacted your work too. Absolutely. Okay.

[00:02:52] Jeff Thigpen: I just want to get to know you a little bit.

[00:02:54] If you could let everyone know where are you from? What kind of influenced you in terms of your background to pursue

[00:03:01] Brooks Johnson: being. Sure. Well, thanks for that. Especially today, it occurred to me this morning as I woke up today, of course, it's September 11th and I was born and raised in long island, New York. And, uh, while I did my undergraduate degree at Campbell university, I moved back to New York.

[00:03:18] Post-college to just begin my life and career. And, uh, I was in ministry at the time youth ministry to be specific during nine 11, when that occurred, uh, that day 2001. And, uh, You know, I will never forget. It's just etched in my brain where I was, what I was doing again, I was in youth ministry, so I wasn't in the city.

[00:03:43] I was often in the city with my job because I worked a lot with the youth ministry in the city to be short. And so what I distinctly remember, which is typical of New York in the late summer, early fall, the weather was just outstanding, you know, very low humidity in crystal clear. And so that is to say, While I was approximately, you know, 30 miles outside of Manhattan.

[00:04:06] I remember stopping on the side of the highway with tons of cars that were parked on the highway. Just seeing the plumes of smoke, still feel the crystal clear blue sky. And as I always kind of pause and say my prayers, I just, I thought about it today and being with you, Jeff. And I thought about.

[00:04:29] Truthfully, how it was such a juxtaposition that day. You had this absolutely beautiful day where you're, if you're on long island, you perhaps are breathing in the Atlantic sea air, feeling the crispness and anticipation of the autumn. Uh, lots of things going on in the beginning of the school year, you know, so on and so forth.

[00:04:51] For me being a giants fan, thinking about the beginning of the NFL year, uh, and big blue. More seriously. You know, what I took away from that was just how death really is always around us. It's not a glamorous topic that we don't particularly like to talk about, but in part that's why Jeff, I appreciate what you've been doing with this good grief series is talking about things that are different.

[00:05:18] And so that's a kind of a, maybe a interesting segue into what compels me is that we are on this journey together, regardless of who we are and what we do, frankly, regardless of what our faith or our beliefs are. We are on this journey together. And I just continually find ever since September 11th, 2001, really beforehand.

[00:05:40] And after that, we are better when we learn how to journey together, when we learn and identify what we have in common. Versus what makes us different. Yeah.

[00:05:50] Jeff Thigpen: And so many of us wake up every day and we look at the clear blue sky and think, wow, this is a great day. And then several hours later, we have a loved one who has a heart attack or something or something traumatic happens, a car accident, something.

[00:06:04] You end up in your position as a chaplain, dealing with those situations every single day and dealing with families that are in crisis, not sometimes it's long-term illness, illness that people are going through, but sometimes it's something that just happens out of the blue and it happens in ways that we have to immediately respond to.

[00:06:18] So being a chaplain, you

[00:06:20] Brooks Johnson: get a seminary, I guess. Yeah. So kind of continuing, um, what you asked first, uh, you know, ministry took me from long island, New York to Winston Salem, North Carolina, where I moved. In 2003, again, I was still in youth ministry at that time. Really contemplating my future. And yes, to answer your second question, I ended up as I was kind of grappling with, okay, what am I going to do in my ministry, future going to wake forest university, school of divinity.

[00:06:47] I'm a very proud graduate, excellent program. I felt like I was really there at the peak. As they were blooming into who they are now. I literally, uh, graduated on the 10th year anniversary of that school. And it was during that time, it was a 2007, 2008 when I did my first unit. Of what is called CPE or clinical pastoral education.

[00:07:14] And so one of the things that I'm particularly proud of as an Episcopalian, so I'm an ordained Episcopal deacon for whatever that means to anybody. Um, I'm still trying to figure it out yet or figure out how to spell it, but, uh, seriously, one of the things that I'm most proud of in that tradition is that anyone seeking any level of ordination.

[00:07:32] Is asked to do one unit of clinical pastoral education. And the reason for that I believe is because it is not only dealing with some difficult stuff, but in dealing with that difficult stuff, you're really leaning into learning more about who you are at the deepest of levels. And I was one of those individuals that when I did my unit, I just could not wait for the next one.

[00:07:57] A lot of times you kind of hear the specs. People do it. And they're like, okay, boy, I'm glad that's over with, but I was one of those who really leaned into it and I really appreciated so much of what it taught me. And so that really helped to form my path towards chaplaincy specifically. So I finished my degree at wake forest in 2009 and I had applied and did my residency at Wakefield.

[00:08:20] Baptist health or what people love to call the Baptist. Uh, so I did a year long residency there in chaplaincy, and so I did three more units of clinical pastoral education graduated in 2010. Um, and then I have another small degree from Virginia theological seminary up in Alexandria. And then that kind of led me kind of to high point.

[00:08:41] I started off at high point medical center actually, I've been there long enough where it was still just traditionally a community hospital started that was before UNC healthcare managed it. And I started doing, you know, the night shift, basically. I was an on-call chaplain and I worked, you know, multiple days a week.

[00:08:59] Covering the nighttime and, and, uh, I got my foot in the door and here I am eight years later. Wow. So

[00:09:06] Jeff Thigpen: in faith settings, you have pastors reverends, rectors,

[00:09:11] Brooks Johnson: and moms. You've

[00:09:12] Jeff Thigpen: got a Jewish

[00:09:14] Brooks Johnson: leaders, chaplain. Yeah. What is a chaplain? I'm glad you asked. And I also, I have to say, it's funny to say, so technically.

[00:09:23] You could call me the Reverend Brooks Johnson, or you could call me father Brooks, but in the hospital, especially here in the Bible belt, when people see me show up, they say, oh pastor, what's going on, pastor. Um, I have several staff members who I've got good relationships with and they love to call me preacher, how's it going, preacher.

[00:09:43] Um, but when I show up, particularly in our inpatient psych unit, which is one of my care areas and I lead. I always introduce myself as the chaplain. And then I tried to just break the ice and say, after a pause is everybody know what a chaplain is. And a lot of people shake their head. Yes. And whether they do or not, I kinda just gently go into, well, technically I'm an ordained minister in the Christian tradition specifically, but I choose to serve in this congregation.

[00:10:09] And I use that word intentionally because I'm really honored that I have the opportunity to journey with people from all walks of life. Uh, really from all over the globe, even in little old hat point. And, you know, as a chaplain, what I do is regardless of their faith tradition or where they come from, I just journey with them.

[00:10:31] Jeff Thigpen: Yeah. So your, your congregation, so to speak as a group, Yeah, you're providing support to across faiths and cultures. Absolutely different, you know, religious beliefs, some have none everybody's dealing with crisis.

[00:10:44] Brooks Johnson: Yes.

[00:10:44] Jeff Thigpen: Uh, you know, and you walk in the door of a patient's room and you also are with doctors and nurses and the whole institution as they're trying to help take care of people.

[00:10:54] Yes. What triggers a chaplain to become involved in situations at the, at the hospital?

[00:11:02] Brooks Johnson: Sure. Good question. Either the, the, the formal way to answer that is because I am a clinician and I'm part of patient care, active patient care. I'm a patient facing staff member. I get referrals. You know, in a way that doctors or nurses would where people put orders in.

[00:11:19] So they put a pastoral care order in, or sometimes people get confused, they call it a pastoral care order or a spiritual care order either wants the same thing goes through the computer charting system. And that is a way for us to be made aware that either the patient has requested something for us.

[00:11:37] Or, uh, that staff have asked for us to be involved in that patient's care. So it could be anything from talking about issues of spirituality or talking about their faith, or, you know, perhaps. As you might guess their crisis of faith in this particular healthcare moment, or it could be, you know, talking about their plan of care and Jeff, as you and I had talked about prior, I'm very pleased that I'm a part of the palliative care team at our hospital and, you know, palliative care very quickly.

[00:12:11] The way we approach it in the hospital is I think a broader way of meeting patients needs by talking about after identifying their diagnosis, talking about, you know, what is it that their goals are? You know, not just the short-term goals, but perhaps their long-term goals, regardless of length of time that they may have to live.

[00:12:31] Palliative care does not always mean hospice care or end of life care. But it does mean looking at a person holistically. And not just identifying their medical problems, but how can they, how can we address their medical problems in the context of what they wish to accomplish? If you want to use that term, what their goals are when they're discharged from the

[00:12:55] Jeff Thigpen: hospital.

[00:12:56] So it's maximizing the input. Yeah, I'm looking at both their spiritual needs, their health care experience. What is it that they're dealing with at that given moment, you know, processing what is happening? Yes. Um, looking at their human needs, anger, doubt, hope. Yep. The emotional tolls. And like I said, you're dealing with families as well in those situations.

[00:13:18] Yeah. A lot to deal with you kind of

[00:13:19] Brooks Johnson: like a Jack of all trades. Jeff, if I could, I really liked your choice of word. What triggered. The chaplain to be involved. Yeah. You know, for me, I feel like speaking for myself, I feel like one of the things that I can bring to the hospital setting is a presence for which I can function really.

[00:13:42] Listening really listening to what's going on. So what I mean by listening is not just with my ears, but with my eyes. Uh, so for example, when I make rounds currently with our ICU team, you know, I'm looking at the doctors, the nurses, the social workers, their body language, you know, when they show up at the door of that patient, you know, are they.

[00:14:03] Chipper and bright because they already kind of have a sense of the plan of care or the outlook, or are they, frankly right now in this pandemic, are they just tired? And these are difficult cases and okay, how are we going to solve whatever problems present themselves today? Um, you know, so listening between the lines, like what, what is said or what is not said, or how do people engage with patients or family or do they not?

[00:14:32] So, you know, I think triggers is a great word, cause I always triggers for me. I hear that word and I think, okay, well it's important for me to be alert. Wherever I am and wherever I go, whether that's a patient room or quite frankly, whether that's a cafeteria, some of the most powerful conversations I've had with staff are right outside the cafeteria, because I asked them how they're doing.

[00:14:53] And they know that I take that quite seriously and I'm going to carve out time to listen to their response. And then those well know that depending on their response, I'm going to say, well, let's talk about. Hmm. So that has led to some really, really good conversations. So, you know, triggers is for me just being aware, like I said, you know, we're on this journey together.

[00:15:15] So if we can kinda talk. Communicate then we can be better off. Excellent. Yeah.

[00:15:21] Carly Malcolm: Great. You're involved with a lot of different people going through these really difficult experiences. Um, what's your approach to spiritual care when you're dealing with people who are in times of crisis. And

[00:15:33] Brooks Johnson:  thanks for that question.

[00:15:35] I never presumed someone's faith, frankly. I never presume someone's spirituality. So I look at it from the standpoint of I'm partly there because of my faith and my spirituality and how I feel. I represent God and I, my personal, as well as my spiritual beliefs are, we are all created in the image of God.

[00:15:56] Some of us know at some of us, don't how it is. We. Journey, as I've already said and discover that, or are in tune with that, or are even simply introduced to that. I kind of feel like that's where I'm at when I maneuver through the hospital. So what I always take in consideration first and foremost is that.

[00:16:20] A family member, or again, even a staff member, they're humans, they're humans first and they have feelings and have feelings based on what's going on with them, of course, in a hospital setting most oftentimes medically. And so how can I connect with them in a way to quickly build rapport? And see where it is that I can be present to help them unpack anything, whether that is of a spiritual nature or not, perhaps, and sometimes Jeff, you and I talked about, uh, like advanced care planning and thinking about healthcare powers of attorney or living wills and stuff like that.

[00:16:55] I think we're going to talk about that a little bit today, too. Um, but sometimes doing that kind of stuff is a pathway to talking about spirituality, you know, thinking about, for example, with the healthcare power of attorney, who those people that you trust the most in your life, that you would want to make decisions for you when you were cognitively not able to make decisions.

[00:17:13] That of course it can be a springboard for, you know, family history, which oftentimes can include, you know, a person's spiritual upbringing. So it's not unusual for, for those things to kind of segue into much bigger conversation. Um, and then I always try to follow the patient or family members lead. So again, going back to the listening or the triggers, like what, what do I hear in their description of their upbringing?

[00:17:45] Do they talk about, um, go into a particular church or being a part of a particular faith community? Uh, was that important to them? Was that important to their parents? How might it be important to them now? Or how might oftentimes have people been raised in the church? Uh, I find this a lot here. At least in my setting raised in a church and then they kind of went away from the church for awhile, but now they're kind of contemplating.

[00:18:12] Perhaps not the church, but maybe God. Um, and a lot of times that is, you know, brought on by their particular condition, right? Yeah. There's

[00:18:21] Jeff Thigpen: a comment that, of, uh, some called some folks used to bees. I used to be a Baptist that used to be there for that, but then you're not as Biddle and you really just want to have a conversation or connection with someone to talk about what you're dealing with in the meaning of life.

[00:18:38] And the figuring out what, what that then means for, for you. And I think what I'm hearing is you do a lot of listening. You ask a lot of questions, you're trying to do it in a way that you're trying to figure out what is important for that person and provide that type of support. And you're almost doing triage.

[00:18:52] You're doing you're, you're dealing with a lot of situations. A lot of people it's always different and people are, uh, I come at things in entirely different ways. Sometimes I know when you, when we talk about religious faith and spirituality, there's a joke. There's a check about. Well, you get 10 religious people and you get 12 opinions about their approach and what they're dealing with.

[00:19:13] And so we're always processing within that space, right? To be able to build the relationship, to develop the trust and the support that people need, whether it's spiritual, religious, uh, support, emotional support, and, you know, and people say, you know, all of that can relate to the physical body. Um, have a sense of wellness in that situation.

[00:19:33] And so what are some common situations that you see with patients at the hospital when they come in, in terms of, of what they're dealing with and what they're dealing with with their loved

[00:19:43] Brooks Johnson: ones? I think so often, you know, patients come in again, regardless of what the diagnosis is and. The underlying kind of thing that we as chaplains deal with is how that intersects with okay.

[00:19:59] Where they are. Are they, you gonna he'll get better, whatever we define and healing as, and then based on kind of that information, how do they wrestle with their own kind of past, you know, how do they. Come to terms with perhaps what they did or what they didn't do. Um, and that could be as simple as well.

[00:20:23] You know, I don't have a good history with a PCP, you know, uh, my doctor, my everyday doctor, I don't go see the doctor and you know, this is a result of that. Or, you know, I've got all these bad habits and this is a result of that. Um, or it can be quite big as in, you know, From a spiritual standpoint. Well, this is the result of my not being faithful, which is really heavy and frankly really difficult.

[00:20:50] Do you

[00:20:50] Jeff Thigpen: have, um, a lot of similarities or situations in terms of actual end of life situations where people are dealing with the immediacy of death, what do you see in some of those situations that

[00:21:03] Brooks Johnson: are. You know what I see, I tend to gravitate towards the positive, even in the midst of death, which is obviously heavy enough, we don't need to add to its weight.

[00:21:15] And so what I often see that I just think is beautiful and honestly compels me to say that death is a really sacred moment, regardless of your faith tradition. What I see is oftentimes people reconciling, reconciling with family member. Perhaps reconciling with God or truthfully reconciling with themselves, you know, learning how in some way, whether they even use this language for giving themselves for past wounds hurts that they have inflicted on others or that have been inflicted on them.

[00:21:51] And to me, that's one of the most. That's what makes death oftentimes the sacred moment, you know, Jeff, as a jokester, uh, you know, well, a joke, you know, death and taxes, right? Oh. And

[00:22:06] Jeff Thigpen: we're going to have the tax director. Uh, he's committed. There you go. There you go. Save us with Gilford county, talking about death and tax,

[00:22:12] Brooks Johnson: death and taxes.

[00:22:13] There you go. Yes. So, you know, it's going to happen to us. We can't avoid it. If you haven't already, you could easily devote a podcast to, you know, what society tells us, which is we should look a certain way, be a certain way, have this, have that. What do we define as success? So on and so forth. But in the end we have the opportunity.

[00:22:33] You, you use the word Jeff B to be in relationship. And oftentimes in death, what I see are relationships that may have been. Had a tremendous amount of pain inflicted upon them for which they have been separate for so long. And then somehow they come to reconcile and that's a beautiful thing.

[00:22:53] Carly Malcolm: So you spoke earlier about how in your approach, you keep people's humanity in mind, but you're human too.

[00:22:59] So what kind of support is there for you and for other staff who are helping people to go through such heavy

[00:23:05] Brooks Johnson: topics? Yeah. Thanks for asking that question. One of the things I do have to say, I've got a fantastic mentor. Uh, who's become a good friend who is my colleague at high point medical center. Um, his name is Joseph.

[00:23:18] He's the other chaplain that's there during the day. He's been there almost 20 years. And so he, when I started about eight years ago, really gave me the green light to think about how it is that we intentionally care about staff. Because most people going back to, how do you define a chaplain? Most people think about, well, that's the minister who shows up when someone's dying.

[00:23:40] And fortunately that is only one of so many things that we do in the hospital. And so I see. As you know, how we care for each other, as staff members really has everything to do with how effectively we care for our patients and families. So to answer that question and, you know, we created a space in the hospital that we call the away.

[00:24:04] It's a space that's designed specifically for respite, for staff only. Um, and in there I have all kinds of things. Like, you know, I've got manipulatives, like we've got Play-Doh in there, coloring books and crayons. Uh, like I have a lot. Labyrinth, so you can trace it with your finger. So you could do it. If you wanted to, with your eyes closed, there is a small pewter labyrinth that has kind of like a, um, a stylist with it.

[00:24:32] And you can trace that we have kind of other manipulatives in there, like games and different things to kind of alleviate the mind. The challenges that perhaps you've been facing, there all kinds of books, books, particularly on poetry in there, you know, I find poetry, a wonderful way to welcome people, to contemplate think reflect in a non-threatening way.

[00:24:54] We've got some comfortable lounge chairs, you know, yoga tools, you know, things to stretch with. And, you know, there's a little, uh, a fountain and kind of different things like that. So that's a space that's used. Um, I'm often welcomed to do things like blessing of hands for different staff members. So that's where for me, uh, what I like to do is I bring a seashell.

[00:25:17] As I mentioned, growing up on long island. I've, I've always been surrounded by water. And so when I was a kid, I used to love collecting seashells, and I have a collection that I've collected from beaches all over the Eastern seaboard. And so I've used those from anything from baptism. Two blessing of hands.

[00:25:33] So I bring the seashell, I have some herbal oils, some essential oils that I keep in my office and I fill the shell with the oil. And I, you know, talk about creation, talk about how we are an active part of creation, specifically staff. And so therefore staff are giving of themselves to care for others.

[00:25:50] And so it's a very symbolic blessing of who they are because through their hands, they are showing their spirit, their care of others. So that is amazing. It's cool. Yeah, it's cool. It's, it's real touching. And that's another thing that opens the door. People to kind of see who we are chaplains and not just, uh, sitting with patients and families, but really being there for them.

[00:26:15] And, um, oftentimes that can lead to follow up conversations about, you know, all kinds of things.

[00:26:20] Jeff Thigpen: Yeah. I mean, in terms of wellness in, in employees, uh, like I said, doctors and nurses and support staff who were there and their job is to care every single day for the wellness. It's hard who were coming in. I imagine incredibly hard, the support network and something as simple as blessing hands.

[00:26:40] Yeah. Amazing. Yeah. What have you learned about yourself?

[00:26:44] Brooks Johnson: You've been there for what? Eight years? Yeah, almost eight years. Almost eight years. And I've learned that I'm passionate about helping people. You know what we were talking about kind of getting into all this. And I mentioned like my first unit of CPE and kind of wanting to dive into the deep end right away.

[00:27:01] You know, some people specifically, since we're talking about the hospital, it's like in the ed, people are wired with that kind of rush, you know, nurses and doctors have that rush. You know, they want to be in the midst of the crisis. And I guess in a similar way that that's kind of where I am. I joke about how the greatest thing about my job is I have no idea what's going to be there when I get there.

[00:27:21] But I've also learned in time that one of the hardest things about my job is I have no idea what's going to be there when I get there. And that's exhausting, you know, while I love caring for others, particularly the staff. I also know that it really is important to care for myself. And sometimes I'm not really great at that.

[00:27:41] You know, we're all human beings. And so that can be tough. Definitely.

[00:27:46] Carly Malcolm: Definitely. So what advice would you give, like, from your perspective as a chaplain, um, to people who are coping with grief during this time of pandemic with all of the added stress and challenges

[00:27:57] Brooks Johnson: that come with it. You know, I tell people all the time, patients, family, and definitely staff to just be honest with themselves, give themselves grace.

[00:28:07] I find myself saying that a lot lately, give yourself some grace allow yourself to feel because you know, emotions, aren't bad things. We, we get scared of them for where they may lead us. But inherently, they're not bad things at all, and we need to be in touch with them. Right. I tell nurses all the time.

[00:28:24] It's important to have self-awareness trust that you're a trained professional. You know, there are people around you who, if you are so sad and you're weeping so hard in a patient's room, they'll rescue you and get you out of there, but to be vulnerable enough. To share a modicum of emotion with the people that you work with, or I believe even the people you work for that's human and that allows people to also foster some of their own emotions that perhaps are repressed or that they're shielding so much because they're scared.

[00:29:01] And certainly during this time of pandemic, uh, I mean, you can feel it around the hospital. People are stressed and they have a right to be stressed, but we, while none of us can predict the future, what we truly have is the present and the best way for us to be praying. Is to really think about our emotions and honor those emotions in of course, the appropriate ways.

[00:29:25] So I encourage people to give themselves grace allow themselves to feel, take a time out when you can, or when is appropriate, um, or care for yourself.

[00:29:34] Jeff Thigpen: Yeah. We're going to have additional podcasts that talk about. Advanced care planning, but I wanted to open that up a little bit to you in terms of, yeah.

[00:29:42] When we talked earlier in the year, when I went over and visited you, it was, you know, so much of what's going on in our society is we do have a hard time talking about death and dying and end of life. And so in a lot of cases, You know, it, it hits us in ways at which we may not be prepared in your experience.

[00:29:59] How do you see that impacting your role with families and people who are coming in dealing with those kinds of situations in terms of their ability to both understand the bureaucracy of the new life planning as it relates to what you're talking about the whole time, is it you're dealing with people who were in crisis.

[00:30:14] You deal with people who are mourning and

[00:30:16] Brooks Johnson: [00:30:16] dealing with serious. So in, in the world of bureaucracy, I guess, or, you know, institution, I'm a part of. Or institutionalism, right? I mean, I'm a part of that. Obviously I work for a hospital in a medical system and there are, you know, procedures and protocols. And so having things like, you know, advanced directives can be particularly helpful, be helpful because they are guidelines as to what a person wants or perhaps doesn't want.

[00:30:41] And so I see it as not another. Piece of paper to do paperwork. I see it as a pathway into dialogue, into building some relationship because as I tell patients and family members and quite candidly, as I tell staff, uh, when it comes up or when they ask me about it, um, you know, one time I was explaining advanced directive to a patient in a unit, and I kind of looked out of my periphery and I noticed that staff were kind of gathered around and one physical therapist.

[00:31:12] Hey, I never even knew what an advanced directive actually was, but the way you explained it, can I do one of those? And so, and the way I explain it is it's an insurance policy because it ensures what you want to happen to you. What do people often want? They want to be in control right of their healthcare.

[00:31:28] This is a vehicle to be in control when you may not cognitively be able to. So I do. Take very seriously that it's an opportunity whether someone completes them or not sure I'd love for them to complete them. The hospital would really love for them to complete them, but it's, it's a pathway to talk about these bigger issues, like death or dying.

[00:31:49] How do you, when, or if something happens to you, how do you wish to be treated in those circumstances? And when I kind of couch it that way, it seems like that really opens up into some good conversation. And so there's no question. That it helps the patient and the family and the decision makers. And there's no question that it helps the hospital.

[00:32:09] So I see that as the classic win-win.

[00:32:12] Jeff Thigpen: Okay, well, uh, thank you. It's been real interesting conversation in terms of learning what a chaplain is, your approach to spiritual care and what you do there at the hospital. And this has been a really good conversation. Cool. Anything else that you think would be important for people to understand about chaplaincy by what you do about how to get additional resources?

[00:32:32] Brooks Johnson: Sure. What I would say to that, what immediately comes to mind is, again, I've already mentioned him, Joseph, my colleague, he's got so much wisdom and I so enjoy working with him. And, you know, he helped me to realize that, you know, we've had this discussion all the time. Some departments are called pastoral care.

[00:32:47] Some departments are called spiritual care. Uh, right now wake forest. They have spiritual care and pastoral care under the umbrella of faith health. So there are all these, you know, names, but my boss, you know, we often talk about just being supportive care and the reason for that is not to whatever you call it, water it down.

[00:33:04] But it's to recognize that we are a part of a team approach to contribute to a person's wholeness and their wellbeing. And that can lead to some serious conversations about a person's spirituality in a very non-threatening way, or it can get them the care they need, whether that's a palliative care referral, a hospice referral, advanced care planning or whatnot.

[00:33:27] So what I'm so appreciative of in being a chaplain is the opportunity to support people.

[00:33:33] Jeff Thigpen: Well, thank you. I think that that is, is so important in terms of the work that you do as a clinical chaplain. Carlina definitely appreciate the fact that you've taken the time to come in and talk to us today on this podcast.

[00:33:44] I think there's a whole lot of really good information and, uh, it's, it's quite clear that you have a heart for your work, and I'm glad that you were able to

[00:33:52] Brooks Johnson: be here with us. Well, Jeff and Carly, thank you for your time and your questions. I really appreciate it. Thank you. Yeah.

[Outro] 

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. 

And I'm Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief Podcast. 

Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated?

In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates and more, to give our listeners the knowledge they need to make decisions for themselves and their loved ones. 

We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast, and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:01:00] Welcome to the Good Grief Podcast. I'm Jeff Thigpen, Guilford County Register of Deeds with Carly Malcolm lead for NC fellow from the North Carolina Institute of Government. Today we have Jodi Kolada to talk with us about her work in the adult care world. Jodi is the director of business and caregiver outreach with Wellspring solutions, leading the organization’s business development and strategic growth, as well as just one navigator and caregiver support and education efforts. Jodi has got a master's degree in gerontological studies from Miami University of Ohio. She is a certified co-leader of powerful tools for caregivers, she's a certified trainer of the UCLA longevity center memory fitness program, as well as a certified instructor of the dementia dialogues program from the Arnold School of Public Health at the University of South Carolina. She presents to faith, civic, and community organizations about caregiving issues upon request. She's originally from New Jersey and has been married to Mark for 20 years. They have two children, Spencer who's 17 and Sally 15, and they have a dog named Rocky. Now that is amazing. Welcome to the Good Grief Podcast, Jodi, glad to have you with us. 

Jodi Kolada: [00:03:06] Thanks so much for having me. 

Jeff Thigpen: [00:03:08] All right. What is Wellspring Solutions and what are the services that they provide? 

Jodi Kolada: [00:02:28] Well, Wellsprings Solutions is formerly the Adult Center for Enrichment or ACE for short. Which might ring a bell to some of you. We've been serving the community for 36 years, going back to what, 1984 or so. And in April of 2017, the organization's name was changed to Wellspring Solutions to better align with being part of the Wellspring family. So I'll be talking about that a little bit and we're our own 501 C3 nonprofit. To go into the services that we offer, you know, we understand the toll that caregiving takes physically, emotionally, spiritually, socially, and certainly financially. And you know, when you're caring for someone with a chronic illness and you're not really sure how long that's going to last for. So we offer home and community-based services to older adults in Guilford County and their caregivers with specialized adult day services, group respite with our connections program, caregiver education and support, as well as home care, and our navigator program, which I'd like to just touch on a little bit. Our navigator program is for families in the community that just don't really know what type of help they need, but they know they could benefit from some resources. So we have a social worker, our navigator that will go out and visit with an older adult and their caregiver in their home at no charge. And basically have a conversation, assess the situation and offer guidance regarding resources in the community, whether they are with Wellspring Solutions or not. So it is a great service that we have for those in Guilford County.

Jeff Thigpen: [00:04:15] And so you have the Wellspring Solutions and the Wellspring group, which is the parent organization, can you talk to us about that? 

Jodi Kolada: [00:04:25] Yes. The Wellspring Group. So in 2013, we became part of Wellspring services, Inc, which is now the Wellspring group. And the Wellspring group is a not for profit organization whose mission is to provide aging adult services which create an experience that exceeds the needs of an evolving and diverse population of older adults in Guilford County. And the Wellspring Group, yes, it's the parent company of the Wellspring solutions, Wellspring Life Plan Community, and Pace of the triad. 

Jeff Thigpen: [00:05:02] Yeah, talk to us about that. 

Jodi Kolada: [00:05:04] Sure. So the Life Plan community is an active senior community where residents have, you know, all they need, services and amenities so that they can experience a full life in their retirement years. There's many services that are offered for those who live in garden homes, villas, apartments, and they offer skilled nursing care as well as memory care. There’s wellness activities and aquatic and fitness center events and it's a level place to just enjoy your retirement. PACE offers home and community-based services like we do at Wellspring solutions, and it stands for the program of all inclusive care for the elderly. They provide community-based services to individuals who are enrolled, who need medical care and support to continue living at home. So they are basically at a level where they would benefit from nursing home care. But with the support of PACE and the support of a caregiver, they can be safely at home with the support of PACE. You do need to be 55 years of age and there’s some other eligibility criteria to enroll in PACE. And they also have a PACE day center that operates from Monday through Friday from eight to five, for those who would benefit from the socialization and, you know, just getting out and having some activity. 

