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Created: 02/20/2018 • Last updated: 03/07/2018 General information Organization Ryan House Contact First name Tracy Contact Last name Leonard-Warner Contact e-mail tleonardwarner@ryanhouse.org Contact phone number 602-200-0767 Address Street 110 W Merrell St, 1st Floor City Phoenix State Arizona ZIP Code 85013 From what tribe is the Gila River Indian Community organization requesting the grant? Total grant amount request 50,000 1 / 2 The Gila River Indian Community offers multi-year awards. If your organization is requesting a multi-year grant for this project or program from the Gila River Indian Community, enter the amount to be requested each year. Amount Year 1 (Gila River Indian 50,000 Community Grants Only) Year 2 (Gila River Indian Community Grants Only) Year 3 (Gila River Indian Community Grants Only) Year 4 (Gila River Indian Community Grants Only) Year 5 (Gila River Indian Community Grants Only) 2 / 2 Gila River Indian Community Grant Application Grant Cycle 2018 Cover Sheet Municipality Information 1. Date of Application: 2/23/2018 (NOTE: Click or use up/down arrow keys to move among fields) 2. Name of City, Town or County: Maricopa County 3. Mayor (City or Town) or Board of Supervisor’s Chairman (County): Steve Chucri 4. Mailing Address: 301 W. Jefferson Street, Suite 960 5. City: Phoenix State: Arizona Zip Code: 85003 6. Acknowledgement of Submission by Authorized Municipality Representative: Typed Name/Title: Zachary Wolfe, Finance Department Signature: Applicant Information 7. Department/Organization Name: Ryan House 8. Is this a 501c non-profit Organization? No Yes If yes, attach IRS Determination Letter 9. Application Contact Person: Tracy Leonard-Warner Title: Executive Director 10. Phone Number: 602-200-0767 11. Mailing Address: 110 W. Merrell St., First Floor 12. City: Phoenix State: Arizona Zip Code: 85013 13. Email Address: tleonardwarner@ryanhouse.org Website Address: https://www.ryanhouse.org/ Project Information 14. Project Name: End of Life Services for Children at Ryan House 15. Purpose of Grant: End of Life Care Services for Terminally-Ill Children 16. Priority Funding Area Healthcare 17. Annual amount requested $50,000 18. Number of years that funding is 1 requested 19. Total amount requested (annual $50,000 amount x number of years) 20. Has your organization received past Yes; Capital Campaign grant of $500,000 awarded between funding from GRIC? If yes, list each year 2008-2011; $100,000 awarded in 2014, and $50,000 and amount awarded in 2017. 21. Geographic area served Maricopa County and throughout Arizona For Office Use Only: Data Entry Receipt Evaluation Outcome A Approval Recommended/Amount $ A Denial Gila River Indian Community Grant Application Grant Cycle 2018 Narrative Please structure your proposal to provide the following information in the order indicated. Provide the narrative in paragraph form in the text field provided. Please be thorough but strive for brevity. 1. Briefly describe the organization’s history, mission and goals. Ryan House was founded in 2004 by a visionary young Arizona family whose eight month-old son, Ryan, was diagnosed in 2002 with Spinal Muscular Atrophy and given months to live. With generous investments from the Gila River Indian Community, the Board of Visitors, Hospice of the Valley, St. Joseph’s Hospital (and other donors), Ryan House opened its doors in 2010. The inspiration and model for Ryan House is the first children’s hospice in the world, located in Oxford, England (Helen House). While living in London, the Cottor family was referred to Helen House after their infant son was diagnosed with a life-limiting condition. The Cottors’ experience at Helen House convinced them of the essential need for facility-based, family-centered respite, palliative and end-of-life care. The Cottors returned to their home state with a passion to establish a similar house for Arizona families, and bring this unique care model to the United States. Today, any Arizona child from birth to 18 with a life-limiting or terminal condition who is cared for at home is eligible for Ryan House services. Our mission is to embrace all children and their families as they navigate life- limiting and end-of-life journeys. The children we serve suffer from conditions that cause significant functional impairment and are diagnosed by physicians to be irreversible and terminal. These children are not expected to live into their 20s, and require round-the-clock medical, and basic, care. Our primary goal is to provide a continuum of care to enhance the lives of Arizona’s most medically-fragile children and their families on the most difficult journey imaginable. The care delivered at Ryan House is coordinated and seamless for each child and family, as we work closely with the child’s primary physician and other care providers. Our secondary goal is to support the entire family to help the family remain intact, and even thrive, during the challenge of caring for their sick child, and their child’s death. As one parent stated, “Ryan House is a heaven-sent place for families.” Our programs would not be possible without the Gila River Indian Community’s founding support. In 2016-2017, Ryan House served 207 clients throughout all of our programs and services. We are forever grateful for your generosity and passion for our