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It’s July 23, 2022, and I am arriving in Downtown Reno to walk in my first-ever Pride Parade. Even more amazing, I am going to be walking with a group of my coworkers, announcing to our entire community that our employer supports us being our full and truest selves. I arrived alone, but in the staging area I met new people who worked in other departments of Renown, coworkers I might never have met if not for Pride. I even took a selfie with one of these new friends. Someone passed around flags for us to hand out to the audience as we marched by. I took a rainbow-striped temporary tattoo in the shape of the Renown “R” and used my water bottle to apply it. There was an overwhelming atmosphere of excitement and joy that can only come from gathering with other human beings who are overflowing with love. We started the Parade waving handfuls of Pride flags high and gave those flags out to the audience as we passed. By the time we were done walking, our hands were empty, but our hearts were full. I couldn’t have stopped smiling if I’d tried. I’d joined the parade as a single person, but as we walked, I became part of a community. Not only the Renown community, but a community of Proud queer people across northern Nevada. And by extension, the LGBTQIA+ community all around the world – past, present and future.  With the multiple recent state laws proposing to strip away the rights of LGBTQIA+ people, many of us have felt a noticeable decline in our mental health and feelings of personal safety.  As a member of the queer community, I have felt these mental health effects too. I am fortunate and privileged enough to not have experienced workplace discrimination in my current position. But before Renown, I – like so many others in the LGBTQIA+ community – had a negative experience at a previous job, and afterwards I was hesitant to share my full self while at work. To be able to walk in a Pride Parade with my current employer, healed a little bit of that past pain inflicted by my former employer.  When our liberties are under attack, Pride is more important than ever. We must remind ourselves, especially when others cannot seem to remember, that we are loved and worthy of love. I am grateful to work for an organization that is willing and able to fight this good fight with us.  I will certainly be back to walk in this year’s Pride Parade, and I sincerely hope to see you there too! Be sure to wear comfortable walking shoes, sunglasses and of course keep your skin safe with sunscreen. Whether you’re part of the LGBTQIA+ community, or just an ally, you are welcome.

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Becoming a caregiver or playing a more active role in another’s healthcare is a big responsibility. At some point, almost all adults will support an aging parent or a loved one in need. Keeping track of their needs and wellbeing, while also prioritizing your own can become overwhelming. It’s important to know: you are not alone, and help is available. Read on for 11 tips to help you manage your time, your own wellbeing and your loved one’s care. Self-care comes first. When your main priority is the person in your life who needs care, it’s easy for your own needs to take the backseat. Give yourself time each day to focus on your personal wellbeing. It’s hard to give a loved one the care they need if your own needs are not met. Prioritize the Activities of Daily Living (ADL). Make a note of what ADLs your loved one can do alone, what they need help with and what activities require the most help. This will help you work through the day with them, as well as plan out how the day’s activities will go. Do a home safety audit. Do showers, bathtubs and steps have safety grab bars? Look around the house for additional tripping hazards, like rugs or electrical cords. If your loved one struggles with day-to-day navigation of the home, consider scheduling an occupational therapy appointment. This type of therapy helps a person develop or maintain the motions required to accomplish daily tasks. You might also qualify for a referral to in-home healthcare, such as Home Care. Have the hard conversation. The best time to discuss views about end of life care and to learn what choices are available is before a life-limiting illness or crisis occurs. With advance care planning, you can help reduce the doubt and anxiety related to decision making at the end of life. Completing an Advance Directive is a great tool to sort out all these decisions before they’re needed. Attend a free workshop to learn more and complete this important document. Identify when you need respite. Respite care involves receiving a short-term break from caregiving. Organizing in-home care for your loved one will allow you to step away and tend to your needs. By identifying what kind of respite care you are seeking, you can find the right person to provide you with that much-needed break. Don’t wait until you feel overwhelmed, plan ahead. Write down insurance contact information. Have a direct connection to the right insurance professional for support and advice. If your loved one is