Video Poem: “Pieces of Our Minds” (Dementia, Alzheimer’s Disease, Hospice, Nursing Homes)

"Pieces of our Minds" is one of sixteen original poems included at the end of each chapter of my book "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes.” It is the first of several video poems and stories I will be introducing.

Dementia refers to a group of conditions that gradually destroy brain cells and lead to mental decline. Various conditions can cause dementia, but Alzheimer’s (Ahlz-high-merz) disease is the leading cause. There is no cure for patients with dementia, and eventually they need complete care. Their quality of life improves when they receive effective healthcare and support.

As a hospice volunteer in Detroit nursing homes, I learned that dementia is like a fluttering bee. I never knew when it would make honey or sting. I participated in adult fantasies often. An important lesson I learned is that I don’t know the extent of anyone’s mental boundaries. One thing I know for sure is that I visited their Oz weekly and became a better person.





Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hospice Worker Strategies When Families Expect Miracles

The terminally ill and their families often expect miracles. What can hospice workers do when families firmly hope for miraculous recoveries of dying patients? Doctors are particularly challenged when families continue to speak of divine intervention after all earthly procedures have failed. Respect for the spirituality and religions of others is important during healthcare treatment. Knowing how to walk that fine line of balance can weigh heavily on the quality of death journeys.

Research by the University of Pennsylvania School of Medicine, USA has provided a practical approach to this concern that allows families' beliefs in miracle healings to coexist with practices of good medicine. The following strategies applied to meet the unique needs of families are involved:

1) Exploring the meaning and significance of miracles

2) Providing balanced, nonargumentative responses to families' expectations of miracles

3) Negotiating patient-centered compromises while demonstrating respect for families' spirituality and doing what is medically appropriate.

Using these strategies can provide a means for hospice workers to maintain good relationships with families expecting miracles while medical practices are implemented. Patients are always the first priority.

This Fox News video clip is an example of why many people believe in miracles, regardless of a medical prognosis. Viewers witness the miracle of Val Thomas, a woman who was technically dead for almost 18 hours after two heart attacks. Rigor mortis had even set in. Yet, she lives!


Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Caregiving with Music Enhances Communication

Are you a caregiver? Do you sing? Do you enjoy playing music? If you answered “yes” to these questions, you have the ability to add vitality and meaning to patients’ lives, especially those who have dementia. Music and singing can uplift their spirits.

A study was done to enhance vocally expressed emotions and moods in the communication between caregivers and persons with severe dementia. Participants included nine nursing home residents with dementia and five professional caregivers. The presence of background music and caregiver singing enhanced the communication between caregivers and residents. Background music promoted playfulness. Caregiver singing improved sincerity and intimacy in their interactions.

How do these results influence you as a caregiver who sings or plays music? They support your efforts to provide quality of life for patients with dementia. Take the time to find kinds of music you think patients will enjoy. Let the magic play.

You can read the research that was reported in the “International Journal of Nursing Studies.”

In this video, Mary Peakes, a hospice nurse, sings "I Wanna Go" to patient Pamela Rucker, who died a few days later. Pamela’s daughter stated, “I want to thank all the hospice nurses. I am so grateful for these angels who helped my mother and her family through this difficult time.”

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Processing Grief Through Art: Drawing a Dying Loved One (Video 2:30 mins.)

Those of you who have grieved at the bedside of a dying loved one can probably recall the many streams of thoughts that confronted you. Grace Graupe Pillard experienced her own unique recollections while drawing pictures of her dying mother every time she visited her bedside.

Grace makes it clear that she and her mother had a rocky, but affectionate, relationship. Her mother, a refugee from Nazi Germany, was receiving hospice care at the time. While drawing, Grace began to experience her mother in an objective way for the first time. An intimacy evolved between them that she had not known before. Her mother knew she was being drawn. In spite of their turbulent differences, their similarities surfaced. In the last picture of this visual diary, her mother’s mouth is open.

After studying scanned pictures of her mother, Grace noticed clearly in the flow of the lines the different emotions she had felt while drawing. She says her artistic involvement in her mother’s dying helped her to process the grief of losing someone who was such an important part of her life. Grace created an exhibition of her drawings in a show titled “Stop Stealing My Face.”

This video showcases an interview with Grace Graupe Pillard and displays of her artwork.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Friendship, Loneliness, and Senior Women Living Alone (Video: 1:04 min.)

Do senior women with family members who live nearby really need friends as much as senior women without family members living nearby? According to this research, they do. Reported in the “Journal of Gerontological Nursing,” a study by the University of Northern Iowa in Cedar Falls examined the role of friends in predicting loneliness among women over age 65 who lived alone. Researchers hypothesized that those women who didn’t have family members living nearby would be lonelier than those who did. Well, that didn’t happen. It turns out that “close friends were important for women living alone, regardless of whether they had family living locally.” This information is noteworthy because it emphasizes the need for making social connections a priority in the lives of older women who live alone, regardless of their local family connections.

