Employee Spotlight: Natasha Vakili

Natasha Vakili found her passion for hospice very early in her career.  After personally utilizing hospice services for her grandparents, she quickly saw the value hospice has for patients and families.  She strives to ensure all patients and families benefit from hospice care in the same positive way as her family.  Natasha’s focus is on maintaining financial stability so patients and families may receive the best care possible. Not only is she a Certified Hospice Administrator, she has her BBA in Business Administration and a BA in Psychology.  Natasha joined Apreva Hospice in early 2011 and has since been dedicated to providing the highest service to Apreva patients.

Employee Spotlight: Danish Farook

Danish Farook is the Chief Business Officer for Apreva Hospice. His background as a Physician MBA allows him to focus on the transformation of healthcare in the Hospice arena, including development of patient focused teams, outcomes-based models, and business development. Danish strongly believes in a “Patient First” model of care.  He is an alumnus of University of Xochicalco Medical School with post graduate training in the art of surgery. Danish is a member of the American College of Surgeons, Latino-American Federation of Surgery, American Society of Bariatric Physicians, American Association of Physician Leadership, and National Hospice & Palliative Care Organization.

Employee Spotlight: Leigh Ann Grass

Leigh Ann Grass, RN, BSN, PHN maintains focus toward creating a culture of treating patients and families as if they were our own family members.  She places concentration toward the ultimate goal of patient-oriented healthcare and finds each day a blessing in doing so.  Her career consists of 13 years of emergency, trauma and flight nursing; with the last 15 years in hospice and palliative care.  Every day her professional objectives include using her skills, knowledge, and theory to improve the quality of life and comfort level of her fellow San Diego County community members. In addition to her important career at Apreva, she also sits on a local hospital Board of Directors.

depressed young schoolgirl with stop bullying text on notebook helpless and scared as victim of bullying

National Bullying Prevention Awareness Month

Bullying is defined as abuse and mistreatment of someone vulnerable by someone stronger, more powerful, etc. Unfortunately, bullying is nothing new. However, with each new technological advancement we see, bullies find a new outlet to use to prey on their targets. In honor of National Bullying Prevention Awareness Month, Apreva Hospice is taking a stand and raising awareness for the immense need to stop bullying.

Bullying Can Occur at Any Age

Typically, we think of bullying as being something that occurs among adolescents. However, bullying can occur among any age group, race, or gender. Any instance of mistreatment or seeking to hurt someone or make them feel badly is considered bullying. It can happen at school, at work, or even among friends and family.

Bullying Doesn’t Always Stop When You Go Home

Although they can be wonderful means of keeping in touch with old friends, social media and other online communication platforms can negatively contribute to bullying. The days of going home to escape a bully are long gone. Now days, bullies can just log on to their computer or grab their phone and pick up right where they left off. In some instances, bullying can be more extreme online because the bully feels more confident when hiding behind a screen. Some even create a fake social media profile to target those who are more vulnerable.

The Impact of Bullying

Bullying can impact a child in many ways. It can weigh on them emotionally and physically and can have a negative impact on their relationships with friends and family.

Emotional and Social Impact of Bullying

Kids who are bullied often have a difficult time making friends and maintaining healthy relationships. If no intervention occurs, they can develop something called “learned helplessness,” which means they feel as though there is nothing they can do to change the situation. As a result, they give up. This can ultimately lead to severe depression.

As a bullied child grows into an adult, they may continue to struggle with issues with their self esteem and may have a difficult time developing and maintaining relationships. Understandably, they may also have a hard time trusting people, which can have a major impact on relationships.

Physical Impact of Bullying

The physical impact of bullying goes beyond the bruises of physical bullying. Children who are bullied often experience anxiety which can result in health issues due to the stress on their body. This can include things like ulcers, headaches, stomach aches, or simply getting sick more often.

Impact of Bullying on the Family

Bullying does not only cause harm to the child who is bullied. It can also affect their parents and siblings. Parents may feel helpless. They may also feel as though they failed to protect their child and, in turn, start to question their parenting abilities. However, it is important to remember, no one can predict who a bully will target. Parents should never feel responsible for the choices a bully makes and should instead focus on helping their child heal from the bullying. The bully is the only person to blame.