Carly Malcolm: [00:06:27] Can you talk about the memory care center?

Jodi Kolada: [00:06:29] Sure. So our memory care center is for seniors over 60, who have a diagnosis of dementia. And, you know, we offer activities to engage our members, enhancing their memory fitness and their physical activity and movement. And we just do that with a lot of programming, evidence-based programming to boost their memory fitness and to just get them moving and also to allow them to creatively express themselves with art and with music. We offer breakfast, and lunch and an afternoon snack and there are staff there to assist with their care needs. So if they need assistance during meal time, or if they need assistance in the restroom, our staff can help them. There's also healthcare monitoring by a nurse, and we are open Monday through Friday from seven 30 in the morning to 5:30 PM. And while this is operating, we're giving caregivers a much needed break from their caregiving responsibilities, but we also have caregivers who are employed. So knowing that they can bring their loved one to the program before they go to work and pick them up when work is over. It gives them that peace of mind that their loved one is in a safe and comfortable setting, being with their peers and being with our staff.

Carly Malcolm: [00:07:44] And then what about, you've got connections at the memory club. What is that?

Jodi Kolada: [00:07:47] Connections is more of an abbreviated day of socialization and engagement for our members. There is lunch and music and exercise, current events, and no hands-on care is provided. So it's for our members who are more independent, they benefit from the socialization, their caregiver gets a break. And I always say too, for as much as the caregiver needs a break from taking care of their loved one, their loved one needs a break from their caregiver. They need to be able to experience a different environment other than their home. And new people and visits with peers and they look forward to coming to the program. That is a four hour program from 10 to 2 on different days. We operate at a faith organization. So as you can expect right now, we have some operations that are not in place due to COVID-19. And we have a temporary partnership right now, right downtown with the Greensboro children's museum. They are offering some space for our program to continue. So, yeah, it's been a challenge. There are some family members from the memory care center and connections that just don't feel as though they're ready to have their loved ones, you know, come back, understandably. So we've been doing wellness checks. We check in with them, make sure that they feel supported, that they know we care and we miss them. And yeah. So that's what both of those offer to the caregiver and to the members that come. 

Carly Malcolm: [00:09:13] What are some of the common challenges for caregivers of people with Alzheimer's and other forms of dementia, and I guess also for the people who have Alzheimer's and dementia with their caregivers.

Jodi Kolada: [00:09:24] there are many, you know, when we talk with our family members and our caregivers and our participants and I'll focus more on caregivers, you know, when we talk in support group, when we talk just one-on-one, when we talk at our education opportunities, there's a lot of stress. So knowing how to cope with that can be difficult. There's feelings of, you're caring for a parent, there's role reversals that are hard to cope with, oftentimes spouses share that they feel lonely as their loved one has dementia and they're not able to engage in conversation like they used to before. Many times caregivers share that they feel a lack of, you know, just that spontaneity to be able to just get up and do things because they can't leave their loved one at home by themselves. There's the mental and physical issues, you know, depression might happen, anxiety, physical issues, just transferring help and hurting your back and not having those safe body mechanics in place. And a lot of caregivers have difficulty finding balance. If they're working, if they're caring for a parent and small children. Unfortunately, I can go on and say that there are challenges worrying about finances. And there's a lot of grieving that goes on. So I think those are challenges that are shared by, if not all caregivers, the large majority.

Carly Malcolm: [00:10:45] How do caregiving needs change and evolve as dementia progresses?

Jodi Kolada: [00:10:48] So as dementia progresses, caregivers will see that their loved one's ability has changed. The care recipient is going to need more help with activities of daily living like getting dressed, bathing, eating, their ability to communicate is going to change, and when you have a loved one who can't always communicate their needs and their wants and their frustrations, that results in a lot of frustration on everybody's part. And it becomes really important for the caregiver to understand how to communicate effectively with their loved one who has memory impairment. And as the disease progresses, oftentimes the individual with dementia loses good judgment and good reasoning, and the caregiver really needs to find just understand the best ways to approach, to communicate, to promote dignity to lessen their loved one’s agitation. And the need for self care though, that's always going to be there in the earlier stages and the later stages. And when the person progresses and they're in the final months of dementia, you're going to see an increase in that deterioration, eventually the person will need 24 hour care and it really is important that you can focus on their comfort on palliative care measures, and just to always keep in mind to respect the person's wishes. You should just be clear about, you know, what they wanted, what they articulated to you in the past and try to do your best to uphold what they wanted as they near death. 

Jeff Thigpen: [00:12:18] How do you support caregivers in coping with the difficulties of their role? You mentioned the mental anxiety and the physical anxiety and a number of things that are going on, both with the person experiencing that and the caregivers.  

Jodi Kolada: [00:12:33] So I mentioned one of our services is education and support. So we offer educational workshops and training, classes that are offered in a series and we offer caregiver retreats. So the classes that we offer, the underlying theme in what we do is always to talk about the importance of self-care. And like I talked about that physical care, you also need to be energizing your emotional self care, your social self care, your spiritual self care, and just remember, you know, to have fun. So we try to talk about our classes, how to reduce stress, and relaxation techniques. We will talk to them about mindfulness, about guided imagery, activities that are known to reduce stress. We will also talk about financial planning, legal planning, end of life planning, dementia care topics, because when someone is feeling stressed, when they have the information to move forward and make good care decisions, you feel empowered, you just feel a little bit better about the whole situation in general. Our retreats, those are offered, you know, in person, of course, typically, and we would have lunch and an opportunity to connect. We would typically offer activities that a caregiver might not have access to like Tai Chi and yoga and breathwork, and just a lot of discussion about ways to just cope. And we also talk about things like, you know, being grateful because when you are stressed out and have a lot of challenges in front of you, when you feel grateful, it's hard to really focus on the negative. And just being able to laugh during challenging times. So again, when we have a support group, there might be laughter, there could be crying. But there's sharing that's going on, and that's how we hope that we are addressing the need for caregivers to feel like they can share their story. 

Carly Malcolm: [00:14:34] And then in offering that support to caregivers that can also be kind of emotionally challenging and draining for the people doing that work. So what kind of resources are available to you and how do you cope with those emotional challenges of your job? 

Jodi Kolada: [00:14:47] Okay. So for me to cope, I rely just like I would mention caregivers should visit with other caregivers to connect and to share what's going on with their personal caregiving journey, I find that I cope best when I talk about if something's bothering me to my coworkers, because that's always helpful to talk to someone who just gets it. My husband is also in the senior industry, so he gets it. But if he did not, I wouldn't want to come home and really unburden myself and feel like that was how I was going to benefit from lessening my, you know, grief and my, you know, feeling sad about some of the situations that we run into. Resources, I would say we share self-care resources with caregivers all the time, and I would be crazy not to practice what I preach. So for me, the resources that I use are to try and just focus on breathing when I'm feeling anxious, or if I'm feeling like I need to lift my spirits, I will talk to a friend. I'll listen to music. And I think about the ways that I can reduce my stress because it's different for everybody. So those are really the resources that I'll put in place.

Jeff Thigpen: [00:15:59] Yeah. And Jodi, you know, you kind of mentioned about the seriousness that, you know, is a part of this work and the emotional toll a lot of the case it takes on patients and caregivers and staff. And in some of the support systems you have, you mentioned the idea of the importance of being able to laugh and not necessarily about all this, but through all this in such a way that it can be a symbol of wellness. Can you talk to us about that? 

Jodi Kolada: [00:16:33] Laughter is actually evidence-based shown to reduce stress. In fact, we partnered for a virtual conference just yesterday and the day before, and we had a laughter yoga specialist join us on that conference.

Jeff Thigpen: [00:16:55] A laughter Yoga specialist?

Jodi Kolada: [00:16:56] Yes, it might feel a little awkward, but it's a fun activity. It actually has its benefits to just do the exercises of laughing. But when I talk about being okay to laugh, I think it's important to find the humor in situations that are stressful if you can. We are not laughing at our loved one, we're laughing, you know, with or during the situation. And a lot of times it has its benefits. If you find that you're so stressed out about something with your loved one, and instead of you balling up your fist and grimacing and becoming frustrated, if you just find the humor in it and laugh, it's contagious and it's much more likely that your loved one is going to lighten up as well and laugh, and it can really brighten up the, you know, the daily routine. So there's definitely a difference between laughing at the circumstance and trying to find humor in it and laughing at someone. So I just hope caregivers don't feel guilty if they do laugh or they share a laugh with their loved one. I think that's just finding a moment of joy that you should appreciate and try to do more often.

Jeff Thigpen: [00:17:53] Yeah, we've done a number of podcasts and we interviewed an author of a book who had a conversation as a caregiver with his mother where he needed to take her keys from her. And so that was kind of a funny conversation. But you're right. I mean, people are dealing with just incredibly complex and emotional and spiritually draining issues at times. And we all get run down, whether you're going through it or you're providing support to people that are going through it. And the capacity, the ability, the perspective of being able to take a second and appreciate and enjoy and to laugh, I think is probably incredibly important for all of us. 

Jodi Kolada: [00:18:38] I agree.

Jeff Thigpen: [00:18:39] Yeah. Well, thank you Jodi, for being with us today. We both really appreciate it, Carly and I, and the information you shared about Wellspring and talking about a number of these issues that are important for all of us to understand and know as part of the Good Grief Podcast concept. We are reaching out to a number of community organizations to get a lot of this information and you've done a great job of laying it out. And so on behalf of Carly and myself, thank you very much for being here. 

Jodi Kolada: [00:19:09] It was my absolute pleasure and I appreciate you inviting me. 

Jeff Thigpen: [00:19:12] Jodi Kolada, director of business and caregiver outreach with Wellspring Solutions. Thank you very much for being with us.

Jodi Kolada: [00:19:18] Thank you. 

Outro

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.Guilforddeeds.com. You can also email us at endoflife@guilfordcountync.gov or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. 

And I'm Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. 

Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? 

In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates and more, to give our listeners the knowledge they need to make decisions for themselves and their loved ones. 

We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief Podcast, and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:01:00] This is Jeff Thigpen, Guilford County register deeds and Carly Malcolm lead for NC fellow from the North Carolina Institute of Government. And this is the Good Grief Podcast where we talk about death and dying unapologetically. Today, we have Pam Strader with us. Pam moved to Greensboro in 1996 with her husband, Joe Wood, and newborn son. She joined the staff over at West market street, United Methodist church in downtown Greensboro back in 1997 to work as an associate pastor. She's done that for 22 years. Her husband, Joe, is a teacher with the Guilford County schools. Pam and Joe have two adult children Brian and Mary Helen Wood and included within their family Fanny Matswati, who came to Greensboro from the Democratic Republic of Congo. In addition to her ministry at West Market Street, Pam has been involved in ministry with Congolese refugees for the last decade. And she's currently on leave from the United Methodist church. With those experiences, she's also found herself in the world of caregiving. And today we're going to talk to Pam about her experiences as a caregiver, how it's impacted her daily life and what she's learned along the way. So, Pam, welcome. Thank you for being with us today. 

Pam Strader: [00:02:18] Thank you. I'm glad to be with you. 

Jeff Thigpen: [00:02:21] When we talked about a month ago, you talked to me about the situation that you found yourself in as a caregiver, and I'm wondering if we could just start out and you could explain, you know, what you're dealing with in the world of caregiving and how it's impacted your life. 

Pam Strader: [00:02:36] Sure. In the summer of 2019, my father who lived an hour away in Lexington, North Carolina, became ill, and I was trying to go over every night to check on him. We had been worried about him for a period of time living by himself, but we realized as I found packages of cookies in the bedroom and other signals that he was not taking care of himself. And in the course of bringing him to our home in Greensboro for him to recover from a brief illness, my husband, Joe, and I looked at him one night and just said to him, dad, Joe and I would just love for you to just stay with us. Now we said this to someone who had been very, very resistant to leaving his home. He had been a caregiver himself for my mother for 10 years, and she had died in 2010, but he had lived by himself for nine years and had lived in Lexington since 1962. So his friends, his church, his connection to my mom and their life together was all wrapped up in that house in Lexington. So dad finally acquiesced and said, he thought it was a good idea to come and live with us. 

Jeff Thigpen: [00:03:59] And you come out of a family history where you saw your parents taking care of their parents, right? 

Pam Strader: [00:04:05] We did. Both of my parents grew up as only children. So our family, my two older brothers and I witnessed our parents become caregivers for our grandparents. And each of our grandparents received care through some extended illness and both of my grandmothers ended up moving in with my family over a period of years during junior high and high school. We also saw my brothers pitch in with the care of a grandfather with Parkinson's. And after a late night high school football game, we would all pile into the car on a Saturday morning and drive to Reidsville to help my grandmother care for my grandfather. So we were pretty hands-on as a family. 

Jeff Thigpen: [00:04:52] So with your dad, I think you were telling me that you saw him take care of your mom for a number of years, and then he took care of himself after that for awhile. And then based on the situations that you just mentioned, he then moved in with you all. Can you talk about how that has changed your life? 

Pam Strader: [00:05:12] I think one of the big things that happened was realizing that I was losing control really over a sense of structure in my daily life. Dad, sometimes sleeps in till 12 or one. And then sometimes like he did this morning, he comes walking in on the walker into the breakfast room at 8:00 AM. So it's very difficult for me to plan things, and it's difficult for me to keep commitments to people or appointments apart from him. So I have found that I really am pretty limited with what I can do outside of caring for him on a daily basis. 

Jeff Thigpen: [00:05:55] So there's been this change in control that you've had over your life and in terms of your interactions he's been your priority.

Pam Strader: [00:06:03] Yep. And what goes along with that, as you find yourself being isolated and I have found that, you know, for someone who was used to being out and about and caring for others and having lots of appointments and being very busy, finding myself, you know, very isolated some days and that my only interaction is with dad and with my husband. So that's been a big change. 

Jeff Thigpen: [00:06:27] So the idea of taking care of yourself is a piece of this change, and I think one of the things you mentioned to me was that sometimes you see that your friends may not call you anymore because they think you're too busy and you find yourself having to reach out to them, and I think that's different, right? 

Pam Strader: [00:06:45] It really is one of the things I don't think I realized was that folks would, because I'm not out circulating, I don't have that contact with folks, but they also know that I'm a caregiver. So they hesitate to call because they're afraid that they may be calling at a bad time. And then since I can't really go out and, of course we're all in that circumstance with COVID, but it's hard to get out and meet folks for coffee or lunch or something like that, even before COVID because I just did not know what my schedule was going to be. So it has been isolating. And what I've found that I need to do is pick up the phone and call and check in with some folks who I've known over the years and who are my friends and family but it takes me taking some initiative with that. And I know that I need that contact. 

Carly Malcolm: [00:07:36] So throughout this process, have you learned anything new about yourself going through these challenges? 

Pam Strader: [00:07:41] I think for a while I got a little, I will say, I think I got a little depressed and one of the quotes that has really fed me in my life is Victor Frankl, who was a survivor of the Holocaust, and he said the last of human freedoms is to choose one's attitude in any given circumstance. So choosing what kind of attitude I'm going to have each day is something that I realize is my choice. And I can choose to kind of get depressed about things or I can choose to try to find the joy in each day. And I think the longer I've been in this situation now it's a little over a year, I think I've really gotten to a better place where I'm choosing to find joy. And this morning, my father woke up with a funny dream. He said Harry Truman was on one side of him in a car going somewhere and then Scully the sports commentator was on the other and we had a good laugh about that. So the other thing I learned was that I didn't know a lot of things about my father. So one of the real joys has been hearing stories that I'd never heard before and asking him about significant periods of history and what were those like for him. And that's been a wonderful thing, and I realized I've gotten to know my father as a person who lived through fascinating periods of the 20th century a lot better. And that has been a real gift. I will say, dad, I never knew that about you. And so we're still in a place of discovery and he's 88 years old and I'm still discovering new things about him. So I think sometimes when you live with people you forget to ask questions, but we take the time to have some of those conversations. And so I think that has been, I think to be able to engage with the person you're caring for and venture into some new conversations is a wonderful way to grow personally and in the relationship.  

Carly Malcolm: [00:09:52] Wow. Yeah. So not only learning about yourself, but also about your father and the world more generally, that's pretty incredible. Do you think your role in your faith community, has that prepared you for this new role as a caregiver? 

Pam Strader: [00:10:04] I think journeying with families over the years, certainly, I think has given me a pastoral perspective and a practical perspective as I've journeyed with families, as they've had to make choices and decisions about the care of loved ones, whether it be making a decision to make a move from a beloved home to a nursing facility or senior community or in our situation into a family member's home. I appreciate what an excruciating decision that can be. And I think I also learned how difficult it is for people who need that care to admit to it and to be willing to make a change. And I think that informed my husband Joe and me in trying to always make sure dad knew that he had a place to come when he was ready. But I think it also helped us in the way we framed the invitation, which was we want you to leave where you are, instead we said we want you to come be with us. So it was an invitation into our home and not so much a request that he leave his home. So I think that that's helped and understanding that these things can take time. And we tried to be patient with him over the last couple of years that he was in his home till we really felt like it had come to a point where his safety was putting him at risk being by himself. But to try to be respectful and loving with the invitation to come and be with us.

Jeff Thigpen: [00:11:48] Right. So with that, you've got your personal experience in dealing with your father as a caregiver, as well as your pastoral and spiritual care role that you played within your faith community in dealing with a number of people who've had to deal with these kinds of issues. With that said, what kind of advice would you give others in terms of those who may be listening to this that may be venturing in the world of caregiving, especially when it deals with older parents.

Pam Strader: [00:12:18] I think the book of Ecclesiastes in the third chapter has a wonderful verse that says, for everything there is a season and a time for every matter under heaven. And I think an image that's helpful for our family is to recognize that this is a season in our lives. This is a season in my father's life where he was a caregiver for my mother, but now he's the one receiving care. And that those seasons in our lives are not permanent, but they are seasons in which we can grow, seasons in which if we engage them again with an open attitude of seeking to learn and to grow and to love that it can be a very fruitful season. And so my advice would be to engage in the season of caregiving, to live into it fully, to seek and capture the joy in each day. Learn those new stories of your loved one and seek wisdom that often our older parents and family members have to offer to us if we take the time to be present and to engage them. But I'm very thankful for the pause I think it has given us where we are taking the time to be present with each other and not so rushed with the busy-ness of life. I think caregiving forces you to slow down and it can be a time where you can really be intentional about taking care of yourself in ways that maybe when you were working, you did not. It may be taking the dog for a walk twice a day, instead of once a day and pausing to hear that story from your loved one's childhood or young adult life or working life or their parenting experience that can offer enrichment to your own life. But I would say to engage in the season and to seek to grow in your relationship with the person with whom you're providing care. It can be a time that, while it can be challenging and not everyone is fortunate enough to have a parent who settles in and says, this is home. There are some persons for whom this is very, very difficult, and they continue to be combative and resistant in many ways. If we continue to try to love and respect the people we're caring for, I think there can be many fruits in the season. 

Jeff Thigpen: [00:14:51] Yeah, well, that's exactly right. And I really appreciated when we were talking earlier just about the process of going through this and navigating through it, not at all kind of being clear how things are going to land, but bringing your full self into it. And as you’re kind of alluding to an appreciation for the season in the sense of the challenges it brings, but I remember you saying there's a joy with it. And I kinda sense that in terms of how you are having this time with your dad. And I really appreciate you taking the time to give us a unique perspective of someone who is laboring in the field right now, who's really in the middle of this situation. And it continues to unfold every single day and in your life with your family and I appreciate you coming and I appreciate you being willing to come on and just share the story and the situations that you're dealing with and your approach to it, as well as the experience that you've gained from it. With that said, on behalf of Carly, we would definitely like to appreciate you for being with us today. 

Pam Strader: [00:15:34] Thank you so much. 

Jeff Thigpen: [00:15:36] All right. So, Pam Strader has been an associate pastor within the United Methodist Church for 22 years with a background in spiritual and pastoral care. And she's talked with us today about caregiving. So again, Thank you very much, Pam, for being with us and this is the Good Grief Podcast. 

Outro

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.Guilforddeeds.com. You can also email us at endoflife@guilfordcountync.gov or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. 

And I'm Carly Malcolm, lead for North Carolina fellow for Guilford County from the UNC School of Government, and welcome to the Good Grief Podcast.

Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated?

In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. 

We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief Podcast, and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:01:00] Welcome to the good grief podcast this week, we have a special guest with us, Reverend Odell Cleveland. I'm joined by Carly Malcolm, who is my Institute lead fellow from the North Carolina Institute of Government, and today we're going to talk about caregiving. Reverend Cleveland currently serves as the chief administrative office officer at Mount Zion Church, which is a 119 year old, predominantly African-American church in Greensboro. I've known Odell for 20 years, at least, with the welfare reform liaison project, which is a nationally recognized faith-based nonprofit. He's been the CEO of that for 16 years. In 2016, he shifted into the caregiving world in the sense of structurally, but he's been doing that for a very long time. He's been instrumental in creating an organization called caregiver contact, where he partners with ARP, United Healthcare and others. He has a new book called It's my Turn Now: Caregiving 101, hot off the presses. I've read it. And it is a sober look at caregiving and particularly, and personally based on the caregiving that Odell and his family has given to his mother, Glenda Adams Cleveland. So we're going to talk about the book today and Odell, thank you for being with us today. 

Odell Cleveland: [00:02:16] You Know, thank you for the whole concept of Good Grief, because when I think about that, it's just amazing. The vision you had to bring that together to make it so much easier for so many other people to deal with issues. So thank you. 

Jeff Thigpen: [00:02:30] Yeah. I mean, we've been doing this podcast series, it keeps expanding and what's been really a gift to me, and Carly who has been my partner in this, is that we've learned so much about end of life care and issues associated with that, which really in terms of your book makes it incredibly relevant. And so one thing I did learn in your book that I did not know, you're a national champion in AI basketball at the University of South Carolina, Spartanburg.

Odell Cleveland: [00:02:59] University of South Carolina, Spartanburg, which is now University of South Carolina, Upstate. But Jeff, that was many years ago, that was many pounds ago. So, what once was, is we fantasize about that, but the reality is now I’m just a 60 year old man who just continued to do the best we can to take care of people 

Jeff Thigpen: [00:03:20] Forget your national, you know, honors and Divinity school and Harvard, I love Basketball. That’s all. 

Odell Cleveland: [00:03:27] Yeah. And hall of fame, you know, forget all that kind of good stuff. Forget all that kind of good stuff. Did I say I made the hall of fame, Jeff?

Jeff Thigpen: [00:03:36] Oh, yeah. That was the sentence after. Anyway, that was awesome to read that. Something I didn't know about you and you grew up in Charleston, right? 

Odell Cleveland: [00:03:45] Yes Charleston, South Carolina. I grew up in public housing in Charleston. And the interesting thing about my journey around caregiving is the fact that once you grow up poor, I mean, real poor, you know, divorce, single mom divorced with four kids living in public housing, and then you get blessed to have an opportunity to come through the cycles in society that you're not poor anymore, now you go to the White House, now you go to Paris, now you go to other places, it just gives you a different perspective and you have to decide, what are you going to do with that perspective? Are you going to run away from who you are and what you want and be something new? Or are you going to look back and continue to help people? And we choose to look back and continue to help people. Yeah, 

Jeff Thigpen: [00:04:26] Yeah, so much of where we go in life, a lot of times is so intertwined with where we come from. I'm really interested in your mother. This book centers a lot around the caregiving process that you all have had with her. Can you talk about growing up again and your mom and what happened to her that created the situation where you all had to really take care of her in terms of a caregiving role?

Odell Cleveland: [00:04:50] Definitely, you know, again, I stated that we were living in public housing, divorced single mom in the sixties in Charleston, South Carolina, deep South. And my mother got sick and went to the emergency room and she was having a stroke at the age of 25. Well, the attendance there sent her back home. And anyone who knows anything about strokes and stroke victims knows that minutes count. So she got sent back home for two, three days saying, come back on the free clinic day. Now my mother was working full time. She had insurance, but a lot of time biases, and in those days in the South, if you were a black female, a lot of times people would look at you, but they would look right through you. They would look right past you. So they sent her home assuming we deal with people like you on the free day. And they sent my mother home. So my mother laid at home for a day and a half until we got another private doctor who made them admit my mother. Now this is the Medical University of South Carolina, one of the most prestigious schools there is. So what would have happened if they would have admitted my mother and treated her for a stroke a day and a half earlier, how would that have changed my life, how would that have changed her life? But we thank God that my mother lived, you know, my mother stayed in the hospital for about three and a half months. Many didn't know if she would live or die. And so the family started having conversations. Okay. She's probably going to die, what happens to the children? And of course, people started dividing everybody up. And I was the one that there was a lot of extra conversation around who's gonna take Odell. Because Odell wasn't the angel that he is now.

Jeff Thigpen: [00:06:22] He wasn’t the angel. And that was 1968, right? 

Odell Cleveland: [00:06:27] Yes. 

Jeff Thigpen: [00:06:28] All right. In your book, you use an old Testament verse, I think it's in Ecclesiastes talking about time. How do you use that in relation to how you structured the framework of the book?

Odell Cleveland: [00:06:38] Well, it talks about King Solomon, the wisest man. And King Solomon talks about a time, a time for everything. And I won't repeat the scripture because everyone knows it, but I structured it like we're on a journey. You know, we’re here, I remember I used to be the little kid running up and down the dirt roads of South Carolina barefoot with no shoes on, playing on grandma's porch. Well, now I'm the older in the family and now I have grandkids. So the life cycle, the cycle of time, we have to understand that we're not going to be here forever, and sooner or later somebody is going to be coming to the office looking for a death certificate. You know what I mean? Like you say, the final graduation of life, we get you the birth certificate, and then you get your death certificate. So I'm trying to structure the book to help people understand that this is just a part of your journey. This is going to be over eventually because when it comes to caregiving, I look at it as three things, I guess the three-legged stool. It's going to become a time in our lives where we either become a caregiver or need a caregiver. That's the first thing. There’s a point in time. The second thing is the duration of time. How long, Lord, how long will my role as a caregiver last? Will I have to take care of someone for six months or for six years or whatever. Will someone have to take care of me? And the last thing is the end of time. When my time as a caregiver is up, will I feel guilty or relieved, and will I feel guilty for feeling relieved. Meaning this, I've talked to so many caregivers who say, Hmm, I am so glad that I spent the time I did with my loved one before they died, because this journey is to death. I mean, usually it doesn't reverse itself. This is a one-way march and you know where it's heading, but a lot of times we don't want to accept where it's heading. So, if we accept that this is where we're going, we’re marching to the grave, then let's take the time that we have, let's take the time and do the best we can, and then all these other things like sibling rivalries and all these other stuff start jumping up and popping up, how do we deal with that and manage it? And that's what the book is structured to try to help not answer all the questions, but try to help people on that journey because one way or the other, we are all going on that journey. 

Jeff Thigpen: [00:08:43] Yeah. One of the things I’ll add is that, what I really appreciated about it was, I could see myself being a child with my mother, and then as you saw yourself as a child with your mother, and then as an adult, you're in a different role being a caregiver to your mother. And we'll talk a little bit more about this, because there's some funny things in here. 

Carly Malcolm: [00:09:03] Yeah. So for a long time, it was your younger brother that was acting as the caregiver for your mom, but then he retired, right. So, can you talk about what happened after that? 

Odell Cleveland: [00:09:12] Yes. My younger brother is Genero Bernard Cleveland, we call them Naughty. And he's been taking care of my mother and he works as a civil engineer, Charleston, South Carolina, and he moved in to live with my mother to take care of her. Well, he was retiring in June, this past June and he told us that, Hey, when I retire, I'm leaving. I'm moving out. So it's a very passionate part of the book that I described that whole scenario when we had that conversation. And it was just so emotionally overwhelming that I just started crying because here it is, I call it our caregiving backbone, Naughty is saying, listen, I've sacrificed my personal life. I sacrificed my professional life and not that I had enough, but I'm moving on. And we had to have a family conversation because the family meetings are so important. My mother, she had to be a part of it. Naughty of course, myself and my oldest sister, and we talked about it and we said, okay, we will come in and we will help, and we'll do some other things. Well, so far he hasn't left. He retired. He says it's not time for him to leave yet, and I think in a lot of cases, it might've just been, I need some more help, you know. That might've been a plea for help, and a lot of times we don't always want to deal with it because it creates a sacrifice. I go home every two weeks. I get on that road and drive to Charleston. I get tired sometimes, but I have no choice. And the key is I want to let my last days with my mother be something that I enjoy, not something that I endure, because if I'm enduring it, she knows, I know. But at the same time who says, it's my responsibility, who says it's the children's responsibility to take care of their parents? Is that an unwritten rule? What happens when we say, we don't want to take care of our parents? Because you're going to have some siblings, thank God is not in my case, that says, you know what, I'm not taking care of mama. And then they go down a litany, a list on why not. Because when I was one year old, they did this. Jeff was her favorite, so let Jeff take care of her. Well, Carly is the executor of the will, let her take care of her. All those things start happening because if we don't want to do something, we'll find any reason to say no. And if we want to do something, we will find any reason to say yes. So we love Naughty. We support him. We understand his personality. His personality is different from Odell. Odell has never met a stranger. My brother is very reserved, keeps us feeling as close to the vest. So we have to deal with him in a way that is comfortable with him. That's a powerful piece in the book, because even when I think about it now, it just brings me to tears.