This video titled "Knitting Together" showcases a group of older women who socialize through weekly knitting sessions. A woman shares near the end, “I’m here to enjoy the company.”

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Meeting the Death Monster in “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”

In America, death is still a terminally ill taboo in great need of palliative-hospice care. Too many people avoid talking, hearing, writing, or reading about the end of life. As an author and consultant on hospice and eldercare, I have been told on several occasions that the topic is just too “depressing” or too “final.” Several months ago, this reluctance to deal with death visited a friendship. I had given a casual friend a copy of my book “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes.” Not knowing her feelings about death, I decided not to talk to her about the book unless she brought it up. Recently, she did. I’ll call her Alice.

Alice works in the healthcare profession, so I was somewhat surprised to discover that she feels strongly that death, a frightening stalker of her dreams, is her enemy. She shared that death has stolen too many of her loved ones, including pets. She helplessly dreads the thought of losing even more. My own acceptance of death, which comes across clearly in my conversations and writings, seems inappropriate to her. She finds my views too accepting of her enemy, too casual a regard for life. While she says she would consider hospice care along with other options, she admits she could never be even an average hospice volunteer.

What is her feedback regarding my book? She loves the patients’ stories and my comments about interacting with various people in the nursing home world. The original poetry, which concludes each chapter and probably nudges her own poetic abilities, pleases her. She finds the discussions on caregiving, dementia, death rituals, and bereavement informative. The explanations about school-nursing home partnerships and the ideal nursing home described in the chapter “Baby Boomer Haven” are particularly enjoyable. But she dislikes emphatically the premise that there is a “right” way to die.

I am not sure if her hostility toward death has changed much, but I hope that this book meeting with what she refers to as “the monster” has impacted her positively on some level. Those of us who embrace the topic of death will continue to be viewed with dismay by those who deal with mortality through avoidance and resignation of themselves and loved ones as victims of death’s malicious powers.

Alice’s revelations reinforce the importance of promoting death as a natural part of life that should be experienced with dignity by everyone. One person at a time, I believe conversations and writings enhance lives of the naysayers by slowly empowering them with death acceptance, even as they resist the message. I appreciate Alice’s frankness in sharing death’s painful presence in her life and in giving feedback on my book. Most of all, I commend her willingness to become a ball of courage rolling into the high weeds where the death monster lives.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Impact of Death Rattle Sounds on Hospice Workers

Anyone who works closely with dying patients may have heard death rattle sounds. Hospice workers, including volunteers, who have heard these sounds in the presence of patients’ relatives and friends may feel the need to explain to them what the patient is experiencing and reassure them.

According to “Wikipedia,” a “death rattle is a gurgling or rattle-like noise produced shortly before or after death by the accumulation of excessive respiratory secretions in the throat. Those who are dying may lose their ability to swallow, resulting in such an accumulation. While it is medically established that the death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex. It is sometimes misinterpreted as the sound of the person choking to death. In terminal care, drugs may be used to reduce secretions and minimize this effect.”

A study reported in “Palliative Medicine” was done to see how the death rattle sounds impacted hospice staff and volunteers. Most expressed negative feelings about hearing the sounds. Many felt the need to intervene to end the sounds using a therapeutic option. The study concluded that “doctors and nurses need to consider why, when and how they intervene and the consequences of that intervention.” You can read more about this study here.

It would be interesting to read firsthand information from hospice workers, healthcare staff members, and other caregivers regarding their personal experiences with a patient during a death rattle experience.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

BlogTalkRadio Interview with Frances Shani Parker and Viki Kind (30 mins.)

Recently, I was interviewed by Viki Kind, a bioethicist and medical educator who specializes in end-of-life issues. A hospice volunteer with Hospice of the Conejo in Thousand Oaks, California, Viki is also host of the BlogTalkRadio Show “Kind Ethics.” BlogTalkRadio is the social radio network that allows users to connect quickly and directly with their audiences. Using an ordinary telephone and computer, hosts can create free, live, call-in talk shows.

Viki Kind and I covered several topics during our 30-minute interview. They included the following:

1) “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
2) Writing
3) Urban Nursing Home Issues
4) Cultural Diversity
5) Racial-Ethnic Healthcare Disparities
6) Healthcare Research
7) Service-Learning (Definition, Implementation)
8) School-Nursing Home Partnerships
9) Ageism
5) Semi- Sensory Deprivation
6) Honoring Patients’ Histories

You can listen to the "Kind Ethics" interview here.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Wii Fit and Wii Sports for Senior Rehab (Video 2:17 mins.)

Nintendo Wii Fit and its older sibling Wii Sports continue to enhance the world of rehabilitation by exercising entire bodies of seniors and others. The newer Wii Fit uses the Wii Balance Board, a pad that players stand on while doing various types of exercise, including calisthenics, yoga, and balance games.

