Pages

Monday, September 18, 2017

Homeless and Old (Research, Video 3:25)

Older homeless adults have high rates of geriatric conditions which may increase their risk for acute care and nursing home placement. In research interviews of 350 homeless adults 50 and older in Oakland, CA, the following results revealed their living environment over a 6-month period:

1) Participants stayed in 4 primary environments: unsheltered locations, multiple locations including shelters and hotels, intermittently with family/friends, and, in a recently homeless group, rental housing.

2) Overall, 38.9% of participants reported difficulty performing 1 or more activities of daily living, 33.7% reported falls in the previous 6 months, 25.8% had cognitive impairment, 45.1% had vision impairment, and 48.0% screened positive for urinary incontinence. The prevalence of geriatric conditions did not differ significantly across living environments.

The prevalence of these conditions was higher than that seen in housed adults 20 years older. Clearly, services addressing geriatric conditions are needed for older homeless adults living across varied environments

My Detroit Pk-8th grade school where I was principal had the highest student homeless population in Michigan. I have visited a well-run homeless shelter before. Unfortunately, the large homeless shelter where I visited regularly that housed several of my students had unacceptable conditions on many levels. Those conditions, along with having to follow certain rules, are major reasons why many homeless adults refuse to stay in shelters. Substance abuse was high. My primary focus was on getting the children out to school and meeting their needs there. On the day the shelter was permanently closed due to poor food and other conditions, there were several emergency units transporting victims of food poisoning to the hospital.

The following video gives a disturbing review of conditions in some homeless shelters in New York City. Possible solutions are also discussed.




Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, September 11, 2017

Cancer Patients’ Last Year of Life (Research, Video 2:33)

Can general predictions be made about cancer patients and their healthcare experiences during their last year of life? The last year presents many challenges and is a critical period in terms of providing quality care for optimal patient satisfaction. In a study of 5,102 Medicare beneficiaries with cancer diagnosed within one year before death , various measures of healthcare experiences were reported.

1)    Patients with higher general or mental health status were significantly more likely to indicate excellent experience with nearly all measures examined.
2)    Sex, race/ethnicity, and education also were found to be significant predictors for certain ratings.
3)    Greater time before death predicted an increased likelihood of higher ratings for health plan and specialist physician.
4)     Clinical characteristics were found to have few significant associations with experience of care.
5)    Individuals in fee-for-service Medicare plans (vs. Medicare Advantage) had a greater likelihood of excellent experience with health plans, getting care quickly, and getting needed care.

Patients within a year before death from cancer experience critical issues related to health plans, physicians, and medical care associated with socio-demographic, insurance, and clinical characteristics. These conclusions are important in providing guidance for the development of programs to improve the experience of care among individuals with cancer.

Research shows dying patients tend to live longer at home than in a hospital after families have received training and support. In this video, Jennifer Glass' husband, Harlan, took her picture every day for a year, starting on the day she was diagnosed with lung cancer until she died the following year. 



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, September 4, 2017

Grandparents, Great-Grandparents Parenting Again (Research, 2:41 Video)


The number of grandparents raising children continues to increase in America. There are more than 13 million children living in homes with their grandparents. Without grandparents' loving support, many children’s lives would be in great jeopardy. But these grandparents’ own health and quality of life are often put at risk for declining after they make that child-rearing commitment. These are some of the statistics about grandparents raising grandchildren. I have listed a few below:

1)  There are 2.7 million grandparents raising grandchildren.
2)  Two events have contributed to large spikes in this statistic: the recession that occurred between 2007-2009 and the epidemic of crack use in the late 1980′s.
3)  Custodial grandchildren have higher levels of behavioral and emotional problems than children in the average US population.
4)  Families that have a grandparent raising a grandchild help to save taxpayers over $6 billion each year because they keep those children out of the foster care system.
5)  With 1 out of every 5 households in poverty, it is essential for grandparents to be given the information they need to access resources in their community to get resources they need. When this can happen, many grandchildren are given an extra chance to succeed. AARP offers several supportive resources.

While it is common now to read about the millions of grandparents raising grandchildren, very little is mentioned about great-grandparents in similar circumstances. Imagine parenting again after 65 years of marriage. When I think about great-grandparents accepting a responsibility of this magnitude with challenges legally, financially, physically, and mentally, I think about the Cooks. Their story is one of my favorite videos. They have reached that amazing stage where they can look back on their wonderful accomplishment with great pride in knowing they saved their great grandson's life “like a seatbelt.”




Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries.
Hospice and Nursing Homes Blog

Monday, August 28, 2017

Anesthesia Fear (Research, Video 1:30)


Afraid of anesthesia? You definitely belong to a large group of the population. Your sex and age can also impact your feelings about this procedure. Research on surgical anesthesia involving 400 patients with 80% experiencing preoperative fear reveals the following top three causes of anesthesia fear:

1) Fear of postoperative pain (Will you be in pain after the operation?)