mission. Thank you for believing in us. 2. If the applying organization is non-municipal or a non-profit 501c, please describe your relationship with Arizona municipalities including past and present support, whether through partnerships, collaborations, in-kind contributions, grants, tax-based funding or other. Describe the supporting municipality’s role in this project. If the applying organization is a municipality governmental sub-division please enter the text “Not applicable.” Ryan House has had collaborative relationships with many cities such as the City of Phoenix, the City of Scottsdale, as well as the State of Arizona, since our founding. We serve children throughout the entire area of Maricopa County. We have received funding from the City of Phoenix in the form of several CDBG grants, and Gila River Indian Community Grant Application Grant Cycle 2018 both the City of Scottsdale and Maricopa County have accepted Gila River Indian Community funds previously on our behalf. We are applying through Maricopa County again this year, as the majority (90%) of children we serve are Maricopa County residents. We are grateful for the opportunity to apply through the County. 3. Describe the proposed project and planned goals and activities. Ryan House is respectfully requesting continued funding to support our End-of-Life Care Program for medically-fragile children with terminal illnesses at Ryan House. We are expanding our services for terminally- ill children and their families, and funding from the Gila River Indian Community will help us give these children and their families the culturally-sensitive and quality-driven end-of-life care they need and deserve. From diagnosis through end-of-life, Ryan House provides a comprehensive program of family-centered care including medical, psychological, social and spiritual support service and therapies. Activities provided include full medical and hospice care, activities to strengthen family relationships, and activities to enhance their overall quality of life; all end-of-life planning and care is family-driven and family-focused. Our approach addresses the emotional, spiritual, and social needs of the family while also providing relief of the symptoms, pain, and stress associated with any serious illness. Our skilled and dedicated Care Team that provides hands- on-care around the clock includes registered nurses, certified nursing assistants, medical directors – physicians that are experts in the pediatric care of children with special healthcare needs – social workers, a certified Child Life Specialist, a non-demoninational chaplain, and volunteers. Parents and siblings have the opportunity to stay overnight in our family suite to be close to their child as well. Medically-fragile children served (ages birth through 18) typically suffer from approximately 75 different diagnoses, including: blood disorders, various cancers, congenital abnormalities and syndromes, neuro- degenerative disorders, cycstic fibrosis, cardio-pulmonary illnesses, consequences of tragic accidents, such as near drownings and car crashes, shaken baby syndrome, muscular dystrophy, brain defects, undiagnosed genetic conditions, and more. At Ryan House, we wrap our arms and hearts around each one of these children and their families as they lose their child. This critical program at Ryan House is the only pediatric end-of-life and hospice program of its kind in the entire state of Arizona and encompasses supportive planning and care consistent with clinical, cultural, and ethical standards of each family served. Fifty-two (52) children passed away at Ryan House last year (2016- 2017). This program will serve another 50-60 children in 2018-2019. Members of the Ryan House Care Team provide parents, guardians and/or siblings with long-term support systems through the child’s end of life and beyond. With the care provided by our prestigious care partners and highly-trained staff, we are able to foster a loving community that offers ongoing support and compassion from diagnosis to end-of-life. We provide therapies for children, such as art, music, and hydro. Our Story of Me room provides our children with the chance to tell their “story of me” using various media technologies and therapeutic play. The room provides opportunities for families to document the story of their child’s life prior to their death. It provides a state-of-the-art multimedia experience that allows Ryan House children to capture memories and promote healthy communication with their entire family; the room helps capture the child’s journey - from diagnosis through end-of-life. Gila River Indian Community Grant Application Grant Cycle 2018 We also provide bereavement care, which supports families in a number of ways, offering a personalized tile in Ryan House’s Memorial Garden, a Treasured Memories bereavement box for families, on-site support groups and family counseling. Far too many days end with tears as we comfort families struggling with their child’s condition and premature death. With funding from the Gila River Indian Community, we will continue to provide world-class care and services to medically-fragile children nearing end of life and their families as they navigate the unimaginable. 