Carly Malcolm: [00:11:43] Yeah. There's a lot of complicated emotions that go into caregiving. Particularly, you talk about if you're caring for somebody who wasn't necessarily there for you and who wasn't present in your life, can you talk about those dynamics?

Odell Cleveland: [00:11:54] Yeah. I mean, I hear from people all the time. It's like, listen, here's this person in a lot of cases with someone, not always, but sometimes. So I don't want to stereotype or anything like that. However, when someone in the South and other places maybe got pregnant as a teenager, a little earlier, and the grandmother stepped in and said, I’ll raise the child and you go ahead with your career and everything else. Well, biologically, the grandmother is not the mother, but the grandmother is the mother because that's who raised the child. Well, sometimes what happened to the mother, but guess what? It was the father too. So now 20, 30 years later. Well, I'm your dad, I need you to come and take care of me. Well, you never did much for me before, other than to be a sperm donor. So now how do I deal with that? Or in another case we have divorces. What happened if I was the child, your mom did whatever grown ups do, and you all got a divorce. And now you over there living with another family, but for some reason, however that turned out, now you want me to take care of you. How do you take care of someone who didn't take care of you? How do you love someone who didn't love you? How do you care for someone who didn't care for you, because this is a sacrifice. You are asking the people to open up their homes, you’re asking them to open up their wallets, you’re asking them to open up their emotions and what happened if you're not willing to deal with the legal part of it with the will, with the resources, with all this stuff, because you can't just ask someone to support you and you don't support them.

Jeff Thigpen: [00:13:22] And there's one funny part when I was reading the book, it's talking about your mom, when it comes back to her and a lot the caregiving centering around the needs of your mom, but also this new time and space that your mom is living in. And there was a story you raised about taking your mom's car keys. 

Odell Cleveland: [00:13:43] Oh, man! Oh, wow!

Jeff Thigpen: [00:13:43] You know, you're like a teenager, you know, when your mom or my mom would take my car keys if I don't do anything right now, you're the adult with your mom. Talk about that story.

Odell Cleveland: [00:13:52] I think that's chapter three, we call it the Epic struggle because the underlying cause behind that is independence. I think we all remember that when we got our driving permit, it’s independence and our driver's license and man, we would borrow the family car. Well, then we got our own car. It's like we could come and go as we wanted to, as long as we had gas money. And now you're telling the person who taught you how to drive that I'm coming to him or her and say, I'm taking your independence away. Well, you know, that's hard. And the fact that my mother was having some little bump ups, she was bumping up here, bumping up there and she would say no big deal, but we knew that it was time. Now I didn't just walk in and take her keys because that wouldn't work. My mother is a very independent woman. We started having the conversations a year out, mommy you know, your driving is like not before and she would just get quiet. And then we will say one thing and the other, you had another little bump up and she would get quiet. And eventually we got her to surrender, to surrender her keys, and one day I was in there, she was complaining about her cars and stuff. And I said, well, you know, Queen Elizabeth's husband, he's 90 something years old, he gave up his driver's license. And my mom, just as stubborn as she could, said yeah, but you know what, you don't need a driver's license to drive, you know, so then she didn't give up her keys. And she was so right, and the way she hit us, she said, listen, we are fighting for our independence. And as a child, you're the child, I'm the adult. And you get into that all the time. I'm the adult, you're the child. But at the same time, you have to look at it and manage it like you are the adult. You are my mother, you are my father. I love you. However, I have to make some tough decisions right now that's gonna affect you and it's gonna affect me, and I'm not always going to be her pumpkin. That was her favorite nickname for me. She loved her Punkin. Well, sometimes I know the pumpkin gets on her nerves, but I'm doing what I think it's best for her, and for the family. Because the last thing I would want to happen is for my mother to be out there and hurt herself or hurt someone else because she wasn't in a position to drive. 

Jeff Thigpen: [00:15:51] What is funny is I've got your book and I'm looking at the page where you share the story. And it says, she looked at me with that contagious smile and said, yeah, but I bet he didn't give up all his sets of keys. 

Odell Cleveland: [00:16:02] Exactly. 

Jeff Thigpen: [00:16:03] Remember, you don't need your driver's license to drive, you need keys.

Odell Cleveland: [00:16:07] That's what she said. 

Jeff Thigpen: [00:16:15] She sounds like someone I would really like.

Odell Cleveland: [00:16:18] I think they described my mother as a pistol. You know, she's a pistol, but I love her, sharp tongue, but I love her. And she still, from time to time brings that up. You know, I can't go where I want to go. I'm depending on someone else, and who wants to be dependent on somebody else, mainly her children.

Carly Malcolm: [00:16:31] So you talk about caregiving with your siblings, you know, that sibling rivalry, what do you see as important when you're caring for someone like your mother, who you love.

Odell Cleveland: [00:16:38] My mother put me in charge as the person who could sign all the documents, the person who could do all this kind of stuff. And we've always got along well as children. It was four of us. My youngest sister got killed tragically in a car accident. When you have the power of attorney, and you could sign things over, you could do all this kind of stuff. You have to be careful because I was chosen to be the one. But then that means I have a sister and a brother who wasn't chosen. So I immediately started asking my mother, why did you choose me. And she said, I didn't choose you. The attorney chose you, you know, so it's like, nah, nah, nah. So that's a whole another deal because when parents choose someone to be in charge of all their affairs, you have to be careful. So immediately what I did, I said, okay, the bank accounts, let's put my sister and my brother's name on the bank accounts, not mine. And you start giving up the responsibility, and the accountability because, Naughty immediately said, okay, Odell, if you have the power of attorney and everything else, what happens if we need a check to pay for something? You’re in Greensboro, North Carolina, we in Charleston, what do we do? You're going to come down here every time you write a check. And I knew my brother, I knew him. I knew his personality. So that was passive aggressive saying, I don't know if I agree with this decision, you know, but he wouldn't say that. So I immediately say you are absolutely right. Let's do this, let's open up a separate account that is not my mother's money, but the money the siblings will put in to help cover things and Naughty you and my sister, Glen, you all will be responsible on that account. And that kind of brought everything down, you know? It brought everything down to say, okay, he's not tripping. He's not ego tripping. He's not trying to act like he's the big cheese, and we all work for him. And that's important because remember, I don't know, well, you have sisters and brothers, sometimes you disagree over something, and 20 years later, it boils down to what you disagreed about when you're three years old or when you were five years old or when you were 13 years old. And right now we don't have time for that. We're trying to come together as adult children caring for elderly parents. 

Jeff Thigpen: [00:18:45] Right. And you spend a chapter talking about how to have a family meeting. I thought that was really interesting. A lot of us, you know, when I read that I was going well, you know, yeah. We kind of have these conversations, but you were really deliberative about talking about the need to have a structured conversation among your siblings and even inviting your mom to be a part of that. Can you talk about that? 

Odell Cleveland: [00:19:08] Yeah. You have to, you have to invite the person who you are caring for because in a lot of cases we act like it's us. Well, it's not us. It's all of us. And that person who we're taking care of has to have a say so or buy-in. So I said, okay, I won't go through all the steps. Those who would love to purchase the book will see all the steps, but it's just a structured way of how you bring people together on neutral ground. How do you let people know what the meeting is going to be about? You're not ambushing anyone. You're not having these sidebar conversations, you don’t have hidden agendas. This is what the meeting's going to be about. And I don't know about you all, but in every family and my family, not immediate family, but we have drama kings and drama queens. We have people who they're emotional and they're going to just kind of blow the meeting up. And when you ask them a question that they don't want to answer, they're going to say, well, whatever. Well, that's not allowed. That's not allowed and you let people know upfront. You have to participate, either going to be a part of the problem or the solution, but you can't say you didn't know. Because a lot of people say, well, if I had known, I would have did this and I did that, no, you know, here's the agenda. Only what we’re going to talk about is what's on this agenda. And if you have something else that you want to bring up, okay, we're going to put it in the parking lot and we'll deal with that on the next meeting and a structured meeting cuts down on a lot of the craziness, a lot of the craziness. But you send it out two weeks in advance. Let everybody look at it and say, you know, just like any other meetings. Not Robert's rules of order per se, we don't want to go that far. But we want to say, look at what we plan on talking about, please share your thoughts with everyone, because that takes away that power of that person talking to this other person on the side. No, everyone, because we have nothing to hide. We have a loved one who's dying and we want to go from point A to the best way we can to the grave side. So how do we make that happen, and I need everybody to participate. So that's how I did it. And I think it's like eight steps and people tell me those steps are just so important to them because they didn't know everything from being on mutual grounds, it’s not a one person house, what do you do with the children? You know, all this kind of stuff and just open and honest conversation, because I think one of the things that we miss, we want everything to be fair. Well, it's hard to be fair when one sibling may have more resources, financial resources than another, another sibling may have more time than someone else, and another one may not be the best at emptying surprise bed pans. You know, everybody can't be a caregiver. Everybody doesn't have it. However, everybody can do something. So let's decide what you're going to do, and once you decide what you're going to do, then we commit to it. Because it's not fair to say, well, we all got to split it 50, 50, 50, that doesn't usually work.

Carly Malcolm: [00:21:44] Right. So another thing you talk about in your book is that sometimes caregivers can be designated the explainer in chief. Can you talk about what that means?

Odell Cleveland: [00:21:51]. You know, that was like going to the hospital. You go to the hospital, Mom goes to the hospital, you have all these gidgets and gadgets and the doctors coming in and telling you this, and everybody's telling you that, and people calling you on the phone, family members calling in the phone, well, what's going on with mom? What's going on here? And you like, I don't even know. There's so much stuff going on and everybody wants you to explain everything to them, and they're asking you questions. And they're asking about the medications and asking you about the insurance and Medicaid, Medicare, private pay, the doctor's appointments and all this kind of stuff, and it's just overwhelming. And why you have to explain to everybody over and over and over again, and then people get upset about mom or dad's condition and sometimes that frustration, anxiety being upset, rolls on to you as the caregiver, and you don't need that. And a lot of times people don't understand, you know, someone may call the register of deeds office and they are upset about the death certificate. It's not about the death certificate, it’s about the death. It's about the death! That's what they are upset about. And you have to level them out, help them, even though they’re yelling, even though they're screaming, even though upset. And that's what the explainer in chief means. You have to have the mental capacity to help everybody understand the truth while not allowing them to create their own narrative.

Jeff Thigpen: [00:23:14] That is an incredible point and leads into the next question I was going to have is that you write about, as a caregiver, when things fall apart. And you started it with the serenity prayer, but you mentioned there was an expanded prayer that was shortened related to the AA serenity prayer. I'll leave the reader to read that longer quote, I'll say it spoke to me. But I thought it was really interesting that you... and you do that throughout the book. Is that you do a really good job of, again, soberly as a caregiver, you're not only dealing with the great times. You're dealing in many cases with situations that fall apart, not just with strangers, you know, you're dealing with family members who are deeply committed to the situation and there's so many dynamics at play. So can you talk a little bit about the idea of things falling apart as a caregiver and what that means?

Odell Cleveland: [00:24:09]  Well, I think that a lot of times we have a plan. We're going to do this, this, this, the scenario that I used was we had a big tree and the tree fell during the storm. The tree fell. The tree blocked the street and tore up our fence, it tore up the neighbor's fence. It knocked down the power line. So we had the forestry come in, the EMS comes in, the fire truck comes in, all that stuff, and that's the last thing a caregiver, my brother needed. It fell on his boat that was in the yard. And you have to understand that that scenario was similar to how things fall apart in our lives. We are sitting there thinking we got it all under control and we are so overwhelmed that we're not asking for help. Well, we asked for help, we say, well, I shouldn't ask for help. They see what's going on. They understand, but we asked you, do you need help? You like, I got it, I got it. And then all of a sudden you blow up and you're like, no one’s helping me. No, one's doing this. No, one's doing that. And that's the part about when things fall apart. Because in my personal life, a lot of times, you know, I think I have certain things then the next phone call or my son in California might need something, or my son and my grandkids in Charlotte may need something, or my wife may have to work overtime, but it's so much. So we have to give ourselves permission to not be perfect. We're not perfect. We give ourselves permission. It doesn't always work, you know, the way we have it planned. So if we give ourselves permission to come up short sometime, then it'd be okay. But if we don't. Then we're going to cause problems for us and problems for others. Because a lot of times we are not in control. We don't control this. We think we are, we can manage it, but we don't control it. And that's what the whole thing about what things fall apart. Giving people permission to be real 

Carly Malcolm: [00:25:49] So near the end of the book you discuss memories sort of as a segue into potential health problems as we age, whether it's dementia or Alzheimer's. Can you talk about those things?

Odell Cleveland: [00:26:00] Yes, personally. My mother, I don't want to say, I don't want to analyze her or do anything like that, cause I'm not a professional to do that. However, I know it's easier to communicate with her early in the morning than in the evening. I know sometimes she will repeat herself and sometimes she’ll forget certain things. So for me personally, I sit there and look at my mother sometimes and say, wow, this is a strong black woman who's been there for me and everybody else. I remember once when I was in the third grade, my mother, you know, I've talked about her having a stroke. She walked three miles to the elementary school because they were going to put me in a special ed class. And I remember her walking with a wooden cane in her left hand and a metal brace coming off to her thighs on her right leg. And she came down there to make sure that they didn't put her pumpkin in special ed class. And this is a woman now that struggles to get out of bed, to use the bedpan. And, you know, you just think about it. And the memories, and I say this a lot. One day I was flying back from Israel, we were coming back from an Israel interfaith trip and I thought if one black single divorced mother can take care of four kids in the South, in the sixties, early seventies. Why can't the three remaining kids take care of one mother. Those are the memories. That's the stuff. That's what drives me. That's why I'm committed to, in spite of, I'm gonna do everything I can do, understanding now that I have a wife, I have a career, I have a lot of other things, but how do you walk away from the memories? How do you walk away from someone who did so much for you and help you become who you are today? So I remember her as where she was, but I have to fight the memories back to deal with the reality of where she is now and the role that she played in my life then, now I have to play kind of like a reverse role in her life, and with the understanding way back in my mind that one day, Odell, someone's going to play this role for you. So when it comes to memories, you know, she kept forgetting and I remember as a child, there was this beautiful picture of her Olan Mills. I don't even know how we can afford to have Olan Mills' picture when we were so poor. But a beautiful picture of my mother that I fell in love with as a child. And I remember asking her a question once, I said, mommy, why did you take this picture? And she said, well, I was 24 years old and I felt something was going to happen to me. So I took a picture because I didn't want my children to ask people what my mother looked like, who was my mother? So she took the picture and I remember making copies of that picture and I put it all over the house because I wanted her to always see that picture and remember who she was, you know, who she was. And that's the memories, because if we're not careful, she'll forget who she was and we'll forget who she was. And it's more to life than just this last chapter. You know, it's a lot, there’s a lot of good, there's a lot of bad. It's a lot of mistakes. It's a lot of good times. And if we're not careful, we’ll just remember the thing that hurt us the most, you know? 

Jeff Thigpen: [00:29:04] That's a powerful statement. With this journey that you've been on since, you know, from the beginning, just in terms of growing up in Charleston and the struggles that your family had to go through in addition to your mom having that stroke when she was only 25 and the caregiving experience that your brother has gone through as well as now, in terms of the extended family. You know, there is this point near the end where it talks about the time where caregiving ends. And I go back to the question that you actually mentioned, which was that you ask at the beginning and then ask at the end, when your time as a caregiver is over, will you feel relieved or guilty and will you feel guilty for feeling relieved and that's heavy. And I think at the end, you talk to someone who gives you a nuanced answer to that. So I guess that'll be kind of the final question is, you know, how do you talk through the caregiving experience as it's ending? 

Odell Cleveland: [00:29:58] Well, you go back to the beginning, you go back to the beginning. You go back to as a person, and I'll make this short, as a person, I couldn't go around hating white people because my mother was misdiagnosed and I think she was misdiagnosed because of biases, and she was a poor black woman. If I allowed that to be the end of the story, then I’ll be hating white people for what happened to my mother. And then I'm hating people who had nothing to do with that. But I'm so bitter, I'm so hurt, that's so deep inside of me and I'm hating everybody. Well, we know what hate does, hate destroys the person who's harboring any caring and nurturing the hate. Now my mother taught us not to hate anyone. My mother never, ever talked about someone who did her wrong. She didn't do that. We focus on God, thank you for allowing my mother to live. Because she said, when she was going through her journey in a hospital, she said, God allow me to live long enough to see my children be grown. That was her prayer. It wasn't God, give me vengeance on who did me wrong. So now when you go to the end and the person said I was talking about his mother. He was taking care of his mother for six months and he said, Odell, you know, I had so much going on with my mother and I wanted her to die, but I didn't want her dead. And I think that's the statement you're referring to. He said I wanted her to die, but I didn't want her dead. And what I got from it, because I'm very careful not to interpret someone else's meaning, but what I got from it, and he agreed is that she's going through a lot. You know, she's going through a lot. My mother is going through a lot. Now my statement is not, I want her to die, but I don't want her dead. That's not my statement, but I often think, how long, Lord. Not how long for me as a caregiver, but how long for her. You know how long for her, but that's way out of my pay grade. That's between her and God. That's the same conversation that her and God had when she was laying in the hospital for three months and they didn't know whether she was gonna live or die. So, if they can have that conversation, they can have this other conversation. I'm not trying to preach to anybody, but at the end of the day, I want to stand on the side of the grave. I don't want to preach at the funeral. I don't want to be Reverend Odell, I want to be the son. I want to be Pumpkin. I want to sit on the front pew and say, God, I feel good that I did all I can do to take care of my mother. So I'm relieved that she's with you, but I'm not even guilty for feeling relief. I'm happy that I'm relieved. I'm happy that I don't have the responsibility of caregiving anymore. Now other people say, Oh my God, you’re selfish, blah, blah. They can say what they want to, let them come and change those bad times. Let them call me right up and down that high. And I'm not complaining. I'm just trying to be real. And that's what this book is all about. It allows people to be real because a lot of times we can't even be honest with ourselves. 

Jeff Thigpen: [00:32:45] That is an incredibly heartfelt response. And in terms of reading the book, I was left feeling that in your writing is that these are incredibly human stories. You are going on an incredibly complex journey in the book around caregiving. And one thing I'll mention as we're moving toward closing is that we're going to focus on health inequities. And I think, you know, for example, race inequities, those things can be life and death. And the situation with your mother is a perfect example of being in a situation where she needs immediate care with a serious illness and doesn't get it in a way that could have had a qualitative difference on her life. My heart is so appreciative of you in sharing the impact of caregiving as it is ending. And I'm also thinking about, you know, based on this message, what is our responsibility to make sure the dignity, worth and potential of everyone is valued as it relates to not only being a caregiver, but receiving care. And so, Odell, I really appreciate you being here. I know Carly and I have really enjoyed the opportunity to talk to you about your book. The book is called It's my turn now: Caregiving 101 by Odell Cleveland. You can purchase a book at www.OdellCleveland.com. And it is a book that is both easy to read and some way short, and it is also when you can really marinate on and that at different points of the book, it really speaks to your heart about being a caregiver and what that means. So Odell, thank you for your leadership in Greensboro. Thank you for what you do, not only within the faith communities in the church at being a person that is always trying to help our community find common ground around a lot of things. I appreciate you for doing all that. And I really do appreciate you for writing this book. So thank you very much for being a part of the Good Grief Podcast.

Odell Cleveland: [00:34:34] Listen, and thank you all both for having me. And I just think Good Grief is amazing. I love what you all are doing because we need it. We need it. Thank you. 

Thank you. 

Outro

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.Guilforddeeds.com You can also email us at endoflife@guilfordcountync.gov or find us on Twitter with the handle @guilford_ROD. We hope you've enjoyed this episode and until next time, take care.

Intro

Hi, this is Jeff Thigpin, Guilford County Register of deeds. And I'm Carly Malcolm, lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast, and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:01:00] This is Jeff Thigpen, Guilford County Register of Deeds with Carly Malcolm, lead for NC fellow from the North Carolina Institute of Government and welcome to The Good Grief podcast. Today we're going to talk about elder care and estate planning with attorney, Dennis Toman. A certified elder law attorney at the elder law firm in Greensboro, North Carolina. Born on the plains in North Dakota, Dennis had a big family and he learned the meaning of hard work, being frugal and planning ahead. After attending law school in North Carolina, Dennis founded the Elder Law Firm with a mission of planning and helping local families be better prepared for elder care and other legal issues on the backside of their lives. Dennis, thank you for being with us.

Dennis Toman: [00:01:46] It's my pleasure. I'm very happy to be here. Thanks for having me.

Jeff Thigpen: [00:01:49] Yeah. Dennis, why did you choose, after going to law school, to specialize in elder care law?

Dennis Toman: [00:01:57] Well, that's a question I think about a lot myself. I don't think I ever planned to actually start and do elder care law, I've always thought I'd come out and be a corporate attorney. I got an accounting degree and came out of law school and planned to be a corporate attorney, in fact, that's what I did for quite a while. But I had the opportunity to help some families who were facing problems with, you know, finding care, paying for care, how to make sure that, you know, with the spouse in the nursing home, they didn't lose their house, and I was fortunate to help them. They really appreciate it, I enjoyed doing it, and it really comes down to family. This is a wonderful way to be able to help people who are concerned about their family and making sure things turn out better.

Carly Malcolm: [00:02:41] What does a typical day in the life look like for an elder law attorney?

Dennis Toman: [00:02:45] Well, for my office and what we do, we really take more of a planning aspect and so we don't spend much time in court. In fact, our goal is to keep people out of court. You know, we're talking with families who are at various stages along the estate planning eldercare journey continuum. And so we talk about what's important to the people who have concerns, maybe there's something that's keeping them up at night, they're worried about what's going to happen, as part of if they were to become disabled, and their loved one was to become disabled and unable to make decisions. You know, they're worried about the probate process, or perhaps they've lost a loved one recently and need to think about how to administer an estate. So we spend a lot of time talking with families to consider what they're worried about, consider what some of the possibilities would be for them to proceed and implement good plans and keep them heading in the right direction, you know, for whatever life throws at them.

Carly Malcolm: [00:03:50] So what are some of the most important questions that proper estate planning would answer?

Dennis Toman: [00:03:55] Well, when we're talking with our clients, you know, there's really three questions that we always want to make sure that we answer and that they feel comfortable that they have answered. And the first one is the one that quite often people will come in and that's, that's what they think about for estate planning. And that is, what happens if they die, what happens if a loved one dies? What's going to be the process of making sure property transfers to the right people, you know, what can be done to perhaps avoid some of the probate process in the court administered estate administration? So what happens if the person dies is one critical question. But then really, the question that I think winds up being even more important is what happens if a person doesn't die, but instead, they're going to need care. How are we going to get that care? Where's that care going to be received? How are they going to pay for that care, hopefully, without having to grow go broke? So you know what happens if they don't die, but they need care. And then that third question which often I don't get asked, but I bring up and once I bring it up, it becomes just a sigh of relief that yes, this is going to concern. And that is what happens if they don't die, but they get Alzheimer's and they aren't able to make their own decisions, or perhaps they have a stroke, where they're not able to make their own decisions or an accident or injury. And in that situation, having the right decision makers in place to make sure that their wishes are carried out that the people that they know and trust and love are going to be the ones who are making those decisions for them. And that the documents that we put into place can wrap around and protect them in the way that it needs to be that perhaps typical estate planning might not do.

Jeff Thigpen: [00:05:45] So you mentioned documents, what estate planning documents do you think that people should have?

Dennis Toman: [00:05:52] Well, there's some basic pieces to this and that's where you start and then maybe you go beyond that a little bit further depending upon the situation. And of course, most people that we're working with are not dealing with the state tax issues. So the concern is going to be, you know, not directed at complex tax matters. So for most people, the situation that we're going to be looking at is, well, they need a will, everybody needs a will, but they need to have more than a will. So somebody comes in and says I've got my estate planning done, because I've got my will. No, they really don't have their estate planning done, in fact, they're missing probably the most important parts. And that is, besides the will, pretty much everybody needs to have in place, a good solid, I call it a powerful power of attorney for financial and legal decisions. And that's where I see too many people fall short. The other type of power of attorney that we need to have in place is what's called a healthcare power of attorney, for someone to be able to make medical decisions in case the individuals unable to make or communicate their own decisions. So those three documents, will, healthcare power of attorney, financial power of attorney, critical, as well as having a living will that expresses wishes about what types of care should be provided If a person's not going to get better, and they're not able to make their own decisions. As well as and this is something that gets overlooked quite often we want to have a HIPPA release or a medical privacy release in place because we don't want somebody to be in the emergency room with any question about the family members being able to talk to the health care providers because of the HIPAA laws. So we start with that, a will, financial power of attorney, healthcare power of attorney, HIPPA release, and a living will, which is the declaration of the desire for natural death. And then quite often, depending upon, you know, the situation, what assets are there, the family matters, what the goals are, we'll implement some sort of trust based planning either a revocable trust, or sometimes it's a protect your trust to make sure we can put assets into a trust that provides additional protection for the family.

Jeff Thigpen: [00:08:10] Yeah, so you've mentioned about seven documents here dealing with the individual and also the financial issues to communicate one's desires needs and or to help protect the person or the families in terms of making these decisions. A lot of times, well, I do a lot with Land records and we have, sometimes people come in and say, yeah, I want to transfer land, and they go, do I really have to have an attorney? And sometimes it is not necessarily the desire around, you know, they want to try to do it to get it done but they may not get it totally right, sometimes they want to save money. As an attorney who does this, what do you see usually, is the cost factor involved in proper estate planning? And do people need a lawyer's help? Can they do it themselves? You know, what are the maybe the benefits and consequences of that question in terms of your, your perspective?

Dennis Toman: [00:09:05] Sure. Yeah. And I think that's, I mean, the, the, I think you bring up a good point, Jeff, in that the first need is for people to see the need. They have to understand that something needs to be done and then the next question is going to be how are they going to get it done? And there are situations where, you know, very straightforward, perhaps not as much as you know, that there's going to be at risk if there's a mistake made, that somebody could get a will done, perhaps with, you know, by themselves, or, you know, through an online service, you know, very straightforward situations, you could save some money doing it that way. But the real problems arise, you know, in situations that aren't quite so straightforward, unfortunately, everybody thinks their situation's simple. They always think, you know, I don't have anything you know, complicated, but the, I've been practicing law long enough to understand I don't know all the answers, but I know a lot of the questions. And so the advantage to someone who has seen the need, we need to do something, get the right plan in place, in working with an experienced estate planning elder care attorney is going to be they have the opportunity to say what they're worried about and to have that conversation about, well, this is, you're worried about that, but have you also considered this? To, you know, say, Okay, well, this is what you'd like to accomplish but what if something a little bit different happens? How are things gonna work out, then? So the real cost of, you know, not having the right proper estate planning can be enormous, you know, problems with family disputes, problems with estates getting tied up in court because there's a mistake that was made on the will that somebody wrote up themselves, and it left out something that was very critical, it wasn't clearly written, and didn't have enough, you know, backup, you know, alternative results, if it's the first thing didn't happen, what was going to happen in the other situation, you know, problems that occur that if they're not thought through, are just going to be devastating for the family. And so the costs involved, plus the fact that people don't get a second chance at this, you know, they go ahead and prepare their documents, we help them with that. They're not written in stone, they can come back and change it if life changes, and they have, you know, want to change later, they certainly can. The problem is when somebody loses the ability to sign their documents, if they become incapacitated, unable to make their own decisions, or if they died, we can't go back and change things. And so they weren't done right that time, you know, then they've got a real problem on their hands. And that's why we want to make sure people get the appropriate help to get the right plan and documents in place for them, and that they can just then go on living life and not keep worrying about Gee, did I do that right? Should I have done something different? You know, and just be able to have that peace of mind to say, Hey, this is taken care of, now, let's go ahead and you know, not worry about it for a while.

Jeff Thigpen: [00:12:18] So people can, you know, hear what these documents are and some people say, well, yeah, I think I could probably do this, but I'm telling you. I know, there gonna be a lot of people listening to this and I just say, it sure is beneficial to get the advice of an experienced attorney in dealing with these kinds of issues because I know you all deal with this every day, you see the situations that come up, and you can really do a good job helping families plan, individuals and families, plan this in such a way that peace of mind in terms of getting that counsel can be extremely helpful. So yeah, thank you.

Carly Malcolm: [00:12:50] So you told us about the documents that the typical person would expect to need. But are there any special situations that might need some extra attention in terms of estate planning?