eligible Medicare, this is a good opportunity to review their current selections and if they would benefit from a Medicare Advantage Plan or Medicare Supplement Insurance. Seeking out expert advice or information on Medicare options is a great way to navigate this. Consider calling a broker, or attend a free educational seminar with Senior Care Plus. Gather legal and financial information. Make a list of all existing legal documents and financial accounts that your loved one has. These might include a will, advance directive, power of attorney, bank accounts or investment accounts. If you have questions about how to manage them, or need assistance in setting up additional framework, reach out to a lawyer, legal service, financial adviser or bank representative. Create an inventory of medical information. Identify where all of your loved one’s medical records are, as well as a list of providers or healthcare practices where they have received care. Consider if you should have your loved one give you Proxy Access in MyChart, which allows you to access all the features in MyChart on their behalf, including viewing upcoming appointments, viewing test results and emailing a doctor on their behalf. Make a list of what others can do. Think about all the little (and big) things that need to happen, and write down tasks that others could take care of you. When someone says “let me know what I can do” you’ll be ready with a pre-written list of items they may be able to assist with. Tasks could include tackling around-the-house repairs, scheduling lawn work, helping to walk the dog, taking a car for an oil change and cleaning. Find programs and events for social enjoyment. If and when possible, seek an activity outside of the home. Look for community centers that have programs for seniors, recreational activities or meals that you can patriciate in together. If leaving the home is not an option, arrange for visits or in-home activities, such as movie nights, card games or time to visit with family. Research long-term options. If you will be considering a nursing home or assisted living, make a list of amenities that you and the person you are caring for would like. Take this list with you when visiting potential locations to make sure you don’t forget to ask about each item.

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We plan for the birth of a child, weddings and retirement, but rarely do we discuss how we want to be cared for at the end of our lives. Getting through this challenging conversation and completing an Advance Directive can give you peace of mind that your loved ones will not have to make difficult choices on your behalf. The best time to complete an Advance Directive is now – don’t wait until a life-limiting illness or crisis occurs to discuss your views about end-of-life care and to learn what choices are available. By preparing in advance, you can help reduce the doubt and anxiety related to decision-making for your family if you cannot speak for yourself. What are Advance Directives? An Advance Directive is a document that states your choices about medical treatment and names another person to make medical decisions on your behalf if you are unable to. This document allows you to make legally valid decisions about future medical care.  “Completing your Advance Directive is a gift you give your family,” says Director of Palliative Care, Mary-Ann Brown RN, MSN. “The stress associated with these difficult decisions is decreased if everyone knows what is important to you and what you want at the end of life.”

Read More About Plan Early: Completing Your Advance Directive

August is National Make-a-Will month. We talked to Renown Health Foundation Planned Giving Officer, Abbey Stephenson, to learn more about wills, trusts, and estate plans and why you should feel motivated this month to get started. Did you know that 2/3 of Americans don't have a will or trust? If this is you, don’t worry, you’re not alone. Although there are laws in place to determine who inherits your assets if you die without a will or trust, having a will or trust ensures your assets go where you want them to go after you are gone. They can also help minimize disputes between family members and heirs about who gets what. In Nevada, the laws that govern who gets what if you die without a will or trust can be found in Chapter 134 of the Nevada Revised Statutes. There are other documents that people often prepare at the same time as their will or trust – like an advance health care directive and durable power of attorney for assets. These documents all together are called an estate plan. Although they have other purposes too (like nominating a guardian for a child, planning for disability or avoiding probate, which is a court process), wills and trusts are documents that say who will receive your assets after you are gone. The most common type of trust is often called a revocable living trust or a family trust. People who have a trust usually still have a will, although it is a shorter form of will called a pour-over will. It’s a good idea to talk to an estate planning attorney about whether or not a trust makes sense for your family or circumstances.  