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.

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:

End-of-Life Conference

  • Registration and vendor exhibits begin at 7:30 a.m.
  • Program begins at 8:30 a.m.

Conference Purpose

Participants will gain greater understanding of the complex issues in providing palliative and end-of-life care.  Focus will be on terminally ill, aged, Alzheimer’s and pediatric populations. Topics will include communication techniques, quality of life management and grief care.

Continuing Education: 6.75 contact hours

This activity has been planned and implemented in accordance with the accreditation requirements of the Washington State Medical Association through the joint providership of Benton Franklin County Medical Society (BFCMS) and Chaplaincy Health Care.  The BFCMS is accredited by the WSMA to provide continuing medical education for physicians and nursing.

The BFCMS designates this conference activity for a maximum of 6.75 AMA PRA Category 1 Credit(s)™.  Physicians and nursing should claim only the credit commensurate with the extent of their participation in the activity.

This activity meets the criteria for up to 6.75 hours of Category I CME credit to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission.

Application has been submitted for 6.75 hours of CEUs to the Washington Chapter, National Association of Social Workers (NASW) for Licensed Social Workers, Licensed Marriage & Family Therapists and Licensed Mental Health Counselors.

Early Bird Registration

Fee is $75. Deadline: October 4, 2017.

Full-Time Student: $50

(Must be a full-time student in a health care profession. Student ID required and major may be verified.)

After October 4, 2017 Registration Fee: $100

Registrations will be accepted at 7:30 am the morning of the conference. No refunds for cancellations after October 4 or “no-shows”.

No shared registrations accepted. Substitute attendees are always welcome. Please notify Jannette Weber at if a substitute plans to attend in your place.


If you wish to stay the night Thursday, October 12 or Friday October 13 a special conference rate of $119 is available at the Spring Hill Suites hotel conveniently adjoining the conference center. Click here to reserve your room. Use code: CHPC

Conference Agenda

7:30 a.m.         Registration opens – Vendor exhibits open

8:30 a.m.         Having the Hard Conversation – Jeff Beck, MD, Seattle Children’s Hospital

10:35 a.m.       Break

10:45 a.m.        Alzheimer’s Disease Trajectory: From Diagnosis to End Stage – Nancy Isenberg, MD, Virginia Mason Medical Center Neurology

11:45 a.m.       A Caregiver’s Perspective: End-Stage Alzheimer’s –  What Professionals Need to Know –  Anne Koepsell, MHA

12:30 p.m.       Lunch

1:15 p.m.

  • Concurrent session A: Pediatric Palliative Care – Jeff Beck, MD
  • Concurrent session B: Mindful Encounters with Challenging Families – Catherine Zimmerman, LICSW

2:15 p.m.         Break

2:30 p.m.

  • Concurrent session A: Spiritual Care at the End of Life – Craig Timmons, MDiv., MEd
  • Concurrent session B: Mindful Encounters with Challenging Families – Catherine Zimmerman, LICSW (Repeat)
  • Concurrent session C: Grief Support for Children & Families – Heather Babler, Clinical Facilitator, Cork’s Place

3:30 p.m.         Break

3:45 p.m.

Palliative Care Panel – How Palliative Care Fills the Gap

  • Omar Khan, MD, Kadlec Regional Medical Center
  • Jannette Weber, RN, Director, Chaplaincy Palliative Care
  • Wayne Kohan, MD, Trios Palliative Care
  • Bonnie Davis, MD, Lourdes Health

4:45 p.m. – Closing, CME Certificates

Presentation handouts will not be provided. Conference materials and presentation slides available online October 6, 2017.  Click Here.

Thank you to our sponsors: Visiting Angels | Tri-City Cancer Center | Professional Case Management | Guardian Angel | Tri-City Home Health | Bellevue Healthcare

You’ll Never Walk Alone

This video from our 2016 Lighting the Path Breakfast demonstrates through personal testimonials how Chaplaincy Health Care serves others so “you’ll never walk alone” during serious illness, end-of-life, seasons of grief and life’s challenges.

Chaplaincy 2016H264med from Chaplaincy Health Care on Vimeo.