Dennis Toman: [00:13:00] Yeah, I think, you know, obviously, one that's very common is when we've got blended families, when we've got second or third marriages, and there's children from prior marriages. Those are going to be situations that we need to spend some extra time thinking about, not only how does property pass, but also who's going to be in charge, who's going to be the decision makers, and how's that going to work out, because blended families, you know, maybe a very simple, you know, ready for everything just to go to, for example, the surviving spouse, and then let them make the decisions but sometimes that's not going to be the best result. Another special situation would be if we're dealing with a family who has a child with special needs, and they're likely to be unable to work and take care of themselves and probably are going to need care over their lifetime, and most likely are going to require and be able to benefit from financial service through government programs such as Medicaid. So when we got a child with special needs, the parents can take action to make sure that the inheritance that they would leave for that child will not interfere with those government programs. And also that the inheritance can be appropriately managed so that it really benefits that child and improves their quality of life, that becomes absolutely critical in that regard. And then, you know, there's many other special situations, but the other one that I would mention is when we're dealing with a diagnosis of Alzheimer's or dementia, because so often, when someone has a diagnosis of Alzheimer's or dementia, they're perfectly able to make decisions on their own now, but the writing is on the wall that it's very likely that soon they won't be able to know soon might be years from now, but it's critical for them to meet with, again, an experienced Elder Law estate planning attorney who can say okay, these are the things we want to make sure we've got to put into place. And it may be that it's a caregiver spouse who's wanting to protect the ill spouse, the spouse with Alzheimer's, just in case the caregiver spouse dies first, how are things going to turn out better for that surviving spouse, you know, we never want to see somebody out of money out of options at one of the most frail and vulnerable times their lives and having the right plan put in place means we can protect that surviving spouse, so that we don't have to worry about them running out of money and, you know, trying to live on what little bit they can keep after they are eligible for Medicaid. So those are just some of the special situations, obviously, estate tax issues, charitable inclination, planning to weave money for charity, you know, situations where children may be likely to go through, you know, marital problems, their own divorces, or even you know, might be sued, ways to protect that inheritance again, for that child. Those are all special things that people need to consider as part of their plan. And all of a sudden, they realize that, hey, maybe this isn't just a simple will, and you're done. But there's more to it involved. And so that becomes very important too.

Carly Malcolm: [00:16:18] Thank you for that. Could you describe the typical process of getting in place the right estate plan?

Dennis Toman: [00:16:24] Sure. Then, again, I think, you know, Jeff made the point, that observation and it was a good one. First, you know, where there's the need, you know, need to go out and get a state planning done and so that's all through life. And one of the things that people don't really understand is, as soon as their child turns 18, their child needs to have a power of attorney in place too, because once the child is an adult, the parents can no longer make decisions for that child. And so without a proper power of attorney in place that the child has, maybe naming the parent as a decision maker, they're going to be left to the guardianship process, which they really want to try to avoid. In that situation. My point is that, you know, the need, and the need is all through life for brand new, you know, 18 year old adult, a college student, young person starting out and career, family, making sure that they got guardians name for their minor children, you know, all the way through to when we're dealing with someone who may be in advanced years, but contacting the lawyers office, they're going to probably set up a time to have an initial conversation about what you want to accomplish, what's important to you, what are the assets, income, health, family goals, that sort of thing. So it's a matter of, you know, understanding the situation, I call it a vision meeting quite often to make sure that we've got the right idea of where we want to go. And at that point, typically, the lawyer can provide a good estimate on what the price is going to be for providing those services and get the right plan in place. And so many families do appreciate having the, you know, the fixed price contract, which is okay, this is the plan we're planning to do. This is how much it's going to cost. Now we're ready to go ahead and get started. The next part is probably going to be a design meeting, to flesh out a little bit more some of the details, some of the intentions for how things will work out. And then based upon what the information that's been gathered, then do a signing meeting to go ahead and sign the documents and have them in place. We get them scanned in so the person has not only the originals, but a scan as well. And then an assistance with funding and making sure that assets are titled properly, that the right beneficiaries and IRAs and life insurance and annuities. And if there is a living trust, how to go about retitling assets into that living trust. So it really is a process. It's also not just an event, it doesn't happen just once. I think it's important that people review their estate plan over a period of time, you know, so about every three years, every three to five years, we recommend that people do that again because, you know, families change, health changes, finance changes. You know, I tell our clients, sometimes I get smarter, too. So you know, if they wait three years, I might know more three years from now, and, but it's just the critical thing is it's not just papers that go into a file or a notebook that gets put on the shelf, but it really ought to be revisited like I said, every three to five years.

Carly Malcolm: [00:19:40] One of the things that you mentioned in there was the concept of guardianship. When would it be appropriate for someone to appoint a legal guardian?

Dennis Toman: [00:19:47] Yeah, a guardian is going to be needed of course for a minor child who is going to own property. So sometimes, you know, particularly when someone doesn't have a will and they pass on, then a child who's under age is going to need to have a guardian appointed. And that's a court appointed, or court supervised process of determining who's going to be the guardian, a person can name a guardian for a minor child in their will, in their will. So that's very important for younger families to make sure that they've accomplished just in case neither parent is living. Another situation would be when someone's not able to make decisions that are in their own best interest. And so they can't, they've reached a point where they're no longer competent to make their own decisions. In that situation, there's going to be a need for a guardian, unless we've got the powers of attorney in place. And the guardianship itself is something that I encourage people to avoid whenever possible. Sometimes people come in and say, Well, I need to appoint a guardian for my husband, because he has Alzheimer's, or you know, my mom needs to have a guardian. Well, are there ways that we can avoid doing that? Are there documents in place already? Or do they still have enough capacity to sign documents that could avoid that guardianship? And so if we're going to need to have a guardian, that's one thing. Many people think, well, I'm not going to need a guardian, because my wife can make my decisions for me or my husband can make my decision. And in fact, the way the laws in North Carolina work is that the law presumes that if you did not get around to preparing a power of attorney, to name someone to make decisions for you if you became incompetent, if you did not do that, then the law presumes you presumed you, you meant not to do that. The presumption is that you didn't want to name a power of attorney, you wanted the guardianship. And so, again, The guardian is the default, but we prefer for people to have the powers of attorney so that we can avoid that guardianship.

Jeff Thigpen: [00:21:53] Interesting. Yeah, of course, we're living in the time of COVID. And there's been a lot of impact related to nursing homes and things of that sort, what rights are protected for people who are living in nursing homes in general? And how can someone file a claim if they believe those rights are violated?

Dennis Toman: [00:22:13] Yeah, right now especially is a tough time, for both the people in the nursing homes as well as the caregivers there at the nursing home. And so it's a difficult decision to place a loved one into nursing home under the, under typical times, in these times, it's even harder because of the lack of access to the residents due to the COVID concerns. And you know, in that regard, the number one thing is to try to have a relationship with the care team at the facility, the administrators, the CNAs, the nurses on the floor, that's always a good thing to do. And then there are North Carolina nursing home rights, which are, you know, include a number of provisions. And it's it, you know, those are actually posted at each nursing home. And then if there are problems, I encourage families to first again, talk with the administration at the facility. But an excellent resource here locally is the North Carolina Ombudsman, Long Term Care Ombudsman Program is right over in Kernersville. And calling them, getting them involved with concerns over the level of care at a nursing home or assisted living is an excellent way to start and make sure that you have an advocate on your side to sort through things. And sometimes that can't get sorted through and has to be, you know, go to a next level, but that's a great way to start.

Jeff Thigpen: [00:23:34] Dennis as Register of Deeds, I get questions all the time about families wanting to put their children's names on the deeds and that kind of thing in terms of when they get in these situations where they're dealing with loved ones who are sicker or dealing with death and dying. What do you ever take on that?

Dennis Toman: [00:23:50] Yeah, that's a question we get asked all the time. And the answer is, of course, people want to protect your house, especially if they're going to need nursing home care down the road, because there's Medicaid estate recovery, which can result in the house getting lost to the government if the person in the nursing home is on Medicaid. And so in order to protect the house lots of times they say, well, should I just put my house into my child's name? And the answer to that is be very, very careful before you do that. And the reason is that once a person puts the child's name on to the house, some unexpected things are going to happen. You know, number one, if you put your child's name onto the house, that means anything else is going to be done from there on out is going to require their signature and if they're married their spouse's signature too. And so that, you know, don't make a gift to your child unless you also give it to your son in law, our daughter in law. And the other is of course, there's a five year look back for Medicaid purposes that a person is going to be ineligible for a period of time if they need to apply for Medicaid within five years after they've made that gift. Plus, there's the other issue of taxes, which I've just seen too many horror stories happen, where people have put their child's name onto their house thinking everything was going to be fine. And then they find out, they created tax problems, they created family problems, something happens to child, the child dies, or becomes disabled or goes through a divorce, you know, life happens, and their child's name is on the house now. And the parents are the ones who wind up paying the price. There's much better ways of planning to protect the house than simply deeding the house over into the child's name. And usually that's going to involve some sort of protector trust in planning ahead or if we're in a crisis situation, there are other strategies that we may want to employ. But we don't want to just put the house in the child's name, unless we thoroughly consider that first.

Jeff Thigpen: [00:25:47] Well, thank you very much for answering that question because now when folks come in my office and they ask, hey, should I do this? My answer is always you may want to consult an attorney. Thank you for offering that up because that's the reason why. All right. Well, thank you so much attorney Dennis toman, who is a specialist certified in elder law with the elder law firm in Greensboro, North Carolina. Dennis, on behalf of Carly and myself, we really appreciate you coming in and spending some time with us. Well by phone around issues of elder care, around estate planning, helping us understand all of these documents and why they're really important and the impact that they have on our lives and why it's so important to think about these things now. We like to talk about on the podcast that we know in many cases, we live in a culture that has a hard time preparing for issues of serious illness and death and dying. And sometimes when we're not doing this planning, it sneaks up on us and causes all kinds of problems. And as someone who was a part of that system in terms of the registered deeds, who worked for the clerk's office and many other government institutions, there are attorneys like you who are out there who help members of our community navigate through not only the issues of making sure this stuff is done, right and it reflects their wishes. But it's also the practical matters of trying to take care of things when people lose their loved ones. And so, planning is so important. And thank you so much for taking the time to come in and talk with us on the Good Grief podcast.

Outro

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.Guilforddeeds.com. You can also email us at endoflife@guilfordcountync.gov or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

Robert Garcia (Ejecutivo de cuentas en Trellis Supportive Care)

[Intro]

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do. Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

Carly Malcolm: [00:01:00] Hola a todos y bienvenidos al podcast “Good Grief.” Me llamo Carly Malcolm, soy una becaria de la Escuela de Gobierno de la UNC en la oficina de Registros Públicos del Condado de Guilford. En este podcast, hablamos de temas de muerte y morir, porque queremos que todos en nuestra comunidad no solo puedan vivir bien, sino que, cuando llegue el momento, su pesar sea más tolerable y poder morir en paz. Muchas veces es difícil pensar y hablar sobre este tema, y por eso estamos aquí para tener esas difíciles conversaciones y eliminar el misterio y el estigma de los problemas relacionados con la muerte. Hoy tenemos un invitado especial, Robert Garcia. Robert es un ejecutivo de cuentas en Trellis Supportive Care, ubicado en Winston Salem. Robert ha trabajado en Trellis por casi diez años. También es director del Consejo de la Autoridad de Tránsito en Winston Salem y es embajador de la Cámara de Comercio del Condado de Davie. Robert tiene mucho conocimiento sobre los problemas que afectan a las personas mayores. Ayudó a formar HIPSS, una organización de profesionales de la salud que sirven a las personas mayores, y ha sido presidente de esa organización. Estoy feliz de tener a Robert con nosotros hoy para informarnos sobre Trellis y explicar algunos malentendidos comunes sobre el hospicio. Hola Robert, gracias por estar aquí.

Robert Garcia: [00:02:24] Ah, pues muchas gracias Carly. El gusto es mío.

Carly Malcolm: [00:02:27] Usted puede decirnos, ¿Qué es Trellis Supportive Care? Y ¿A cuáles comunidades sirve?

Robert Garcia: [00:02:32] Bueno, Trellis Supportive Care, hace dos años que cambiamos el nombre. Antes era Hospice and Palliative Care Center. Pero en celebrando cuarenta años de ser la primera compañía del hospicio, cambiamos el nombre a Trellis Supportive Care. Nuestra oficina está en Winston-Salem, pero ahorita, o cuando comenzamos, comenzamos en Winston-Salem. Pero ahora, podemos atender a gente entre trece condados, por ejemplo aquí en Guilford, en Greensboro, en Thomasville, Lexington, Yadkinville, Mocksville, Salisbury, Walnut Cove, unas ciudades que tenemos aquí cerca, y nosotros comenzamos la primera compañía del hospicio. Pero ahora hay muchos, pero nosotros fuimos el primero.

Carly Malcolm: [00:03:22] Sí, y ¿Qué servicios se ofrecen?

Robert Garcia: [00:03:24] Pues, hospicio. Trellis Supportive Care es una compañía del hospicio y también ofrecemos cuidados paliativos.

Carly Malcolm: [00:03:32] ¿Cuál es la diferencia entre cuidados paliativos y el hospicio?

Robert Garcia: [00:03:39] Ah, eso es una pregunta que todos tienen. Hospicio, y dejame primera explicar lo que es hospicio. El hospicio es un tipo de medicina, no es una casa, no es un lugar, es un tipo de medicina para el fin de la vida. Cuando uno tiene una enfermedad terminal, y los doctores y el hospital dicen que tiene seis meses o menos de vida, y también no está recibiendo tratamientos para aliviarse. Ese es hospicio. Bueno, cuando uno dice “palliative care” como se dice en inglés, cuidados paliativos, eso es un tipo de cuidado cuando uno tiene una enfermedad muy grave, pero todavía está recibiendo tratamientos para aliviarse. Muchas veces hay dolores y cosas que pasan con la persona fuera de esa enfermedad. Nosotros podemos ayudar con eso. Por ejemplo, cuando uno tiene cáncer, y están recibiendo los tratamientos pero muchas veces se ponen malos de otras cosas afuera de la cancer. Nosotros podemos ayudar con eso. Pero, sí es muy diferente cuidado paliativo y hospicio.

Carly Malcolm: [00:04:59] Y ¿Cuáles son las consecuencias de los malentendidos comunes sobre el hospicio?

Robert Garcia: [00:05:04] Pues, eso es una cosa que pasa por todos los estados unidos. Por ejemplo, la gente que necesitan hospicios, casi 60% de la gente que pueden recibir servicios no tocan servicios porque no entienden, porque muchas creen que cuando uno va al hospicio, es que están dejando vivir a la persona, que ya no tienen más vida, que van a hacer algo para… Los tratamientos que tenemos nosotros no es para aliviarse. Por ejemplo, la persona ya tiene una enfermedad terminal, ya dijen los doctores que tienen 3 meses, 5 meses, 6, lo que sea,y nosotros, el trabajo de nosotros es para ser la vida que tienen hasta que llegue ese dia, es lo mejor que podemos, para atenderlos, para tenerlos sin dolor. Y también para ayudar a la familia. Como yo digo, cuando los doctores que tal le dicen a alguien tienes que hablar de hospicio, bueno pues la familia también están sufriendo del corazón, de su mente, que ay dios mío ya llegó ese día. Bueno, sí, pero nosotros podemos ayudar y no no más el paciente pero también la familia, para hablar con ellos para que entiendan mejor. Es una cosa muy difícil pero si es mejor para la persona porque hospicio, como yo digo, es un tipo de medicina o médicos que son especial entrenados para atender a pacientes que ya están al fin de su vida.

Carly Malcolm: [00:06:45] Parte de su trabajo es visitar a los pacientes y sus familias. ¿Qué hace en estas visitas informativas?

Robert Garcia: [00:06:52] Ah, gracias por preguntar eso. Sí me da mucho gusto cuando me hablan en la oficina para ir a ver familias y pacientes. Por ejemplo, si alguien está en hospital y los doctores que tal dicen que la familia necesita hablar con hospicio, porque con la enfermedad y con todo lo que está pasando están recomiendan el hospicio, pero uno no sabe de hospital y no entiende lo que es. Bueno, lo mas necesitan es hablar. Cuando hablan, podemos decir vamos hacer un tiempo para ir en persona. Ahorita es muy difícil porque como lo que está pasando con COVID, pero podemos hacerlo en persona o también en el teléfono, o yo puedo ir y platicar con la familia y paciente de los servicios de hospicio. Y muchas veces es para explicar y para que ellos entienden, porque hay tanta gente que no entiende lo que es hospicio, en cualquier país o en cualquier idioma, todos tienen un modo de pensar en lo que es. Y yo entro y yo digo, mira esto van a recibir con los servicios, las visitas, las personas que van a venir. Todos las preguntas que tienen yo puedo contestarlas para que ellos están más a gusto cuando dicen, bueno estamos listos.

Carly Malcolm: [00:08:21] ¿Hay algunas preguntas comunes que las personas tienen cuando piensan en ingresar al hospicio?

Robert Garcia [00:08:27] Siempre no entiende lo que es hospicio. Me preguntan ¿Roberto que vamos a recibir? Y tengo que explicar, dependen en la persona van a tener una enfermera, doctores, y todo lo que necesitan para cuidar la persona en la casa. Por ejemplo, si necesita una cama de hospital, una silla de ruedas, una silla para el baño, lo que sea, todos llegan a la casa. También nosotros tenemos una farmacia y si algunas medicinas que necesitan, van a llevar a la puerta. No se tienen que ir a una farmacia para recibir estas medicinas. También las otras cosas que tenemos. Las preguntas son ¿cuántas veces van a venir a ver mi mama, mi papa, o mi hermano, mi hermana? Bueno, depende. Porque hay mucha gente que está al primero de su enfermedad y hay otros que están más adelante. Todos son diferentes. Pero las preguntas siempre son ¿qué vamos a hacer? Porque en todas las idiomas, todos dicen, pero me dicen que cuando hablan hospicio, por ejemplo hoy es jueves y ha tenemos no más de un día, dos días, eso no es cierto porque pueden recibir los servicios más temprano o más adelante en la enferma.

Carly Malcolm: [00:09:55] Usted también enseña talleres sobre la directriz avanzada y su importancia. ¿Qué espera que aprendan los participantes?

Robert Garcia: [00:10:04] Ay bueno, pues eso es muy importante. Por ejemplo mucha gente cuando ellos sé que usted oyó, hemos visto que cuando una familia esta en hospital y la persona en la cama no puede hablar, no puede decir lo que ella o él quiere. ¿Quién va a hablar por ella, por él? Bueno, si no hay alguien que él apunta, va a ser la esposa o hijos o hijas o niños. Cuando uno tiene sus papeles ya escrito y en frente de todos sus doctores en hospital van a ser, bueno pues yo tengo mi amiga Carly que va a ser la persona que va a hablar por mi. Dios no lo quiere, si algo pasa y yo no puedo hablar, ella va a hablar por mi. Pero vamos a tener esta plática porque, por ejemplo, para que Carly entienda lo que yo quiero o que no quiero, porque muchas veces en hospital, si hay 3 personas, 4 personas, hay 4 ideas que vamos a hacer, y los doctores necesitan entender qué quieren ellos para esta persona.

Carly Malcolm: [00:11:14] Si y quiero decir que yo asistí a uno de estos talleres y yo pienso que fue muy útil. Usted hace que un proceso poco intimidante parezca más fácil de entender y completar. Puede explicar, ¿Qué es el proceso de hacer eso, de elegir un poder legal para atención de salud o de tener un testamento en vida?

Robert Garcia: [00:11:41] Bueno estos dos papeles es, como digo, un papel donde uno dice, yo voy a apuntar una persona, y en muchas veces yo les digo apuntan dos personas quien va a ser esa persona que va a hablar. El papel va a tener sus números, sus teléfonos, toda la información para hablar. Mira, por ejemplo, tenemos a Roberto Garcia aquí en el hospital y dice aquí que Carly Malcolm es la persona que tenemos que hablar. Carly, somos el hospital, Roberto está en el hospital y tenemos que hablar con usted. Bueno, y luego, el otro testamento de vida es un papel que uno tiene que tener mucho tiempo para leer. No es muy difícil pero son cosas que usted, y dios no lo quiere, pero por ejemplo, que quiero yo si algo pasa en el hospital donde tengo una enfermedad que si es muy grave, terminal. Y voy a decir, mira, Carly yo no quiero o si quiero estos tratamientos. Al gusto, sin dolor, pero no se tienen que mantener mi vida si ya los doctores dicen que no parece, por ejemplo, Roberto tiene pero unos días de vivir. ¿Qué quieren hacer ustedes si algo pasa? Y yo quiero, por ejemplo, yo quiero estar en paz. No necesitan ponerme en máquinas, por ejemplo para ayudar con el respiro, o también con el corazón. Si ya me dicen que ya está a este punto, estoy bien. Pero lo apunté en el papel para que todos lean, porque eso es lo que yo quiero, no lo que otros quieren o no quieren. Estos dos papeles son muy, muy importantes y los talleres que tenemos son en inglés pero si también, si van a su computer, si se dicen gotplans123.org, uno puede apuntar español y todo está en español, también los papeles están en español.

Carly Malcolm: [00:14:01] Bueno, muchas gracias Robert por compartir sobre su trabajo en Trellis y la importancia de los servicios que ofrece. Tendremos enlaces en la descripción del episodio para los documentos y recursos que mencionó. Gracias por estar aquí.

Robert Garcia: [00:14:16] A pues si, muchas gracias, y también por favor háblanos. Es todo lo que tienen que hacer, como les digo, en cualquier idioma, lo mas necesitan es hablar si tienen preguntas. Y muchas gracias por invitarme hoy.

Carly Malcolm: [00:14:32] Gracias.

[Outro]

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[Intro]

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do. Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:01:00] Welcome to the Good Grief podcast this week. I'm Jeff Thigpen, Guilford County Register of Deeds with Carly Malcolm, who is the NC lead fellow from the UNC Institute of Government who's here and this week we have a special guest, Mr. Robert Garcia. Robert is an account executive with Trellis Supportive Care headquartered in Winston Salem. Robert has been with Trellis for about 10 years. He's been involved in a number of counties in this region. He is the current chairman of the Winston Salem Transit Authority, chairman of the board, ambassador with the Davie County Chamber of Commerce and he understands a number of issues as it relates to seniors and adult care. One of the things is the HIPSS, Healthcare Industry Professionals Serving Seniors. We'll ask about and talk about with him. And he's the president of that organization. Thank you very much for being with us today, Mr. Robert Garcia.

Robert Garcia: [00:01:55] Well thank you very much for having me.

Jeff Thigpen: [00:01:56] All right. Yeah, you and Carly connected and I'm, how did you all meet? Where did your passion for this kind of work begin?

Robert Garcia: [00:02:03] Well we met one of our networking events she spoke at. And so I, as networking events are supposed to go, you're supposed to network. And I thought, I want to find out what she's doing and so we connected I want to say about a month and a half ago. And she told me about the podcast and invited me on and I said, I'd be more than happy to come talk about the issues that are confronting, of course, our senior population and also too in the healthcare industry a little bit as it pertains to what we do at Trellis Supportive Care.

Carly Malcolm: [00:02:32] Yeah, So let's get into that. What do you do at Trellis Supportive Care? What communities does that organization serve?

Robert Garcia: [00:02:37] Well, I'm an account executive and I've done a little bit of everything in my 10 years. Right now, my main focus is community outreach and awareness. I've also called on referral forces, ie. hospitals, doctor's offices assisted living, skilled nursing facilities. I think I said doctor's offices, but right now it's community outreach and awareness where I reach out to the community, whether it be large businesses, County governments, city governments, civic groups, where I go and I, and I do workshops for them. I can do a series of workshops depending on what their needs are. I can do advanced care planning workshops, I can talk to them about how to be their own healthcare advocate, how to speak to their doctor. Certainly do the hospice, what used to be referred to as a hospice 101 or just a basic overview of what hospice is so I can tailor it to most any group, depending on what they need.

Carly Malcolm: [00:03:30] So generally, or I guess more expansively, what services are offered by Trellis Supportive Care as an organization?

Robert Garcia: [00:03:36] Sure. So a little over two years ago, we rebranded to Trellis Supportive Care. We were formerly Hospice and Palliative Care Center. We're very proud to be the very first hospice in North Carolina. And we are very proud to be a nonprofit agency, I might add. It started off a course in Winston-Salem that's our main headquarters, and as the need grew, we grew to 13 counties and we have regional offices up in Walnut Cove, Stokes County. We have an office in Mocksville and Davie County and another office in Salisbury and Rowan County. So through those three outlets on our main campus in Winston-Salem, we're able to serve 13 counties.

Jeff Thigpen: [00:04:09] So you’re looking from Rockingham, Stokes, Surry, on down to, I guess, Cabarrus and Stanley counties in the 13 County region that it covers Guilford and Forsyth, as you mentioned. People may not understand Trellis when you first begin talking about it, but they do understand hospice. So when a person has to deal with hospice, what does that mean?

Robert Garcia: [00:04:31] That's a very good question. We like to refer to it as when people hear the H word, hospice. Hospice by definition, hospice is a form of medicine, it's end of life care. When somebody has been given a terminal diagnosis, they've also been given a prognosis of six months or less and the next key there is that they're no longer seeking curative treatment. There's so many myths or misunderstandings about hospice care and one of them is, let's say today's Wednesday, somebody gets a call and they think that if they come under hospice care on Wednesday, that it's 24, 48 hours away, which is so not true. Granted, that can happen, but I always referred to the fact that when we get letters back from families, 95, 98% of them always say, we wish we called sooner because the care is there for them. The circumstances are already put forth, the diagnosis, the prognosis is already there. And so hospice care is just that it's end of life care. It's a specialized field. Our physicians, our medical director, our nurses, nurses assistants are all trained in end of life care.  

Jeff Thigpen: [00:05:32] And in many situations we tend to equate palliative care and hospice care together. What's the difference between the two?

Robert Garcia: [00:05:40] Good question and that's one of the main reasons we took out hospice and palliative care. Cause a lot of people were using that in their name also, and then there was a care center, but there is a difference. So let's say on this wall to my right, this big wall is palliative care. And this is, I'm stealing this from our medical director, Dr. Michael Layla. And in the middle of that, you do a small square and that's hospice. Hospice is all about palliative, but not vice versa. Palliative by definition means to ease and comfort, pain and symptom management. And when we practice palliative care, it's during serious illnesses when people are still seeking care to treatments, but through their aggressive treatments, the symptom management that comes along with that, that we can assist with, there is a big difference between just palliative care and Hospice care. Hospice has palliative all over it, but not vice versa.

Carly Malcolm: [00:06:29] So when we spoke earlier, you told me that the majority of people who need hospice don't end up getting it, because they're afraid of that and like you were talking about and that's one of the things that you address in your informational visits. So how do you address that with patients and their families?

Robert Garcia: [00:06:45] Very honestly. Because they've already heard it. Here's what happens if someone will have the discussion with their physician and it is brought up and like I said, people hear the word, they hear the term, and normally they will leave out of there. And it's not a very easy pill to swallow, it's not very easy to take in. So all of a sudden they start relying on their memory or maybe past experiences with other family members or other friends or families in regards to hospice, so there's a lot of questions. One of the things that we find to be so helpful is when people call and we say, we'll be more than happy to do an information visit, and that's exactly what it is. Before I got here this morning, I did an information visit with a family member. I visited with a patient and the family members and completely review all of hospice with them. What comes with hospice services, what our agency provides for us, what transpires, how it happens, how it's paid for, all the details and I do it very slowly, very concisely, and allow them to ask a lot of questions in a setting that they're comfortable in and then let them make the decision because it truly is, it's a decision that people make from a standpoint of their diagnosis and their prognosis. Like I said, that's already been put in place. I automatically, as I like to say, I put the elephant right there in the room and they already know that. And then I let them know, but then I have, everybody's different. Every family's different. There's different viewpoints on end of life care depending on age. That's the other thing, sometimes people think that hospice is always about elderly people. We do everything from pediatric hospice care, all the way up. There's different ages, different cultures, different backgrounds, different religious beliefs. So you have to cope with a lot of these different entities. When you're talking to people, they all have different viewpoints. A lot of times it's just listening and then giving them the facts to work with and then answering their questions. And making them comfortable with saying, I understand now I'd like to proceed and receive services.

Carly Malcolm: [00:08:42] Yeah, and one of the populations that you specifically work with during your informational visits is Hispanic patients and families. So do you see any challenges in terms of language or cultural barriers and differences?

Robert Garcia: [00:08:54] Very much so of course, with the language barrier. We're very fortunate in the fact that we have language lines and we also have some people in our clinical team that are bilingual. My job, I help them out in bilingual situations where I can go and help them. But in information visits, it helps a great deal because there's different Latin cultures, especially here in our triad region and different people have different viewpoints of end-of-life care. What somebody in Cuba might think of end of life care. Somebody in Venezuela has a different outlook or people from Mexico or people from Chile or Colombia. So there's a lot of challenges there and trying to understand that.

Jeff Thigpen: [00:09:28] Can you talk to us a little bit about HIPSS, I think I mentioned it as the healthcare industry professionals and supporting seniors. What can you tell me about that group?

Robert Garcia: [00:09:31] Yes, it’s a great group. It started off in Winston Salem, and it's a networking group of professionals with hospice agencies, home care agencies. Assisted living facilities, skilled nursing facilities, people in different physician's offices, anybody dealing with elderly. And so they started Winston-Salem and then an offshoot of them started in Davidson County. And I work a lot in Davidson County and I started in with them. And then I ended up becoming the vice president and the president of the group. I just relinquished my presidential duties about two months ago. It's a great group and it's networking people and much like there's one here in Greensboro called Trial at Triad Retirement Living Association.

Jeff Thigpen: [00:10:15] And that was where y'all met, right?

Robert Garcia: [00:10:17] Yes. And when you take these people and this networking group, they are so passionate about what we do. We're all in it for the right cost. And so we help each other out. If we don't have the answers, I might say, well, call my friend so-and-so at this particular agency may be a home care agency or at a memory care unit. And so we help each other out. We're always referring to one another, trying to help out families.

Carly Malcolm: [00:10:40] Yeah. And so you also teach workshops on advanced care planning, you were kind enough to invite me to one of them. So what do you hope for participants to take away from those workshops?