2) Fear of intraoperative awareness (Will you be awake when you shouldn’t be during the operation?)

3) Fear of being sleepy postoperatively (Will you be sleepy when the operation is over?)


Other fears related to surgical anesthesia include drains, needles, saying personal information, and not waking up at all after surgery. What roles do sex and age play? Females are more likely to experience fear before surgery, and patients over 40 years old are at higher risk of being afraid.


Are anesthesia fears unwarranted? No, there are always risks associated with any anesthetic procedure. However, serious complications such as paralysis and death are rare. Because so many people fear anesthesia before surgery, now would be a good time to relieve some of that anxiety with this video featuring Dr. Richard L. Kahn of Hospital for Special Surgery (HSS) who addresses the safety of surgical anesthesia and possibilities regarding what to expect:



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog

Monday, August 21, 2017

Hospice Dementia Live Discharge Impacts Caregiver Grief (Research, Video 2:23)

Live discharges from hospice include patients deciding to resume curative care, improved patient conditions beyond hospice guidelines, or hospices inappropriately using live discharge to avoid costly hospitalizations. In terms of patients discharged who have dementia, another layer of concerns can be added for caregivers. Caregiving a hospice patient who has dementia includes a series of transitions in their roles. When the patient no longer meets eligibility criteria, it can be very difficult for caregivers who have been anticipating an end to understand the discharge in the context of their grief process.  

Research on hospice discharge of patients with dementia explains the unique grief experience of these caregivers. They struggled to understand the patient’s terminal prognosis as temporary. In addition, caregivers were left to resume caregiving responsibilities or assume a new caregiving role after experiencing a loss of hospice services. Hospice social workers are particularly needed to offer emotional and other concrete support to caregivers who experience a live discharge of patients who have dementia.

This video indicates the symptoms and behaviors commonly seen during the final stage of dementia progression.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, August 14, 2017

Keeping Older Adult Volunteers (Research, Video 2:15)


The presence of older adult volunteers in many nonprofit organizations is increasing steadily along with their numbers in the general population. But how can they be persuaded to keep returning? When it comes to keeping older adult volunteers, being mindful of what motivates them and their needs are significant. A critical clue lies in the reasons they find their service satisfying. That’s what will tell you when and how to hold them.

A research sample of 172 older adult volunteers reported that, in addition to enjoyment of the volunteer tasks, the degree of satisfaction with management is an important predictor of older volunteers’ intention of remaining in service. These answers have important implications on how organizations manage volunteerism and the relationship between paid staff and volunteers.

Numerous volunteer programs exist that provide varieties of tasks that need to be done. One popular program in America that is designed specifically for older adults is Senior Corps RSVP (Retired and Senior Volunteer program). It is one of the largest volunteer platforms for individuals at least 55 years of age. Their motto is “lead with experience” because experience is what these volunteers have and what our community needs.

Sharing with volunteers the many research-based benefits that they can receive is another means of encouragement. As this video highlights, those benefits include improvements in health, longevity, brain function, depression, and a sense of purpose.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, August 7, 2017

Caregiver Guilt, Gender, Forgiveness (Research, Video 1:32)


Women and men who are caregivers don’t always want to be caregivers. Some enjoy nurturing their patients and find the caregiving experience challenging, but rewarding. Few people talk about caregivers who feel depressed, trapped in a hole with no way out except the death of persons in their care. Even reading this may sound scary. Imagine the guilt a caregiver might have when these feelings rise to the surface during their daily living.

This study analyzed guilt among family caregivers of dependent patients from a gender perspective. Interviewed were 73 family caregivers and 23 health professionals (family medicine, community nursing, and social work) with a focus on the following areas of guilt:

1) Guilt for abandoning family and friends

2) Guilt for the relationship with the dependent person

3) Guilt for placing the relative in a nursing home

Results indicated that women report more guilt than men for abandoning family and friends because of their relationship with the dependent person. Regarding nursing home placement, no difference was observed as a function of gender.

Guilt is a major problem that must be addressed by caregivers and healthcare professionals. Not finding solutions for guilt can lead to mental health issues. Caregivers need respite time away from patients, so they can share their experiences, gain information from others, and relieve stress. They need programs that save them time and make them feel that they are cared about by others. They need people to be their caregivers by temporarily relieving their burdens, sharing an uplifting activity, being good listeners, and providing encouragement.

One important beginning for caregiver relief of guilt is forgiveness of self.
In this video, Dr. Alexis Abramson discusses various ways for accepting and alleviating caregiver guilt.
    

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, July 31, 2017

Predicting Your Future Health (Research, Video)

Can people accurately predict their own health? Can self-rated predictions of mortality or decline in instrumental daily living activities be mostly true? This study of self-rated health predictions and decline in instrumental activities of daily living included community-dwelling older adults 65 years or older (2,638 males and 3,346 females). 