Baseline tests established with Wii Fit keep track of patients’ individual progress. This direct feedback from the game is a big plus because it always keeps patients abreast of how well they are doing. With variety, tracking, and personalized fun provided by the Wii games, more seniors can look forward to rehab with “old school” opportunities to hula-hoop and twist.

Patients at St. Mary’s Medical Center in San Francisco are pleased with both Wii products when used in recovering strength and balance from traumatic injuries or surgery. This video shows Wii Sports and Wii Fit being used by patients at St. Mary’s Medical Center.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hospice Cultural Diversity: Share What Your Hospice Organization Is Doing

It is no secret that hospice services are underutilized nationally among people of color. While several barriers to utilization have been studied, solutions always include the necessity of more outreach to racial-ethnic groups by hospice organizations.

Promoting cultural diversity requires sincere commitment to hire more people of color at all staff levels, more input from people of color on what their needs really are, and more hospice recruitment in their communities at churches, schools, recreation centers, events, etc., along with media, particularly in their languages. Hospice workers must take proactive outreach roles in presenting the benefits hospice provides, while making recipients of their services feel welcomed and respected.

These are examples of what two hospice organizations are doing:


Julie Cranz
Hospice Volunteer Coordinator
Hospice of Western Kentucky
Owensboro, KY

Our hospice started an ACCESS committee in order to identify, educate, and serve populations that we do not currently serve. We have contacted the local NAACP president, who has forwarded information about us to all minority churches in our city. We will be making a presentation at an NAACP meeting and offering free health screenings at local minority churches. We also changed the photos on our brochures to ensure that a diverse population is represented.




Monica Escalante
VP of Volunteers, Community Education and Outreach
Montgomery Hospice
Rockville, MD

We have done quite a bit regarding cultural diversity. We have prioritized the work within the agency. MH has diverse staff, and our senior management is also very diverse (ethnically and also in terms of professional backgrounds and experience). Developing cultural competency is an important part of staff orientation, and we also have engaged our experienced staff in an annual discussion about culturally competent care. Finally, we have language interpretation services provided over the phone and available 24/7.

For outreach, we have done the following:

The Spanish Outreach
We offered bereavement groups, translated many flyers, and have a Spanish information page on our website (with several articles): http://www.montgomeryhospice.org/patients/indexSPANISH.php
We also participate in the Latino Health initiative and many festivals they organize.

The Asian Outreach
We participate in health fairs for all minority groups. Last year, we connected with a series on “Working with Asian Populations at End of Life” organized by a truly influential grass roots association.

African American Outreach
A bereavement counselor attends the Black Ministers conference on a monthly basis and our Manager of Outreach has a MH booth at every African American event in the county.

We are in constant communication and provide helpful information to the faith community (we have a huge email list), and through them, we reach another diverse segment of the population.

All our communications, flyers, and other tools are tested for cultural competency; we do that using our own diverse staff, who happen to love providing this kind of feedback.



Surely, more hospice organizations have cultural diversity best practices to share that others can explore. Quality end-of-life care is an entitlement for everyone. That is the hospice philosophy. What is your hospice organization doing to promote cultural diversity? Please comment below.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Nursing Home Staff Shortage: Patient Neglect and Abuse (Video 2:07 mins.)

One reason I wrote "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” is to relate, not only cozy stories that depict the positive side of my hospice volunteer experiences in nursing homes, but to also convey those seldom mentioned negative aspects in need of improvement. The reality, supported by research, is that the quality of life for all patients, whether at home or in institutions, depends on the context of their care. Among other variables, that context includes policy makers, staff, equipment, race, and location. That context also includes me, and that’s why I advocate for patients.

Book Excerpt:

“Sometimes a shortage in staff had harmful consequences for patients. This included being left in unchanged beds, not being fully clean, and not being assisted when help was required for eating. Some patients tried to feed themselves, using their hands when they couldn’t see their eating utensils. Patients waiting for help sometimes stared at their food while it turned cold. Those with depression or dementia often had little interest in food. They needed someone to motivate them throughout the meal.”

Staff shortages in nursing homes negatively impact patients around the country. There is no excuse for patient neglect and abuse, especially when it is criminal. According to the National Citizens' Coalition for Nursing Home Reform (NCCNHR), it is a violation of state and federal law for any person, including facility staff, volunteers, visitors, family members or guardians, or another resident, to neglect or abuse a resident.

Neglect and abuse can be reported to the following:

1) The nursing home’s administrator, director of nursing, and social worker
2) The state or local ombudsman
3) The local police or state law enforcement
4) A Protection and Advocacy or Adult Protective Services agency
5) The state survey agency that licenses and certifies nursing homes (often in the Health Department)
6) A citizen advocacy group, or other church or community group that visits regularly

This video about alleged patient neglect and abuse in some New York nursing homes indicates that critical staff shortages can be a contributing factor.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

What Motivates Hospice Volunteers? (Video 4:52 mins.)