Robert Garcia: [00:10:49] The importance of having your advanced directives done. And of course, advanced directives, just so that everyone knows is your living will and choosing a healthcare power of attorney. A healthcare power of attorney is different than your durable power of attorney. A healthcare power of attorney is someone that you have chosen to speak for you in a healthcare situation where you cannot speak for yourself. It's as simple as that, we hope that we never have to use anyone, but in the event that that comes up, you have chosen someone to do that the living will has to do with end of life or prolonging life in those situations where they're just decisions that you make and that you've listed out much like you would list out things that you wanted in your will, how you want things to transpire after your death. Well in a living will, there are certain things that you might not want your life prolong because of maybe you have advanced dementia and they don't think that it's going to get any better. Do you really want your life prolonged with life sustaining measures, ie. resuscitation, respiratory assistance, that type of thing. So these are the decisions that you make in advance. They're noted, they're posted, they're very simple to fill out. You saw it on the workshop, two sheets, and then the third one is your signature line where you just have to get it notarized and then just get it to all the right people, physicians, offices, hospitals, your family, and let everybody know. And you hope, like I say, I always tell people you hope that you never have to use it, but it's there because there's so many times where you might be in a situation let's say in a hospital, where there's a lot of people trying to make a decision for that person that's lying in bed. Sometimes there's a little dynamics going on, but if you were to ask that person what they really wanted, it might be totally different than what they're talking about. So this just takes the burden off of your loved one's shoulders. And you heard me during that workshop, it's what you want, or don't want.

Jeff Thigpen: [00:12:35] It's so great that you're doing those workshops, because one of the things that we're learning in all these podcasts is when you're dealing with end of life issues, what we all ultimately want is for that person who is going through that to be the center of the decision-making in terms of what are their wishes and what you're explaining with these advanced care directives and the power of attorneys and living wills all those kinds of things, are a part of what is extremely important when we find ourselves in those situations and or with caregivers for people in those situations and unfortunately we live in a society where we don't like talking about death and dying at times, and/or we don't talk about it until we're faced with it up close and personal. And so I really appreciate the work that you do in sharing that knowledge, because it is really important, we really want to encourage everyone who listens to these podcasts to do that planning work. Definitely be working to have sessions to get more detail with that.

Robert Garcia: [00:13:23] And one important thing, if I may, just on that one note is that there's no age limitation on this. A lot of times people think, Oh, you have to be a certain age to do your advanced directive. I tell people if you're 25 years old, married and have a child, you should have your advanced directives done. You can change them whenever you want to change healthcare, power of attorney, or maybe some things on your living will so it's not an age specific thing. Our tagline is, and by the way, gotplans123.org is a great website that we developed some years back that you can go to. There's great videos and testimonials, and you can even pull the documents off of it, and that's gotplans123.org. But our tagline is we plan for marriages, we plan for retirement, we plan for babies, but we don't plan for these healthcare situations and that's what this is about.

Carly Malcolm: [00:14:13] Yeah and as someone who took that workshop with you, I'll confer. I knew how important it was to have those things, but it seemed like a very daunting task and after going through that workshop and, you know, you explaining really just how simple it is, it seems much more doable.

Robert Garcia: [00:14:28] I always tell people, especially younger people, probably everybody in this room, when I ask who's got life insurance and everybody will raise their hands and I always say why? And they go, what? And then they get it. This is just planning, you know, this is just taking care of things for you.

Jeff Thigpen: [00:14:47] Robert, you know, a good friend of mine, Reverend Odell Cleveland wrote a book, we’re going to be interviewing him related to our podcast, but this whole concept of caregiving, I think is a really important concept. And in your role with Trellis, what are some things you see related to the needs of both getting the information you need as a caregiver being in that orbit?

Robert Garcia: [00:15:07] Yes, it's so important. Caregiver, and I'm young enough to remember that when you never heard that term and nowadays you hear it a lot. You see people that are maybe in their upper forties all the way to maybe they're, close to their retirement age, thinking about, Oh, the next phase in life and then all of a sudden they're confronted with the care of their mother, their father, maybe their aunt, their mother-in-law father-in-law whoever the case might be and that's been put upon them. One of the things that we do, not only through our agency, and of course, with Odell, he talks about it in his book, are networking groups that I talked about earlier, is getting people to plan ahead to take that luck. Now they'll say, well, my dad doesn't want to talk about it, right. Well, okay, that's an uncomfortable subject maybe, but it's one where you want to prepare. That if they are reaching that age, that you've got all the details on hand that you've got them written out, that they've got the healthcare power of attorneys, maybe the durable power of attorneys. What does mom want? What does dad want? What policies are in place? How do we have to do it? Because when he comes upon you, it's like a tidal wave and you're scrambling. So maybe you're 53 years old and you're taking care of your parents. You’re working, you have children in college, maybe you still have some in high school, whatever the case might be and then all of a sudden, you're having to find out all this information on how to take care of your loved one that maybe has just been determined that they need a memory care unit because they have a form of dementia that they might have Parkinson's all of a sudden. What do we do? Oh, I've heard about that, what is that? What is this? You know, and you're up at night at 9:30, 10:30 at night, looking it up on a, on a computer. There's a lot of us in the industry that have these workshops that are available to you. I always stress to people, take advantage of the Alzheimer's association, Parkinson's, you name it. They've all got workshops, if you go online that they're doing another podcast, much like you're doing. They let people in to what it's like and their support groups also, because support groups are great. When you turn into a caregiver, there's a lot of stress. There's physical stress, there's emotional stress, there's financial stress that comes with it, you know, and it's just tugging at your heart because you're caring for your mom or your dad or your loved one. And all of a sudden, you're, you're also trying to balance them all and maybe you might have some health issues going on. So I always tell people, just try to plan ahead, not just try, plan ahead, have that conversation. And I'll leave you with this. I spoke to a civic group one day and they were probably between 45 and 55 years old. And it's almost like I always tell people if I were to have a seminar on how to pick lottery numbers, I could fill a Coliseum. Once you start talking about these subjects and they don't want to talk about. But I tell them how important it is, because when it comes over you you're going to go, where do I go? What do I turn? What it costs that much? What am I other options? What about Medicare? Medicaid? What is, what's the differences? What does that include? I heard this, I heard that. And yeah, so just taking the time to chart the plan, like I said, at the beginning, when, when it comes to planning for college or a marriage or a baby, you do all these things ahead of time, right? Same thing. Plan ahead.

Jeff Thigpen: [00:18:02] Excellent points, absolutely. Well, Robert, we really appreciate you being with us today and talking about Trellis Supportive Care and the work that they do. Do you, off the top of your head, know the Trellis website?

Robert Garcia: [00:18:14] WW Trellis dot, it should be on my card, dot org.

Jeff Thigpen: [00:18:18] Let me check your card. www.trellissupport.org

Robert Garcia: [00:18:27] Those two S’s run together there with the end of Trellis and support.

Jeff Thigpen: [00:18:30] That’s right, yeah. Thank you very much for being with us today Robert and appreciate your work with Trellis and all you do, and in the community.

Robert Garcia: [00:18:38] And thank y'all and everything that you're doing to get the word out because that's what's so important is to get people to come to these podcasts and informational workshops to get the information, so thank you for doing this.

Jeff Thigpen: [00:18:49] All right on behalf of my cohort, Carly Malcolm, and myself. Thank you for being here and thank you for being part of the Good Grief podcast.

Robert Garcia: [00:18:59] Thank you both.

Jeff Thigpen: [00:18:59] Take care.

[Outro]

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[Intro]

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well but when we die, we can also die well, because we care. So, we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end-of-life challenges.

Jeff Thigpen: [00:01:00] Welcome to the good grief podcast. I'm Jeff Thigpen, Guilford County Register of Deeds. With Carly Malcolm with me, who is the lead for NC fellow from the North Carolina Institute of Government. Hello, Carly. Today we have a special guest, I think every week I'm doing this, I say it's a special guest, and so, but you're special and I wanna make sure we get it all out of you today. And so, I'm glad to have Wendee Cutler with us, who is the executive director of the Carolina Foundation for Jewish Seniors. She moved to Greensboro with her husband, Ivan in 1989 from San Francisco. She is a consultant. She is a community leader. She's on the Guilford County commission on aging, the Greensboro commission on status of women with a lot of volunteer experience within our community and a lot of organizations. Thank you, Wendee, for being with us today. When I spoke to you a few weeks ago on the phone, and we first started talking about end-of-life issues and serious illness, I kind of saw in you that you are like a Jacqueline of all trades in that you see so many different sides to issues that come up related to aging. You know it on the ground and you have personal experience in dealing with it. And you also have an understanding of the bureaucracy and the hurdles that people face when they're dealing with these kinds of decisions and you have a real passion for it so thank you for being with us.

Wendee Cutler: [00:02:23] Thank you for having me, Carly, Jeff. I really look forward to this, Jeff. Everybody is special.

Jeff Thigpen: [00:02:30] That's right. Well, tell me, where did this passion begin to develop related to your work with seniors and talk about the North Carolina serious illness coalition task force, that group. But where'd all this start?

Wendee Cutler: [00:02:44] I think it started in childhood. I had wonderful parents that believed very strongly in family. And at the time when I was very young, we were in Sacramento, the whole family was in San Francisco. But there was never a month that went by that we didn't stop and see each other at least once and have every family holiday dinner together and things like that. And I developed a very, very close relationship to my grandparents. I revered them. I always respected them. I loved them. One of the worst things you could do to me, if I had done something wrong in my parents' eyes was to threaten to tell my grandparents I never wanted to disappoint them. And I think that in itself started this lifelong situation that I wasn't even aware of until the last 20 years or so of compassion for our older people.

Jeff Thigpen: [00:03:41] And so that transformed itself into actual work.

Wendee Cutler: [00:03:45] It did in a very roundabout serendipitous way. Our daughter was about to begin kindergarten. I had stayed home with her for those first four or five years. And a friend said to me, Hey, I've got a great job opportunity for you. And it was right when Carolina Foundation for Jewish Seniors was getting its foot on the ground. It has grown tremendously since then and as it's grown my abilities and my feelings have grown as well.

Carly Malcolm: [00:04:16] Could you tell us a bit about like the goals of the foundation and what you do there, who you fund?

Wendee Cutler: [00:04:21] Well in order to tell you the goals like, I kind of have to tell you a little bit about our history. We began as the Blumenthal Jewish home for the aged in Clements on the Yadkin river and from the, the early sixties till the late nineties, we were a nursing facility. It started out predominantly for the Jewish faith people because there was no Jewish nursing home between Richmond and Atlanta. So this was chosen for that location because it could serve North and South Carolina, everything changed and as more residential facilities and adult living communities and what have you came about, fewer people were sending their loved ones to nursing homes in one location so far away, they were keeping them closer to home. That combined with Medicaid, which then opened the doors to people of all faiths, created a situation where because we still maintain the fact that once you entered the doors of Blumenthal Jewish home for the aged, you could stay as long as you lived or until you chose to leave, regardless of your ability to pay because of those values, we found ourselves losing considerable amounts of money. So the board at the time. Had wonderful wisdom and said, we still need to serve this Jewish aging population, but we need to do it in a different way. That is when they created Carolina foundation for Jewish Seniors. And they said we will be a grant making foundation. We will find other nonprofits that work directly with the Jewish senior population in North and South Carolina. So for the past 14 years, we receive grant applications on an annual basis from organizations throughout North and South Carolina. And to date, we have awarded over $3 million in grants to these organizations.

Jeff Thigpen: [00:06:15] I was looking at your website and you cover a lot of areas from alzheimer's and memory loss to case management, mental health counseling, wellness, and I was seeing, you know, you had of course Greensboro in there, but you had Asheville, Raleigh, Winston, Charleston, South Carolina. So you all award these grants to a number of different organizations as we're seeing in North and South Carolina, right?

Wendee Cutler: [00:06:40] And we're constantly reaching out trying to find other pockets where we haven't represented ourselves well enough. The original vision was to be a nursing home with, without walls. But what we have found as time has evolved is needs have changed, you know, initially we were kind of like, Oh, we'll just provide grants to their lunch and learns or whatever they have. But obviously as time has gone on, we have found that the needs are much greater in what we call the case management or social work areas. So we now focus the majority of our funds in those areas.

Carly Malcolm: [00:07:10] And so then you're also a member of the task force on serious illness care. Could you talk about your role there?

Wendee Cutler: [00:07:18] Sure. That was a task force that was put together by the North Carolina Institute of Medicine. And it was a one-year task force, which we completed our job back in I think January. And they found out that there are a number of players around the state, which is typical throughout the rest of the country, I assume, that they know their own area very well. People tend to work in their own silos, but they don't always know what the other person's needs are or how to best serve that area. So this task force was put together to try and find out where improvements can be made in treating the individuals with serious illness care, whether they're a newborn or an end of life senior and it was quite rewarding. It was very gratifying to be in with a group of professors that are mostly the boots on the ground people. The physicians, the medical care providers, the case management people, the social workers, the D H H S people, that type of thing. And I felt so honored to be included because I'm not in those categories. So I walked in and represented myself. As one of the individuals needing the services. That task force completed its job came up with a series of recommendations, which the NCIOM just published in a book recently. And out of that, the in North Carolina serious illness coalition was formed. Many of us felt our job is not done, so we're continuing to move ahead and try to make sure that information is more readily available, that people have access to it. That the individuals, that's the key part, is that the individuals know what's out there, what they should think about what they should put in place, all those things.

Jeff Thigpen: [00:09:11] Yeah. And we've interviewed the CVA who are part of that coalition. I think it's like a 75-page report that they came up with with a lot of very specific recommendations, as it would relate to say, North Carolina DHHS, as well as recommendations for the general assembly to consider. And it sounds like in your comments when you kind of came into this work by being in the position you were in, you almost learned how to be an effective case manager of the case managers, you know, and seeing it through the eyes of a person who's going through the system and that’s probably served you very well.

Wendee Cutler: [00:09:45] That's an interesting way of putting it. I have never thought of it that way, because what I love to do is put people with the right information and the right person to provide that information.

Jeff Thigpen: [00:09:56] So tell me, what do you see as some of the main issues and challenges that you come across in either the work with the foundation and the work, you know, your consultative work in terms of dealing with seniors who are dealing with serious illness?

Wendee Cutler: [00:10:08] With serious illness, it sort of falls into the whole gambit. Some of the aged folks that I work with on an individual basis in my private consultation practice, they have no clue. They have not thought about things in many cases. Some are very astute, some know about an organization called Five Wishes where you can get a booklet that will walk you through step-by-step what you need to do, who you need to make sure has the information, that type of thing. Also, the Mind My Health that the Seviers are part of, that organization has, has a wonderful website where you can, for free, upload your documents and then through a password you or your designated representative can easily download them if there's an emergency. But what I have found in the aging population is like many of us, nobody wants to think of their own longevity. They don't want to think about what's going to happen to me. You know, everybody thinks that they'll just close their eyes one day and be gone, but they don't stop and think that there could be a couple of days or there could be years in between getting to that process from when they became ill. So I try to encourage everybody to make sure that their wishes for how they are cared for or not cared for, medically, spiritually, you know, in any way are known to the people that they want to represent them, whether it be family or friend or whoever that it is in writing, that they have completed, what's called advanced care planning, documents, their medical powers of attorney, their MOST forms that the hospitals frequently use, you know, all these different legal forms that medical people would be required by law to follow. And if you don't have them in place, then it's a whole different story because the medical profession has to do by law, whatever they can to try and bring you back to good health again, and it may not be what your wishes in that situation.

Carly Malcolm: [00:12:10] Right, and so when we're talking about the Jewish population, are there any aging or end of life issues that are specific to that community?

Wendee Cutler: [00:12:18] For the majority, everything is the same. Now the most important thing within the Jewish community is to make sure that if they have specific religious values and desires, that those are recognized. You know, sometimes they want to make sure that the rabbi or a Cantor or some other person can be there to perform certain prayers and blessings for them, sometimes they may have a wish that once they pass, that they're taken care of by what's called a team called the Chevra Kadisha. This is a sacred group that comes in and prepares the body for burial. They do a special bathing. They say special prayers. They dress them according to the, the rituals. And the beauty of this group is that they are sort of a secret group that most people don't realize they're on this team. And the reason for that is it is the one good deed that you can do for a person in which they can never thank you because that person whose past can't thank you for being so gentle and taking care of them so lovingly.

Jeff Thigpen: [00:13:29] Yeah, yeah. I remember when we were talking on the phone, you kind of blurted out, passwords! Passwords!

Wendee Cutler: [00:13:34] Oh yes! Oh my gosh! I got to tell you a funny story. Passwords are huge. You know, everybody thinks, Oh, I have all my legal documents in place. Everything's notarized. Everything's filed what, blah, blah, blah. But the biggest thing they don't do is have a list with their passwords to all their accounts, which can be horrendous. I know from experience from losing my brother, my mother and my father. To go through and try and work the systems and get the information that's needed. And all of a sudden you find out, Oh, there was an account I didn't know about or things like that, but a list of passwords are vital. But the funny story is my brother-in-law, Art, a blessed memory, had a file in his desk drawer and it said Art's dead.

Jeff Thigpen: [00:14:21] I liked the guy already!

Wendee Cutler: [00:14:23] Well, he, you know, he is a brother to my husband and you know, my husband. He had instructed his son that when the time came and you know, whether his health had declined so badly or whether he was gone, that everything he would need would be in that file. To me, that was one of the most loving acts he could have given his child or his family, because everybody knew exactly what he wanted, where it was, how to get it, how to obtain it, what he'd have to go through. Was there a life insurance policy? Was there an investment account? Was there more than one bank account? You know, where would you find the deed on the house or the lease agreement to the, you know, apartment or home you're living in, or, you know, all these different things. From my perspective, the more information you can provide your loved ones, the easier it will be on them to spend their time truly mourning you and not wrapped up in all the details.

Jeff Thigpen: [00:15:22] Art may be dead, but art is totally alive in this conversation because you're right. It's like when we look at the state of advanced care planning and the things that we need to do in order to be prepared to do what you're alluding to, is that the person, their wishes, their directives are clear. And that those of us who were left can act on them in a way that both remembers them and also, you know, adheres to what they wanted. You know, we are in a society these days where we know that a small percentage of us are prepared and that's why these podcasts, you know, I think are going to be really important because we're going to be talking about these stories and what you learned in a situation, you know, based on a brother who was prepared and was clear and you know, and what we find in many situations is we find that people are in an end-of-life situation and their wishes aren't known. And while you have those of us who are left, who are mourning and trying to figure things out, we didn't have to deal with the bureaucracy that comes with it. And so developing knowledge and information to be clear as we can on this is really important. And having the support to be able to put that together and there are a lot of good organizations that do that and know that you can appreciate that in your work.

Wendee Cutler: [00:16:39] I do greatly. And another thing that is really important for people to know is what are their burial wishes, if any? You know, some houses are divided like mine, where I choose one avenue and my husband chooses another. One of my brothers-in-law chose one avenue, one chosen other, and you have to make sure that you honor those people's wishes. It's so important that more information is out there. People often think that I'm too open with people because I'm an open book, I'll share anything with people about myself. Now I'm very private and very closed mouth when it comes to my clients or certain things about the foundation that should not be made public, you know, things like that. But when it comes to myself, I'm an open book. So I, for one, have shared with a few friends, what my personal wishes are at my end of life. And it's interesting because a friend of mine passed away recently, that was young, only 61, and it was unexpected, but it took about a week from the beginning of the onset till the end. And this person and I had had multiple conversations on how we would want our healthcare to go should something happen. And when this person passed and I spoke to the spouse, the spouse said, boy, I hope I did what they really wanted. And that is when I told the spouse that I had had this conversation multiple times. You did exactly what was wanted that made the spouse feel so much better. That lifted the level of grief so much because there was reassurance that the true wishes had been followed.

Jeff Thigpen: [00:18:21] Yeah. Things like advanced directives, powers of attorney, the idea of doing the work of support and preparation for level ones, knowing the passwords.

Wendee Cutler: [00:18:31] Don't forget about airline mileage. Don't forget that hotel rewards, don't forget about some of these things.

Jeff Thigpen: [00:18:38] All of them come into play. And a lot of times we don't see him coming and, you know, and we're dealing with the loss and we just aren't prepared for that next death certificate that we need to submit to an insurance company or something else that helps you take care of a bureaucratic resolution. And it, it impacts the mourning process, right? Betsy Gomberg who, of course, you know, he was talking to us about funeral wishes and things like that. And within the, the Jewish faith tradition, the idea of that lasting like a year in times in terms of that tradition. And so a lot of times, we don't know exactly when illness is going to strike or death is going to strike. But the idea of coming up with ways at which we support one another there's processes is really important. Wendee talked to us in particular about the impact of COVID in terms of the impact it's had on, on your work with seniors.

Wendee Cutler: [00:19:27] That's really interesting because COVID hit right at the time that we were going to have our grant allocation meeting this year, which normally would be an in-face situation where the whole allocation team is together for a full day. Well, obviously we couldn't do that because everybody was on lockdown. So like many people we resorted to zoom. We are all zoomers now and I think we're getting zoomed out a little bit too. The big thing is all these seniors who've been served by all these organizations throughout North and South Carolina that we award grants to now had to find another way to serve this population. And they are the most needy of the group in these situations because so many of them are experiencing isolation and depression and all different types of things. So what was the natural alternative? Well, you convert to zoom, but now you have a problem. Many of these seniors have no idea about technology. Some of them don't own a smartphone, let alone a computer or a tablet. So now you have to find a way to get these products out to them and teach them how to use it. And it's interesting because one senior that I know, all of a sudden is slowly figuring out the zoom and went online to some religious services. Oh my God! This is so wonderful! This helps them reconnect, help some to be a part of everything, helps them to feel still connected to the outside world.

Jeff Thigpen: [00:21:02] So COVID has come with the risk and challenges of social isolation, the solutions have also been challenging in their own right in different times, but that's really important to know.

Wendee Cutler: [00:21:12] Extremely important. And I have to say that people have really risen to the occasion and finding ways and being creative in helping the senior population.

Jeff Thigpen: [00:21:20] I appreciate that you're with us and you're leaving us with a lot of good information sources. Got the Piedmont Triad Regional Council Area Agency on aging. You mentioned Mind My Health, Five Wishes and there's some other organizations, you got Authoracare. We're going to have a number of different organizations that we're already interviewing, but we'll continue to be able to put together a good source of information for people, and also continue to, to communicate all the good work they're doing in the community. Any last parting words, in terms of just general advice related to advanced care planning and end of life issues and serious illness that you think might be helpful to the listeners?

Wendee Cutler: [00:21:57] Don't be afraid to talk to your family, your designated representative, whomever you choose to be the one to carry out your wishes, be open about it. Be honest about it. Tell them exactly what you want. I was fortunate, going back to my family experience. I was able to ask my mother, what are your wishes? What do you want a year before she passed? I mean, that made such a difference when it came to the day of, so that I could just be with my grief and not have to think about decisions.

Jeff Thigpen: [00:22:35] Hmm. Well, thank you very much, Wendee Cutler. Wendee Cutler is the executive director of the Carolina Foundation for Jewish Seniors on the North Carolina task force of serious illness care and coalition. Thank you very much for being with us today.

Wendee Cutler: [00:23:00] Thank you. And I think this is a wonderful addition to our County that you're providing by producing these podcasts.

Jeff Thigpen: [00:23:15] All right. Thank you very much.

[Outro]

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[Intro]

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do. Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:00:45] Welcome to the Good Grief podcast. I'm Jeff Thigpen, GuilforSaved County Register of Deeds and I'm joined with Carly Malcolm who is our NC lead fellow from the North Carolina School of Government working on special projects, which means she is like a real cracker jack and she has got a lot of good questions today because we have a great couple with us here today. David and Catherine Sevier, I want to welcome you both here to the podcast and you know, like the Register of Deeds, not a lot of people know what I do until they need something really important, like a death certificate or, you know, birth of a child, marriage, buy a home. I think in the advanced care planning world, you two, whether you know it or not, are like a power couple. And what I mean by that is you all have been at the forefront over the last 5 to 10 years of some really interesting changes in North Carolina. And I'm grateful to have you both here today, because I know you have a lot of good information. And while I say you're a power couple, I will refer to Brody that when I was telling him that you guys were going to be here today. And he kind of got quiet and then he kind of gave what I would consider the highest compliment is that you all are just plain good people. And to me that covers along with a lot that we'll cover today, that's all I really need to know. So again, thank you for being here. And first of all, I just want to throw out, just tell me your backgrounds. I know individually, you know, you can let me know, David, I think you were a Navy commander and Catherine, you're a doctor and I think, and how y'all met and everything, just so we can all get to know you a little better and we'll start with David.

David Sevier: [00:02:44] Sure. Well, Catherine and I met about 12 years ago, up in Washington, DC and we were both singles at the time and had a date and we decided pretty quickly that we kind of liked each other. So, it progressed from there, and about nine months later we got married. So, it was pretty exciting. She was working at the American Diabetes Association and I was heading a commission on the future for the Department of Veterans Affairs health system.

Jeff Thigpen: [00:03:19] So what happened was you saw Catherine in that vintage nurse sweatshirt that I see her wearing on Twitter when she gives updates, and that probably got your eye right?

David Sevier: [00:03:30] Well, it certainly didn't hurt it.

Jeff Thigpen: [00:03:33] Catherine. Tell me a little bit about your background

Catherine Sevier: [00:03:35] Before I met this gentleman. I was engaged in mostly healthcare related things. I am a nurse and I have a doctorate in public health. I started out in the cancer world at the beginning of my career and did a master's thesis on the care of people who were dying when I was in my twenties and have carried that work with me now for four decades. So, it has been a labor of love, I think, more than anything else. And it was a realization as a young nurse that people really need to talk to each other and they need to share with one another what their wishes are, what their feelings are, and what their fears are. And it was that that really got me interested in this whole area and it continues to be my interest today.

Jeff Thigpen: [00:04:23] Well, and I was really grateful to get the connection to both of you. We'd met a couple of times over the past year and just a wealth of information and perspective about why in terms of not only advanced care planning but communication, control, the ability to have family centered ways and community centered ways to deal with aging and illness in a way that has real integrity and I've appreciated that perspective I think that you bring to this work. Which kind of brings us into advanced care planning. What's the kind of state of that in North Carolina right now, in terms of the overall need of it or within the United States? I know David, when we met earlier, you shared some really interesting numbers about the number of people who are or are not prepared around advanced care planning. Everybody thinks it's important and the implications of when we aren't prepared and as a result of that, bringing it into North Carolina, kind of what are some of the main issues that you see?

David Sevier: [00:05:24] Sure. Well, statistically, about 35 to 38% of the American population of adults have advanced care plans of some sort or another, so that is not bad, but we also realized, that number hasn't changed dramatically over the last 10 to 15 years and so that's not a good thing. You asked about North Carolina, here in North Carolina, we have traditionally been on the lower number of that because of a couple of things. One is that a legislated requirement for getting an advanced directive is that an individual, once they've decided they're going to do it, they have to get two unrelated witnesses and a notary to sign those documents. And then they have to make them available to their health system. And so that's not been an easy road to move forward on. So, it's caused some challenges here in North Carolina and we're working to try to make a difference in that.

Jeff Thigpen: [00:06:32] Yeah, so in North Carolina, we have an aging population. It's aging rapidly. A lot of folks, whether or not drinking or not were unprepared in a lot of cases to talk about our wishes. Catherine as a nurse with a background in nursing. How do you see the implications of not being prepared in terms of dealing with issues of aging and or serious illness or end-of-life care?

Catherine Sevier: [00:06:53] Well, I was gonna say, I like to back it up and say that none of us know when we're going to walk outside and get hit by the 52 bus. So, we think of needing advanced care plans when we're older, but the reality is that something could happen to any of us where we weren't able to speak for ourselves. And so think of a young couple and I've had, I've spent most of my career in the cancer world, and I took care of many young people who were living with a fatal form of cancer that was close to the end of their lives who had young children who had spouses, who had businesses, they were still operating and they needed to have their affairs in order. And they certainly needed to help their families make that transition from when I can't speak for myself anymore, here’s what I want you to do. And one of the things that I realized often was it wasn't so much that as a nurse, that I had a judgment or a value of what they were going to do, it's that I wanted them to know what they wanted and to have shared that with their family members, because of the piece that you have is very different when you've made your wishes known and the peace that your family has after you're gone is immeasurably different.

Jeff Thigpen: [00:08:17] Yeah. So, David, there was the idea of in the Medicare system, the amount of money that is spent in the last year and in the last month. And I remember that conversation because Catherine, you chimed in and said, that's just the financial cost. What you're raising is there is an emotional cost, there’s a stress that comes along in those situations. If we had a better system in place, could it be incredibly helpful?

Catherine Sevier: [00:08:44] Absolutely. And the other thing that, unless your family's different than mine, We're not monolithic. So, two kids can have very different opinions about what they want to happen to mom or dad. So the other thing that you want to think about is how do we get our family singing out of the same hymn book, so to speak? Rather than putting them in the position where they're having to negotiate their differences by your bedside.

Jeff Thigpen: [00:09:12] And we'll talk about Mind My Health, which I think is really helpful in doing that.

Carly Malcolm: [00:09:15] yeah, absolutely. I was wondering if you all would talk a bit about the serious illness task force that you have with the North Carolina Institute of Medicine and the work you're doing there.

David Sevier: [00:09:24] Sure. I'll start off and I'll let Catherine talk about it a bit as well. About two years ago, the North Carolina Institute of Medicine said that they were going to put together a task force on serious illness care. Serious illness, We defined it in the task force as basically you wouldn't be surprised if somebody were to pass away within the next 12 months. So that's what defines a serious illness that somebody is getting close to the end of life. So the task force was focused on how we, in the state of North Carolina, can provide better care for individuals when they get to that point and prepare for that as a state, both from the federal, the state, and the private side of things and looking at advanced care planning, looking at care provisions. So, we looked at hospice care and palliative care and a number of things and so we studied that for a year.