Now that you’re ready to get started, here are some mistakes to avoid: 1. Failing to plan Not setting aside the time to plan may be the biggest mistake. Failing to prioritize preparing or updating your estate plan means your last wishes and desires may not be fulfilled. The right documents memorialize what you would like to happen upon your disability and death so that other people can know and follow your wishes with respect to your care and your assets.  2. Failing to coordinate beneficiary designations Certain types of assets like life insurance and retirement accounts are not covered by your will or trust and need to be addressed separately. These types of assets are referred to as non-probate assets because they transfer under contract principles and don’t require court supervision or probate to be distributed to the named beneficiaries. By completing beneficiary designation forms provided by the retirement account custodian, insurance company or financial institution, you can direct your assets to one or more beneficiaries. 3. Failing to title your assets properly Asset titling refers to how you own your asset – such as in your individual name, jointly with someone else, or in a trust or entity. For example, assets titled for two people with a “right of survivorship” will automatically go to the surviving owner. Review your asset titling and make changes, if needed, to ensure your property and assets are passed down the way you intend. 4. Failing to include charities meaningful to you In addition to providing for family members and other important people in your life, you many also choose to give to charities meaningful to you in your estate plan. When you include a charity in your estate plan, that gift is called a planned gift and many charitable organizations, including Renown, recognize such donations through their legacy giving societies. As you prepare to make your own will or a more comprehensive estate plan, we recommend you consult with a lawyer. Here are some free resources that may be helpful too:  Renown Health Foundation is proud to sponsor the Family Estate Planning Series put on by PBS Reno and the Community Foundation of Northern Nevada. The free, 8-week course of 90-minute, in-depth workshops is a great place to learn much more and to help you get started in the planning process. The next course begins on September 7, 2022. More information can be found here. Renown Health offers periodic advance health care directive workshops where attendees can learn about, complete, and sign their directive. The next workshop is scheduled for September 14th. More information can be found here. The American College of Trust and Estate Counsel provides information on a number of commonly asked estate planning questions here. If you are interested in including a charitable gift to Renown in your estate plan, we would be happy to talk to you about how your gift will make a difference for our mission. Please contact Abbey Stephenson at abbey.stephenson@renown.org or visit renown.org/LegacyGiving to learn about Renown Health Foundation’s Legacy Giving Society and ways to give.

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Renown Health has long supported northern Nevada’s LGBTQ+ community Pride events with sponsorship, and we’ve collaborated with local and regional LGBTQ+ organizations as an ally. Renown’s Pride Committee works to deepen and broaden our external and internal efforts around LGBTQ+ community engagement, advocacy, and healthcare issues related to sexual and gender minorities, which is part of the greater Diversity, Equity and Inclusion efforts Renown is undertaking. According to Harvard Chan School, data shows that nearly a sixth of LGBTQ+ adults feel they were discriminated against based on their sexual orientation and gender identity. As a result, this brings to light the important need for education within the healthcare setting. Renown Health is bridging the gap for our LGBTQ+ population, and we know more work needs to take place in order to become an inclusive organization. Below are a few ways we’re working on improving our response to LGBTQ+ needs, and celebrate, respect and honor our diversity by being inclusive. Diversity, Equity and Inclusion The Diversity, Equity and Inclusion subcommittee was formed to heighten the awareness and develop a plan on how to better serve all of our diverse populations, including our LGBTQ+ patients. As the largest healthcare provider in northern Nevada, we knew that we could do a better job. The subcommittee provides us a forum to discuss ideas and develop plans to provide better care to these populations. Updated Medical Records with Preferred Name and Pronouns Of course healthcare is personal. We meet patients at their most vulnerable states. And relating to every person by the correct pronoun shows we respect their gender identity. A new medical records update supports our doctors, nurses and care team in capturing this vital information. We are now able to capture every person’s preferred name, sex and sexual orientation to better care for them. Kathleen Zaski BSN, RN, Manager of