People serve as hospice volunteers for various reasons. That fact is official and supported by research gathered from 351 mailed surveys. Volunteers from 32 hospice organizations gave their reasons for performing regular service. Their comments were ranked in order of importance. The “American Journal of Hospice Palliative Care” reported these results:

1) Help others and learn
2) Foster social relationships
3) Feel better
4) Pursue career goals

Why is this information useful? An analysis of this data can help volunteer coordinators in their approaches when recruiting. Younger volunteers reported stronger career motivations. Retired and unemployed volunteers reported stronger social motivations. Emphasizing service, varied learning experiences involved, and potential for social networking will encourage others to consider participating in hospice volunteer opportunities.

In this video, San Diego Hospice volunteers explain the win-win rewards of serving hospice patients.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”

“Hospice and Nursing Homes Blog”

Muslim Purification Death Ritual

The crescent moon and star symbolize the Muslim faith.

In my last post, I talked about embalming and preparing the body of the deceased for the wake, funeral, and burial. This excerpt from my book “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” describes the death ritual preparation experience of a friend of mine whose husband was a Muslim. No embalmment and make-up were used. The body was washed, covered, and buried as soon as possible. I write this with respect for Melvin and in my continuing efforts to inform others of the many facets surrounding death.

“Muslims wash the body of the deceased during a special purification ritual. My friend Carolyn, who is not a Muslim, participated in the washing of her Muslim husband’s body and received great comfort through her involvement. I asked her about her participation in this moving death ritual.

She explained, “The Imam, a Muslim leader, mentioned that three adults, including a spouse, could wash the body of the deceased during a ritual that prepares the loved one for being with Allah. He asked if I wanted to go to the funeral home and be a participant in washing Melvin, my deceased husband. I welcomed this opportunity. I knew Melvin would have wanted me to be actively involved.

In a private room at the funeral home, I used soap and water to clean Melvin’s upper body, while the Imam and another gentleman washed his lower body. During the washing process, I spoke tenderly to Melvin. I told him how wonderful he looked and how much I loved him. Even though he was dead, he wore the most beautiful smile. I knew he heard every word I said. The room was very quiet and serene. After three complete body washings, Melvin’s body was dried, oiled, and wrapped in two pieces of plain white cloth. A final covering displayed writings of the Holy Quran.

“How did you feel about your role during this ritual and afterward?” I inquired.

“What I felt most while washing Melvin was an inner sense of calm. I knew his wishes were being carried out, not only with that ritual, but with all the Muslim rituals related to his death. As I washed him, I knew he was at peace. I remembered how bad his pain had been sometimes before he died. He had prayed aloud to Allah to have mercy on him during his suffering. I felt relief knowing his distress was over. I appreciated the respect he was given. Washing Melvin’s body was a blessing that helped me in my healing.”

© Frances Shani Parker

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Preparing the Dead Before a Wake and Funeral (Video 3:56 mins.)

As a child growing up in New Orleans, I looked forward to going to open-casket wakes at funeral homes. I felt good about wakes, not because I found them entertaining, but because I appreciated the seriousness and empathy of the rituals. This excerpt from my book “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” describes my experience, which motivated me to write this post about one form of preparation of the dead.

“Viewers sat in rows of chairs facing the casket and softly talked among themselves. This time together was a reunion for them as well as a time to discuss how the body was dressed and “fixed up” with cosmetics. I had no idea that many people had wakes with closed caskets, no funerals at all, and that death rituals were performed in different ways among various cultures and religions. Comments about the deceased wearing a smile, looking peaceful, or appearing to be asleep were considered good compliments.”

© Frances Shani Parker

I never thought about the people who were involved in preparing the body in such a way that we would be more likely to think the deceased looked content. This video gave me a better understanding of what actually takes place before the body is displayed at this kind of death ritual. I show it with respect for the deceased and in my continuing efforts to inform others of the many facets surrounding death. This "Embalming, Dressing, Casketing and Making-Up the Dead" video shows funeral directors preparing the deceased before the wake and funeral.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hospice Volunteer Training Ethical Issues

How should I respond when a patient’s family offers me gifts and gas money?

Is it okay to date my patient's unmarried caregiver?

Can I ask the family to only speak English when I’m around, so I won’t feel left out?

My patient wants me to help him commit suicide. He hates being alive in his condition. How do I handle this?

These are a few ethical questions that may concern hospice volunteers as they go about their duties of providing quality of life care for terminally ill patients. Perhaps you can think of many more. While training classes that certify hospice volunteers cover many topics, they don’t always cover the varied situations that can arise for someone playing the role of healthcare volunteer and friend.