Bullying Can Have a Lasting Impact

Bullying is not only painful in the moment- it can also have a lasting impact on those targeted. Studies show the effects of bullying last well into adulthood and may have a greater impact on mental health than originally thought. Our experiences growing up – both positive and negative – shape how we view things and ultimately who we become as adults.

Stop Bullying

According to stopbullying.gov, quick and consistent response from adults can help stop bullying over time. It is important to send a clear message that bullying is not acceptable. We can all do our part to help stop bullying. If you see someone being bullied, don’t be a bystander. Use these tips to become an upstander!

Pretty, young Asian woman with her arms around an older Asian woman outdoors during sunset

Caregiving During COVID-19

By: Laura Mantine, MD

During periods of crisis, like the COVID-19 pandemic, family members and close friends continue to provide daily care for their loved ones. These caregivers provide the initial response and defense for individuals who are often battling chronic medical illnesses. Like many first responders, caregivers often experience stress due to heavy workloads, fatigue, and anxiety. There are important steps that caregivers can take to help manage and cope with this ongoing pressure.

Important Steps for Caregivers to Take

Caregivers should develop habits and strategies to maintain their own physical health and emotional well-being. A caregiver can reduce transmission of a virus by diligent personal and patient hygiene. Washing hands with soap and water for at least 20 seconds frequently throughout the day has been shown to reduce viral spread. It is also important to wash your hands during food preparation, toileting, and blowing your nose, coughing, or sneezing. To be at your best, be sure to eat healthy, balanced meals, maintain a regular sleep routine, and find chances to exercise whenever possible. There is also a constant barrage of pandemic-focused news that can be overwhelming, so try to limit your intake to a certain time or times each day, and do not mistake social media opinion for fact. Remember to take care of yourself, as your loved one’s well-being relies on your ability to maintain your own.

Caregiver Burnout

Over any amount of time, caregiving can be physically, mentally, and emotionally exhausting. Caregiver burnout can happen in any caregiver-patient relationship, but the risk is heightened in times of increased stress like the COVID-19 pandemic. When suffering from burnout, a caregiver may experience hopelessness, overwhelming anxiety, sleep problems, or difficulty coping with everyday tasks. Although caregiving is a major responsibility, it shouldn’t completely overtake an individual’s life. Make time for yourself and take breaks when possible. Use these spare moments to listen to your favorite music, read, or work on a hobby. Also, stay connected to friends and family. Social distancing doesn’t mean total isolation so reach out to friends and family regularly for casual chats and wellness checks. Consider spending time together virtually, whether by watching a movie over a video chat session or playing games together online. If you live with loved ones, find ways to help and support each other.

During these uncertain times, caregivers remain a valuable constant for their loved ones. Please stay physically and mentally healthy as you perform your crucial role.


“Family Caregiving During the COVID-19 Pandemic.” Scott R BeachRichard SchulzHeidi DonovanAnn-Marie Rosland. Gerontologist. 2021 Jul 13;61(5):650-660.

“Ensuring Adequate Palliative and Hospice Care During COVID-19 Surges.” Jean Abbott, MD, MHDaniel Johnson, MDMatthew Wynia, MD, MPH. JAMA. 2020;324(14):1393-1394.

Person's Hand Placing Last Alphabet Of Word Stress

Caregiver Stress Awareness in Hospice Care

By: Joelle Jean, FNP

Caring for a loved one who is terminally ill and on hospice is emotionally and physically taxing. In 2015, an estimated 39.8 million caregivers provided unpaid care to an adult with a disability or illness. The estimated value of the service supplied by caregivers is up to $470 billion since 2013.

Caregivers may deny help from others, perhaps out of guilt or obligation. However, 1 out of 6 caregivers report not being asked what they need to care for themselves. Caregivers can work up to 8.3 hours per day or 66 hours per week during their loved ones’ last days of life. Often, this is in addition to working a full-time job and caring for their own immediate family.

Caregivers are at risk for depression, severe fatigue, or burnout, or even health issues such as hypertension, stroke, obesity, or weight loss due to stress.

What is a caregiver?

