North Hawaii Hospice

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Plans for landscaping at North Hawaii Hospice include lots of green space and foliage. (PHOTO BY ANNA PACHECO| SPECIAL TO NHN)
The foundation has been laid and construction is underway on an additional building for North Hawaii Hospice in Waimea. (PHOTO BY ANNA PACHECO| SPECIAL TO NHN)
Construction is underway to expand the North Hawaii Hospice facility in Waimea, which will provide much needed additional space. (PHOTO BY ANNA PACHECO| SPECIAL TO NHN)
Executive director of North Hawaii Hospice, Katherine Ciano, stands in front of the current office in Waimea. (PHOTO BY ANNA PACHECO| SPECIAL TO NHN)
North Hawaii Hospice is beginning preparations for the annual floating lantern ceremony held in August, volunteer coordinator Catrinka Holland, left, and volunteer Kyrsten Kaha assemble lanterns. (PHOTO BY ANNA PACHECO| SPECIAL TO NHN)
Debbie Washburn, registered nurse and director of Clinical Services at North Hawaii Hospice, works at her desk in the office. (PHOTO BY ANNA PACHECO| SPECIAL TO NHN)
Sandy Sunahara creates a hospice lantern. (PHOTO COURTESY OF NORTH HAWAII HOSPICE)
Floating lanterns are released at The Fairmont Orchid, Hawaii for North Hawaii Hospice. (PHOTO COURTESY OF NORTH HAWAII HOSPICE)
Construction is underway to expand the North Hawaii Hospice facility in Waimea, which will provide additional meeting and storage space. (PHOTO BY ANNA PACHECO| SPECIAL TO NHN)
Construction is underway to expand the North Hawaii Hospice facility in Waimea, which will provide additional meeting and storage space. (PHOTO BY ANNA PACHECO| SPECIAL TO NHN)

When a tree falls in the forest, maybe nobody hears. But when a tree falls in Waimea, the community wants to know why. Recently, Katherine Ciano, executive director of North Hawaii Hospice, has been answering more questions about the final days of trees, than people.

The usually quiet Hospice property, tucked around a bend in Mamalahoa Highway, has been busy cutting and removing unhealthy trees, trucking in construction materials and pouring a new concrete slab, to make way for the expanded services North Hawaii Hospice provides.

“We are actually building another cottage, with a lawn and a tall hedge,” Ciano said. “And we are working with the Waimea Outdoor Circle to replace the trees.”

The tall, overgrown ironwoods and eucalyptus, not native species, had not been maintained and practically hid the previous A-frame structure.

“The trees were fighting for sunlight,” she said. “The arborist looked at them and finally said ‘No, just take them out.”

She said the landscape plan, donated by Mark Mahaney, also includes native shrubs that will add color, and a signature ohia tree by the NHH sign.

“The property is only bare-naked during construction,” said Ciano. “It’s not going to be a parking lot.”

The second cottage will help NHH better accommodate their already expanded services, allowing private space for counseling, and more public space for office staff, community and board meetings, volunteer training, etc.

Ciano said that NHH has doubled in size in the last six years, taking on more patients, increasing community outreach, and providing for the new HMSA pilot program, Supportive Care Service. Not the same as Hospice, SCC is a similar level of extensive services for those with very serious life threatening illnesses who are still fighting the disease.

Ciano said that NHH already serves three or four SCC patients, and that the program could help to diminish people’s fear of hospice.

“We call it the ‘H-Word,’” said Ciano. “It’s a scary, scary thing, an overwhelming thing, like ‘this is the end.’”

Not just for people in their last few days, the most valuable care North Hawaii Hospice gives may be weeks or months before the patient’s death.

“Thirty percent of patients are coming in the last week of their life,” said Ciano. “Families haven’t had the support, the comfort they could’ve had … And so often people say, or their thank you notes say, ‘If only we had known earlier.’ It’s a national problem too.”

And, patients can rally and improve. Some gain weight, feel better, find the energy to go out and do things they love—from going fishing to a walk on the beach or a trip to Las Vegas.

“Yes, you can graduate from hospice,” said Ciano. “We graduated 13 last year.”

What is hospice?

It may be easier to describe what hospice is not. Contrary to popular myth, hospice is not a place where people go to die. Rather, it is a “philosophy of care,” providing help for patients at the end of life, and for their families and caregivers.

Hospice service includes nursing care and pain management, counseling and spiritual support, caregiver assistance, communication with doctors, and much more.

Not just for cancer patients, and not just for the elderly, NHH helps people of all ages with a wide range of terminal illness—as well as their families.

“They are so experienced with comfort care, and with families,” said Barbara Campbell of Waimea. She and husband Charles cared for his mother Mercy Campbell, who passed away at age 104 ½. “They provide great relief during surely one of the most difficult times for caregivers and families,” she said. “Hospice came and brought out the best in all of us.”

How much does it cost?

Services are free to patients and their families. Medicare, Medicaid and private insurance pays hospice directly.

How does it work?

A physician may recommend hospice care for a patient, or family members may drop in or call the office to inquire about services. NHH has an inter-disciplinary team that conferences on every single patient, to best understand their individual situation and coordinate care in the home. The team includes a social worker, nurse, hospital aid who takes care of bathing, volunteer coordinator and a counselor for emotional and spiritual support.