The College of Nursing at Utah did a study that explores ethical issues hospice volunteers confront during their assignments with patients. These are the prominent themes resulting from interviews of hospice volunteers:

1) Dilemmas about gifts
2) Patient care and family concerns
3) Issues related to volunteer roles and boundaries
4) Issues surrounding suicide and hastening death

The study also concludes that hospice volunteer training should include more discussions after the initial training. This later training should include more ethical situations confronting volunteers and strategies for dealing with them.

You can read more here about this study of hospice volunteers and ethical issues.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Who Wants a Hospice-Palliative Care Volunteer?

Everybody wants a hospice-palliative care volunteer, right? Wrong. I never assumed that patients would always be glad to have me as their hospice volunteer, and it’s a good thing I didn’t. One day I met a patient who made it clear I wasn’t wanted. My book "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” explains what happened. This is how the initial conversation went with a hospice patient named Lelia:

“When I first met her, she was sitting alone in a dimly lit room she shared with three other women. Her blouse was unbuttoned, exposing one sagging brown breast and a wormlike scar where her other breast had been removed. Depression embraced her like a close friend. A wary look in her eyes told me she had no place for a hospice volunteer on her agenda.

“What’s that, you say you a hospice volunteer, and you want to come see me every week? No, I don’t need to see you. I have enough visitors,” Lelia complained shortly after I arrived. Her tone reeked with annoyance at my intrusive presence in her gated world.

“Lelia, I came by to see you today because I hoped we could get to know each other better. I was thinking that I might be able to help you in some way, maybe with a problem or something.”

“No, I got enough help. Like I said, I don’t need to see you. I don’t need to see nobody. I just want to be left alone.”

© Frances Shani Parker

So much for making me feel welcomed. Fortunately, I was able to win Lelia over and have a very interesting relationship with her. Her story is one of my favorites.

What does research say about dying people wanting hospice-palliative care volunteers? According to the “The American Journal of Hospice Palliative Care," research at Mount Allison University yielded the following results using 100 adults:

Participants were asked to imagine they were terminally ill and told about services volunteers could provide. Finally, they were asked if they would want a volunteer and why. Eighty-nine participants wanted a volunteer, mostly for general support and lack of nearby family. What about the other thirty-five? Some sounded just like my patient Lelia by saying they didn’t need help. Other reasons included being private people.

In the total group, sixty-five participants were aware of the volunteer program. Among those who were not aware, 89% expected their family doctor to inform them of the program. These results indicate a need for more patient information regarding the availability of hospice-palliative care volunteers.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hispanic Elders Benefit from Architecture with Front Porches

I talk about the importance of a front porch in my book "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes.” Baby Boomer Haven, an imaginary nursing home based on best practices of some, but not enough, nursing homes that already exist, has a great front porch. This is how a resident describes the front porch when she takes the reader on a tour:

“I love sitting in my rocking chair out here on the front porch surrounded by nature. It reminds me of when I used to sit on the porch getting my hair combed down South when I was a girl. That’s where I heard grownups tell stories about my family and African American history. The front porch is where I first grabbed a handle on life. In later years, that was where my own children learned life lessons and heard stories that were passed down through generations. Nowadays, other residents and I rock our chairs to discussions about everything imaginable.”

Did you grow up having a front porch or stoop where you could sit for hours interacting with and observing neighborhood happenings? Do you still have one? If you have had that experience, you’ll understand why the research I’m about to explain praises “positive front entrances” for elders in a low-income Hispanic neighborhood.

According to “Environmental Health Perspectives,” researchers at the University of Miami Miller School of Medicine theorized that Hispanic elders’ social, psychological, and physical functioning would be impacted by “architectural features of the built environment” (front porches or stoops) that promoted direct observations and interactions with the neighborhood. Studying a 403-block area in urban Miami, Florida for three years, they arrived at the following conclusions:

Elders living on blocks marked by low levels of positive front entrance features were 2.7 times as likely to have subsequent poor levels of physical functioning, compared with elders living on blocks with a greater number of positive front entrance features. The research supports what those of us who have had front porches suspected all along: “Architectural features that facilitate visual and social contacts may be a protective factor for elders’ physical functioning.”

Excuse me while I go sit on the porch.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hospice Team Meetings and Technology

Hospice services are a team effort. By law, hospice agencies must deliver services using an interdisciplinary approach to patient care. As technology evolves and becomes more accessible, it can play a larger and more beneficial role in the implementation of hospice teamwork. How effectively have hospice teams been using technology to address challenges faced at interdisciplinary team meetings?

In a study reported in the “International Journal of Electronic Healthcare,” 190 representatives of hospice agencies were surveyed by phone regarding the level of technology use in hospice Interdisciplinary Team (IDT) meetings. Survey results indicate that hospice team meetings often do not incorporate technology, even when it could be beneficial. Over half of the participants did not include computers at meetings, even though computers could help them access patient records and medication lists for designing care plans. Technology can better serve hospice agencies if they use it more to enhance the social and product functions of the group process at their team meetings.