Catherine Sevier: [00:10:24] Yeah and as we studied it, what we asked is what do we need to do in North Carolina to give people the best possible care, regardless of where in the state they lived and what their circumstances were financially. So we believe that there are certain things that people are going to want and need, regardless of who they are. And they're things like symptom management, good medical treatment for whatever their terminal illness is. And also, back to where we were a few minutes ago, that need to really communicate and be prepared for what's going to happen downstream. So, we ended up with a task force with 33 recommendations, they covered everything from changing some legislation around advanced care planning to encourage the legislature to provide broadband and telehealth, how do we train the workforce, particularly healthcare workers, to be able to care for people who are seriously ill. So, the recommendations cover everything from clinical care, to the business of the family, to wishes, and to things that government can do to facilitate all of this. The first major recommendation was to pull together people who care about this in North Carolina, form a coalition, and then go about making sure these recommendations actually occur and get implemented. So in February of this year, the coalition came together. It is now the serious illness coalition that is charged with really driving a number of those recommendations to completion.

Carly Malcolm: [00:12:10] Right and so could you talk a little more about the work that you're doing with the coalition? What, y'all are accomplishing?

David Sevier: [00:12:15] We have pulled together, since February, about 133 people who represent 75 different organizations such as the large health systems, Duke and UNC and Cone for instance. We've got the Bar Association, the Medical Society, the AARP. People who are interested in this whole area of serious illness have come together and we have weekly meetings, every Friday morning, we interview somebody who has an interesting story, an anecdote that they want to share. And then we have monthly meetings with the entire coalition, and we're really focused on getting those recommendations that Catherine mentioned. There are 33 overall, there are 13 priority recommendations and we're working to get those accomplished in the state. We're going to be talking to the general assembly, we have already, but we're going to be giving them some real talking points in the spring of next year.

Jeff Thigpen: [00:13:19] And Catherine, I'll chime in now. You're, I can't remember if I mentioned this in the introduction, you're the president of the North Carolina AARP, right?

Catherine Sevier: [00:13:27] I am.

Jeff Thigpen: [00:13:28] Been in that role since when?

Catherine Sevier: [00:13:29] This is my fourth year.

Jeff Thigpen: [00:13:31] Your fourth year, okay. And one of the things I haven't talked to you about, it's called the North Carolina Campaign for Future of Nursing. Can you tell me a little bit about that?

Catherine Sevier: [00:13:41] Sure. So, the North Carolina Campaign for the Future of Nursing is about 10 years old now. It was formed as a marriage between AARP and the nursing community through Robert Wood Johnson. And the idea is that nurses in particular can be community leaders who can help really move conversations, quality of care, and prevention out into the community. So here in North Carolina, our campaign has done things like normalizing all of the educational requirements to move people in the workforce to higher levels of functioning faster. So, we developed a ribbon program with the community college system that now goes through the doctoral level at UNC or do. And the other things that we're taking on now are how do we help communities become age-friendly? So how do we move a community to where there is transportation to get medicines where there are curb cuts so if you're in a wheelchair or if you're young and you're pushing a stroller, you can get across the street. And so, we're focusing on very targeted things and in fact, very soon it looks like we're going to be afforded a Robert Wood Johnson grant for this community to look at some of the work that we're trying to do in equity and diversity.

Jeff Thigpen: [00:15:03] Great, yeah. And you are on a task force on health equity as well. I'm kind of jumping the gun here. We've got a number of questions, but I think that was a part of that work. Can you talk a little bit about the task force on health equity? I think the governor created that task force.

Catherine Sevier: [00:15:21] Well this summer, as we've all been, there's just been a lot of unrest and very soon after the George Floyd tragedy came, the governor Cooper decided, or put together a group and he said, we really need to address this directly. This whole area of equity, economic equity, environmental equity, health equity. And so, he went out to the state and looked and invited people to come in and bring some expertise around those issues. And I'm on the health access committee which is, the working group, which is really asking similar questions to what we're doing with the coalition. And that is how do we make certain that all people have access to health, to care, to the things that they need. And certainly, we know in the state, there is a lot of challenges with both diversity in that area and also geography because what we have available in one community is not what we have in another. So, we're starting to tackle all that, we've only met twice so far, but we've been given a charge of being bold, be direct, come up with quick solutions for the things that we can solve right now. And then look longer term for things that are going to take more work. So, things like telemedicine and broadband are things that pop up right away.

Jeff Thigpen: [00:16:43] Yeah. Telemedicine, broadband, that urban rural dynamic. I grew up in a rural County and, you know, I'm living in Guilford County now, but those are huge issues as it relates to health care access and the ability, because there've been historic health issues that have been endemic to that, for example, to the African-American community. And it's one of those things that when we're in this moment of COVID, it exacerbates it and brings it out even more. And we begin to see it in ways that hopefully with the task force and the recommendations of serious illness taskforce and things like that, there can be these conversations that can lead to action with the general assembly to really help not only lay the technology infrastructure, but a real strategy to help bridge those gaps in access and services.

Catherine Sevier: [00:17:26] Well, there are so many things I could say about that. The one thing I don't want to forget because it's my new mantra is to get your flu shot.

Jeff Thigpen: [00:17:34] Oh yeah, yeah. I haven't gotten my flu shot yet, but I will.

Catherine Sevier: [00:17:38] I’ve promised people, the two things I will say repeatedly for the next 49 days are vote and get your flu shot. So I will say that three or four times before we're out of here.

Jeff Thigpen: [00:17:50] Nursing homes. Talk to us about nursing homes. That's a real passion of yours and you've spent some real time on it.

Catherine Sevier: [00:17:57] Sure. Well AARP, nationally and here in the state, has been very concerned about what has happened in congregate living during the COVID epidemic. And one of the things that we've been very worried about is how do we make sure that people that are in nursing homes and unable to communicate with their family and friends and have visitation, how do we make sure that their wishes are known during this time? And how do we make certain that we find creative ways to keep the communications going between families, patients, and healthcare providers? So for us in North Carolina, what we've struggled with is, first of all, getting enough testing, which we now are finally to the point where we're testing on a regular basis and we're testing the healthcare workers who are the people who oftentimes are the ones that bring COVID into a congregate living facility, not intentionally, but because they're out in the world and then going in. And then how do we make sure that if I'm the daughter, spouse, of someone in a nursing home that I'm able to really keep relationships going? Because one of the things that we know is social isolation is devastating to all of us, but particularly to people who are in a congregate situation without any of their families there. So, we're doing a lot of advocacy work around that, working with DHHS, with other community organizations and really trying to address how we go into the fall when the weather changes and outside visitation isn't possible. What are we, how are we going to meet those needs?

Jeff Thigpen: [00:19:36] Yeah. When we were tracking COVID deaths, when you look at, at least in Guilford County, those within the late sixties, early seventies onto the nineties in nursing homes, it had an incredible impact and so I appreciate the fact that you take that seriously and really are looking at how we can improve care for people, you know, one of our most vulnerable population.

Catherine Sevier: [00:19:58] Well, and the sad fact about this is that while only 13% of the COVID cases in North Carolina are in people over 65, 80% of the deaths are, so that tells you the magnitude of the challenge we're facing.

Jeff Thigpen: [00:20:13] Yeah. Yeah. So let's move on to, I think Carly was going to ask about the health information exchanges and that will probably lay a foundation for getting into Mind My Health, which will be incredibly important for us to discuss.

Carly Malcolm: [00:20:27] Yeah. So back in 2015, the general assembly created the health information exchanges. So, can you talk about what that is and why it's important?

David Sevier: [00:20:35] Yeah. We had the executive director of the North Carolina health exchange authority, Christie Burris, with us on the serious illness task force. She was one of the 65 professionals that were on that task force. And so, we got to know a lot about what the general assembly had done back in 2015 and how the mandate and the funding for this health information exchange came together at that point. North Carolina has led the nation in putting together a funded, mandated health information exchange, call it a kind of intranet for qualified information, very secure, across the health entities throughout the state. And so, it is actually now in thousands of different locations with large health systems, with clinics. It's going to nursing homes currently, and it's a means to transmit information from electronic health records of people to more broad information. So there's a huge amount of data that is available from one system to another. And we're very interested in it because we are on the verge of being able to move an advanced care plan and an advanced directive that somebody fills out to the information exchange to then be made available whenever and wherever somebody shows up and it's needed.

Jeff Thigpen: [00:22:12] So as a nurse, what does that mean?

Catherine Sevier: [00:22:15] Well, it means that you have your data, you have the person's voice at the moment that you need it. Think about an emergency room when someone is brought in via ambulance, they've been separated from their families and they can't speak. Being able to find them immediately and see what it is they have specified and asked to be done takes a lot of the pressure that the health care system feels to do the right thing for the person, because anybody who's providing care in an emergency room or in a hospital, wants to feel that they are honoring that person's wishes. But without that knowledge, then we're in a situation where it differs to our best judgment and we're pretty much required to do everything to try to save that person's life, even if they've made the decision that they don't want that. So having that information is going to be tremendously important and having it, whether you're at home where your healthcare provider is close by, or if you happen to have gone to the mountains for the weekend or the beach, or you're somewhere where you haven't been before. Being able to find you wherever you are is something that we all would like. There are some times we don't want to be found, but when it comes to expressing our wishes, we need to be found.

Carly Malcolm: [00:23:47] Well I was going to ask you, how does the platform of Mind My Health fit into all of that.

David Sevier: [00:23:51] Let me just mentioned how Mind My Health came about and what that is. About four years ago, we were asked to contact the Duke Endowment and the Duke Endowment is a foundation that was established by the Duke family a number of years ago and it's a large foundation. And they have different areas that they're looking at, one of which is health. And so, we approached them and said that we had this idea for developing an online platform to enable people, as we said and do say today, to own their health and plan for care in advance. That is our tagline and it's really an approach that's not just focused on end of life, but broader than that. So, we asked the Duke Endowment if they were interested, little did we know that they had been studying this for some time and had a noted physician, Dr. Atul Gawande, having spoken to them just a couple of months before. And they basically said, well how soon can you get to work on this? Well, we were flabbergasted and they actually gave us about a million dollars to establish this online platform. We since called it Mind My Health, for reasons that are probably obvious so that people have the ability to own their health and plan for care in advance. So, they can go onto the website, mindmyhealth.org, and it's a nonprofit entity and so there's no cost associated with it. They can create their advanced directives there and then they can upload them to the cloud in a secure space. And then as I mentioned, we are just on the verge of being able to transmit that information there, their advanced directives, their legal documents, to the health information exchange. So that's why we had that discussion. That's why that was so important and to make them available whenever and wherever they're needed.

Catherine Sevier: [00:25:53] One of the things I think that's very unique about Mind My Health is that it is outside. Many of us remember having to sign the HIPAA waiver when we go into a physician's office or to a hospital, this is something that the individual owns. And the other unique feature of it is that I can invite you, my daughter or my son, to be a partner with me in that, and then you have access to my information. So, the important part of that is that then we're sharing that information and our kids or our proxies know what we want rather than having to go hunt for it in that emergency, which is what happens now. So, they actually know where it is, they've seen it as we change it, they know we've changed it. And so, all of this can happen outside of the HIPAA wall, but then be transmitted through the health information exchange to wherever the person's receiving care.

David Sevier: [00:26:54] I’ll just mention very quickly that there are a few legislative changes that will be necessary to make that vision happen. And those are some of the recommendations that have come out of this Institute of Medicine task force. So, we will be talking to the general assembly in the spring as the new legislators who are elected in the upcoming election are available. And we'll be saying, we want you to think about developing with us this new approach to how advanced care planning can happen in North Carolina.

Jeff Thigpen: [00:27:31] And that's crucial. I mean, it is foundational to where we go from here because I think you all would probably agree that in many ways, we're in a crisis as it relates to this. We've done things the way we've done them, I mean, advanced directives and things like that. A lot of people don't do them and haven't done them partly because it's cumbersome and it's hard to do and then you're bumped up against a serious illness or something and then you have to either aren't able to express your wishes or you just don't have it or can't find it. And we're in the 21st century, you all know it. Through the legislative changes, you have an information infrastructure that's been authorized. You have an authority that's working with that. You've got this really good software solution that is a major communication vehicle between the person, the family, the caregivers, and also the major healthcare or responding organizations that are in this network of care. And so, I don't know who's going to be in a journal assembly next year, but this is a huge, not only a responsibility, but a huge opportunity to change this game. And if we miss this opportunity to do it, it'll be our own fault because I know y'all put a whole lot of work into this. I think the serious illness coalition had what, 60 people, 60 representatives, and your serious illness task force at 60 members. You've got this whole addition that on the statewide level, all these major organizations have come together and they looked at all this and they have really good recommendations. And simple things like you talk about, you know, not necessarily having to have two notaries to sign-off on this type of information to streamline it and make it easier. To be able to store the information electronically in such a way that all these entities can be able to access it in such a way that it is consumer driven, that it is consumer controlled, that the power’s with the individual and the family and its relationship to this big healthcare system. And so, I don't need to tell you, but I'm a huge proponent of what you all are doing. And I'm a huge proponent of what the task force has done, and hopefully what the coalition will do.

David Sevier: [00:29:39] You’ve got it, Jeff. You’re preaching our line.

Jeff Thigpen: [00:29:44] I know when we met earlier, you all did a demonstration. And like I said, it was a free account. You know, it was a very user-friendly platform. It's so user intuitive, you've got a whole lot of questions that you answer within it and you provide real good guidance in terms of people putting together the information you don't tell them it's right or wrong, but whether or not it's in a format that would be good. There's a way to store the information. And so I really like the look and the feel of it and what has been done so far. And it's a great foundation to build on and my hope is that these kinds of efforts will take hold in ways that help the system improve.

David Sevier: [00:30:25] Absolutely. And it's all for the public good. Nobody's making any money on this. This is funded by the Duke Endowment, funded by the state so it's a win-win.

Jeff Thigpen: [00:30:36] Yeah. And you got organ donation in there too, I guess. I remember seeing there's a relationship with the group that does organ donation. Of course, that's one of the major, what was it, one of the major healthcare decisions we make as teenagers?

Catherine Sevier: [00:30:48] Absolutely. The first time we make an end of life decision and commit ourselves is when we get our driver's license and they say, do you want to be an organ donor? And you get the little heart on your driver’s license and you've made an end-of-life decision, even though you may not have realized it.

Jeff Thigpen: [00:31:03] Yeah and we talk about through these podcasts, how we don't necessarily like to talk about death and dying as a society. When we met, I remember you saying something about, you know, from some of what y'all have learned. Sometimes it's easier for people to talk about these kinds of decisions online, or rather than in person, which is kind of interesting, right?

Catherine Sevier: [00:31:24] It is. It is. I think we can listen better online because we can't interrupt. If you're the child who doesn't want to lose mom, you can look at what mom wants and consider it before you actually have to say, yeah mom, I'll do what you want. So that emotionally, It's much easier for some people. And it brings the question up at a time that you can deal with it.

Jeff Thigpen: [00:31:50] What’s the website for Mind My Health?

David Sevier: [00:31:52] It's mindmyhealth.org. That's it. Very simple.

Jeff Thigpen: [00:31:55] I can remember that. Okay. Well, we've covered a lot of ground so far.

David Sevier: [00:32:00] I'll just say we appreciate you with Guilford County asking these questions, being engaged. We're going to be talking to the EMS director here, I think sometime in the not-too-distant future because, as Catherine said, EMS is a big issue as well and they are probably ones that need to most see what the person's preferences are because they have to respond to emergencies and sometimes people say, I don't want to be taken to the hospital, I'm happy here. So, they need to understand what people's wishes are.

Jeff Thigpen: [00:32:35] Yeah well, Jim Albright has been the EMS director here maybe for five or six years, but he's been with the department for like 32 years. And he was one of our first podcasts and he talked about things like MOST documents, which I had no idea what a MOST document was, but it is really important that you can then share with your first responders and part of the complication in that is that in these systems, you know, they really are important documents to have. The challenge is I don't walk around with it in my back pocket and we need to be able to have systems in place where people can have the time, the effort, the time to plan these things that I don't need in my back pocket. That we have a system in place where Guilford County EMS and cone health and all these organizations, have a relationship to an information infrastructure that is able to access my wishes even, as we started out when I can't express it myself.

David Sevier: [00:33:31] Exactly, exactly.

Jeff Thigpen: [00:33:33] Yeah. So that'll be a good meeting with Jim.

Catherine Sevier: [00:33:36] I think the only other thing we haven't mentioned directly is that many times these advanced directives and these documents are put together in other venues besides healthcare. So, attorneys, when they're doing estate planning and they're putting together all of your wills and trusts and those kinds of things, also do advanced care plans. And so right now, those can be very disconnected from what's going on in your health care world. And that's another one of the places that we think a Mind My Health kind of interaction allows you to take what you got in one place and locate it with all the other important healthcare documents that you have. And so, there's a lot of interests outside of the healthcare system for knowing what those wishes are and forgetting all of that paperwork, if you will, in order, and getting rid of the paper, which is the real opportunity here is to make it easy.

Jeff Thigpen: [00:34:34] Yeah, get rid of the bureaucracy, work toward more seamless integration, and have something that works for people.

David Sevier: [00:34:42] And I'll just say that for all of the challenges that this pandemic has created, and it's been multitude, and having about 200,000 people dying in the United States is unforgivable. But the silver lining that has come about is it has moved us to having these kinds of discussions on a more regular basis. Being able to develop some technologies that can help us even further and moving them in a much quicker way, like tele-health, and developing how we can move these documents in a much more seamless manner.

Jeff Thigpen: [00:35:17] Yeah. I've been a huge proponent of fiber and broadband high-speed internet access for populations that, urban and rural, have a hard time getting that it's affordable. And I've always thought telehealth is a great idea, but because of this pandemic, I think we've made a, I believe we, I hope we've made a fundamental shift in saying, you know, being able to have an information infrastructure and the technology infrastructure with equity for people who can afford it and those who cannot, are incredibly important. It's important for education, it's important for health, it’s important for our economy and all of that. And that's why I really appreciate the particular work you all are doing is because in this niche, you all have been doing this, you know, you're not just coming lightly. This you've been working on it for years and so, I appreciate that.

Catherine Sevier: [00:36:06] So Jeff, the only other thing I thought about is we, the United States has been at this work since 1991. And when we look at that 35% number, we're moving very slowly since 1991 because it was really, during it was, there was some federal legislation at that point that was put into place that said, hospitals have to ask you if you have an advanced directive.

Jeff Thigpen: [00:36:34] 35% people who are prepared, versus those who are not, right?

Catherine Sevier: [00:36:37] Right. And so, you know, we've been at this for a very long time and if that's the pace that we're going, we're not going to be where we need to be for another 40 or 50 years and we can't afford that. So, it's just really important that we seize this opportunity and realize that we have this chance to make a big difference in this by doing the hard work of talking to each other and getting the laws changed.

Jeff Thigpen: [00:37:06] Catherine, I was looking at the, well I don't normally look at the North Carolina Journal of Medicine, you know, it's not on my coffee table, but I was looking you up and I came across an article for the July-August 2020 magazine for the North Carolina Journal of Medicine. Can you talk about what the edition was dedicated to and talk about your article?

Catherine Sevier: [00:37:28] So part of Mind My Health grant was we wanted to make sure at the end of our work, that we were talking about how to communicate in serious illness and advanced care planning. And so, we were able, because of our work with the North Carolina Institute of Medicine task force, to dedicate an entire journal to serious illness. And the journal covers all the things that we've been talking about. It covers HIE, It covers what you do when you have a child with a serious illness. And that's not something we've talked about today, but if you're the parent of a child with a life limiting illness, how you deal with that, it talks about health disparities. We talk about the impact of serious illness on the LGBTQ community. There's a wonderful article in there by Ames Simmons that speaks on that. So the whole journal was really talking about how important it is for us, as we said in our article to lean into this. To lean into the work of serious illness and look for those solutions that will make a difference to these different populations, whether it's a child, whether it's someone that we expect has a short time to live. And how do we tend to all the things that make serious illness care better in North Carolina and the journal's terrific, and you can get it online. So, I would urge anybody to read it, it's full of personal accounts as well as important data. There are a lot of stories in there that people have told about their walk with serious illness so, good stuff in there.

David Sevier: [00:39:10] You can download it at nciom.org, the Institute of Medicine also publishes the medical journal.

Jeff Thigpen: [00:39:19] Yeah. Well, thank you both for being good people. Thank you for the work you're doing with the task force, the coalition, with Mind My Health and as a part of the green, with AARP, and as a part of the Greensboro community, you're in Guilford County, you are home people, you know, this is your home. So, I definitely appreciate you taking the time to come and talk to us about your work mindmyhealth.org is the website. I'm going to plug Catherine's Twitter page and she has great information on there. I went through and I just started scrolling and I'm like, you know, you connect to a whole lot of people when you share stuff. And that's Catherine Sevier. So, you have now been plugged on Twitter.

Catherine Sevier: [00:40:09] Great! I hope so because I will be reminding people, vote and get flu shots.

Jeff Thigpen: [00:40:19] Yeah. Well, I'll be working on that. I know Carly and I really appreciate you being here.

Carly Malcolm: [00:40:24] We do, we do.

David Sevier: [00:40:26] Happy to do it.

Jeff Thigpen: [00:40:27] All right. Well, thank you very much for joining Good Grief.

[Outro]

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[Intro]

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do? Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is also complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:00:59] This is Jeff Thigpen, Guilford County Register of Deeds and Carly Malcolm, NC lead fellow from the North Carolina Institute of government and welcome to the Good Grief podcast. We're going to talk about death and taxes today, and I have no other person that I'd like to talk to about both then Guilford County tax director, Ben Chavis. Ben received the 2018 tax collector of the year award for his outstanding work in Guilford County. Prior to his work in Guilford, he was the tax director in Randolph County. In addition, Ben is the pastor of freedom life church in Asheboro, where he serves his congregation dealing with many of the everyday issues of life and also at times, issues of death, dying, and loss as a part of his ministry. Ben has a degree in business administration from UNC Pembroke and Carly, when I introduced Ben, there are two things I know to be true. One is that he had a solid jump shot on the County basketball team and he's someone that I've thoroughly enjoyed working with as a colleague, a fellow department director, and most importantly, a friend. So thank you for being with us today, Ben. How did you get to Guilford County as tax director?

Ben Chavis: [00:02:29] Very interesting. I guess everyone refers to our profession as the accidental profession. Nobody intended to get in this business but somehow ended up in it, and that was me. Actually, I got to start in ministry before I got into started in the tax field.

Jeff Thigpen: [00:02:47] Where did you grow up?

Ben Chavis: [00:02:48] I grew up in Robinson County, a small town there, Maxton, which is just a little hole in the road. Still is, probably always will be, but just a very humble beginning in a rural country setting, but it just offered me so many life skills and just glad I've got that in my background.

Jeff Thigpen: [00:03:08] And you went from there to UNC Pembroke and got your degree and you said you got into ministry before you got into tax. And so, were you involved with a faith community there?

Ben Chavis: [00:03:19] I was actually involved at a little church right there, my community right down the road from where I lived. In fact, as a teenager, I'd walk to that church. And really that church changed my life and my perspective on life. Really changed my future and made a tremendous difference and impact on me as a person.

Jeff Thigpen: [00:03:37] So when you got into the tax department field, was that in Randolph County?

Ben Chavis: [00:03:43] Actually, what happened there was, I had graduated from UNCP in 1988 and I was working at a local hospital there, Scotland Memorial hospital in Laurinburg, and I read in the newspaper about this job opening in Randolph County in the tax department and it looked fulfilling. I said, Hey, I'm going to give that a try and just graduated so, low and behold, I'd never been away from home and the director offered me a position to come and work there. And I worked there 19 years of my career and have spent the last 13 years here. I think what it really kind of guided me to Guilford County was the challenge of a larger jurisdiction. I love Randolph County; I still live there, fortunate enough that the commissioners allow me to still live there and work here. So, it really was a great transition for me and offer me a whole lot more challenge and I've just enjoyed, and I plan to finish up my career here. I've been in this business 32 years now, and it's just been a tremendous blessing in my life. You talked about earlier about death and taxes, it's amazing that my being bi-vocational it, I deal with both of those on the ministry front. One of the unfortunate things that I have to do is bury people. And then on the tax front, I collect taxes and have been doing that for 30 some years of my life. Folks often referred to me as Matthew and I've been called a lot of other names throughout my career. And when I tell people that I'm a Christian, I'm a minister, they say, how do you do that? How do you, how do you, how are you a tax collector and a preacher? Those don't go together.

Carly Malcolm: [00:05:31] Well, one of the things that we wanted to talk to you about today is land records information to shift gears slightly. So why is it important for senior adults to know about land records?

Ben Chavis: [00:05:51] Well land records are one of the very important things that we do. We maintain the ownership and the land record information for every property in Guilford County. Of course, that is the front end of our process, which directly flows from Jeff's office, the Register of Deeds. We've got an electronic flow of data from his department into our software and it updates the ownership information pretty readily. When I first came to Guilford County 12 years ago, the ownership information was like from six months to 12 months old. So, our data was not up to date and the new software where we got really helped us advance in that regard. And now with it, we're within a week of the time that we get the data from Jeff's office over into the tax department. That new ownership information is there in our records. So, the land records department obviously is the front end of our process and they drive everything that we do. They're the front end of our process and drive everything that we do throughout. So, that's a very important part of what we do in maintaining that ownership information. Also, the property boundary information, geographically, on our maps and through our land records department. So, we maintain the ownership and the land records piece and that is depicted right on our website. Individuals can track that information there and the citizens can view that data and they can help us make sure that our data is accurate, which we want it to be. And we're glad to provide that through an online portal.

Carly Malcolm: [00:07:17] And how does the tax department receive death and inheritance information. Is that an automatic process or how does that work?

Ben Chavis: [00:07:25] Well, I really wanted to kind of dispel a misnomer out there because some folks think that we automatically get that information once an estate is filed. It works through that process, but it doesn't come to us automatically, so, we rely actually upon the owner of the property to notify us of that. And sometimes at the very end of that process, they're frustrated to find out that they didn't, that they felt that information was automatically given to us from the Clerk's Office. So that information does not flow to us directly upon the death of someone or that inheritance information. We obviously need that information too, we need to be notified by the owner that that is transpired. We also provide a form that individuals can fill out if they've lost a loved one due to death and they have ownership of property here in Guilford County, then there's a death notification form that is completed. We have that online, and what they'll need to do is simply complete that and provide us official copies of the death certificate and the will. And we in turn, from that information, we date the information in our system to reflect the fact that that owner may have deceased and that is now an heir’s property. They can get that information to us by those documents by simply mailing them to us to our real estate transfer section of the Guilford County tax department. And our PO Box is PO Box 3138 here in Greensboro, 27402. And if they have any questions about an estate or a will following that, they can simply do that through the Clerk's Office or give them a call if they have questions at (336)412-7550. We definitely, it's vital that we received that information. And there's an assumption on the part of the owner that that information automatically flows over to us, but it does not. So, it's very important that if you lose a loved one due to death and they own property, or have ownership in property here in Guilford County, that that information is conveyed to us so that we can update our records properly.

Carly Malcolm: [00:09:33] Yeah, that's really important information. I appreciate you sharing that with us and with our listeners. In terms of local property tax, are there any relief available for senior adults?

Ben Chavis: [00:09:53] We do. It's really one of the few types of exclusions for an individual that are offered through the local property tax system. Everything we do is mandated by the general statute in North Carolina and we follow a manual if you will, for just North Carolina Machinery Act, and it outlines all the ways they're on the assessment and collection of tax level, how we're to conduct our business. One of the things that it does provide under the general statute is for individuals who are eligible, they get an exclusion on the property tax. That can actually be significant savings for them annually in paying their local property tax on their home. And we obviously want everybody to take advantage of that. We provide that information online and we also include that information in with the listing form in January. So, every property owner in Guilford County, every individual residence, receives an application just in case they're eligible. We want them to complete that and return that back into us during the month of January. As far as the qualifications for the program, there's actually three qualifications that have to be met. Number one, you've got to be a North Carolina resident. You've got to not only be the resident of that property, but own the property and occupied as your permanent residence. And that means that if someone temporarily moves out of the home and it's for an extended period of time and they're not going to return to that residence and they're going to be in a rest home or under convalescent care and there's no hope of them returning home, then they probably would no longer qualify for the exclusion. And also, they must be at least 65 years of age or older, or they could be permanently disabled, as some folks are, as declared by a North Carolina physician. And they would be eligible under those two bases if they meet that age or disability requirement. And the third one is their annual income could not exceed $31,500. So, what is the benefit if I meet those three requirements? That's rather significant in that the individual will be eligible for an exclusion of either $25,000 excluded from your property tax value, the appraised value, or market value of your property, or 50% of the appraised value of your home. Typically, folks are qualifying at the 50% level, which essentially cuts your property tax bill in half, significant savings. Currently we have about 7,000 residential properties in Guilford County that qualify for it. And I feel like there's probably a lot more individuals out there that qualify for this. And if they do, we certainly want them to take advantage of that. Kind of an association with that particular exemption, Carly, is the DAV exemption, Disabled American Veterans. They can qualify for this exclusion. I just explained if they meet all those requirements or they could qualify under the other one which excludes $45,000 in value of their property. So, significant savings there for individuals who would qualify for these two programs. And certainly, we want them to take advantage of it because of the citizens of Guilford County. Certainly, that sector of our population that is eligible for it needs to take advantage of it. And thank you so much for asking about that and we encourage folks to just reach out to us if they've got any questions along that line, that information is online and on our website. And we've got a brochure out there that provides that information.