“Our hospice doesn’t try to impose anything on patients,” said Ciano. “We meet them where they are at – wrap around what traditions they have, as far as faith.”

A Medicare requirement, spiritual care is a big component of hospice.

“Counselors help coordinate connections to what they already have. For example, they could be already members of a faith community, so the counselor would coordinate connections to what they have. It could be that people just need comfort, support, to talk about fears, life goals, what they’d like to do in the time they have remaining, like writing to grandchildren, and other things.”

“We were praying for help,” said Campbell. “They came at the right time to save both of us,” she said. “They were marvelous, and we were so blessed to have their care and their understanding … She needed help and we needed help and Hospice knew how to provide both,” Campbell added. “Mom was in great comfort at the end.”

Symptom management is another important component.

“The field of palliative care is not just about pain,” said Ciano. “It could be itchy skin, nausea, anxiety, lack of appetite, difficulty swallowing. There are all kinds of remedies, pharmaceutical and non-pharmaceutical. We have massage therapists, healing touch and other modalities—provided by people with a practice who volunteer for hospice.”

Who is involved?

Led by Ciano, 28-year Medical Director Dr. John Dawson and a dedicated board of directors, NHH now serves 24 patients, and can go up to 26-28 patients in their 400-square-mile region from Hamakua through Waimea to North Kohala and Waikoloa.

“We have such a great board. They are so committed, so involved. We couldn’t ask for anything more,” said Ciano. “Other executive directors have to be event planners, but our board has a committee, they bring their ideas and throw the whole party.”

Their fundraising has been very successful.

“It’s like a funnel,” said Ciano. “Money comes in from the community and flows out to the community. It’s like a miracle you can watch.”

How do you volunteer?

Volunteers for hospice are always needed and welcome. For in-home care, NHH offers training classes twice each year, and has recently added a new self-directed online course, which allows volunteer trainees to go through the required curriculum before the classroom sessions. Having the online class saves time and enables NHH to offer a third volunteer training session during the year.

“We need all kinds of volunteers,” said Ciano. “There’s patient care in-home, which most people shy away from, but there are so many more opportunities. We need event help, people to stuff envelopes, answer the phone, or tend flower boxes. We even need kayakers – to paddle out and round up lanterns after the ceremony.”

Inspired by Sandy Sunahara, the annual Floating Lantern Ceremony is a tradition in Japan, and on Oahu, at the end of Obon season. Sunahara, who used to make all the ornaments for Hospice’s “Light Up a Life” campaign during the holidays, had wanted to honor her mother with a lantern, but travel costs were intimidating.

“She asked, ‘Why don’t you do it here on the Big Island?’” said Ciano.

With help from The Fairmont Orchid, Hawaii, cadres of volunteers and supporters, it was an overwhelming success.

“The first year we sold 2,000 lanterns,” she said. “We could not believe it.”

Sunahara passed away before the second year, but her legacy continues as a beautiful gift to the community.

For more information, stop by the North Hawaii Hospice office in Waimea, call 885-7547, email or visit

Community Events and Programs

Floating Lantern Ceremony. Sunday, Aug. 24, 5-7:30 p.m. at The Fairmont Orchid, Hawai’i. North Hawaii Hospice invites the community to join in the fourth annual floating lantern ceremony. Held at Coconut Grove, the even includes live music, hula, Taiko drummers and Hawaiian chanting and will be followed by a sunset lantern release into Pauoa Bay. Participants can purchase a lantern for $10, which they can decorate and inscribe with names of loved ones who have passed away. Lanterns can be purchased in advance at the North Hawaii Hospice office.

“Conversations on Death and Dying” with with Sindona Cassteel, MFT, bereavement counselor for North Hawaii Hospice. Third Tuesday of the month, 5:30-7:30 p.m. at Tutu’s House in Waimea. Sessions begin with a video presentation from “Dying Into Love,” an intimate conversation among authorities in the field including Roshi Joan Halifax and Ram Dass, followed by a moderated round table discussion. Attendees explore attitudes and expectations; learn skills to help others and have a more fulfilling and happier life.

“Circle of Support” community bereavement groups. “The Journey of Grief and Reconciliation” is a drop-in group, open to anyone that is grieving the loss of a loved one, facilitated by Sindona Cassteel, MFT, Bereavement Counselor for North Hawaii Hospice. Waimea session: First Tuesday of each month from 5-6:30 p.m. at The Moon Center Tea Room (just above Lava Rock Realty and across from the Red Water Cafe on Kawaihae Road. North Kohala session: Fourth Tuesday of each month from 5-6:30 p.m. at the Kokolulu Cancer Retreat Temple in Hawi, 6:30-8:30 p.m. For information and directions, email Bobbi Bryant or Stephen Shrader

Day of Mindfulness. Sunday, Sept. 13, 9 a.m-3 p.m. at Hamakua Jodo Mission, Paauhau mauka. Presentations and panelist discussion, followed by delicious vegetarian lunch and break-out sessions (limited to 12 participants in each). Katherine Werner Ciano will talk about “Living and Dying Mindfully.” Others presenters are Jody Manabe Kobayashi, Gregory Pai, PhD and Ryan Jigaku Nakade. Cost is $29 and includes vegetarian lunch. Advance registration required by Aug. 24. For more information, call 775-1064.