A caregiver, also known as an informal caregiver, is an unpaid individual or group of individuals who provide care to a loved one. Caregivers can be a spouse, family members, partner, friend, neighbor, or combination of these individuals.

A caregiver assists their loved ones with activities of daily living which include:

A caregiver can also play a significant role in coordinating care for their loved ones. Many are appointed power of attorney or the primary decision maker for their loved ones, managing finances, property, and most suitable medical care for the individual.    

What causes caregiver stress or burnout?

There is no clear definition of caregiver stress. The Merriam-Webster dictionary defines stress as “a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.” Burnout can be a response to stress, defined as extreme emotional exhaustion. According to stress.org, stages of burnout are:

  1. Enthusiasm
  2. Stagnation
  3. Frustration
  4. Apathy or loss of interest

A caregiver with stress or burnout exhibits signs of feeling overloaded, overwhelmed, emotionally drained, tiredness, detachment from the person they are caring for, and a reduced sense of accomplishment.

Who is most affected by caregiver stress?

Caregiver stress affects the person or people directly caring for their loved one. Stress can also affect caregivers in different ways. For example, one caregiver may find specific tasks stressful or overwhelming while another caregiver may find the task relaxing and rewarding.

What are the signs and symptoms of caregiver stress?

Often, caregivers are not aware of their stress or feeling of burnout. Signs and symptoms of caregiver stress can be subtle or obvious. It is important to identify caregiver stress so it can be eased.


Anxiety is a stress response, activating the fight or flight response that happens chemically in the brain. Physically, anxiety can be described as:


Caregivers suffering from stress may not realize they are fatigued. Fatigue is the body’s response to burnout and can be physical, emotional, or psychological.

Weight changes

Stress can cause weight changes and affect eating patterns. Weight change can occur when dealing with caregiver stress. Rapid weight gain or unexplained weight loss is a warning sign of caregiver stress and should be addressed appropriately.


Caregivers may become easily annoyed or short-tempered with loved ones, family members, or friends. Feeling irritable may be a warning sign of caregiver stress.

Feelings of being overwhelmed

Feeling overwhelmed or anxious is normal. Caregivers may become overwhelmed with the amount of care needed to provide to their loved ones. Trouble concentrating, changes in sleep patterns, and changes in eating habits may occur.


Losing interest in activities can be a sign of depression due to the demanding responsibilities of caregiving. Signs of depression include:

Potential health risks as a result of caregiver stress

Chronic stress (or stress lasting for more than six weeks) can have lasting health problems. Caregivers exhibiting signs and symptoms of stress and burnout have a higher chance of developing health risks.

High blood pressure

Caregivers can suffer from high blood pressure due to the stress of caring for a loved one in hospice. If caregivers have already been diagnosed with high blood pressure, stress can make the disease worse. Uncontrolled high blood pressure puts caregivers at higher risk for:

Weakened immune system

The immune system is in place to protect the body from illness and disease. Stress can cause a weakened immune system. With a weakened immune system, caregivers can become sick or develop chronic illnesses such as:

Short term memory loss

Studies have shown that a symptom of chronic stress is the shrinking of the brain. Shrinking of the brain causes short-term memory loss. Short term memory loss affects learning, judgement, and memory process. 

Headaches and body pains

Stress can cause headaches and body pains. On a hormonal level, the increase of cortisol causes headaches even at rest. The physical nature of caring for a loved one on hospice- lifting, standing, walking, and rotating- can cause severe body pain or injury. 

How to relieve or prevent caregiver stress and burnout

Self-care is imperative for caregivers caring for their loved ones in hospice. Self-care means caring for yourself, so you can improve your health to care for others.

Exercise regularly

Finding the time and the energy to exercise might sound difficult. However, even carving out 30 minutes a day has positive effects on your health. Exercising whether it is running, walking, swimming, or doing yoga will lower blood pressure, increase energy, and improve mood.

Asking and accepting help from others

Accepting help can be difficult for some caregivers. It is important to ask and accept help so that you are available for your loved one mentally and physically.

Under most insurances and Medicare, respite care is available to relieve the burden of caregiver stress. Respite care will give short term caregiver relief to those who are in need.

