Frail is Not a Four-Letter Word

by Tim Ledbetter, D.Min, BCC
Chaplain Supervisor, Chaplaincy Health Care

There is a stage of life that may be dreaded more than the conclusion of one’s existence. It is that period of time when one finds him or herself becoming, in a word, FRAIL. Few people like that word; however, when a story is told describing someone’s increased fatigue, vulnerability and isolation, it inevitably seems to be summarized by the exclamation, “they are becoming so…uh…frail.” But at Chaplaincy Health Care, we believe that “frail” is not a four-letter word. Based on a four-stage model adapted from a book by Dennis McCullough*, we are fully aware of and responsive to the changes, losses and opportunities that are present at this particularly important stage of life.

Frail or Fatigue?

Increased fatigue is noticed as one’s once-robust vitality and energy is just not what it used to be. Statements like, “I’m just so tired,” are heard more frequently, along with reasons not to be as active as before. Be aware that fatigue may be of a physical, mental and/or social nature. Increased vulnerability also applies to different aspects of life: from the risk of falling to the risk of being taken advantage of by dishonest people. And increased isolation is often noticed with less frequent attendance at activities or more frequent excuses for not going or being involved. In reality all three aspects of increasing frailty are inter-related and affect each other. Interestingly, when comparing notes with some of the wonderful people who provide Meals on Wheels, they readily recognized these attributes in many of the folks they serve on a regular basis.

Stages of Life

Frailty is not something to be ashamed of or to ignore, but to understand and respond to with skillful compassion and patient empathy. In the continuum of life, the four stages noted above can be labeled as Routine, Stressed, Frail and Terminal. The Routine Stage is where we spend much of our lives (usually)—in the routines that we create, participate in and depend on day in and day out. Getting going in the morning, active at work or school, keeping schedules and appointments, worrying about being late, getting things done—in season and out of season. On occasion, those routines are interrupted by a stressful or distressing event that thrusts one into a Distressed Stage of life compromised for a time by accident, illness, injury, abuse. The natural response to being in a distressed stage is to seek to recover from and adapt to the changes that happened, with a goal of returning to one’s routines. Over time, those stressors become more frequent and prolonged; they start wearing on the person and at some point, the observation noted above begins to be heard, “They seem to be getting kind of frail.” (To complete the stages, eventually the declines and reductions are determined by medical experts to be irreversible and the likelihood of life ending in months and not years becomes real. Like the train station that receives passengers at the end of the journey, the final phase is called the Terminal Stage.)

"Frailty is not something to be ashamed of or to ignore, but to understand and respond to with skillful compassion and patient empathy"

Lessons Learned about Frailty

Students of the trajectory of human living have learned that a Frail Stage is not just for “old people.” Persons of all ages, including children, can become frail—just ask staff at children’s hospitals. Likewise we have learned that becoming frail is not a quiet, passive time; rather it is a constantly changing period of life that is characterized by another well-known, well-studied word, LOSS. We know this is so by listening to the stories on the theme of personal, functional loss: “I used to be able to do that and now I cannot ”… “I used to be this and now I am not.” Such situational losses—actually little “deaths”—must not be ignored. As with any loss, there are feelings of sorrow that must be sensed and respected. And there is grieving or mourning that must be done along the way in order to heal the fractures that occur in the hearts of the individual and those who love them.

Lastly we have learned that to be frail is not to be dying or dead—to put it bluntly.
Even though such despairing sentiments are often heard, the other reality is well-illustrated by the metaphorical testimony of autumn colors. The transitions from the vibrant greens and golds of summer to the browns and whites of winter are noticed by all—and feared by many. Like autumn, the Frail Stage embraces bittersweet times of joys and sorrows, of gains and losses, of wisdom and foolishness. The visual glories and declines are both evident in autumn and in the Frail Stage.

Generally there is no way around any of the stages, try as we might to avoid the reality of Life’s ebbs and flows, cycles and seasons. But in our self-sufficient, pro-growth, anti-aging society, the reality of the Frail Stage and our common angst about it continue to demand our best attention and responses. That begins with affirming that Frail is not a four-letter word.


Tim Ledbetter has been with Chaplaincy Health Care for more than 24 years as a hospital and hospice chaplain. Tim is an ordained and endorsed American Baptist clergyman, a Board Certified Chaplain, and a life-long child of God. he has nurtured ongoing interests and participation in physician-chaplain collaboration, biomedical ethics, human subjects research, palliative care, and advanced care planning.

It’s Never too Late to Thank a Veteran, Even at the End of Life

Americans across the country celebrate Veterans Day on November 11, a special day to salute the men and women who have bravely served our country in the military.

