Grief is a living thing, developing through a process and staying with the affected person forever. Lee Coray-Ludden describes progressing through grief like an injury slowly closing, scabbing and then becoming a scar.

Coray-Ludden, bereavement coordinator for Hospice of the Central Peninsula, encounters grief on a daily basis but says it is different for every person. Grief is not a disease to get over — it’s a process to be worked through and lived with, she said. She steps into other people’s losses in her work, getting a chance to see into their lives and understand what they need to get through it.

“When people trust you and open their hearts and their lives to you, it’s a huge responsibility,” she said.

In communities as spread out and isolated as those on the Kenai Peninsula, it can be hard for people to get help at the times when they need it most. Three decades ago, a group of residents recognized this and put together the peninsula’s first hospice service group, Hospice of the Central Peninsula. With a $50,000 grant from the newly formed Lioness Club, the organization started providing its first services in 1986 and hasn’t stopped since. Former workers and supporters gathered at Central Peninsula Hospital Friday night to mark the organization’s 30th anniversary.

Hospice organizations provide service to the terminally ill and dying. Some provide medical care, called palliative care, for end-of-life services; other organizations, like Hospice of the Central Peninsula, provide respite care, which supports long-term caregivers like family members who look after those who are dying.

The nonprofit, which relies heavily on volunteers and community donations, works with clients from Anchor Point to Cooper Landing with bereavement services, respite care and loaning durable medical equipment out of a central loaning closet as well as a lending library with educational books, DVDs and pamphlets. All services are free, paid for through fundraising and support from Central Peninsula Hospital, United Way, fundraising and donations through Pick.Click.Give and private donors. From 2010–2014, fundraising events for Hospice of the Central Peninsula raised more than $60,000, and more than $70,000 in 2013 and 2014 respectively, according to its tax documents.

A volunteer board directs the organization, which has three full-time employees. Executive Director Gale Robison said the board is one of the most active she has ever worked with, and the community has stepped up to help it over the years.

“We’re very much locally supported,” she said.

Bereavement is one of the main services that the hospice organization provides and was one of the first the group found a need for. Two decades ago, when Tom Boedeker got involved with the board, many people were aging and dying on the peninsula alone. Children had moved away or spouses had died, leaving people without someone to be with them during the final stages of their lives. The program has grown since then, sometimes going into schools to help with children who are going through bereavement as well, he said.

“In the early days, the bereavement was essentially a widow (and) widowers group,” Boedeker said.

The bereavement workers see people of all ages. Sue Mann, a former bereavement coordinator, said she remembers working with children going through grief and connecting with them by taking them out to visit with horses, talking with them while they cared for the animals. People express their grief in different ways, she said.

“I was just trying to find different ways to connect to people,” Mann said.

Throughout the process, she found that helping people helped her, too.

“I really realized the healing for me was helping others,” she said.

Marquita Andrus also got involved after an experience of her own with hospice workers. She began as a volunteer board member and eventually transitioned into the executive director role, working there for a decade before leaving the organization in 2013. Being so close to people who are dying can be hard, and some people may not be comfortable enough to do it but still want to volunteer. Andrus said volunteers can work in a variety of capacities, including answering phones at the office. Hospice work isn’t an ordinary job, she said.

“It’s a calling,” Andrus said.

End-of-life care has received additional attention in recent years, both in the medical community and at a federal level. A March 2015 report from the Medicare Payment Advisory Commission, a research group that advises Congress, concluded that many Medicare beneficiaries may be forgoing treatment for their conditions to elect hospice benefits. Hospice services have grown in the past 15 years — in 2014, 46 percent of Medicare beneficiaries who died used hospice services, according to the Kaiser Family Foundation, compared to only 21 percent in 2000.

A program launched this year in 40 states by the Centers for Medicare and Medicaid Services offers coverage for end-of-life care and counseling for Medicare patients at the same time, where they traditionally had to choose one or the other. That counseling reimburses doctors for conversations with their patients about plans for how they want to go through care at the end of their lives. Doctors are learning how to deal with end-of-life too, said Barbara Karnes, who writes and travels to teach workshops on end-of-life issues. She visited Soldotna to teach classes at Central Peninsula Hospital on the topic the same week as the hospice celebration. Death is a normal part of living, and so are its processes, such as someone who stops eating. Many doctors traditionally have not had to have contact with their patients at the end of the patients’ lives — doctors have been in the mindset of “if we haven’t fixed it, we’ve failed,” but all patients inevitably die at some point, Karnes said.

“You can know intellectually (that your patients will die), but emotionally?” she said.

A former nurse, Karnes said she has taken care of most of her patients as “children of the universe,” but has become exceptionally attached to a few of them over the years. Those patients stay with her emotionally, she said. To give herself closure, Karnes said she would go to the visitations of each of her patients after they died, both to say goodbye to the individuals and to their families.

“(Closure) is very important,” she said.

That grieving process isn’t something to be suppressed or treated like a disease to be rid of, Coray-Ludden said. Support systems are important. She wrote down a sentence, scrawling that it was an honor to be able to participate in adults and children’s lives on their way to healing. Thinking twice, she scratched out the phrase “to healing” and replaced it with “to new beginnings.”

Reach Elizabeth Earl at elizabeth.earl@peninsulaclarion.com.