Eat and sleep well

Eating and sleeping well are fundamental in protecting your physical and mental health. A well-balanced meal of fruits, vegetables, and plant-based foods is important for physical and mental well-being. Adding vitamins such as a multivitamin, vitamin D, or vitamin B-12 can also help improve your mood and energy.

Having a good night’s sleep has many health benefits. Feeling well-rested and energized will only benefit you, as the caregiver, and your loved one. Improved memory, mood, and overall well-being are all benefits of quality sleep.

Seek out support groups

Support groups add immense value to caregivers who are caring for loved ones in hospice. Joining support groups reassures caregivers that they aren’t alone. Support groups:

Maintain personal relationships

Maintaining personal relationships is as important as joining support groups. Meeting up with friends or family members allows you to relax. It also allows you to take time for yourself and time away from your loved one. 

Awareness of caregivers’ stress and burnout must be addressed and acknowledged for caregivers to feel supported and recognized for their challenging work. The hospice team and its services are a fundamental part of bringing this awareness to the forefront.

Panorama of happy caregiver supporting smiling elderly man in the nursing house

Hospice and Palliative Care: What’s the Difference?

The terms ‘hospice’ and ‘palliative’ care often get confused. Although they are similar, there are differences between these two types of care.

What is hospice care?

The focus of hospice care is on quality of life when a cure is no longer possible or when the burden of treatment outweighs the benefits. In general patients receiving hospice services have a life-expectancy of six months or less if the illness runs its usual course. Many people think hospice care is just for elderly people or cancer patients, but that is not the case. Hospice benefits people of any age, with any life-limiting illness. The goal of hospice is to provide comfort care by managing pain as well as providing emotional and spiritual support to the patient and their family.

Where is hospice care provided, and who is involved?

Hospice care can be provided anywhere the patient calls home, including nursing facilities in which they may reside. It involves an interdisciplinary team that includes:

What will the hospice team do?

The interdisciplinary hospice team will focus on things like:

What is palliative care?

Palliative care, like hospice, focuses on quality of life. The difference is that palliative care is appropriate at any stage of a serious illness, not just at end-of-life. It’s an extra layer of support that treats the symptoms of an illness and supports the entire family. Patients who are receiving palliative care can continue to receive curative care such as chemotherapy, radiation, dialysis, and surgery.

Where is palliative care provided, and who is involved?

Patients can receive palliative care in settings such as hospitals, nursing homes, specialized clinics, and at home from a team of specially trained doctors, nurses, and other specialists. This team will work closely with the patient, their family and caregivers, and the patient’s other doctors to ensure everyone is on the same page.

What will the palliative care team do?

The palliative care team offers services such as:

A side-by-side comparison of hospice and palliative care

The chart below can be used to help gain a better understanding of the difference between hospice and palliative care.

Please contact us if you have any questions about the quality hospice services Grane Hospice provides.

Hospice and Palliative Care - What's the Difference - Grane - comparative chart
Close Up Of A Relaxed Young Woman Having Reiki Healing Treatment

Reiki: A Modern Yet Ancient Healing & Relaxation Practice

By: Genna Hulme, Certified Nursing Assistant

Today is National Relaxation Day; and while we could talk to you about reading your favorite book in a bathtub full of bubbles, we are instead going to share with you an ancient healing and relaxation practice that is becoming widespread again: Reiki.

What is Reiki?

Reiki is a very unique form of energetic healing. Using the body’s natural energy flow, it has the ability to balance out disrupted or distorted energy in and around the body’s energetic field. This makes the client feel generally better all around. Reiki is used in multiple health fields around the world making it a fast-growing treatment for therapy purposes as well as a great way to compliment current treatment for many ailments.

Reiki is an ancient form of Japanese healing. It is said to have been passed down for thousands of years from teachers to students. The word itself means Source Light Energy, “Rei” meaning source light and “Ki” meaning energy. Much like other forms of energy-based healing, such as the well-known Tai-Chi, Reiki is learned in a form that is more of a private setting between the teacher and the student. In these classes, the student learns the history of Reiki and how it became widespread today. The student also learns certain hand techniques that help them smooth out the energy, and ways to feel energy as well as its disruptions.