Clinical Informatics and IT Applications at Renown explains why this is so important. “Your name and identity are core to who you are as a person, and here at Renown, we aim to take care of you as a whole person and to provide the highest level of quality care to our community – all while ensuring the experience is exceptional and tailored to the individual. In other words, having the patient’s preferred name and pronoun in the medical record is important to validate their identity, and show we care, in an already high stress environment. Specifically, giving our providers easy access to the patients preferred name and pronoun in the medical record, allows them to properly address their health concerns. This also helps the health care provider foster a closer relationship with the patient. Studies have found this actually increases the quality of care by creating a more open and comfortable environment.” Gender Neutral Restrooms Mitch Harper, Senior Program Development Manager at Renown, recognizes there’s still so much more to improve upon in becoming an inclusive organization. “At the end of the day, it’s about creating a safe and welcoming environment for our community and our employees. Access to basic human services shouldn’t be contingent on an individual’s skin color, ethnicity, sex, gender identity, sexual orientation, age, disability, or beliefs. Ensuring that private restrooms are equally available to everyone on our campus is just one way we can provide a more inclusive, caring space for the people we serve.” Updated restroom locations: Roseview Tower: 10 Sierra Tower: 14 Tahoe Tower: 14 Helping to Lead and Influence Change Sean Savoy, Manager of Spiritual Care at Renown "The foundation of spiritual care is compassion – being with people in need by caring, supporting, and showing empathy, and promoting a sense of well-being. Being a member of the LGBTQ+ community informs that deep sense of compassion and empathy in a very special and unique way. Our human value, social validity, the very reality of who and what we are, even our right to exist, love and just be, are often called into question. This, in turn, can cause many of us to question ourselves and wonder about our self-worth. This experience should engender compassion and empathy so that we can better recognize, listen to and meet others’ needs to help them achieve inner peace, explore coping strategies to overcome obstacles during illness or crisis, and even find new balance by re-conceptualizing themselves in the context of health and illness. I have found that the intersectionality of my gay and spiritual selves has been a blessing in my life." Matthew Maloy, Team Lead Applications Specialist at Renown “I am a Team Lead Epic analyst in the IT department that is responsible for clinical based workflows for ED, Trauma, and Critical Care and have worked at Renown for 15 years. Being a part of the LGBTQ+ community influences my daily work by ensuring the Electronic Health Record reflects best practices such as giving clinicians the ability to document a preferred name, and displaying that throughout the medical record for consistency. Having the ability to influence decisions that move our community toward human value for all of us is a priority in my daily work.” Our Mission Renown Health’s mission is to make a genuine difference in the health and well-being of the people and communities we serve, including the LGBTQ+ community. We continue to build relationships to improve care, fostering better health outcomes for ALL of our patients by creating a more inclusive health system.

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SOGI stands for sexual orientation and gender identity. Being a SOGI-inclusive medical facility means regardless of our differences, we treat others with dignity and respect. Sean Savoy, Renown Health Manager of Spiritual Care, explains SOGI terms and their importance in a healthcare setting below. SOGI History Although the UN passed a historic resolution on SOGI in 2016, it is still a relatively new term for some. Above all, an inclusive environment where every patient feels safe and valued, improves the quality of care in our community. In reality, defining gender and sexuality can be confusing. However, the terms we use to define gender and sexuality are an important influence on how we relate to each other. Generally, "sex" refers to the biological differences between males and females. Still the term “sex” doesn’t fully capture the complex biological, anatomical and chromosomal variations that can occur. Accordingly, having only two (binary) options – biological male or biological female – might not describe what’s going on inside a person’s body. In essence, assigned sex (also called "biological sex) is given at birth based on medical factors. These include your hormones, chromosomes and genitals. Most people are assigned male or female, and this is what’s put on their birth certificate. When someone’s sexual and reproductive anatomy isn’t clearly female or male, that person may be described as “intersex.”  