Jeff Thigpen: [00:13:25] Yeah Ben, my mom, who is now going to be 84 years old today. She found out about the exclusion, the Homestead exclusion probably six or seven years ago and it's made a huge difference for her. She's on a fixed income, you know, doesn't have a lot of extra money to spare. And this is a program that if you qualify or are eligible or have questions, definitely follow up with the tax department about this, it can make a very big difference. And I appreciate you sharing that, Ben. I'm gonna back up for a second and transition back into your work within your faith community. And I know you mentioned early on that, you know, growing up in Maxton, you had a faith community down there that meant a lot to you and changed your life in a lot of ways and then you now are the pastor of Freedom Life Church in Asheboro, but talk to us about what led you into that journey and what was it that led you to where you are now? And by the way, I'm an elected official in Guilford County government, you're the tax director appointed every two years, right. I'm appointed every, well I’m elected every four years. But these are spaces that we, you know, we have church and we have state, and we honor those and I think in this podcast, we're going through them, you know, in our capacities. And so, I want to honor your whole person today, in terms of both of your roles.

Ben Chavis: [00:14:53] And certainly that is the makeup of who I am. You just described that and I appreciate that Jeff because my faith really carries me in so many other sectors of my life. And what really got me into that area was I was an 18-year-old realist searching for direction in my life. Had not a clue about what I was going to do after high school. And I discovered faith at 18, during that summer straight out of high school. And through my faith, I began to get direction for my life, went to a local community college and then from there I got a two-year degree from there and then went on to UNC Pembroke. I got a full year degree in business administration, but I tend to think that my faith really kind of began to transport me through life and carry me to my destiny. And who knew that it ended up in property tax, but it did. But from there, and that was 1987. Well, actually that was 1982. I'm telling my age here, I’m getting to be in that sector with a lot of the senior adults, so I'm getting close. That was 1982, I really struggled about where I went from there as far as my faith. And I was still in college trying to figure that out and in 1987, I truly believe that, as it relates to ministry, it's a calling. I feel like I just kept listening to the voice of the Lord to kind of direct me and guide me. And I just kind of kept bartering with him and trying to escape my calling so to speak and try to get away from that and I finally got to the place where I said, hey, I'm called. I have folks calling me before he calls me. They were telling me, yeah, you definitely got a calling on your life to do ministry. And I said, Oh, I'll just wait on that until I get out of college or something. But in 1987, I just yielded to that, what I term, a calling of my life. And I used to do that and then of course, the next year I graduated college and then went on this journey for the last 32 years of being in this business. I've been involved in ministry since 1982 in that small local church. Cutting the grass, cleaning the church, doing all those things you do in a small church, I was just learning to serve. My life has been blessed tremendously in that I have the opportunity to serve on both fronts as a minister of the gospel and in my capacity as a tax assessor collector in Guilford County serving the people of this great county. 450,000 people in this county, I get an opportunity to serve them. And what better thing could you ask for the opportunity to serve. And the commissioners allow me to do that and I try to serve them and serve the people to the best of my ability. I think myself and my staff do that on a daily basis. But again, to me, it's all driven out of my faith foundation. That’s where it’s all derived from.

Jeff Thigpen: [00:17:48] And both require somewhat of a pastoral influence in many ways. Both within your church and when, you know, when that taxpayer calls in and is a little upset about that bill. And in your role as pastor and serving a congregation, how does issues of grief and death and dying come into that space for you? You don't know this, but I listened to your sermon or it was a message on Facebook this weekend. And particularly, for just a second, you acknowledge someone in a loss. I don't even know if you remember if you did that or not, but I remembered that you did listening to it. And I would expect well, in both roles, but in that role in particular, you are in general helping people in life like I said in the beginning, but also dealing with the issue of death and dying and grief. And so, I guess what the question is, what has been your approach to that space when you go into it in your faith life, in your congregation?

Ben Chavis: [00:18:59] Well really what’d you do is, to me, you’re approaching it from a biblical perspective. The Bible has so many wonderful attributes about how you conduct yourself as a person and as a servant. I just simply identify with what the scripture says and that we grieve with those that grieve, and we rejoice with those that rejoice. So, to me, you just kind of, because I've had an opportunity to grieve myself last year, I lost my mother and I'm glad to hear you still got your mom. She was really the only parent in my life that I ever knew. She really, really is at the very core of who I am because I saw her struggle so much in life and it's made, and I swell it with tears, even right now thinking about her, because I hadn't planned on getting into this, but she had a stroke at 38 years of age, I was a senior. You talk about things that change your life, I was a senior that year, December of 1981. I remember it like yesterday, had just turned 18 on December 6th. So, she has a stroke, she's 38. I watched the rest of her life be permanently disabled on one side of her body, but yet that didn't stop her. And I just, many times I put myself where my mom lived just to see what she did to make life beautiful, she just made life beautiful with that kind of issue going on in her life. And last year when I lost her in July of last year, I was in the hospital with her for about a month. I stayed with her, basically, I slept in the room with her for about a month in Florence, South Carolina. The amazing thing that brought me back to my mind was that she lived 38 years on one side of a stroke and 38 years on another side of their stroke, 76 years of her life. She lived physically with a capable body for 38 years but then again, she had lived with a disabled body for 38 years, but yet she endured so much. And, really that kind of helps me relate to other people because of what I've gone through personally, and my faith, it drives me to and identify with people. So when people are hurting to be a minister and to have a great heart, you've gotta be able to do that. So if I get a taxpayer, who's going through a difficult situation. They've maybe just lost their spouse, I try to, I first of all, say, hey, I'm sorry for your loss. I'm sorry to hear you lost a loved one because I can relate to that. So you simply grieve with those who grieve and you rejoice with those who rejoice.

Jeff Thigpen: [00:21:29] Thank you. Yeah. Powerful. She sounds like she has, she had the DNA of a monster truck. That's why, that's how I describe my mom. And my mom went blind for a little while. I think all of us come to the table, recognizing those in our lives that have struggled tremendously through physical pain, through situations that, in the messiness of all of it, we draw strength. It sounds like you got a lot of wisdom out of that life.

Ben Chavis: [00:22:02] Just by looking at her, examining her life. Just being there for her. And that's what people need, especially when we're talking about end-of-life issues. People just need, we don't need to forget this sector of our community. These people are treasures and they have been there for us all those years. And the awesome thing, when I stood before that congregation doing my mom's service last year, was I could stand up there with a clear conscience knowing that I had done from my mother, all of that I could do. And really that's what, we owe that to people that are facing end of life issues and coming to the end of their journey on this earth. And we have an obligation to them, and sometimes they're a forgotten entity when they should be the most celebrated. We celebrate babies, we celebrate anniversaries, we celebrate all of these. Why not celebrate somebody in their Twilight years, making sure that they're remembered while you have them.

Carly Malcolm: [00:23:01] Are there any other ways that end-of-life issues factor into your job and your ministry?

Ben Chavis: [00:23:16] I think I've pretty well covered it all today. I hadn't, I had not expected to getting so personal, but that's who I am. I try to be transparent with people and try to relate to people and identify with them. And I think that's why Jeff and I get along so good, Jeff's just real, and I liked that about him.

Jeff Thigpen: [00:23:25] One of the things that we, Carly and I, have seen is the real need to be prepared and live in a culture, in a lot of cases, where we don't. What we don't see is, sometimes, the preparation beforehand and then before you know it, you may have a person in your congregation just looking a death of a loved one in the eye. And I'm sure you kind of see varying levels of preparation and thought that those families may have put into that moment. And we talked a little bit before the podcast about advanced directives and you know, those kinds of preparatory things that probably make that transition go easier.

Ben Chavis: [00:24:02] I would close with this and simply say, what we've talked about today is preparation as far as making life easier on your loved ones, once you do pass. That's very, that's critically important that you take care of a lot of that paperwork, deed work, just being prepared to hand that off to your heirs and having everything in order, because I can tell you, I have seen in this business so many times where that issue did not get resolved before the parent deceased. And it ends up being a source of contention with those that inherit the property because that had not been properly planned out. So, to me, that is something you can prepare for, but as far as grief and when that loved one is gone and no matter how much you prepare for that emotionally, spiritually. I thought I was prepared to lose my mom because I was sitting there dealing with that issue contemplating that for an entire month thinking this is probably going to be the end.

Jeff Thigpen: [00:25:15] What did you learn from that that’s helped you?

Ben Chavis: [00:25:19] That you simply surrender. As much as I wanted to keep her, we talked about her living 76 years, I wanted her to live 77. I wanted her to have another year, but she had been in the hospital, in and out of the hospital, like three times in 2019. And I just knew that things were not going to get better. And I think that what I learned was there comes a point you got to release and let go, but it's something beyond your control. And I would say to those who grieve, I like to apply what the scripture says about Moses when the Lord is speaking to Joshua to lead the people of Israel. He said to him, he says, stop you're grieving. It's time to lead my people into the promised land. And basically the Lord allowed them 30 days to grieve. And I know people make it seem like that is cruel, that is harsh. But yes, you need to allow your period of time to grieve, but then you move on from that point. And that's what I did with my mom. In fact, I was in my car on my way to the service, the funeral service. And it was like the Holy spirit spoke to me and said your grieving over. And from that point forward, I did that sermon and celebration of life from my mother, because I felt like my grieving was over, I needed to start rejoicing. So we moved from grief to rejoice, we can't live constantly in a state of grieving because it eventually will pull us down. And some folks never are able to get past grief, but you have to and I'm not a counselor, I'm not a professional and certainly they might need some help and assistance in doing that. But that's my perspective on grieving that you allow yourself a period of time to grieve, to weep, and to get every emotion out. Don't hold it in. Let it be released. And then you simply move on with life.

Jeff Thigpen: [00:27:17] And Carly and I have done a number of these podcasts and what you're saying is so important and it goes into several spaces, but most notably I'm thinking about caregiving because we've had several interviews, Odell Cleveland writing a book about caregiving as well as a Pam Strader. And also, within faith traditions, we had a person from the Jewish faith talk about the grieving process in the Jewish community, which in some cases is similar in the Islamic community as well. So we're learning these connections, but the heart of what you're saying is that life and death are interconnected in a lot of ways. And we are born, we live and then we, and our loved ones die. And we mourn them and it's natural and it's also natural to then live again as part of that life cycle process and part of dare I say, the faith tradition, is to live fully and that's all connected. And it sounds like when you got up and talked about your mom, that was probably one heck of a message.

Ben Chavis: [00:28:25] I felt inspired because my mom lived that kind of life. She overcame so much. She's just overwhelmed by so much, but yet she persevered and that's part of, like you said, life, grieving as a part of life, but then you bounce back and you allow life to return. And I'm sure my mom wouldn't want me to, and I don't think most of our loved ones that have passed on would want us to grieve over them being gone. They want us to eventually move on with our life. They want us to live life to its fullest.

Jeff Thigpen: [00:28:59] Thank you Ben Chavis. To get more information by Guilford County tax department, please go to the Guilford County webpage. You pull up the tax department there to learn more about Freedom Life Church in Asheboro, they have Facebook. Or you can try to be friends on Facebook and listen to his messages. On behalf of Carly Malcolm, the NC lead fellow from the Institute of Government and myself. We'd like to thank you, Ben Chavis, for being a part of the Good Grief podcast.

Ben Chavis: [00:29:26] Thank you so much for having me today.

[Outro] Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com. You can also email us at endoflife@guilfordcountync.gov or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[Intro] 

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do. Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is also complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

•Carly Malcolm [00:00:59] : Hello everyone and welcome to the podcast “Good Grief.” I’m Carly Malcolm, and I work as a fellow from the UNC School of Government in the Guilford County Register of Deeds Office. In this podcast, we talk about subjects of death and dying, because we want everyone in our community to not only live well, but also, when the time comes, to be able to grieve well and die in peace. Often, it’s difficult to think and talk about this topic, and that’s why we’re here to have those difficult conversations and eliminate the mystery and stigma of issues related to death. Today we have a special guest from our own Register of Deeds Office, Felipe Allende. Felipe is a business systems analyst and has worked in the ROD Office for over 3 years, after having worked in the private sector for nearly 10 years. He is a graduate of Bloomfield College and has a Masters in Network Information Systems from Stevens Institute of Technology. Although he works in systems, Felipe answers calls and questions about the Register of Deeds for Spanish-speakers. He has a lot of information to share about the ROD Office and the role of the office related to death certificate. Welcome Felipe and thanks so much for being here.

Felipe Allende [00:02:21]: Thank you Carly, and greetings to everyone listening to us.

•Carly Malcolm [00:02:24]: To start, can you explain the role the Register of Deeds office? Because many people don’t know until they get married, have a baby, buy a house, or someone dies.

Felipe Allende [00:02:36]: Sure. The mission of our office is to register, preserve, maintain, and provide access to real estate records and vital records in an effective and efficient manner, in accordance with the North Carolina General Statutes. My role in our office is to ensure that our technology infrastructure is always up-to-date and processing all of the deeds in an effective manner. I’m constantly in contact with our vendor BIS y with the county’s IT department to ensure that our systems don’t have any problems. At the same time, being bilingual, I help the Hispanic population with any questions related to the services offered by our office, acting as an interpreter between them and the agents/supervisors of our departments.

•Carly Malcolm [00:03:22]: Well, how is the ROD office involved in issues related to death?

Felipe Allende [00:03:28]: The ROD receives and records death certificates from the Guilford Co Health Department for all deaths that occur within Guilford County. Once recorded the death record stays on file forever and the ROD can issue certified or uncertified copies of these based on our customers’ needs.

•Carly Malcolm [00:03:50]: What is the process for requesting a death certificate?

Felipe Allende [00:03:54]: Only immediate family members, attorneys or funeral homes can request and obtain certified copies of death certificates. Anyone can request and obtain uncertified copies of death certificates. Requests can be made in person (under normal circumstances), online at ncvitals.com or through the mail.

•Carly Malcolm [00:04:43]: You mentioned funeral homes. How does the Register of Deeds office interact with funeral homes?

Felipe Allende [00:04:49]: The ROD office works closely with funeral homes. Funeral Homes generally are the entities that gather personal information of the decedent from a family member so the death certificate can be completed. The funeral home then forwards the dc to the doctor/medical examiner to fill out their portion of the dc (cause of death and contributing factors). Then the dc goes to the Health Department for a final review before it is then sent to the ROD. Funeral Homes usually request dc’s for the family members of the decedent. They can request through an online portal, in person, mail in or fax.

•Carly Malcolm [00:05:36]: In our office, how are death certificates kept? Who can access them?

Felipe Allende [00:05:43]: Death Certificates are submitted to the ROD electronically. They are assigned a book and page number, indexed and scanned and are kept on record on a database. Death records are a public record so anyone can view and obtain uncertified copies, but only immediate family members, attorneys or funeral homes can obtain certified copies.

•Carly Malcolm [00:06:10]: It’s rare, but what happens if something on the death certificate is wrong?

Felipe Allende [00:06:15]: An amendment must be made if an error is discovered on a death record after it has been put on record. Call our office, our number is 336-641-7556, and depending on the error, we can tell you what information is required for the correction.

•Carly Malcolm [00:06:36]: In the same way that many people don’t know what the ROD Office does, they also don’t know what it doesn’t do, for example wills and estates. Where should people go to handle things related to wills and inheritances?

Felipe Allende [00:06:53]: In the Wills and Estates division of the Clerk of Court’s office, you can request more information. Their number is 336-412-7550.

•Carly Malcolm [00:07:09]: Finally, my last question for you, what resources are there at the Register of Deeds office for non-English speakers?

Felipe Allende [00:07:17]: Our webpage has the option to change the language in the upper right part of the screen. For our Hispanic population, we have two agents, Jeanette Zendejas an myself, that can take their call and help them with any questions.

•Carly Malcolm [00:07:33]: Well, thank you very much Felipe for answering these questions. We’ll have links in the episode description for the resources you mentioned. Thanks for being here.

Felipe Allende [00:07:43]: Thank you, and thanks to the public.

[Outro] 

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[Intro]

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm, Lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do. Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is also complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

Carly Malcolm [00:00:59]: Hola a todos y bienvenidos al podcast “Good Grief.” Soy Carly Malcolm, y trabajo como una becaria de la Escuela de Gobierno de la UNC en la oficina de Registros Públicos del Condado de Guilford. En este podcast, hablamos de temas de muerte y morir, porque queremos que todos en nuestra comunidad no solo puedan vivir bien, sino que, cuando llegue el momento, su pesar sea más tolerable y poder morir en paz. Muchas veces es difícil pensar y hablar sobre este tema, y por eso estamos aquí para tener esas difíciles conversaciones y eliminar el misterio y el estigma de los problemas relacionados con la muerte. Hoy tenemos un invitado especial desde nuestra propia oficina de Registros Públicos, Felipe Allende. Felipe es un analista de sistemas y ha trabajado para la oficina de Registros Públicos por más de tres años, después de trabajar en el sector privado por unos diez años. Él es un graduado de la universidad de Bloomfield y tiene una maestría en redes del Instituto de Tecnología Stevens. Aunque él trabaja en sistemas, Felipe responde a las llamadas y preguntas de hispanohablantes sobre los registros públicos. Tiene mucha información para compartir sobre la oficina de Registros Públicos y el papel de la oficina relacionado con los certificados de defunción. Bienvenido Felipe y muchísimas gracias por estar aquí.

Felipe Allende [00:02:21]: Gracias Carly y un saludo por ellos que nos escuchan.

Carly Malcolm [00:02:24]: Para empezar, puede explicar ¿Cuál es el rol de la oficina de registros públicos? Porque mucha gente no lo sabe hasta que se casa, o tiene un bebé, compra una casa o alguien muere.

Felipe Allende [00:02:36]: Seguro. La misión de nuestra oficina es de registrar, preservar, mantener y proveer acceso a documentos de propiedades y vitales de una manera efectiva y eficiente de acuerdo con los Estatutos Generales del estado de Carolina del Norte. Mi rol en nuestra oficina es asegurar que nuestra infraestructura tecnológica esté siempre actualizada y que procese todos los documentos de manera efectiva. Siempre estoy en contacto con nuestro vendedor BIS y con el departamento de tecnología del condado para asegurar que nuestros sistemas no tengan ningún problema. A la misma vez, siendo bilingüe, ayudo al público hispano con cualquier pregunta relacionada con los servicios que nuestra oficina ofrece, actuando como intérprete entre ellos y los agentes/supervisores de nuestros departamentos.

Carly Malcolm [00:03:22]: Bueno, ¿cómo está involucrada la oficina de Registros Públicos con los problemas de la muerte?

Felipe Allende [00:03:28]: La oficina de registros públicos recibe y registra los certificados de defunción, que son enviados por el departamento de Salud del condado de Guilford, de todas las muertes ocurridas dentro del condado de Guilford. Una vez que el certificado es registrado en nuestro sistema, el registro es guardado de por vida y dependiendo en la necesidad del cliente, podemos proveer copias certificadas o no certificadas.

Carly Malcolm [00:03:50]: ¿Cuál es el proceso para solicitar un certificado de defunción?

Felipe Allende [00:03:54]: Solamente familiares directos (padres, hijos, abuelos, nietos, viudos, padrastros), abogados o funerarias pueden pedir y obtener copias certificadas del certificado de defunción. Cualquier persona puede pedir y obtener copias sin certificación del certificado de defunción. Los pedidos se pueden hacer en persona (durante la pandemia no estamos aceptando el acceso a la gente a nuestras oficinas), también lo puede solicitar por medio del internet usando nuestra página www.ncvitals.com o por el correo utilizando el formulario que es accesible por nuestra página de registros públicos.

Carly Malcolm [00:04:43]: Mencionó las funerarias. ¿Cómo interactúa la oficina de Registros Públicos con las funerarias?

Felipe Allende [00:04:49]: La oficina de registros públicos trabaja cercanamente con las funerarias. Las funerarias son generalmente las entidades que colectan la información del fallecido por parte de un familiar de tal manera el certificado de defunción pueda ser completado. La funeraria, una vez que tiene listo el certificado, lo envían al doctor o al médico forense para llenar la sección del documento que les corresponde, este envuelve la causa de muerte y los factores contribuyentes. Ya completado el certificado, es enviado al departamento de salud para una revisión final antes de que sea enviado a nuestra oficina de registros públicos. Las funerarias usualmente piden una copia del certificado de defunción para la familia del fallecido. Esta misma se pide por medio de la internet, en persona, por correo o fax.

Carly Malcolm [00:05:36]: En nuestra oficina, ¿Cómo se guardan los certificados de defunción? Y también ¿quién puede acceder a ellos?

Felipe Allende [00:05:43]: Los certificados de defunción son enviados a la oficina de registros públicos electrónicamente. Se les asigna un número de libro y un número de página, es indexado y escaneado y por último se registra en nuestro sistema. Actas de defunción son registros públicos para que cualquier persona pueda verlos y pedir copias no certificadas. Como fue mencionado anteriormente, solo familiares directos, abogados y funerarias pueden pedir copias certificadas.

Carly Malcolm [00:06:10]: Es raro, pero ¿Qué pasa si algo en el certificado de defunción es incorrecto?

Felipe Allende [00:06:15]:Una corrección debe ser hecha si se encuentra cualquier error en el acta de defunción después de que esta haya sido registrada. Llame a nuestra oficina, nuestro número es 336-641-7556, y dependiendo del error, nosotros le indicamos que información es requerida para la corrección.

Carly Malcolm [00:06:36]: De la misma manera que mucha gente no sabe lo que hace la oficina de Registros Públicos, tampoco sabe lo que no hace, por ejemplo los testamentos y estados. ¿A dónde debe ir la gente para gestionar cosas relacionadas con testamentos y herencias?

Felipe Allende [00:06:53]: En la división de Testamentos y Estados, conocida como wills and estates, en la oficina de la corte, usted puede solicitar más información. Su número es 336-412-7550.

Carly Malcolm [00:07:09]: Finalmente, mi última pregunta para usted, ¿qué recursos hay en la oficina de Registros Públicos para personas que no hablan inglés?

Felipe Allende [00:07:17]: Nuestra página de internet tiene la opción de cambiar de idioma en la parte de arriba a la derecha. Para nuestro público hispano tenemos dos agentes, Jeanette Zendejas y yo que podemos tomar su llamada y ayudarlo con cualquier pregunta. 

Carly Malcolm [00:07:33]: Bueno, muchas gracias Felipe por responder estas preguntas. Tendremos enlaces en la descripción del episodio para los recursos que mencionó. Gracias por estar aquí.

Felipe Allende [00:07:43]: Gracias a ti y gracias al público.

[Outro]

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[Intro]

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do. Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is also complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen: [00:00:39] Welcome to the Good Grief podcast. I'm Jeff Thigpen, Guilford County Register of Deeds with Carly Malcolm, lead for NC fellow from the North Carolina Institute of Government. Today, we're going to learn about the Guilford County Clerk's Office and who better to have with us today than our very own Clerk of Court, Lisa Johnson Tompkins. Lisa was elected Guilford County Clerk in 2014. Her top priority as Clerk of Court has been customer service. And she believes and knows that the Clerk of Courts Office, in many ways, is the face of the courthouse. She oversees offices in Greensboro and High Point. She is a graduate of North Carolina A&T State University in the field of public relations, advertising, and applied communication. She got her law degree from North Carolina Central and is a former assistant District Attorney and serves as an Adjunct professor at GTCC. Thank you very much for being with us, Lisa.

Lisa Johnson Tompkins: [00:01:56] Well thank you for having me.

Jeff Thigpen: [00:01:57] Okay. So, I'm the Register Deeds and you're the Clerk of Court and we need to get this straight because people call me the Clerk of Court and they call you the Register of Deeds. So, we're going to get this straightened and I'm going to let you lead the way. Can you tell me what the Clerk's Office does and what the core services are and how it's governed and those kinds of things so people can truly understand what you do? And at a later podcast, I will talk about the Register of Deeds. So, at some point the public will know what we both do. Lisa, tell us about the Clerk of Court's Office, what are its core services and how's it governed?

Lisa Johnson Tompkins: [00:02:31] Well first again, thank you for having me on this podcast. This is a wonderful opportunity to educate people about the Clerk of Superior Court's Office. The Clerk of Court is governed by the North Carolina constitution, article four, section 93, and also by the North Carolina general statutes 7A-100A. And the constitution provides that there'll be a clerk of court in every county. And in North Carolina, there’s a hundred counties so there are a hundred Clerk of Superior Courts across the state. Clerks are elected every four years and our duties and our powers and our jurisdiction is governed by the general statutes. The Clerk of Court is a full-time employee of the state of North Carolina and in every Clerk's office, especially in Guilford County, we have a criminal division, a civil division, a juvenile division, bookkeeping, estates, special proceedings, and of course, administrative services that handles everything else that the Clerk itself needs. So, you know, in Guilford County, we're just different from any other county because we have two courthouses. So that's a difference as far as Guilford County with respect to the Clerk of Superior Court's Office.

Jeff Thigpen: [00:03:41] Yeah. What has been your core priorities as Clerk?

Lisa Johnson Tompkins: [00:03:45] Well, as the elected Clerk, I have five main priorities. The first of which is that I am the ex-officio judge of probate. I'm an administrator, which means that I oversee personnel issues and I have 150 employees. I'm a controller responsible for distributing and taking money, and safeguarding those monies when they are deposited with the Clerk of Superior Court, I'm a record keeper and I'm a manager and a supervisor. And so those are my core duties as the elected Clerk of Court.

Jeff Thigpen: [00:04:15] Yeah and the Register of Deeds Office has about 30 employees. You have 150 employees, so that's quite a job.

Lisa Johnson Tompkins: [00:04:24] Yeah, very much so.

Carly Malcolm: [00:04:26] And you also mentioned those two different locations. Can you tell us where those are?

Lisa Johnson Tompkins: [00:04:29] Absolutely. We have two locations, one in Greensboro, and then one in High Point. The Greensboro office is located at 201 South Eugene street in Greensboro, North Carolina, which is downtown. And then our High Point location, which is the High Point Courthouse, is located at 505 East Green street in downtown High Point.

Carly Malcolm: [00:04:48] Okay. Can you tell us what areas of your office deal with end-of-life issues?

Lisa Johnson Tompkins: [00:04:52] With respect to end-of-life issues, two of our main divisions that deal with that are estates and special proceedings. So, I know that maybe some people have heard of the estates division, but maybe some people are not familiar with the special proceedings division, so I will try to tackle those so people can understand those better. Our estate's division oversees the administration of an estate and to see to it that the wishes of the decedent are followed or the applicable laws of the state of North Carolina are followed in the absence of a will. So, if someone dies, what we call intestate, without a will, then we follow what the general statute says. Otherwise, we try to make sure that we follow the directives of the person who drafted the will. And then we also process the paperwork for a spousal allowance in the estates division. Now with respect to our special proceedings division, how it relates to end of life, our special proceedings division may be utilized during that process if real property needs to be sold to create assets for the payment of debts through an estate. So, even though the person may have a will and it says you can dispose of the property as you see fit. If that property needs to be sold to then put that money into the estate to pay the debts of the estate, then you have to ask for permission through the special proceedings division. And then also if you don't have an estate that you want to open, but maybe there's a vehicle in the decedent's name that you want to transfer in. A lot of times that happens with a husband and wife. Maybe the husband died, and the car was in his name. You come to the special proceedings office to transfer that title and that's by filling out a form with the DMV. But just like the Register of Deeds Office, we both have separate roles, but sometimes they overlap one another, but we don't give legal advice. We are administrative in a number of different areas, unless it requires us to make determinations with regard to special proceedings in estates, because we are having a judicial function in those particular areas. That about covers it.

Jeff Thigpen: [00:07:05] Yeah. And that's, are your staff deputized?

Lisa Johnson Tompkins: [00:07:07] They're sworn yeah, they're sworn for their particular office.

Jeff Thigpen: [00:07:11] Yeah. We have an oath that we both have to take as elected officials and we have staff that have oaths and we call it deputizing them, but they act on our behalf every day. And as you just said, the idea of the administrative nature of what we do in the sense that we have to, you know, really be aware that we're not providing legal advice to people and that we're providing the information that they need. What happens when somebody dies and doesn’t have a will?

Lisa Johnson Tompkins: [00:07:38] Well, if someone dies and doesn't have a will that's called, like I had said earlier, dying intestate. And so, we follow what we call the Intestate Succession Act, and that is provided by the general statutes. And we just follow, whatever the statute says for us to do.

Jeff Thigpen: [00:07:53] Yeah. And just to say again, wills and estates are in the Clerk's Office and not in the Deeds Office. And I'm sure along the way, you'll have some things that you'll say, well, that's in the Register Deeds Office, not in our office. What does a state and probate refer to?

Lisa Johnson Tompkins: [00:08:06] Well, the term estate can refer to a number of different things, but generally speaking, especially through the end-of-life category, the estates typically refers to the money or the real and personal property that a person had at the time of their death. And probate means that it’s the official proven of the will and establishing the validity of a will. So essentially, it's just the administration of a person’s will.

Carly Malcolm: [00:08:33] What dictates, how an estate will be handled?