These fellow Americans have made profound sacrifices in defense of freedom and they deserve our heartfelt thanks and appreciation. Honoring our nation’s Veterans includes supporting them throughout their entire lives, especially at the end.

As our nation marks Veterans Day, Chaplaincy Hospice Care deepens our commitment to increase Veterans’ access to the compassionate, high-quality care available from the nation’s hospice and palliative care providers. One of the ways we’re making this happen is through our active involvement with We Honor Veterans, an innovative program of the National Hospice and Palliative Care Organization that we created in collaboration with the Department of Veterans Affairs.

There is something else that’s important for every American to do – and that is to say, “thank you” to our country’s Veterans. Not just on November 11 but all year long.

Ask your friends, neighbors, coworkers and others in your community whether they have served in the military (you may be surprised how many have)—and thank those who have served for their sacrifice.

It surprises many Americans to learn that every day, 1,800 Veterans die. That’s more than 680,000 Veterans every year – or 25 percent of all the people who die in this country annually.

If you know a Veteran who is in need of the special care hospice brings to people facing serious and life-limiting illness, please reach out and help them learn more about care options by visiting

To all our nation’s Veterans, thank you.

If you are interested in helping us honor those veterans, please contact Malia F at (509) 460-5813 or

End-of Life-Conference

Join us for the 3rd Annual End-of-Life Conference: The Art and Science of Managing Advanced Illness

Gain greater understanding of the complex issues in providing palliative and end-of-life care. The event's focus will be on clinical and cultural leadership, the role of the interdisciplinary team, medical cannabinoids, spiritual care, Hospice 101, pain and symptom management and the care every patient deserves. 6.5 CMEs (available).


Three Rivers Convention Center
7016 W. Grandridge Blvd
Kennewick, WA 99336


7:15 AM - 7:45 AM  —  Registration
7:45 AM - 7:55 AM —  Welcome & Reflection
8:00 AM - 9:30 AM —  Key Note Presentation: "The Best Care Possible: Clinical and Cultural Leadership for the 21st Century" by Ira Byock, MD
9:30 AM - 10:00 AM  —  Break & Book Sale/Signing with Dr. Ira Byock
10:00 AM - 11:00 AM  —  Medical Cannabinoids, Brian Lawenda, MD
11:00 AM - 12:00 PM  —  "We all Care: Key elements to Successful Communication in Dealing with the Seriously Ill" by Rainy Sauer, MDIV, BCC, GCPC, Chaplain, Chaplaincy Health Care
12:00 PM - 12:30 PM  —  Lunch
12:30 PM - 1:30 PM  —  Breakout Session #1
Concurrent Session A
"You Too, Can Provide Spiritual Cares", Tim Ledbetter, DMin, BCC, Chaplain Supervisor, Chaplaincy Health Care
Concurrent Session B
"Hospice 101", Wayne Kohan, MD
Concurrent Session C
"What Every Patient Deserves", Mary Ann Clute, PhD, LICSW and Rie Kobayashi, PhD, LMSW
1:30 PM - 1:45 PM  —  Break
1:45 PM - 2:45 PM  —  Breakout Session #2
Concurrent Session A
"You Too, Can Provide Spiritual Cares", Tim Ledbetter, DMin, BCC, Chaplain Supervisor, Chaplaincy Health Care
Concurrent Session B
"Delirium - Ideas for Treating Our Least Favorite Symptom", Wayne Kohan, MD
Concurrent Session C
"What Every Patient Deserves", Mary Ann Clute, PhD, LICSW and Rie Kobayashi, PhD, LMSW
2:45 PM - 3:00 PM  —  Break
3:00 PM - 4:00 PM  —  "Searching for Wellness: Tools to Cultivate Resilience in a Culture of Burnout", Gregg VandeKieft, MD, MA, Hospice & Palliative Care Specialist, Providence Health Systems
4:00 PM - 4:15 PM  —  Wrap up and CMEs



If you wish to stay the night Friday, October 19 or Saturday, October 20, a special conference rate of $129 is available at the Spring Hill Suites hotel, conveniently adjoining the conference center. Click here to reserve your room. 

If calling in a reservation, use the Group Code: CHCC

SpringHill Suites, Kennewick
7048 West Grandridge Boulevard
Kennewick, WA 99336
(509) 820-3026

End-of-Life Conference Registration Open

Chaplaincy Health Care’s third annual CME/CEU End-of-Life Conference is Friday, October 19, 2018, at the Three Rivers Convention Center in Kennewick. The keynote speaker will be Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life.