4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the Gila River Indian Community. Our request for the End-of-Life Program at Ryan House satisfies the Gila River Indian Community’s “Healthcare” funding area by providing world-class care for children with life-limiting and terminal illnesses. While at Ryan House, our interdisciplinary care team assumes full medical care of each child throughout their stay, while they have unique opportunities to maximize functioning, receive pain relief, and significantly increase their quality of life. Without Ryan House, children would suffer, medical costs for families and the community would significantly increase, and families would crumble, facing lifelong and devastating effects. 5. Identify the needs/problems to be addressed, target population and number of people to be served by the project. The diagnosis of a terminal illness in a child is devastating for all involved: parents, kinship caregivers, family members, and the children themselves, as they grieve for the life they had planned for their child and believed they would have. The journey is most often long, lonely, and devastatingly sad. It is difficult to acknowledge that a child is dying and will not live a normal lifespan. Clinicians share many of the same stresses that the child’s family members experience. The strain, disruption, pressure, and depletion associated with such stress require significant personal and professional efforts to adapt and achieve balance. Many pediatric patients still die in the hospital setting where the focus is on diagnosing, curing, and prolonging life. Life-saving efforts are usually common when the patient is a child. When working with the dying, these skills are less important and can lead to potential for conflict in goals, values, interests, and frames of references. Across the nation, about 41,000 children die each year from a variety of illinesses. Many of them are qualified for palliative care; however, the demand for planning, pain management, and end-of-life care far exceeds the services available. Ryan House understands the emotional and physical impact of caregiving at home and works aggressively to provide families with critically needed end-of-life care services for their terminally ill child. http://www.slate.com/articles/health_and_science/medical_examiner/2017/01/our_health_care_system_fails_te rminal_kids.html Spillover effects of illness on family members can be substantial. In a study conducted by the U.S. National Library of Medicine National Institutes of Health (2013), family members were interviewed after the death of their child and reported experiencing psychological and health-related effects. Most significant was that during the timeframe that they cared for their terminally ill child, their quality of life diminished. Family structures were Gila River Indian Community Grant Application Grant Cycle 2018 weakened (other children received less attention and became resentful of their dying sibling); spouses and partners expressed feelings of neglect and loss of connectivity with the primary parent caring for the terminally ill child. Families also reported high rates of divorce and/or separation from their spouse or partner. The spillover effects of their child’s illness took its toll on caregivers who reported experiencing increased mortality risk, mental and physical strain, and ultimately, hopelessness for their caregiver situation. The families participating in the survey had no source of out-of-home palliative care in their communities. For children facing end-of-life in Arizona, Ryan House is the only place that provides pediatric end-of-life and hospice care for medically-fragile children – there is nowhere else to turn. At Ryan House, our goal is to ease each child’s pain and suffering, and to provide the best quality of life - through their end of life. Our home-like environment provides a safe and comfortable place for families to be embraced by our Care Team while they endure the unbearable. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864647/ Our goal is to enhance the lives of children with life-threatening illnesses while supporting the entire family. This goal directly aligns with the Ryan House mission of embracing all children and their families as they navigate life-limiting or end-of-life journeys. Ryan House offers a new, innovative, and cost-effective healthcare delivery model for children who are terminally ill; it improves quality of life and serves as an alternative to costly emergency room and hospital use. This program is desperately needed because the pediatric end-of-life and hospice care services and programs of Ryan House are not duplicated anywhere else. Ryan House is the only organization of its kind in Arizona and the entire Southwest, and is one of only three of its kind throughout the country. Furthermore, the financial burden related to costly medical treatments and care often results in the loss of jobs, homes and even bankruptcy; therefore, all Ryan House services are provided free of charge to families. Finally, the need for this program can also be demonstrated through the stories of the children and families we serve. Please find one such story below. A Ryan House Parent’s Testimony of Courage and Love “It was 5:05 pm on a Friday afternoon when the doctor’s office called and confirmed what I viscerally knew- our precious baby was confirmed to have CMV infection. And it was a daughter we were having. I thought I never