However, a person’s biological or assigned sex may be different from a person’s actual or perceived gender identity or expression. The word “gender,” therefore, is more difficult to define. It could refer to the gender or sex role society determines is acceptable, desirable or appropriate based on a person’s perceived sex. Likewise, it could refer to an individual’s own gender identity or preferred gender expression. What is Gender Identity? To summarize, gender identity is one's innermost concept of self as male, female, a blend of both or neither. To clarify - how individuals perceive themselves and what they call themselves. Of course sometimes a person's genetically assigned sex does not line up with their gender identity. These individuals might refer to themselves as transgender, non-binary, or gender-nonconforming, for example. Another key point is the process of gender transition. This specifically refers to more closely aligning your internal knowledge of gender with your outward appearance. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), the term – which replaces Gender Identity Disorder – "is intended to better capture the experiences of affected children, adolescents, and adults." What is Sexual Orientation? Sexual orientation is an internal or enduring emotional, romantic or sexual attraction to other people. For example, you could be heterosexual (straight), gay, lesbian, bisexual or even pansexual. SOGI Terms to Know Below are some common SOGI terms according to the National LGBT Health Education Center and the Human Rights Campaign. The following list is not meant to represent every term (or definition) used by the LGBTQ+ community. LGBTQ+ Stands for lesbian, gay, bisexual, transgender and queer (or questioning). The plus encompasses other identities that fall under the queer umbrella with one common theme: they are not strictly straight or cisgender. Queer An umbrella term used by some to describe people who think of their sexual orientation or gender identity as outside of societal norms. Some people view the term “queer” as more fluid and inclusive than traditional SOGI identities. Due to its history as a derogatory term, the term is not always embraced or used by all members of the LGBTQ+ community. Sexual Orientation Terms Asexual (adj.) – Describes a person who experiences little or no sexual attraction to others. Asexuality is not the same as celibacy. Bisexual (adj.) – A sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender and people of other genders. Gay (adj.) – A sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender. It can be used regardless of gender identity, but is more commonly used to describe men attracted to other men. Heterosexual or Straight (adj.) – A sexual orientation that describes a person whose sexual or emotional attractions and behaviors focus exclusively or mainly on members of the opposite sex or gender identity. Lesbian (adj., noun) – A sexual orientation that describes a woman who is emotionally and sexually attracted to other women. Pansexual or Omnisexual (adj.) – A sexual orientation that describes a person who is sexually and emotionally attracted to people of any sex or gender identity. Pansexual people may refer to themselves as gender-blind, asserting that gender and sex are insignificant or irrelevant in determining whether they will be sexually attracted to others. Gender Identity Terms Bigender or Binary (adj.) – Describes a person whose gender identity is a combination of two genders. Cisgender (adj.) – A person whose gender identity aligns with the assigned sex at birth or biological sex. Gender non-conforming (adj.) – Describes a gender expression that differs from a given society’s norms for males and females. Gender transition (noun) - The process by which some people strive to more closely align their internal knowledge of gender with its outward appearance. Some people socially transition, whereby they might begin dressing, using names and pronouns and/or be socially recognized as another gender. Others undergo physical transitions in which they modify their bodies through medical interventions. Intersex (adj.) - A variation in sex characteristics including chromosomes, gonads, or genitals that do not allow an individual to be distinctly identified as male or female. Non-binary Alternate terms are gender queer and gender non-conforming. Transgender (adj.) – Describes a person whose gender identity and assigned sex at birth do not correspond. Also used as an umbrella term to include gender identities outside of male and female. Sometimes abbreviated as trans. SOGI Awareness Again, not all people use the above terms in the same way, so respect and sensitivity are key. And the healthcare setting is an especially vulnerable one. Maintaining the dignity and humanity of every individual during a medical interaction is essential. The U.S. Department of Health and Human Services requires all Electronic Health Record (EHR) systems be able to collect SOGI information from patients. This promotes better understanding of health treatment outcome disparities in order to reduce them. Renown Health’s mission is to make a genuine difference in the health and well-being of the people and communities we serve.