The conference is geared toward the health care community including RNs, ARNPs, MDs, and Social Workers and will provide an opportunity to gain a greater understanding of the complex issues in providing palliative and end-of-life care. Topics covered include clinical and cultural leadership, the role of the inter-disciplinary team, medical cannabinoids, spiritual care, Hospice 101,  symptom management for delirium, providing the care every patient deserves and how to cultivate resilience in a culture of burnout. Brenda Swenson, Director of Hospice Outreach for Chaplaincy Hospice Care said, ‘This is a great opportunity to earn 6.5 CMEs/CEUs while hearing from some of the best and brightest in the field of end-of-life care.”

Chaplaincy's End-of-Life Conference Keynote Speaker, Dr. Ira Byock.

Dr. Ira Byock, Conference Keynote Speaker

Dr. Ira Byock’s presentation titled “The Best Care Possible” focuses on clinical and cultural leadership, tackling the crisis that surrounds serious illness and dying in America and his quest to transform care through the end of life. After his presentation, Dr. Byock will be available, with his book The Best Care Possible,  for purchase and signing.

The conference agenda also features regional experts such as:

  • Dr. Brian Lawenda, renowned Harvard-trained Radiation Oncologist, Stanford/UCLA-trained Medical Acupuncturist, Integrative Oncologist and former U.S. Navy Commander who serves as Northwest Cancer Clinic’s Medical Director speaking about medical cannabinoids.
  • Rainy Sauer holds a Masters of Divinity, is a Board Certified Chaplain and recently received her Graduate Certificate in Palliative Care from the University of Washington. She has worked with palliative care patients for the Tri-Cities Cancer Center and recently joined the Chaplaincy Palliative Care team. She will present key elements to successful communication with seriously ill patients.
  • Dr. Gregg VandeKieft is the Southwest Washington Regional Medical Director for Palliative Care for Providence St. Joseph’s Health. He is board certified in Family Medicine and Hospice and Palliative Care. His topic focuses on searching for wellness and he will provide some much needed tools to help cultivate resilience in midst of burnout.

These are just a few of dynamic speakers on board for the day. See the full agenda and a list of breakout session topics and speakers here.

Registration is open. The Early Bird rate for the conference is $100 before October 5, 2018. After that date, the regular registration rate is $125. There is a discount for full-time students studying in a health care related field. Online registration is available here. This conference has been approved for 6.5 continuing education credits are available for nurses, physicians and social workers. For questions or additional information, please call (509) 783-7416 or email:

Evening for the Angels

Join us for an evening with the stars, under the stars in the courtyard at the Richland Red Lion as we gather to support Chaplaincy Hospice House. This year’s theme is “The Great American Songbook” performed by Cathy Kelly, accompanied by Steve Haberman. New this year is a Social Hour beginning at 6 p.m. Show starts at 7 p.m. As usual, we’ll be serving superb wines and decadent chocolates.

Memorial Service

We at Chaplaincy Hospice Care invite you and other family members to a memorial service. We will honor those loved ones who died, in a service of recognition, music, and prayer. Anyone remembering a loved one who has died is welcome.

Date: Thursday, May 10, 2018
Time: 6:00 – 7:00 p.m. Reception to follow Place: First Christian Church, 1921 S. Olympia St., Kennewick WA

Love and death touch every person in a totally unique way. We find comfort and strength in meeting and sharing with others who are making the same journey.

We invite you to bring a picture or other small memento of your loved one to the memorial service. There will be a time to bring those forward during the service, as well as place a lighted candle in honor of your loved one. Pictures and mementos may be picked up following the service.

There will be a time during the service when you and others in your family will be given the opportunity to speak aloud the name of your loved one, if you wish to do so.

Please invite other family members and friends whom you think may want to attend. All are welcome.

Chaplaincy Health Care Spring Newsletter

Our Spring Newsletter is blooming with information! Read about our 2nd annual Heart of Healing fundraising event for Cork’s Place and the announcement of our second thrift store location. That’s right! Repeat Boutique will be opening the end of March in the Uptown Shopping Center in Richland.

Our spring support groups are listed as well as our current “wish lists” for each program. Your support makes a big different and allows us to continue offering quality compassionate care to those in our community who are dealing with serious illness, end-of-life, or loss.

Click here to read the Spring Newsletter.


Memorial Service

Please join us for a special memorial service of recognition, music and prayer. Anyone who wants to remember a loved one who has died is welcome.

Lighting the Path Breakfast

Join us for the Lighting the Path Breakfast to learn about the many ways Chaplaincy Health Care touches lives in our community.

Harvest Craft & Bake Sale

Stop by the Harvest Craft & Bake Sale at the Repeat Boutique, 22 W. Kennewick Ave to get some holiday shopping done for yourself or loved ones. There will be a wide selection of small quilts, table runners, bibs for babies and adults, aprons for kids and adults, hand-crafted candles and more!

A portion of the proceeds will benefit Chaplaincy Hospice Care.