You can read more here about this study on technology and hospice team meetings.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Nursing Home Smoking: A Hospice Volunteer’s View (Video 1:16 mins.)

According to MI law relating to nursing homes, smoking is either not allowed or restricted to certain areas of nursing homes. This whole idea of smoking in “restricted” areas reminds me of a restaurant I visited where smokers and non-smokers were separated by five feet of aisle space down the center of a small room. I could actually see a cloud of smoke hanging over the non-smoking section. Where was the “restricted” area?

A nursing home is a healthcare institution. Considering the fragile mental and physical conditions of many residents, I question the safety of some of the restricted areas. Several of my hospice patients who smoked had oxygen tanks stationed near their beds. As if the fire hazard of smoking is not enough, the issue of healthcare should certainly be more of a priority.

All the nursing homes where I volunteered had indoor smoking areas to accommodate patients and staff who wanted to smoke. I held my breath to avoid second-hand smoke every time I briefly entered a smoking room to get a chair when they were not available in the halls. Smoke, which was both seen and smelled, floated into the halls every time the doors to smoking rooms opened. Whether they smoked or not, everybody’s nostrils were assaulted with sucker punches of first or second-hand smoke.

In this video, an elderly woman who uses an oxygen tank sparked a fire at an apartment complex for the elderly. While she was not in a nursing home smoking area, the resulting fire and crisis in having to protect, console, and evacuate all the other residents to buses taking them to a shelter could easily have happened at a nursing home.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

BlogTalkRadio Interview with Frances Shani Parker, Author of “Becoming Dead Right” (30 mins.)

Earlier this week, I was interviewed by Patricia Grace, a certified senior advisor and host of the BlogTalkRadio Show “Aging with Grace.” This show airs weekly on Monday evenings in Pennsylvania and showcases discussions related to eldercare. BlogTalkRadio is the social radio network that allows users to connect quickly and directly with their audiences. Using an ordinary telephone and computer, hosts can create free, live, call-in talk shows.

Patricia Grace and I covered several topics during our interview. They included the following:

1) Hospice Care
2) Caregiving
3) School-Nursing Home Partnerships
4) Healthcare Research
5) Culture Change in Nursing Homes
6) Ten Tips for Becoming Dead Right

You can listen to the "Aging with Grace" interview here.


Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Caregiving with Sensitivity: Semi-Sensory Deprivation and The Virtual Dementia Tour (Video 3:04 mins.)

I have been a big fan of semi-sensory deprivation training for some time. For example, lack of eye care for nursing home residents is widespread in America and greatly impacts these residents’ quality of life. It’s only logical that if volunteer participants could wear glasses or goggles that have lenses smeared, so their vision is blurry, they can arrive at a better understanding of what patients with impaired vision experience. Simulations impairing speech, smell, taste, hearing, walking, talking, eating, touching, etc. help others really experience what patients are going through on a daily basis, and they provide great discussion. Nursing homes, hospitals, and medical schools are supportive of providing these experiences.

Because family members care for most patients with dementia, it is important that family caregivers develop more sensitivity to patients’ experiences. One example of training to improve their sensitivity is The Virtual Dementia Tour. This training developed by P.K. Beville for Second Wind Dreams “helps sensitize families to the needs of their loved ones” by helping them see, feel, and hear in ways similar to the experiences of an elderly person with dementia. Second Wind Dreams® is a national non-profit organization based in metro Atlanta.

In this video about the Virtual Dementia Tour, participants perform everyday tasks such as matching socks while wearing the following:

1) Dried corn in their shoes to simulate arthritis
2) Gloves with taped fingers to simulate declining age
3) Goggles to simulate impaired vision
4) Headphones to simulate background noise distractions that interfere with patients’ focus

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hospice and Nursing Home Poem: Volunteer-Patient African American History

My book "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” concludes each chapter with an original poem. I was inspired to write this poem while watching my hospice patient sleep. I thought about our common history that bridged our communication beyond her dementia and enhanced my respect for all she represented.

Deeper Than Words

The outside world arrives
wearing my willing face.
Toothless, your smile widens
like a baby’s hungry for attention.
Almost ninety-eight years old,
your inner candle still glows.

A hospice volunteer, I lean closer,
talk into your listening left ear,
“Today is Sunday, Miss Loretta.”
My news drifts away like smoke.
You stare at me through dying coals.
Whatever I ask, you whisper, “Yes.”

I stroke your age-softened arms
while your hazed mind masters sleep.
Watching you, I dream generations
of women, black and strong, each one
a book of sustaining stories
about joy, pain, courage, survival.