Finding relaxation in the chaos

We now live in a world of burnout, leaving people feeling drained, depressed, stressed out, etc. Every day, we as humans are set up to operate in a way that brings us many challenges. These challenges may cause stress, leaving our thoughts and emotions in a cloud, creating depression, and other mental health issues. If one has a physical health issue, it could have been rooted into the stress of environmental factors. These physical and environmental issues can create some distortions causing a person to have judgmental impairment of basic life decisions. When there is impairment, it plays a domino effect making that person’s thought processes chaotic, hence bringing chaos in their life.

During this process, it is important that we keep up with self-care and restoration. Using Reiki is an excellent way to help! During a typical session, the Reiki Practitioner has the client relax in a sitting or lying position. The client will be instructed to take a few deep breaths as the room is filled with aromatherapy and soothing music. This will help the client physically start to relax. The practitioner will scan their hands over the client feeling for energetic disruptions in their field. When there is a disruption, the practitioner will then meditate and breathe as the “clouded” energy dissipates leaving the client feeling relaxed and stress free. This can last for as long as the client needs. Reiki sessions may last anywhere between 45-120 minutes.

A modern yet ancient practice

Today, Reiki is growing widespread throughout the world. This old/new practice is giving the medical field more options for patients dealing with any life crisis. Cancer treatment centers now include Reiki as a part of the treatments received. It can also be seen in Physical Therapy offices and Athletic Therapy offices. Some Chiropractors also use it as a part of pretreatment for body alignment. Some hospices also use it as a free treatment from a volunteer who is kind enough to offer! Reiki is also being used as an employee wellness practice to aid employees who work in stressful environments. This gives them the opportunity to be able to clear their minds and organize their thoughts, causing them to perform better and be relieved of the stress and “noise”. 

Reiki is a very unique process of healing. As an ancient practice, it definitely has potential to help aid us while we go through our toughest times. With just a few sessions, it will aid the body’s natural energetic functions to generate a better flow causing the client to relax and clear their head.  Whether it is through a job, ailments, or family dynamics, taking time out for self-care will help make some positive changes in ways of thinking and lives, allowing the client to take back control of their mind, body, and soul. There are many opportunities out there for anyone to receive Reiki since it is our birthright to make time and space for ourselves.


Nurses assisting elderly people at a retirement home

Hospice Services for Nursing Facilities

By: Dr. Margarita David DNP, RN

Having a hospice provider working as a partner with a nursing home may improve the quality of care a nursing home resident receives during end of life. Many studies have shown that having a hospice presence in nursing homes reduces hospital readmissions, improves the facility’s performance scores, and facilitates conversation between the resident and their families regarding end-of-life treatment options.

The difference between nursing homes and hospice

When a loved one’s health condition declines, the decision to transition to comfort care is not an easy one. However, before a decision is made you must know the difference between a nursing home and hospice.

Hospice care services

Hospice is an approach to care for people experiencing a life-limiting illness. It offers comprehensive services that address the physical, spiritual, social, and emotional needs and preferences of the patient and family. The hospice team includes nurses, doctors, social workers, certified nursing assistants, and chaplain and bereavement services to ensure that the patient receives medical, physical, emotional, and spiritual support in any place the patient calls home.

Nursing homes and long-term care facilities

Nursing homes and long-term facilities serve as a place where the patient lives and needs assistance with activities of daily living such as bathing, dressing, and toileting. Care is provided by trained nurses that are ready to handle the nursing and medical requirements of the residents.

Patient hospice care eligibility

For a resident to qualify for hospice care, the resident must meet the hospice eligibility requirements that have been established by the U.S. Centers for Medicare & Medicaid Services (CMS). Although there is not a standardized list to qualify, CMS guidelines help with determining if a resident’s condition is appropriate to receive hospice care.

