Legacy-Building Nonprofit Enhances Hospice Education, Bereavement Support

A recently developed student-led bereavement program is expanding hospice education while boosting volunteer opportunities in grief support.

Pre-med students at John Hopkins University and Brown University have established Letters Without Limits, a nonprofit legacy-building service designed to preserve and document serious and terminally ill patients’ memories. Students transcribe patients’ audio-recorded memories into letters for their loved ones.

The legacy services have a two-fold purpose for patients and healthcare providers, according to Max Siauw, co-founder and treasurer of Letters Without Limits. The nonprofit aims to improve quality and provide research-backed educational data, he said. Siauw is a certified nursing assistant and currently a biomedical engineering student at John Hopkins University.

“We are still learning as we go as college students, and it’s more about training our volunteers in the dignity therapy approach that we use,” Siauw told Hospice News. “We standardize the way we train all of our volunteers on documentation. It’s learning how to listen to the patient and hear their concerns without trying to give advice, or trying to fix anything. That’s really helpful for me and others with a future career in the clinical space.”

Improving hospice volunteerism

Letters Without Limits is a collaboration of medical and university students, hospice and palliative care clinicians and volunteers, as well as rehabilitation service providers. The nonprofit provides legacy keepsakes for patients and their families.  

Student volunteers are connected with providers and hold conversations with patients at the bedside. Patients’ messages are transcribed over the span of two or three hour-long sessions, which are available in digital or printed copies.

Letters Without Limits offers services to patients in hospice, palliative care or rehabilitation settings. Launched in July 2024, the nonprofit has since expanded to have 45 locations working with providers across 11 states.

Several healthcare providers partner with the organization, including CareHospice. The Virginia-headquartered organization is a group of hospice and palliative care providers with more than 150 locations in 20 states.

Collaborating with Letters Without Limits has helped strengthen person-centered care delivery, said Mike Del Vecchio, director of volunteer services at CareHospice. The nonprofit’s services have helped bereaved families to process positive moments of reflection after a loved one dies, he stated.

The collaboration has also increased volunteer opportunities at the bedside, resulting in improved engagement and retention, according to Del Vecchio.

“From a hospice perspective, the program complements our holistic approach to care by addressing emotional and physical care,” Del Vecchio told Hospice News in an email. “It creates meaningful volunteer opportunities, allowing volunteers to engage in impactful, purpose-driven interactions with patients. Many volunteers find these experiences deeply rewarding, which can contribute to volunteer satisfaction, engagement and long-term retention.”

Strengthening education, future workforce

Letters Without Limits has helped to increase hospice awareness among student volunteers, according to Omkar Katkade, co-founder and president of the nonprofit. Katkade is studying neuroscience at John Hopkins University.

Students often lack sufficient exposure to hospice and palliative care in their clinical training. The nonprofit’s services allow for more education in areas such as goal-concordant communication and assessing the nonmedical and bereavement needs of patients and their families, Katkade said. These learning opportunities help to build a healthcare workforce with more experience in providing interdisciplinary, diverse support, he stated.

“One of our core philosophies is to try and foster volunteers in the idea of humanism in medicine,” Katkade told Hospice News. “There’s an aspect of trying to think beyond just curative care. I’ve grown myself through doing this work, and it goes beyond impacting the patients. I’ve seen how heartbreaking it is when patients could have really benefited from hospice but come too late. We hope by putting these letters out there, we’re exposing people to this field as a way to help that transition.”

Letters Without Limits’ most active chapters are at John Hopkins University, Brown University, Emory University and Washington University (WashU) in St. Louis, Missouri. The nonprofit is currently seeking expansion at Harvard University, Columbia University, University of Pittsburgh and University of Michigan, among other institutions.

Documenting patients’ narratives has been a rewarding and educational experience, said Tanish Joshi Apte, a pre-med student at WashU. Joshi Apte helped to establish a local chapter of Letters Without Limits at WashU after joining the nonprofit in 2025. He is part of the WashU Hospice and Palliative Care Club (WUHPAC), an organization that trains students to serve as nonmedical volunteers in end-of-life and serious illness care.

Through volunteering with Letters Without Limits, students have the ability to learn more about how to support patients’ diverse emotional and spiritual needs. The training is invaluable for new healthcare professionals entering the field, he said.

“It’s been a great way to really engage and be able to provide patients with an opportunity for that whole aspect of end-of-life care,” Joshi Apte said. “While we may not be healthcare professionals right now … we’re equally important in terms of the care team in hospice. With the whole program, we want to talk about death in a more meaningful and appropriate way. It’s not just treatment plans for the patients, it’s things that make them happy by listening to a patient.”