Within your warm brown frame,
spirits from our common history linger.
Aides say you have dementia,
that you don’t know a word I say.
Our language goes deeper than words.
We speak to each other’s souls.

© Frances Shani Parker

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Culture Change in Nursing Homes: What Works, What Doesn’t (Video: 1:59 mins.)

Most people agree that changes in the stereotypical, traditional nursing homes are long overdue. What makes a nursing home really feel like home? What needs to happen to make that a reality? What are some of the barriers that negatively impact progress? A University of Pennsylvania research study about culture change in nursing homes focused on theses concerns. After staff interviews were done, three nursing homes reported these results:

Barriers to Change

1) Exclusion of nurses to culture change activity (While nursing assistants were not mentioned here, I’m inclined to believe they were also excluded.)

2) Perceived corporate emphasis on regulatory compliance and the "bottom line” (money)

3) High turnover of administrators and caregivers

Promoters of Change

1) A critical mass of "change champions"

2) Shared values and goals

3) Resident/family participation

4) Empowerment at the facility level

Clearly, changing nursing homes successfully involves input
from all levels of staff, residents, and community. Incentives encouraging achievement of new and shared goals are also effective.

You can read more details about this study here.

You can view this video on the importance of inclusiveness in culture change proceedings.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Healthcare Disparities: Do You Treat Patients Differently Based on Race? (Video 2:59 mins.)

During my healthcare research, I have repeatedly come across data revealing major disparities in America’s healthcare system. Overwhelming evidence indicates that these disparities negatively affect certain racial and ethnic groups. America’s long history of overt and covert racism, with all its stereotypes and discrimination, continues to pervade its institutions in ways underestimated by many people, including those who are victimized by it. In my book "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” I address this urgent matter.

“The responsibility for changing attitudes that cause disparities within the healthcare system rests with that system. This is not only a healthcare issue, but also a moral one. This system cannot continue to sit down in the middle of an unjust road, cause harm to others, and not be held accountable. Healthcare providers must own the fact that a large amount of research on disparities in racial and ethnic minority healthcare is true and make every effort to demonstrate equitable practices.

Better education in racial and ethnic cultural sensitivity, however, is not enough. Negative stereotypes are activated with and without intent, particularly in high-pressure work environments. Serious accountability from healthcare providers must include rewards and penalties. Incentives should be offered to encourage healthcare institutions to work diligently at lowering their incidents of disparities negatively impacting racial and ethnic minorities, as well as women and low economic groups. Solutions must be implemented with ongoing monitoring. Disparities of the magnitude that exists now will not be willed away.”

There is a tendency among some healthcare workers to assume that the solution to this problem rests with leaders of the “institution” when, in fact, it belongs to each person making up the institution. The question “Do You Treat Patients Differently Based on Race?” is one that every healthcare worker must explore at a personal level with honesty. In spite of overwhelming research to the contrary, most responders still say, ”Oh, I’m colorblind. I treat everybody the same.” Recognition of the problem is the first step toward improvement. Racial and ethnic disparities must be eliminated before America will ever realize true equality in healthcare among its diverse populations.

This video "Does Your Patient's Race Affect the Care That You Deliver?" can help get that personal conversation started.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Rural and Urban Hospice Financial Comparisons

If I asked you which hospices, rural or urban, face the most financial disadvantages, which would you say? According to reported research in the “Journal of Pain Symptom Management,” rural hospices fare no worse financially than urban hospices, at least in California.

In the California study, 144 hospices were urban and 44 were rural. Adjustments were made in financial performance factors such as size, years of operation, profits, insured patients, etc. Compared with urban hospices, rural hospices were at least as profitable per patient-day, and they were determined to be “significantly” more profitable than urban hospices when charitable donations were excluded. This study concluded that rural hospices fared no worse financially than urban hospices. These results indicate a need to look further into comparisons of rural and urban hospices on a national level. If any of you have reasons to disagree with or support these results, please let me know.

You can read more details about this study here.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hispanics: Caregiving and Diabetes Research (Video 1:49 mins.)

As a hospice volunteer in Detroit nursing homes, it was not unusual for me to have regular contact with patients who had dementia. One patient named Raynell (pseudonym) is particularly memorable because she had both dementia and diabetes. This excerpt from my book “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” describes how she attributes her diabetic symptoms of tingling and numbness in her legs to an imaginary man named Robert who was in love with her.

“Robert was an imaginary man who passionately loved Raynell, my eighty-year-old hospice patient. It could be said that he shared a room with Raynell and her three roommates. His presence demanded my attention many days when I went there to visit her. He stole sweetness from the moment by repeatedly pinching Raynell’s stout legs. He made her feet rise by pushing up her mattress. Strategically positioned near the foot of her bed, he escaped under it quite easily. That’s how Raynell explained the turmoil he caused her. I pulled up a chair in her world each week and made myself at home. While I respected her condition, often letting her take the lead in our discussions, I always remained mindful of my role as volunteer.“

© Frances Shani Parker

“Medical News Today” reports results of a study released by the United Health Group's Evercare® organization and the National Alliance for Caregiving (NAC) with these results:

1) In America, more than one third of Hispanic households (36 percent) have at least one family member caring for an older loved one. This is a larger percentage than all U.S. caregiving households.