Lisa Johnson Tompkins: [00:08:35] Laws of North Carolina dictate how estates are handled, whether it's with a will or without a will. For instance, if someone dies with what we call a paper writing because a will actually is a technical term. So, when they submit what we commonly know as a will, we refer to it as a paper writing because it doesn't really become a will until the Clerk's Office has deemed it to be the writing of the decedent and his or her intent. But the purported will must comply with all the rules of the state of North Carolina before it will be open as an estate.

Carly Malcolm: [00:09:09] Do you have to file estate paperwork and probate when somebody dies?

Lisa Johnson Tompkins: [00:09:13] No, you don't have to, not necessarily, but if a person has sufficient assets or there needs to be a sale or distribution of assets, it is important that a person or the family members, or even friends establishes an estate. Also, if there's a concern about any outstanding debts that the decedent had, or you need clear title to property, then an estate will probably need to be opened because a creditor, at any time, could come in and open up an estate. It doesn't have to be a family member, it doesn't have to be a friend, it could be any interested party that can open up an estate and asked to administer that particular estate. And so those are some reasons why there might need to be an estate opened.

Carly Malcolm: [00:09:57] And what kind of documents do you need to start that estate administration process?

Lisa Johnson Tompkins: [00:10:01] Well, it really depends on the type of estate. So, if it's a small estate, the documentation is not as great as it would be for a full estate. And fortunately, the Administrative Office of the court in North Carolina has established a link that will help people, with a questionnaire, do the step-by-step processes. And that's on nccourts.gov/services and then you look for the e-filing guide, and it can take you step by step. The only one that doesn't really help is what the full estate and I would always encourage people to contact an attorney for that.

Jeff Thigpen: [00:10:42] Yeah and this question is a simple question, but I see it a lot. And it's really important when people are dealing with estate matters. How do you handle titles for vehicles?

Lisa Johnson Tompkins: [00:10:55] Well, you first want to come to our special proceedings division to try to transfer that title and the form that is used is called an Affidavit of Authority to Assign Title, which is a DMV form and that form number is M as in motor, V as in vehicle, and R as in registration, dash three one seven. And I mean, the form is pretty simple. The biggest part is you must make sure that you list all the heirs and heirs are any person that might have rights to that particular vehicle or particular property. And then you pay the filing fee for that document. Then we certify it and we give it back to the person and they send it to the DMV.

Jeff Thigpen: [00:11:42] Next question with the Clerk of Court is are wills public record?

Lisa Johnson Tompkins: [00:11:48] Okay, so.

Jeff Thigpen: [00:11:50] We're just peppering you with questions.

Lisa Johnson Tompkins: [00:11:54] So here's the trick in Guilford County, I mean, Guilford County is unique in that we have two fully functioning courthouses, and we're like two counties in one with High Point and Greensboro. So, I say that to say that with regard to wills being what Mr. Thigpen said, are they public? They aren't when they are filed with the Clerk's Office prior to someone's death, but in Guilford County, we don't file, we don't accept wills for filing because we were exempted out because we have two fully functioning courthouses. And so, it would be a little confusing as to where the person deposited that particular will, but after the person dies and once the will has been probated, then that is a public record. So, it's not until after a person passes away and an estate is opened, that it is then public. But until that happens, of course, the will would be in safekeeping either in the Clerk's Office, in any other county, or maybe somebody’s safe deposit box.

Carly Malcolm: [00:13:00] And so then are all of the debts of the decedent, do they have to be paid before any of those assets can be distributed?

Lisa Johnson Tompkins: [00:13:07] Well, there is a priority for debts, but all the debts of the estate have to be paid before the estate is closed unless we determine that there are not sufficient assets but it’s still, the debt still out there. So, if assets happen to come through the estate, those debts will be paid. But you know, the top priorities for the payment of debts would be proof that the funeral expenses were taken care of and any attorney's fees. Then it depends on what the will directs and if they don't have a will, then we refer to the Intestate Succession Act.

Carly Malcolm: [00:13:46] so let's say that the decedent left a list of items to be given to someone after their death. Is that something that can be done immediately or does it have to be listed in the inventory?

Lisa Johnson Tompkins: [00:13:56] So if someone passes away and they have items and an estate is open, every item essentially is supposed to be listed on the inventory. However, you can list it in a lump category like personal property. So, if they had two couches and 10 tvs and you know, lots of memorabilia. You could still put that in personal property and you just give that a dollar amount. If it's real property, you have to list each individual property by address, and then you have to list each individual account and bank. So yes, all that has to be listed. It's just how you list it might not be how some people think you have listed, especially in the personal property category.

Carly Malcolm: [00:14:41] Can the items that are listed in that inventory be sold at any time or is there a waiting period?

Lisa Johnson Tompkins: [00:14:47] Well if, it really just depends and without giving any legal advice, I'll give as much legal information as I can. So, if it is, real property doesn't actually come into the estate unless you open up a special proceeding. So, if it's real property then they can sell that at any time. So long as there are no outstanding debt and as long as there's sufficient assets to cover any debts that the estate might have to pay. If it's anything else, what you need to look at is, was there a will and how does the will direct for that to be disposed of? And then if there's no will, then you have to look at the statute to see how those were disposed of. So, it just kind of depends.

Carly Malcolm: [00:15:25] Just to run back real quick. What qualifies as real property? What does that mean?

Lisa Johnson Tompkins: [00:15:30] Real property, like houses, land, anything that is attached to land.

Jeff Thigpen: [00:15:37] How soon can property be sold?

Lisa Johnson Tompkins: [00:15:39] Well, generally speaking, you, before you sell any property, you need to get permission from the clerk and that's done through a special proceeding and you can't include any type of assets from the sale into the estate without going through this special proceeding. So, if you're needing to sell the property for it to come into the estate, then you're going to need to ask permission. Otherwise, because real property does not funnel through the estate, then you can sell it so long as there are no outstanding debts. Otherwise, there's really going to be a lien and the person wouldn't get a good title to the property.

Carly Malcolm: [00:16:16] Are debts paid through the Clerk of Court or do they go directly to the entity that's holding that debt?

Lisa Johnson Tompkins: [00:16:21] That's a very good question. Payments are made directly to the creditor, but it is incumbent upon either the administrator, the attorney for the estate, or the executor to show proof that those payments have been made. And after someone passes away, you're supposed to notify the creditors by placing an ad in the paper that runs four consecutive weeks. And if anybody sends something into our office to say that they are a creditor and they are owed money, that's what we're looking for to see if those things were paid. And then it's usually through a canceled check or some type of statement from the entity saying that there is a zero balance.

Jeff Thigpen: [00:17:04] One thing that comes up is guardianship issues. And can you talk about guardianship and how that relates to your office?

Lisa Johnson Tompkins: [00:17:11] Okay. So, in a guardianship, the clerk is, and that's actually a special proceeding that then turns into an estate if the person is deemed to be incapable of handling their own affairs. So a petition is filed with the special proceedings office. A hearing is heard, and then the clerk's office makes a determination if the person is deemed incapable of handling their own affairs. I don't want to use the word incompetent, but if they're just incapable of handling their own affairs, then we look first to see if there's an individual who is willing to serve. If there is an individual willing to serve, that's the first thing we're looking for. The second thing the statute says is you can appoint guardianship to a corporation. And then the third, if there's not an industry, if there's not a corporation, you can also appoint what we call a public guardian and a public guardian is someone who agrees and takes an oath to handle the affairs of those persons who would normally not have a guardian, individual, or corporation. But the corporation of guardianship is a private nonprofit organization and they provide fiduciary services and care management for the ward with a person who has been deemed to be incapable of handling their own affairs. And so that's really what the corporation of guardianship is. They are just a private entity that helps facilitate that.

Jeff Thigpen: [00:18:36] Okay. Thank you. And I just want to say we got through a gauntlet of questions here. So you made it through the questions that we had out here. Very good information, a lot in here to digest. On the podcast series, of course, this podcast will have links that will go into, and supplemental information in terms of a lot of what the Clerk has just talked about. Lisa, I want to thank you, as a colleague, I've worked with you for six years as Guilford County Clerk of Superior Court, and as Register Deeds have appreciated your leadership. I've appreciated the work that you've done in terms of being a public face to the courthouse and working through issues that come up there. There is a specific project that we're going to be working on together that I think is very important, we kind of joke about this being like cousins in a way related to our institutions. And I appreciate the fact that you're working on upgrading the website in terms of the Clerk of Court's office. And we're working together with the Guilford County Clerk to the Board of Commissioners. So, we have the Clerk to the Superior Court. We have the Clerk to the Board of Commissioners and we have the Guilford County Register Deeds. And so, we're all going to try to work together in the coming year.

Lisa Johnson Tompkins: [00:19:43] People often get us all confused.

Jeff Thigpen: [00:19:46] Yeah. They really do a lot, but Lisa, I, again, I want to thank you for being with us as a part of the Good Grief podcast. And I will say this, early on when we started this podcast series, you were really important in terms of reaching out to and supporting this type of concept and the idea of helping people who are dealing with end-of-life issues and serious illness, not only have support and more community information around services that are available within our community during the mourning process, but also understanding the institutions that are out there, that are there to serve them and the Guilford County Clerk's Office is certainly one of them so on behalf of Carly and myself. Thank you for being a part of the Good Grief podcast.

Lisa Johnson Tompkins: [00:20:28] Well, thank you again.

[Outro]

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[Intro]

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do. Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is also complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

Jeff Thigpen [00:00:59]  This is Jeff Thigpen, Guilford County Register of Deeds and Carly Malcolm, lead for NC fellow from the North Carolina Institute of Government and welcome to the Good Grief podcast. Today, we're going to talk about death certificates at the Register of Deeds office. Our guests, our assistant Register of Deeds, Andrew Atkins, who's the current manager of our vital records area and former manager and assistant Register of Deeds, Elaine Inman. Andrew's been with our office for about 16 years, and Elaine has been here for nearly 19. So between the two of them, they've been here for a combined 35 years of knowledge about death certificates in our office. So I want to welcome you both. As we begin, I just want to give listeners an overview. The Register of Deeds office has basically two core areas, land records and vital records. Land records deals with real estate transactions and any number of legal documents. Vital records covers birth and death certificates and marriage licenses. We offer certified copies of each. Citizens can file military discharges and take part in our Think Of It program too, through our voter records. That's where we partner with around 400 businesses to provide discounts on goods and services and Andrew works along with that program as well. With that background, let's talk a little bit about death certificates. Andrew, where does the death certificate process begin?

Andrew Atkins [00:02:25] So, the actual death certificate starts as a blank template and it's provided by the state office. Usually, the funeral home gets information from the family and fills out the personal information such as date of birth, social security number, education level, et cetera. Then it would go to the medical doctor to sign off of and provide a cause of death. Then the public health for further review and sign off. And then it winds up in our office, the Register Deeds office to review to put on record.

Jeff Thigpen [00:03:00] So we have, you know, a death in the family. And then as you pointed out, it goes through a number of these different areas before it gets to our office. And I'll let you explain, what is our basic role? What do we then do?

Andrew Atkins [00:03:13] So the Register Deeds office records, maintains, and issues, death certificates. Just last year, the year of 2019, we recorded well over 5,600 death records in Guilford County. We issue certified and uncertified documents, and it just depends on what, you know, you need the certificate for whether it's certified or uncertified.

Carly Malcolm [00:03:36] About how long would it take to get the death certificate?

Andrew Atkins [00:03:39] About seven to 10 days. If there's an autopsy needed, you can count on it being anywhere from three months to a year, you know, to get back the toxicology reports and any other types of additional testing that the medical examiner deems appropriate.

Carly Malcolm [00:03:56] Who do we work most closely with death certificates?

Andrew Atkins [00:03:59] So we work more closely with the health department and funeral homes.

Jeff Thigpen [00:04:04] And Elaine, what do most people use the death certificates for? I know that, you know, as I have, in many cases, we've dealt with this in our own lives, but you have experience in terms of knowing what these death certificates are for. Talk to us a little bit about that.

Elaine Inman [00:04:19] Okay. A certified death certificate is needed to file an insurance claim to access any bank accounts or to close the bank account. The certificate is also needed for any retirement accounts an individual had or any 401k accounts. If there is a surviving spouse, the Social Security Office usually needs a certified copy as proof of death in order for any benefit changes. A certified copy of the marriage license is also needed for Social Security Office in these instances.

Jeff Thigpen [00:04:50] And when people come in and get these death certificates, of course, we have individuals come in, in funeral homes, is there an average that they usually get?

Elaine Inman [00:04:57] It can vary on the number of certified copies needed. If there are several insurance policies or retirement accounts or any property, one could be needed for each account. A lot of people will get three to four, but copies can be obtained at any time if more needed.

Jeff Thigpen [00:05:13] We were talking about this the other day. You mentioned the idea of getting marriage licenses too sometimes. Tell us about that.

Elaine Inman [00:05:19] Right. Yeah. Social security will need a marriage license if there are accounts in two names. A marriage license may be needed also just to prove that you are married to the individual, especially if there are benefits involved.

Jeff Thigpen [00:05:32] Okay. And that one other thing is if a body is going out of state, what do folks need to do in those situations? Someone has died in say North Carolina, and they need to go out of state for burial.

Elaine Inman [00:05:45] Right, before a body can be transported out of state or even out of the country, a burial transit permit is needed. These are normally obtained from the health department and the funeral home that has assisted in the family who usually obtain these or help the family attain them.

Carly Malcolm [00:06:00] And Elaine, say there's a problem with the death certificate. What would someone need to do?

Elaine Inman [00:06:05] Okay. If a mistake is found on a death certificate, I'll contact the funeral home to assist the family. They can usually work with our office in correcting or amending the document. For an amendment, proof documents are required, and of course, there are fees involved. The fee for a death amendment is $25 and the Register Deeds Office will complete the amendment paperwork and forward it to the state office in Raleigh. Once they review and approve the process, an amended document is sent to our office to replace the incorrect one. This process can take anywhere from a couple of weeks to several months to be completed.

Carly Malcolm [00:06:42] Okay Thank you. That's some good information to have. So Andrew we're living in the time of COVID-19. Can you talk about what our current protocols are?

Andrew Atkins [00:06:51] Yes. So currently we are closed to the public, but if you do need death certificates, the general public can go to NCvitals.com to get certified copies. If you're working with a funeral home, funeral homes generally provide those for the family. Some funeral homes have an online portal, which they can submit a request and we'll fill it just like that. They can also come and pick them up, the funeral homes that is.

Carly Malcolm [00:07:15] And what would a person need in order to obtain a certified copy of a death certificate?

Andrew Atkins [00:07:19] So for certified copies, you must be an immediate family member, such as a spouse, parent, direct ancestor, descendant, step-parent, step-child brother or sister. It can also be someone seeking a legal determination of personal or real property rights. This would reasonably be an authorized agent, attorney, or legal representative of any of the above. Must have photo identification and it's $10 per certified copy.

Carly Malcolm [00:07:45] Okay. And is there a way, do we have death certificates online?

Andrew Atkins [00:07:49] So not the images, but we do have the indexes available which would, for a death certificate, just be the decedent's name and the date of death. You can, you have to register for that. You would go to our website and click on the online research to log in or to register for the account.

Carly Malcolm [00:08:06] And then we also can offer mail and requests for death certificates, right?

Andrew Atkins [00:08:09] Absolutely.

Jeff Thigpen [00:08:10] Yes. And so genealogists also use our records, what's the easiest way they can get access to them.

Andrew Atkins [00:08:16] They can sign up for an account online, they can register for it. They can view the index of the death certificates, and if they need uncertified copies of the death record, they can send the request through the mail to obtain uncertified copies of the death records.

Jeff Thigpen [00:08:34] Okay. And so they can do that. And then if they get access to the online system, they can see the person's name and the date of death. It'll be very limited information. They won't be able to see the certificates, but they'll be able to get some information that will help them do research in many cases.

Andrew Atkins [00:08:48] And with that information, they can request the uncertified copies. That would be all they would need would be the decedent's name and date of death.

Jeff Thigpen [00:08:56] Okay. Thanks. All right. Well, thank you, Andrew and Elaine, for joining us on the Good Grief podcast to talk a little bit about death certificates. If you want more information about the Register Deeds Office vital records area, you can go to Guilford County government online or www.guilforddeeds.com for more information. Thank you very much for being part of the Good Grief podcast.

[Outro]

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.

[01:28] The main idea behind the End of Life initiative
[04:18] Why Jeff decided to focus on matters of death and dying
[09:38] Goals of the End of Life initiative
[10:50] The main purpose for launching the Good Grief Podcast
[14:03] Main talking points from the project and the podcast series

Hi, this is Jeff Thigpen, Guilford County Register of Deeds. And I’m Carly Malcolm lead for North Carolina fellow for Guilford County from the UNC School of Government and welcome to the Good Grief podcast. Have you ever lost a loved one and had to figure out what to do. Have you ever felt alone and overwhelmed? Did it make you wonder why on earth this is all so complicated? In this podcast series, we bring together community partners to talk unapologetically about issues of death and dying. We answer questions about funerals, hospice, estates, and more to give our listeners the knowledge they need to make decisions for themselves and their loved ones. We want everyone in Guilford County to know that they're supported, that we live in a community where we can not only live and live well, but when we die, we can also die well, because we care. So we thank you for joining us for the Good Grief podcast and for taking this step to be better prepared for end of life challenges.

Carly Malcolm:  [00:00:59]  This is Carly Malcolm, Lead for NC fellow from the North Carolina School of Government, with Jeff Thigpen, Guilford County Register of Deeds. And welcome to the Good Grief podcast. Today we're going to talk with Jeff about how the end-of-life innovation project got started and about the Good Grief podcast series. You know, why we're doing this, what we hope to achieve. We’ll also give insights into upcoming podcasts that we believe will be worth listening to. So, thank you for being with us and let's get started. Welcome Jeff. [Jeff] Glad to be here. [Carly] So, tell me, how did the end-of-life project get started?

Jeff Thigpen:   [00:01:28]  The end-of-life innovation project started with a series of events. In general, I've always looked at our basic service in the Register of Deeds office and said, okay, we deal with birth, marriages, deaths, land records. How can we add value to our core services? And the fact is most people don't know what we do but if you buy a house, you get married, have a kid, get out of the military, you lose a loved one. You come see us. And in a way, we, at the most local level, hold the public trust around some very important times in people's lives. And they come in, people who live in our communities come in every day and they interact with us in those moments. What I found with death certificates, a lot of times when people would come in, it would be fresh on their hearts and their minds. And they were in mourning in many cases. And they'd be dealing with a ton of grief around the loss of a loved one. And then from there, they'd be interacting with a lot of organizations around death and dying. Hospice, funeral homes, Clerk of Courts offices. They were in caregiving environments and many times they were just unprepared for those moments. And in a lot of cases, they hadn't had those conversations. They didn't know about things like advanced care directives. They didn't know about cost factors related to death and dying. And in some cases, because we live in a culture that doesn't like to talk about death, a lot of times emotional and spiritual support were not there, they just seem to be overwhelmed. And the conversation of value came up about, okay, we've got a limited role in this ecosystem. But it's very important and the question is what can we do to leverage that position? Not recreating the wheel because we have a community of support and organizations doing work within our community around death and dying, but how can we amplify what they were doing? And so, we started going down this road and there were a number of web-based resources we looked at. Two of the things that I remember early on was looking at the New Zealand end-of-life website that had a lot of interesting pieces of information. And Hospice of the UK is really good and they had a podcast called Dying Matters, and I would recommend that to everybody in addition to what we're doing here. So, the conversation started and it started going slowly at first. And as I'll mention later and talk about, it's really started happening. And now that you're here with us and we're getting this podcast series started and those kinds of things

Carly Malcolm:  [00:03:58]  Right. So, you're seeing people come in, people who maybe didn't even know what the Register of Deeds was until they really needed you. And you saw that opportunity to make things a little bit easier on people, offer that support while they're dealing with all of these issues related to the loss of a loved one. I know that we talked about several situations that also influenced your passion for this project. You want to talk about those?

Jeff Thigpen:  [00:04:15]  Yeah, I’ll talk about three and a lot of times, whenever you get committed to do something. Sometimes you go, I really want to do this. But that really wasn't how this started for me. It's hard to talk about death and dying and a lot of times again, we don't deal with it until it comes to us. One day I had an unexpected visitor a few years ago, and I'll call her Maggie. She didn't want to see any of my staff. She said, no, I want to see the Register of Deeds and came back and tell me, I was like why? But when she came back and I saw her I could immediately see that, that she had a serious illness. And from the moment I laid eyes on her, I knew that I really needed to explore this and talk with her about why she was there. And she later told me, she had stage four cancer. She had been through a series of treatments and chemotherapy radiation. Her body was weak and you could see it. And I remember she was wearing a red handkerchief over her hair that she had lost—her head with hair that she'd lost. And she came in and I was just captured by her sense of grace and tone and purpose. And I remember looking into her eyes and seeing somebody that obviously had gone through a whole lot. And yet she was really poised and an active part of a process of helping her family come to terms with her impending death. And that moment was really impactful on me because it was a space where I could see life and death.  And it's not unlike an experience that I had when I was with my father. And I'll mention, lastly, this is personal, but that moment with her was really Touching—

Carly Malcolm:  [00:05:58]  Sorry, before we move forward, can I ask what had she come in to ask you about?

Jeff Thigpen:  [00:05:58]  She wanted to know the process of getting a death certificate. [Carly] For herself? [Jeff] Yeah. [Carly] Wow. [Jeff] And that alone. I thought about it. I'm like, how could I ever have the clarity and the strength and the character and fortitude to come in and literally research and understand and get to know the process of my own death process. Not just in terms of physical and emotional, but she was actually looking into the institutions. And so, I'm thinking if someone who's in that situation, had the clarity and the passion to do that. It was something that just stayed with me. Another situation that came up was with a friend of mine. A former County commissioner, Republican County commissioner, Mary Rakestraw, and her husband, Frank were really good friends of mine and Frank died. And he was an incredibly organized person and he was hilarious. Him and I would just have wonderful conversations about politics. We both knew we totally disagreed with one another, but the fundamental thing we all agreed on was that we were all Carolina fans. We all got along and we can always fight and argue about stuff but then we'd always come back to a moment where we could appreciate each other and talk about the basketball season. But Frank laid out everything for her, was very organized and she talked to me about what he did. But she went to a local bank and she was trying to get into the safety deposit box and she just felt like the staff and the people that were just totally not attentive to her. They didn't feel like they respected her grief. She was upset. She was furious. And I just remember her saying over and over, good grief! I had to do this or good grief! I had to go back and verify the will or do something. She's like, I had all these steps that I had to go through. And so, she was really frustrated with the system. She was frustrated with the bureaucracy. And she was in mourning. And so that was another piece of this and underlying both of those two situations, like I said earlier, was that it was personal for me. It became that way after I began really seeing through the eyes of people who were dealing with this more and more that, I think a part of my role and responsibility in my position is to try to find ways to leverage my position to add value to the conversation about death and dying and understanding grieving. like I said, I went through that with my father 22 years ago. And I remember it clearly today and it inspired me to do a lot of things. It was the foundation in many ways, for me becoming an elected official as a County Commissioner way back then when I served with Mary. But the idea that I want to live a meaningful life, I want to contribute to that space because as we talk about a lot, Carly, again, people have a hard time talking about death and dying. I think that Jane Gibson summed that up. When I was talking to her at one point, she used to work with hospice. She said, there are a number of situations where people have a lot of support, but it's those 1:00 AM phone messages and emails that I get that worry me about people agonizing over the death of loved ones. And I think about those folks as we're doing this podcast, because Jane said then, she said, sometimes people just want to hear a voice. They want to hear somebody who they can identify with, and that they may be able to draw some knowledge from. And so, I think our hope in doing the podcast series and through enhancing our web resources and that kind of thing will be helpful to people who were trying to get this.

Carly Malcolm:  [00:09:38]  So, with all of that in mind, what are the goals of the end-of-life innovation project?

Jeff Thigpen:  [00:09:42]  There’re two particular goals, one is to promote online information and research education resources for support for care during end-of-life challenges. That is by no means that all the information we have there is from the Register of Deeds office. We are out there gathering information and knowledge from a variety of community resources. And our hope is that we can help facilitate that. The second goal is to have interactive resources. For example, like the podcast series. Through the podcasts that we've already done, we’ve partnered with hospice organizations and palliative care. We've touched on bereavement counseling. We've had faith communities’ discussions around religion and spirituality, advanced care planning, a lot of pre-planning around funerals and estates and people who were caregivers, we even get into body donation. Yeah, we both remember that one, that was a great conversation. But we are trying to provide both the online resources and the voice to help people deal with these end-of-life challenges. And so those are basically the two goals and I think that we're off to a good start.

Carly Malcolm:  [00:10:45]  Yeah. Yeah. Speaking of the Good Grief podcast series, how do you think that's going?

Jeff Thigpen:  [00:10:49]  I always thought about doing these things but that never really happened. And then somewhere down the line, we picked up this young college graduate from Clemson who came in and grabbed me by the ear and helped put all this together and– [Carly] got it jumpstarted a little bit [Jeff] yeah, it jumpstarted! And in all seriousness, I really want to appreciate you in doing this. I want to thank you. We selected you like you mentioned early on, as a Lead for NC fellow from the Institute of Government and I think you've done an outstanding job helping put together the interviews and scheduling. You've been a great co-host to the podcast. Brody who's here with us today, I want to thank him for helping bring the equipment together and the space for us to do that. And I think, like you said, I think we've done a lot of work in a short period of time. We're interviewing folks before they go live and as we are beginning the podcast series, we are already at about 30 podcasts and the content, Carly, is incredible. The people are down to earth. They cover a lot of interesting pieces of their lives and what they do. And they are a diverse group of people. And I think that we both have been touched by how much they care. [Carly] Absolutely. [Jeff] Yeah. So, I think if I had to give it a grade, I would give it like an A plus, because, and I'm grading on a curve, because we both come into this conversation not knowing a lot and having to pick it up as we go along and we've had some really good teams.

Carly Malcolm:  [00:12:20]  Yeah. Definitely learning along the way. Have there been any moments in the podcast series that have stood out to you?

Jeff Thigpen:  [00:12:24]  Wow. There have been many. I think that, and I'll just, I'll name a few and I'm sure you'll remember, Patti Gasparello with Kids’ Path through AuthoraCare here working with terminally ill children, kids who've lost loved ones. I think she shared several stories in there that probably left both of us in tears. I know I was in tears. Randall Keeney was one and I remember him saying something like no one should have to go bankrupt burying their loved ones. [Carly] yeah. [Jeff] Bradley Hunt, Bradley Hunt was good. Bradley from New Light Baptist Church who has experience in funeral home management talking about things like African-American traditions around life and death and music and culture. As well as talking about the idea of structural inequality of racism and the history of the African-American church, both as a protector of folks in that history, but also a light for people to gather strength and community. And that impacts the reason of life and death. I love the spanish speaking podcast, that I didn't participate in by the way, you did with Robert Garcia with Trellis. And there are a number of others that we did, and I could go on and on about them. But those are just a few. And I think that when folks really get into it, we're going to have these interviews, we're going to transcribe them and have notes and web-based resources that people can refer to. But I just think there's just so many nuggets of wisdom in all of them that I think have been touching to me and I know you too.

Carly Malcolm:  [00:13:58]  Yes, definitely. Yeah. Lastly, can you tell me what you're learning through this project and through the podcast series?

Jeff Thigpen:  [00:14:04]  Yeah, there's this saying that to reclaim dying is to reclaim a sense of living. And, I think we wanted to go into this place and space around death and dying as we say, unapologetically, without preconception, with a little bit of boldness, maybe some naiveté, but we've come here and to be honest, like I said earlier, I don't like to talk about death and dying. I have a hard time with it. We compartmentalize and dismiss it. We fear it. We get so distracted by our culture, that idealizes immortality. I love the Highlander movies, but that doesn't give us the time and the space that we need to actually see that death is a natural part of life. And a friend once told me a long time ago that she had never known anyone to get out of this world alive. And we kind of joke, I think in one of the podcasts, death is batting a thousand, it throws no hitters all the time. And so, we need to get on it. And there's also a saying by a philosopher Mulla Nasrudin, that I was reading the other day that said, if I survive this life without dying, I'll be surprised. We're learning to talk about it. And for me, that's helpful because it helps me get in a position of openness, of learning, of growth, of vulnerability, of listening to people share their vulnerabilities around this and what they see and that I'm not learning alone. We're in this together and everyone that we've interviewed up to this moment has walked away as we have looked at each other going, this is important! We need to do this! And so, I've learned a lot about serious illness and I've learned to see a level of courage from people. And the grace and commitment that they bring to this ecosystem in a way that is just incredibly inspiring to me. So, their stories and the knowledge that they brought touched me. I know they've touched you too. Like I said, I'm not in this alone, you've brought a lot to it as well, and I've appreciated the opportunity to go into the space with so many local voices. It has been a very special project and I just see it as a gift.

Carly Malcolm:  [00:16:24]  Thank you, Jeff so much for taking the time today to go through all of this and also for all of the work that you've put into making this project a reality. This is Carly Malcolm, Lead for North Carolina fellow, and Jeff Thigpen, Guilford County Register of Deeds, and you've been listening to the Good Grief podcast.

[Outro]

Thank you for listening to this episode of the Good Grief podcast. We want your feedback. You can visit our website at www.guilforddeeds.com.  You can also email us at endoflife@guilfordcountync.gov, or find us on Twitter with the handle @guilford_rod. We hope you've enjoyed this episode and until next time, take care.