HVS Thru the Years

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ARCH End-of-Life Suites at Porter Medical Center

A brief Conversation with Dr. Diana Barnard and ARCH board member, Laurie Borden.


The G.R.A.C.E. Model

Presenter:  Brian Joshin Byrnes, Sensei

Bread Loaf Mountain Zen Community 


The G.R.A.C.E. model of Roshi Joan Halifax has five elements:

1. Gathering attention: focus, grounding, balance 

2. Recalling intention: the resource of motivation 

3. Attuning to self/other: affective resonance

4. Considering: what will serve

5. Engaging: ethical enactment, then ending

You can use the following detailed description of each element as a script for your own G.R.A.C.E. practice:

1. Gather your attention.

Pause, breathe in, and give yourself time to get grounded. Invite yourself to be present and embodied by sensing into a place of stability in your body. You can focus your attention on the breath, for example, or on a neutral part of the body, like the soles of your feet or your hands as they rest on each other. You can also bring your attention to a phrase or an object. You can use this moment of gathering your attention to interrupt your assumptions and expectations and to allow yourself to relax and be present.

2. Recall your intention.

Remember what your life is really about, that is to act with integrity and respect the integrity in all those whom you encounter. Remember that your intention is to help others and serve others and to open your heart to the world. This "touch-in" can happen in a moment. Your motivation keeps you on track, morally grounded, and connected to your highest values.

3. Attune by first checking in with yourself, then the person you are interacting with.

First notice what's going on in your own mind and body. Then, sense into the experience of the person you are with; sense into what the other person is saying, especially emotional cues: voice tone, body language. Sense without judgment. This is an active process of inquiry, first involving yourself, then the other person. Open a space in which the encounter can unfold, in which you are present for whatever may arise, in yourself and in the other person. How you notice the other person, how you acknowledge the other person, how the other person notices you and acknowledges you... all constitute a kind of mutual exchange. The richer you make this mutual exchange, the more there is the capacity for unfolding.

4. Consider what will really serve the other person by being truly present for this one and letting insights arise. 

As the encounter with the other person unfolds, notice what the other person might be offering in this moment. What are you sensing, seeing, and learning? Ask yourself: What will really serve here? Draw on your expertise, knowledge, and experience, and at the same time, be open to seeing things in a fresh way. This is a diagnostic step, and as well, the insights you have may fall outside of a predictable category. Don't jump to conclusions too quickly.

5. Engage, enact, and then end the interaction and allow for emergence of the next step. 

From Frank Ostaseski, The Five Invitations.

Welcome Everything. Push Away Nothing. It is our task to trust the moment, to listen, and to pay careful attention to the changing experience. It is a kind of fearless receptivity, always entering new territory – a mystery we need to live into, opening, risking, and forgiving constantly.

Bring Your Whole Self to the Experience.  We draw on our strength and our helplessness, our wounds and passion to discover a meeting place with the other. Professional warmth doesn’t allow us to touch into another persons pain, rather it is the exploration of our own humanity that allows us to be of real assistance.   This allows us to touch another’s pain with compassion instead of fear or pity. We can’t travel with others in territory that we haven’t explored ourselves.

Don’t Wait. Patience is different than waiting. When we wait, we are full of expectations, and can miss what this moment has to offer. Waiting for the moment of death we miss these moments of living. Strategizing about the future, we miss the opportunities that are right in front of us. Allow the precarious nature of this life to show you what’s most important then enter fully.

Find A Place Of Rest In The Middle Of Things. We imagine that we can only rest when we change the conditions of our lives. But it is possible to discover rest right in the middle of chaos. It is experienced when we bring our full attention, without distraction, to this moment, to this activity. This place of rest is always available. We need only turn toward it. It is an aspect of us that is never sick, is not born, and will never die.

Cultivate Don’t-Know Mind. This describes a mind that is open and receptive, not limited by agendas, roles and expectations. Being in the open place of Don’t-Know Mind is not a place of ignorance; rather it is a characterized by openness. We stay very close to the experience allowing the situation itself to inform our actions. We listen carefully to our inner voice, sensing our urges, trusting our intuition. We learn to look and see with fresh eyes.


We live in a time when science is validating what humans have known throughout the ages: that compassion is not a luxury; it is a necessity for our well-being, resilience, and survival. My hope is that the G.R.A.C.E. model will help you to actualize compassion in your own life and that the impact of this will ripple out to benefit the people with whom you interact each day as well as countless others.


"What Happens When. . .?"

“What happens when…?”