heard a louder door slam. Every single wish, hope, dream, aspiration and picture of life with two children- and with a daughter- was behind that locked door of CMV. Cytomegalovirus, in itself, is not a fatal diagnosis. But combined with severe anemia, heart failure and hydrop fetalis it is. Diagnosis brought a whirlwind of fast and reactionary decisions in a small window of time. We were told our baby would not survive by two very good doctors in their field. We promptly broke our lease and moved to Phoenix to be closer to family to feel their network of support through a dying child and a grieving child and grieving family. Finances were tight, but we did it. We spent many weeks researching and talking and networking. Finding more people like us and more people to help us. We found a nurse who did perinatal palliative care. We were her second to last clients. This was our first exposure to perinatal palliative care, but we felt so home in this space. This space allowed us to care for our daughter in ways we felt comfortable. Through the nurse and a local mom who I connected with in a grieving group we found Ryan House and we were swiftly admitted to their perinatal palliative care program. Our new safety net. We still felt the reverberations of that door being slammed, but Gila River Indian Community Grant Application Grant Cycle 2018 Ryan House was there to soften the blow. We felt at home. We didn't have to continue calling funeral homes for the baby that was kicking and rolling inexplicably in my stomach - Ryan House would do it for us. We didn't have to have the burden of death, but we now had the empowerment of life - because Ryan House helps take care of everything. I didn't have to ask any more questions I didn't want to know the answer to because we had people that knew exactly what to do in the moment it needed done. We just had to be a family. The day came that baby girl was to join us earthside. She came earlier than scheduled. I felt the edge of the door of her life creeping closer to being closed each second I spent in labor. The fear was hard. The emotions were hard. But she came to be with us. She stayed with us. And suddenly that door wasn't closed, but it was open. Baby girl decided to stay earthside with us and thrive off of the web of love and support we spent 15 weeks weaving. Her life had opened that door I spent 15 weeks thinking was closed. She is not the daughter I thought, she is not the daughter I anticipated. She is more. She has opened a million and one doors with her life, her journey, her strength and her ability to endeavor. She has pulled us as her family through doors I never thought possible and we have met life changes in ways I could never conceive without her. Her diagnosis was not an end that day to life as we thought - it was only a beginning of a wild, amazingly hard, mostly uphill, but awful, beautiful journey of love and the power of community support. Without the support of our "community", we would not be where we are today. Without Ryan House, we would be without the safety and comfort of palliative care and the tools it brings us to care the best for Corrinne. Without the support of our social worker we found through Ryan House, we probably would have lost our house due to finances from having a single income family. I can't work because I have to keep up with the needs of Corrinne through sickness, 15 doctors and 6 therapists and one hospital admission a month her first 6 months of life. We have an amazing support system with family and friends, but they can't always take our son when our daughter is admitted, making my husband lose work hours. Without the support system we have, I would not be the advocate I am for my daughter, my son, my husband, and my family. I would not have the empowerment to have a voice. This journey would be devastatingly bleak if we did not have the key piece to caring for our daughter- our support community which we have painstakingly pieced together to have the titanium strength to carry us in the bad and celebrate with us in the good. This life of medically- complex special needs is the starkest of emotional juxtaposition. It is both grief and celebration. Pain and joy. Giving up and endeavoring. These coupled feelings are experienced at the same time; in almost the same moment. It's a blessing and a curse. But to us, it is life. It has always, and will always, be the most open of doors for us; one we pass through with intention. I'm not sure another door of life could ever be closed on us because life with our daughter has showed us what infinity is, and we can only ever move forward through the infinity.” Gila River Indian Community Grant Application Grant Cycle 2018 6. Define the project as a new or continuing program. End-of-life care at Ryan House is a continuing program. We are expanding the number of children served at Ryan House through this program. End-of-life care is provided at Ryan House every day of the year. 7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible. The timeline for this program is ongoing; it takes place and serves children 365 days per year. End-of-Life care for children begins when the child enters Ryan House, and ends after each child’s passing. We also provide bereavement services to help families through the grieving process – once a family is a part of Ryan House, they are always a part of Ryan House. Grant funds would be used during Ryan House’s 18/19 fiscal year (10/1/2018 – 9/30/2019). 