Role of hospice in long-term care homes

Hospice care is provided wherever an individual resides, which includes long-term care facilities and nursing homes, and provides specific services at the end of life to residents and their families. The long-term care facility staff provides residential, custodial services to the resident, while hospice care tends to the end-of-life needs. This is what makes hospice and the long-term facility mutually beneficial to each other. Here are few examples of the role hospice plays in long-term care facilities:

  • Specialized skill sets. Hospice staff provide additional expertise to the long-term care facility which include quality of life and comfort during the end-of-life phase. Additionally, once the resident has passed the family is provided with grief support.
  • Improved resource management. The hospice team will coordinate everything related to the hospice plan of care, including medications and coordinated care for the resident that includes their primary doctor, hospice doctors, hospice aides, and hospice nurses.
  • Expert medical education. The hospice team provides education that focuses on the resident’s condition, symptoms, and medications.

How hospice can assist nursing home staff

The hospice team and the nursing home staff share the responsibility for the resident’s end-of-life care.


The nursing home’s staff has a key role in the care of residents since these professionals are often the first individuals to notice changes in the resident. It is important to educate nursing home staff on recognizing signs and symptoms of end-of-life and when to notify the proper healthcare provider. The hospice team provides education that focuses on the resident’s condition, symptoms, and medications, and how to best care for a resident’s medical needs.

Coordinating patient care

Hospice staff helps in the coordination of the resident’s care and medications needed across all their healthcare providers, hospice team, and nursing home staff. This coordination of care assures proper communication and gives the resident’s family the ability to have questions answered.

Find expert hospice care with Grane Hospice. Contact us to learn more.


Five Stages of Grief

Losing someone we love leaves us with feelings of unbearable pain, and while everyone grieves differently, there are five stages of grief that most people go through after experiencing a loss. Very Well Mind describes the five stages as follows.


The first stage of the grief process is denial. In this stage, we are trying to process the reality of the loss of our loved one. When we hear the phrase ‘denial,’ we assume it means we are attempting to pretend the loss does not exist. While this is denial, it is only a part of this stage. Experiencing denial also means we are trying to absorb and understand what is happening. When we lose a loved one, there is a lot of information to process at once. Denial attempts to slow down this process and take us through one step at a time to avoid the risk of feeling overwhelmed by our emotions. It takes time for our minds to adjust to the new reality of life without this person, and denial helps us to minimize the overwhelming pain of the loss.


Next, we move into the anger phase. Anger is very common to experience and tends to be the first thing we feel when we start to release our emotions related to loss. There is so much for our mind to process, and anger can serve as an emotional outlet. We become overwhelmed with feelings of sadness and vulnerability, and sometimes anger feels like the only way to express these feelings. We may also fear judgment or rejection if we admit that we feel vulnerable or scared so anger may feel like a safer way to express our emotions.


When we experience a loss, it is not unusual to feel so desperate that we are willing to do whatever it takes to alleviate the pain. This often comes in the form of bargaining, typically with a higher power. We often feel helpless, and bargaining can give us a perceived sense of control over something that feels so out of control. There are a variety of promises that people may make when bargaining. These can include things like, “God, I promise to turn my life around if you let this person live.” It is also common in this stage to recall times we said things we did not mean and wish we could go back and do things differently. We may also make drastic assumptions that if we had done things differently, we would not be in such an emotionally painful place in our life.


As the emotional fog begins to clear and panic begins to subside, we slowly start to really look at our new reality. At this point, bargaining no longer feels like an option, and we are forced to face what is happening. In this stage, the loss feels more present and unavoidable, and we feel it more abundantly. This can be extremely isolating, as we tend to pull inward as our sadness grows.

No one should ever have to face depression alone. If you or a loved one is struggling with depression, contact the Substance Abuse and Mental Health Administration (SAMHSA) Helpline at 1-800-662-4357 or the National Suicide Prevention Lifeline at 1-800-273-8255.


When we reach the stage of acceptance, it is not that we no longer feel the pain of the loss. It means we are no longer resisting the reality of our situation. Feelings of sadness and regret can still be present once we have reached acceptance. However, the emotional survival tactics of denial, bargaining, and anger are less likely to be present.

We All Grieve Differently

Not everyone will experience each of these stages, while others may linger in one stage longer than others. It is important to remember that we all grieve differently. Your grief is unique to you, just like your relationship with the person you lost is unique. It is perfectly acceptable to feel whatever you are feeling.

If you or a loved one would like grief support, please contact us to learn more about our bereavement services. You do not have to face this alone. We are here for you.

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