2) More than four in 10 Hispanic caregivers (41 percent) have changed their work situation either by cutting back on hours, changing jobs, stopping work entirely, or taking a leave of absence. This is compared to 29 percent among non-Hispanic caregivers.

3) Most Hispanic caregivers are taking care of loved ones with diabetes, including 23 percent of loved ones with a form of dementia.
A 2007 Centers for Disease Control and Prevention national examination survey indicated that Mexican Americans are twice as likely as non-Hispanic whites to be diagnosed with diabetes and 50 percent more likely to die from diabetes as non-Hispanic whites

4) Reasons for Hispanic caregivng included family obligation (84%) and religion (93%).

This video titled “UMTV Latinos Living With Diabetes” showcases the Institute of Minority Health Education and Research founded by Patty Larraga.


Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hospice Care: Can Miracles Save Lives? (Video 1:01 min.)

Do you believe in miracles? If so, you share company with many others. As a hospice volunteer, I noticed early on that many patients held strong religious and spiritual beliefs. These beliefs were important to them when making decisions about their medical care.

Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), has a community outreach guide titled “It’s About How You LIVE – In Faith" to help hospice organizations engage faith communities with end-of-life issues. This guide, done in collaboration with the Duke Institute on Care at the End of Life, is available at the NHPCO website for free downloading.

In this Fox News video clip, viewers witness the miracle of Val Thomas, a woman who was technically dead for almost 18 hours after two heart attacks. Rigor mortis had even set in. Yet, she lives!

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Delaying Dementia with Bilingual Ability

Can you speak more than one language? If you can, you may have a better chance at delaying the onset of dementia symptoms. Dementia refers to a group of conditions that gradually destroy brain cells and lead to mental decline. Many conditions can cause dementia, but Alzheimer’s disease is the leading cause. Most people who have the disease are over sixty-five, with eighty being the average age of diagnosis.

Toronto researchers say that fluency in two or more languages may be able to stave off cognitive decline because of the mental agility required to juggle them in day-to-day life. Principal investigator Ellen Bialystok, an associate scientist at the Rotman Research Institute of the Baycrest Center for Geriatric Care, states, "How you learn the language probably doesn't make much difference; how good your grammar is probably doesn't matter. What matters is that you have to manage two complete language systems at once."

Among the unilingual people studied, dementia began to appear in men at an average age of 70.8 and in women at 71.9. Among those who knew two or more languages, dementia did not begin to appear in men until an average age of 76.1 and in women until 75.1.

You can read more about this research in this “Toronto Globe and Mail” news article.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hospice Volunteer Memorial for Deceased Patients: Christmas Remembrance Tree (Video 2:57 mins.)

Hospice workers experience patients’ deaths on a regular basis. The frequency of these experiences can sometimes cause the individuality of each death to be overshadowed by the totality of them all. Al Poeppel, a hospice volunteer, has found a special way to honor each of his departed patients during the Christmas season.

The outdoor Christmas remembrance tree created by Poeppel is his labor of love. The decorated tree celebrates his deceased patients, supports their families, and encourages introspection among the general public admiring the impressive tree as they drive by. Each tree ornament bears a deceased patient’s name that helps Poeppel reflect on the times he shared with that person. Poeppel thinks families appreciate knowing that their loved ones are remembered. He also hopes that the tree reminds others of the importance of making the most of life.

In this video, you can view Poeppel’s amazing Christmas remembrance tree and hear his heartwarming story.



Season’s greetings to all of you who read my two-year-old blog. I hope the new year brings you many rainbow smiles.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

"The Curious Case of Benjamin Button" – Intl. Trailer (2:35 mins.)

I’m a little partial to movies set in New Orleans, my hometown, and movies that deal with the elderly and mortality. This movie about a man named Benjamin Button (played by Brad Pitt), who is born in his eighties and ages backward, really grabbed me by the collar. His unusual story covers a time period from the end of World War I in 1918 to the 21st century.



Aging, a fascinating theme, is something none of us can stop, as much as we try to wrestle it to the ground. How extraordinary to live the highs and lows of life’s unpredictable journey, moving toward infancy while others become older! This movie, adapted from the classic 1920's story by F. Scott Fitzgerald, begins December 25, 2008.


Starring: Brad Pitt, Cate Blanchett, Taraji P. Henson, Julia Ormond, Jason Flemyng, Elias Koteas, Tilda Swinton

5 Golden Globe Nominations, including Best Picture



Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”