For Whom Is This Service?

Individuals who have been diagnosed with a serious or life limiting illness and their loved ones and caregivers.
Individuals who are receiving palliative or hospice care and their loved ones and caregivers.

Individuals who reside in Oregon or Washington, this is due to RN licensure requirements.

In-home visits are provided 35 miles around Hood River, OR in OR and WA.

Benefits Of This Service

The individual doesn’t feel as alone on their healthcare journey. They are choosing to add Carola to their support team, adding an extra layer of medically knowledgeable support and advocacy. They have one more medical person on their team to ask questions and receive guidance.


What’s Included?

Assessment, consultation, teaching and patient advocacy

Most often those services overlap with each other and are provided during the same appointment. They are offered via video or phone conferencing or in-person, in the client’s home, or a hybrid of both. All nursing services are in addition to medical services the individual is receiving, such as from their Naturopath, Medical Doctor, Medical Specialist, Home Health or Hospice team members or Hospice Medical Director.

They are provided for health issues which have already been evaluated by the individual’s medical provider/s and are not a substitute for medical treatment or professional health care advice. No nursing skills which would require an order from a qualified medical professional are provided. These nursing services are offered as an extra layer of support.

Please see FAQs below for “What kind of Nursing Services are not offered?”


Focused nursing assessments cover information about the individual’s overall health, symptoms, concerns, wishes and goals. They can cover the following areas: Physical, psychological, cultural, spiritual, environmental, psychosocial and safety.

Assessment findings will be provided to the individual or their qualified representative in writing. They may choose to share some or all of this information with members of their medical team.


Consultations are intended to answer the individuals and/or their loved ones and caregiver’s questions or concerns. They may involve multiple individuals, taking as much time as desired.


Teaching and education involves, but is not limited to these topics:

• Planning for future care
• Health conditions and symptom management
• Palliative and hospice care
• Local and general end of life resources
• End of life options and caregiving
• Grief


Nursing Advocacy focuses on the individual’s rights, health and safety, supporting the individual to explore and state their own health care choices, goals and wishes. With the individual’s permission, advocacy also means to keep those choices, goals and wishes in mind when interacting with the individual’s loved ones, caregivers and medical professionals.

Carola offers to meet with the individual as well as their loved ones prior to an important medical appointment to explore their goals and wishes. She can also provide resources and help them formulate questions for their medical provider.

“We were lucky to have Carola as the Hospice Nurse for our mom. Her compassion, patience and commitment were amazing. She was present, caring and listened to mom and us. She was able to connect with mom, having difficult conversations, even using humor, to understand her wishes. When needed, she called the doctor with her assessment findings. She provided valuable information at the right time as well as practical guidance and emotional support.”

— M.S.

“Carola Stepper, RN is a dedicated professional to her patients and families in her sincere, caring nursing qualifications.”

— A.M.


Graduated from the Nursing Program at the University of Erlangen-Nuremberg, Germany in 1989
Licensed to practice Nursing in Oregon (098006505RN) and Washington (RN00119634).
Certified Hospice and Palliative Nurse (=CHPN # 122300188), which is an examination designed for hospice and palliative registered nurses.
Worked as a hospital nurse, Home Health and Hospice Nurse

Frequently Asked Questions

How are they offered?
Via Video conferencing or in-person, in the client’s home, or a hybrid of both.
How often do people usually need to receive those services?

This is each individual’s choice and ranges from one time to regularly scheduled visits.

Is this service covered by insurance? How much does it cost?

Please see Fee Schedule

Nursing services may also be combined with Advance Directive Facilitation, Acupuncture/Acupressure and/or End of Life Doula services.

What kind of Nursing Services are not offered?

Nursing procedures or tasks which would require an order from a qualified medical provider such as a Medical Doctor are not offered. For example: Puncturing of the skin with needles to draw blood or to give medicine or inserting tubes into the nose, bladder or rectum. No administration of any medications, via any route. No on-call services are provided, no services for medical needs or changes in condition which have not been evaluated by a member of the individual’s medical team.

How are these Nursing Services different from Home Health or Hospice Nursing services?

Home Health and Hospice Nursing services require an order from a doctor, are subject to very clear regulations, and are usually covered by Medicare, Medicaid and commercial insurance companies.

Home Health Care Nursing Services are for individuals who are homebound and require intermittent skilled nursing care under the supervision of a medical doctor, for example wound care, IV therapy or injections.

Hospice care, which includes nursing services, is for individuals whose medical provider foresees that their life expectancy is 6 months or less if their illness takes its natural course.

Home Health and Hospice Nursing visits typically last one hour, at times less.

Carola’s nursing services do not require a doctor’s order, however a doctor may refer a client. They are offered additionally to any other medical, nursing or caregiving services, as an extra layer of support. The individual or their loved ones request and pay for her services. The visits can be one to four hours long and can include additional services during the same visit: Caregiver relief (respite), End of Life Doula, Acupuncture and Acupressure, as well as Advance Directive Facilitation. They are always tailored to the clients and their loved one’s needs.

Will Carola Stepper communicate with my doctor and, if applicable with my Hospice team members?
Yes, if the individual signs the “Authorization to use and disclose protected Health Information” and lists their doctor and/or Medical Clinic/Organization/Company, for example their Hospice team.
Additional Resources

Click here for Local Gorge Resources, such as Home Health, Hospice Care, Caregiving, Home Care Organizations and more

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