8. Identify other organizations, partners or funders participating in the project and their roles. Ryan House uses a collaborative, team approach to care delivery and operates in partnership with Hospice of the Valley to provide a full circle of care to children and families beyond its walls. Shared facilities and operations enable both organizations to benefit from considerable cost savings, allowing more funds to be spent on direct services. Ryan House also partners with hospitals, including Phoenix Children’s Hospital, and other Arizona organizations that serve children with life-limiting and terminal conditions, such as Make-A-Wish Arizona. These partnerships ensure that the unique and individualized needs of Ryan House children and families are met. Make-A-Wish Arizona and Ryan House also refer clients to one another for services; the children Ryan House cares for qualify for wishes, and some of the children served by Make-A-Wish Arizona qualify for stays at Ryan House. Furthermore, the two Medical Directors for Ryan House children lead the palliative care program at Phoenix Children’s Hospital, and both are highly-regarded specialists in the emerging field of pediatric palliative care. 9. Would you be able to implement the proposed plan if your organization received partial funding for this project? We would still be able to implement the program if partial funding was received. However, without full funding, we would have to serve fewer children with terminal illnesses as a result. Gila River Indian Community Grant Application Grant Cycle 2018 10. Describe your plan for project financial sustainability beyond the grant period. If this is a program/project previously funded by the Gila River Indian Community describe efforts made towards the previously described sustainability plan. Ryan House has successfully supported End-of-Life care since opening its doors in 2010. We received a generous Gila River Indian Community grant in 2017. However, the number of children and families we are serving continues to grow. Although we are continuing to sustain these activities through our aggressive fundraising program that includes corporate and foundation grants, individual donations, workplace giving campaigns, third-party events, and three signature special events, there are more and more children and families that are in need of our care. Our organization remains fiscally-sound, and our fundraising program continues to grow each year. We have received additional large grants over the last year, and seek to engage new funders who believe in our mission and our work. As a part of our efforts to diversify revenue sources, our Reimbursement Committee continues to work with state lawmakers and insurance industry experts to advocate for Ryan House services. Ryan House is also working to expand and strengthen its Board of Directors and committees, and to further offset expenses by increasing volunteer staff support and in-kind donations of goods and services. 11. Describe your plan to document progress and results. The results of our End-of-Life Program are documented and measured through case management files, medical records, feedback from children and siblings, qualitative testimonials given by parents and caregivers, staff observation and anonymous parent surveys. In our most recent program evaluation conducted by Arizona State University, success of this program and the positive effects of services on children and their families were indicated through the results/outcomes below. • Eighty-one percent of families said that as a result of Ryan House services, their family experienced less stress, anxiety, and exhaustion. • Sixty-seven percent of parents said that their relationship with their spouse or significant other improved. • Twenty-four percent of parents agreed that Ryan House decreased the need for hospitalization and/or emergency room trips, saving their family and the community countless dollars. We anticipate that the outcomes for this grant will be similar to the ones outlined above. Gila River Indian Community Grant Application Grant Cycle 2018 12. Indicate any application to and/or awards made by a tribe other than the Gila River Indian Community for state shared revenues for this and any other project for the past five (5) years. If this information is included in a separate attachment, please indicate that here. Ryan House has applied for, and received, funding from the Salt River Pima-Maricopa Indian Community, specifically for our Sponsor-A-Stay Respite Program for the last 6 years. Awards are as follows: 2017: $125,000 2016: $75,000 2015: $75,000 2014: $75,000 2013: $175,000 Ryan House plans to apply for funds for that program again in 2018 if invited. In 2015, Ryan House applied to Tohono O’Odham for the Sponsor-A-Stay Program for $50,000. This request was declined. In 2013, Ryan House applied for and received an award of $10,000 from the Ft. McDowell Yavapai Nation for our Sponsor-A-Stay Program. We applied for $20,000 for our Child Life Program in 2014 and 2015; both requests were declined. Gila River Indian Community Grant Application Grant Cycle 2018 Project Budget Budget Period: 10/1/2018 – 9/30/2019 For each budget item listed here please provide a narrative description on the