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National Healthcare Decision Day is forthcoming. Here’s an easy and free way to commemorate the occasion: openly discussing how we want to be cared for at the end of our lives. Join Renown Health’s experts at a workshop about making decisions about an advance directive. Among the random national holidays, this one has significance: April 16 is National Healthcare Decision Day. And experts agree that the best time to discuss your views about end-of-life care and to learn what choices are available is before a life-limiting illness or crisis occurs. By preparing in advance, you can help reduce the doubt and anxiety related to decision making for your family if you cannot speak for yourself. “Completing your advance directive is a gift you give your family,” says Mary-Ann Brown, RN, MSN, director of Palliative Care. “The stress associated with these difficult decisions is decreased if everyone knows what is important to you and what you want the end of life.” What Are Advance Directives? An advance directive is a document that states your choices about medical treatment and names another person to make medical decisions on your behalf if you are unable to. This document allows you to make legally valid decisions about future medical care. Find more information about advance directives and the form online. The Conversation The first step in completing an Advance Directive is to think about what’s important to you and talk to your loved ones. The Conversation Project provides helpful tools to guide you and your family through this challenging topic. Getting this information together will help you fill out and complete your advance directives. Some things to consider and discuss with your family include: When you think about the last phase of your life, what’s most important to you? Who do you want involved in your care? Who should make decisions on your behalf if you’re not able to? Where do you want or not want to receive care? Are there specific treatments you would or would not want? Complete Your Advance Directive Planning In order to complete an advance directive, you will need either two witnesses or a notary to sign the form. Be sure to note restrictions on the witness process. When an advance directive is complete, you should keep the original. Copies should be given to your agent named in the form, your family, your doctor(s) and the location that you receive care. Renown Health offers four advance directive workshops every month to cover the details of filling out this document. A healthcare team is available to answer questions and work through the process with you. A notary is also present to finalize the process, which means you can complete your advanced directives during this workshop. Find the workshop by calling 775-982-RSVP for more information. Advance Care Planning Workshop April 17, 1-2:30 p.m. | Free Join Renown Health’s experts for a workshop about making decisions regarding end-of-life care. You will learn how to fill out an advance directive, receive one-on-one assistance and have your documents signed by a notary. Workshops are typically held several times each month. To RSVP, call 775-982-7787

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Watch as two dads look back on their newborn adoption process. They reminisce about discovering their newborn was on his way — and how Renown Health subsequently helped them navigate the process.  During Memorial Day weekend, Chris Mulhern and his husband, Jeffrey Bodimer, learned a set of birth parents chose them to parent their unborn baby boy. After writing a letter to the birth parents, they were chosen over other applicants in a private adoption. The adoption agency took care of many details, like connecting Mulhern and Bodimer to the birth mother and dad. In fact, they could participate in nearly all the phases of the pregnancy. The mother's prenatal care and delivery took place at Renown Health, where Mulhern and Bodimer attended her appointments and took childbirth classes. "Our experience was wonderful at Renown," says Mulhern. "We thought it was absolutely incredible how nice and accepting everyone was." The Nuances of Newborn Adoption Their son, Bradley, was born via cesarean section. And the adoptive parents got to see him an hour after he came into the world. The labor and delivery nurses even helped coordinate everything between them and the birth mom. Mulhern and Bodimer stayed in a room at The Inn at Renown. The closeness of the facility on the Renown campus made it possible to feed Bradley every two hours. Incredible Nurses "They were great, the nursing staff. If we weren't sure about doing something right, about burping him right they would say 'It's okay. He's not going to blow up. He will eventually do it'," says Mulhern. The nurses also made arrangements for the two dads to participate in skin-to-skin contact with their newborn baby. Experts agree parents and babies should be in direct contact for at least the first 1–2 hours after the birth. Taking Baby Home Chris and Jeffery took Bradley home after three days at Renown. “It was the most joyful thing to be chosen as his parents, even before we met him,” says Chris.

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