Life can change for the better or worse at a moment’s notice. While we cannot prepare for many situations we will encounter along the way, having some basic knowledge ahead of time can make dealing with them easier. Because many middle-aged people in our community have the privilege of having their aging parents living longer than ever, we thought it would be helpful to answer some questions that may come up as your loved ones age and prepare for end-of-life.

Q- My mom lives in Addison County and I live out-of-state.  She has recently been diagnosed with a terminal disease and I cannot be with her all the time. What should I do first?

A: Patient referrals to hospice come from their physicians. If your mom has a serious diagnosis and has not already been referred to hospice care, we recommend that you call your mom’s physician and discuss whether a referral to hospice care is appropriate. If the answer is “yes”, and the physician has had a discussion with your mom about her prognosis, the physician will send a referral to ACHHH. This agency will contact your mom promptly and arrange for an intake visit. A member of the hospice team will meet with your mom and work to develop a plan of care to best meet her needs. She will receive kind, skilled, compassionate care in her own home for as long as possible.

Q: Who will provide care for my loved one while she is a hospice patient?

A: Hospice provides an interdisciplinary team which may include registered nurses, a palliative care physician, social workers, home health aides, trained volunteers and hospice chaplains. Hospice nurses provide medical care including pain and symptom management. Social workers assist patients and families prior to death and follow up at scheduled intervals with family members for the first year following death.  Hospice Volunteer Services provides companionship, respite for family members and help with practical matters like shopping and transportation. The Wellspring hospice singers or other musicians from Hospice Volunteer Services visit patients at any stage and provide bedside music. Hospice chaplains assist patients and families with spiritual needs at the end-of-life.  The inter-disciplinary hospice team meets on a weekly basis and reviews the care plan for each and every hospice patient, because every patient is unique. As situations change the care plan is re-assessed and updated with input from the patient, family members and the care team. It should be noted that the hospice team does not provide 24 hour direct care, and in order to stay in the home, a patient needs to have a family member or paid caregiver living with her.

Q: My loved one lives alone but staying in the home is not practical or even possible. She requires hospice care. Are there any other community resources that can help?

A: In Addison County we are fortunate to have Addison Respite Care Home (ARCH) rooms located at both The University of Vermont Network Porter Medical Center (The Estuary) and Helen Porter Rehabilitation and Nursing facilities. These are rooms designed to accommodate people who need end-of-life care but cannot remain in their homes. Each room offers a home-like environment, hand-made furniture and quilts, pull-out sleep chairs for family members and a music system. Patients who are admitted to ARCH and the Estuary rooms are cared for by employees of the hospital and nursing home as well as ACHHH nurses and hospice volunteers.

Q: What should I do if my loved one passes away at home?

A: Do not panic! If your loved one is not under hospice care, you should call 911 and await further instructions from emergency medical and law enforcement personnel.   They will assist you in having your loved one transported to the hospital emergency room where a doctor will make a pronouncement of death.

Q: Is the process different if my loved one was being cared for by the hospice team?

A: Yes! One of the main benefits of hospice care for families is that at the time of death you only need to call Addison County Home Health and Hospice. ACHHH has an answering service which operates after normal business hours. The on-call nurse can go out at any hour to attend to your loved one at the time of death and make the necessary pronouncement. She will assist with preparing the family for next steps. If a person is being cared for by hospice and dies at home, there is no need to call 911.

Q: Once my loved one passes away, is my relationship with the hospice team over?

A: No.  Bereavement support is available from ACHHH and Hospice Volunteer Services. ACHHH provides individual bereavement counseling for family members of our hospice patients and HVS offers both individual and group bereavement support services.


A Hospice Heart

A Hospice Heart      ~Laurie Borden, Associate Program Director

         In Honor of Hospice Volunteers, Garden Party, 5/24/2018  

We are devoted to our volunteers.  You bravely walk into the unknown,

into the depths of the dying process, with your souls open to possibility. 

We offer our gratitude for you each and every day, when we understand

how you transform the world of the patients and families you visit.

Love is a sacred action, which comes so naturally as yu walk the path of

a hospice volunteer.  There is no greater art, avocation or aspiration

than to touch others with your care, your crdibility and your

compassion as we travel on this journey.


                 Deep within us

beats a home

         for our most authentic selves.

Here lives our need

        to hold our most vulnerable others.

We meet on the thresold


                 our simple beings, pausing






                                    until all melts into one

                                    a single hospice heart.


We hope your screens let you seen half a heart or an angel wing.