following Project Budget Detail page. Proposed Budget Expense Amount Amount In Kind Total Budget (list each budget item) requested from requested or contributions GRIC secured from other funders 1. Program/Clinical Salaries $33,314 $100,371 $0 $133,685 2. Facility Costs $3,000 $13,705 $0 $16,705 3. Volunteer Training $500 $1,540 $0 $2,040 4. Grief Support Supplies $7,450 $0 $0 $7,450 5. Program and Educational $736 $0 $0 $736 Activity Supplies 6. Technology Costs $0 $4,645 $0 $4,645 7. Child Life Specialists $5,000 $32,535 $0 $37,535 8. Click here to enter text. $0 $0 $0 $0 9. Click here to enter text. $0 $0 $0 $0 10. Click here to enter text. $0 $0 $0 $0 11. Click here to enter text. $0 $0 $0 $0 12. Click here to enter text. $0 $0 $0 $0 13. Click here to enter text. $0 $0 $0 $0 14. Click here to enter text. $0 $0 $0 $0 15. Click here to enter text. $0 $0 $0 $0 16. Click here to enter text. $0 $0 $0 $0 17. Click here to enter text. $0 $0 $0 $0 Total Budget $50,000 $152,796 $0 $202,796 Gila River Indian Community Grant Application Grant Cycle 2018 Project Budget Detail Please provide a narrative description for each of the project budget items listed on the previous page. Include the dollar figure and how it was derived. 1. Program/Clinical Salaries: This line item totals $133,685 and includes a portion of the cost of our Certified Nursing Assistants, Nursing Staff, and applicable employee taxes and benefits. 2. Facility Costs: The total cost for this line item is $16,705 and includes a portion of occupancy costs. 3. Volunteer Training: This line item includes training costs for volunteers that work with medically-fragile children and their families in this program. The total cost for this line item is $2,040. 4. Grief Support Supplies: This line item totals $7,450 and includes bereavement supplies. 5. Program Educational and Activity Supplies: This line item totals $736 and includes costs for life-enhancing therapeutic activities (i.e. pool maintenance and supplies, child/family activities and events, supplies for The Story of Me room, child life enhancement costs, and additional activity and educational supplies). 6. Technology Costs: The total for this line item is $4,645 and includes telecommunications and technology costs. 7. Child Life Specialists: This line item includes a portion of our Child Life Specialist salaries and their employee-related expenses. The total for this line item is $37,535. 8. Click here to enter text. 9. Click here to enter text. 10. Click here to enter text. 11. Click here to enter text. 12. Click here to enter text. 13. Click here to enter text. 14. Click here to enter text. 15. Click here to enter text. 16. Click here to enter text. Gila River Indian Community Grant Application Grant Cycle 2018 17. Click here to enter text. Other explanation: Click here to enter text. Ryan House recently had the privilege of taking care of a young man, 18 years old, at the end of his life. He had Duchenne's muscular dystrophy and neuromuscular scoliosis, both of which had left him wheelchair bound and unable to care for himself. For the last year of his life, he had experienced pain related to both his disease and the breakdown of his skin. He was hospitalized because of the pain, and his medical team discussed surgery as his only option. This young man was already on service with our partner, Hospice of the Valley, and their Pediatric Palliative Care Team because of his life-limiting diagnosis and the decline in his health over the previous year. He reached out to his team and the Palliative Care Team at the hospital for help. He talked to the adults on his care teams, including his physician, and very eloquently expressed his feeling about living in pain over the past year and the toll it was taking on him and his family. He did not want to pursue another surgery and wanted to explore hospice. He made the decision that it was time for hospice, and his family was supportive. It was a decision no mother should ever have to make, but she knew how hard things had been over the past year for her son, and the pain he had been experiencing, and wanted to support his wishes. After deciding to come onto hospice services, this young man came to Ryan House where the clinical staff was able to control his pain through medication. The medications often left him drowsy, but he was sweet, polite and most of all, grateful to our staff. Ryan House’s Social Worker, Child Life Specialist and Chaplain all provided support to him and to his family, his parents, his siblings, and their extended family. He and his family were able to spend the next three weeks together as a family, while he was cared for by the Ryan House clinical staff. This young man shared his dream with one of the staff of meeting the Arizona Cardinals. A dream which the Ryan House staff, with the help of another Ryan House family, was able to make a reality. Early one morning, all four quarterbacks from the team arrived at Ryan House to visit him and to spend time with his family. They signed a Cardinals’ blanket for him during their visit. This brave young man passed away 3 days later. His family covered his coffin with the signed Cardinal’s blanket during his funeral. The fact that the care team had taken the time to listen to this young man’s wishes and allow him to dictate what his final days would look like brought comfort to his family.