Results reported that poorer self-rated health was significantly associated with decline in both men and women and confirmed that self-rated health is an independent predictor of decline in instrumental activities of daily living among non-disabled community-dwelling older adults.

For those interested in a personal comprehensive diagnosis of their future medical health and health risks, a company started by a geneticist can provide this service at a cost of up to $50,000. Some say knowing the future in such detail is not natural. View other pros and cons in this “WHDT World News” video that includes a brief “60 Minutes” interview. Would you pay thousands to have your future health predicted? 


Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, July 24, 2017

Dementia, Long-Term Care Sexual Intimacy Views (Research, Video 4:54)


When the topic of long-term care sexual intimacy regarding people who have dementia arises, family members, loved ones, and staff have varied views. While research is limited on the best ways these residents can express themselves sexually within guidelines respectful of others, this particular study investigated this issue.

Through interviews, this dementia long-term care sexual intimacy research
explored the views of relatives and care workers of new relationships or sexual intimacy between care home residents with dementia who were still married to other people. The following themes emerged:

1) The views of care home staff and relatives had similarities in general terms regarding the problems arising around expressions of sexuality in care homes.

2) A light-hearted or non-physical connection between residents is deemed acceptable. The moment it becomes a sexual relationship, decision-making becomes more complicated.

3) Staff were inclined to turn to managers for advice and to consider separating residents. They expressed familiarity with distracting residents from situations that were of concern.


4) Relatives were considerate of the difficulties and dilemmas faced by care home staff.


Older adults with dementia can and do express sexual intimacy that is appropriate. Mutual consent is an important factor.  However, sometimes sexual behaviors can be inappropriate. Dr. David Conn explains in this video some causes of inappropriate sexual behavior and how these behaviors can be addressed by caregivers and family members:


Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, July 17, 2017

Age-Friendly Communities for Older Adults (Research, Video 3:41)

Older adults have made their voices very clear about wanting to age in place at home. But without a great deal of support from the community in addition to varied and better services, aging in place will be hard to meet mental and physical needs of a rapidly growing population. More emphasis should be on prevention-focused and community-based approaches.

Fortunately, initiatives such as the World Health Organization's Global Age-Friendly Communities (AFC) Network, with 287 communities in 33 countries, and AARP's Network of AFCs with 77 communities in the United States have stepped up to meet the challenge. What should be provided to create successful age-friendly communitiesThese are necessary considerations:

1) Older adults should be actively involved, valued, and supported with necessary infrastructure and services.

2)  There should be affordable housing, safe outdoor spaces and built environments conducive to active living, inexpensive and convenient transportation options.

3)  There should be opportunities for social participation, community leadership, and accessible health and wellness services.

4)  Active, culture-based approaches, supported and developed by local communities, and including an intergenerational component are important.

5)  Academic geriatric psychiatry needs to play a major role in the evolving AFC movement to ensure that mental healthcare is considered and delivered on par with physical care.

Age-friendly West Chester, PA, which is featured in this video, is a great example of a World Health Organization's Global Network of Age-Friendly Cities and Communities. Older adults there are socially integrated, diverse, and connected to younger generations.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, July 10, 2017

Family Caregivers Managing End-of-Life Pain (Research, Video 2:05)


This is the face of serious pain, a face that many who work in the healthcare fields have seen. I remember describing in a poem a hospice patient of mine in this way: “Eyes that have seen ninety years squint tightly as daggers of pain pierce his cancerous form.” Imagine how family caregivers must feel witnessing their loved ones experiencing intermittent frustration and distress of an internal battlefield of pain.

According to several research studies, pain management was the most identified burden faced by family caregivers in end-of-life caregiving. These fourteen research papers focused on family caregivers' experience of pain management and strategies in end-of-life care. 
These were the major areas of pain management research focus:

1) Family caregivers' engagement in pain management and
    communication with the hospice care team about pain control

2) Family caregivers' knowledge, skills, and effectiveness in treating pain

3) Family caregivers' concerns and experience of pain management


Results confirmed what previous studies have already reported with these themes:

1) Inadequate knowledge and assessment skills in pain management

2) Misunderstanding of pain medications

3) Poor communication with the care team


Efforts in understanding and supporting family caregiving pain management needs are areas that must be addressed far better if patient-centered care is to be realized. Implementation is critical to patients’ care and family caregiver empowerment. In addition, more diverse patients and caregivers must be participants in the research. In this video, Dr. Mimi Pattison, Director of Franciscan Hospice, discusses beneficial pain management for those who are dying:



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, July 3, 2017

Volunteering, Making Friends with People Who Have Dementia (Research)


A hospice volunteer many years in Detroit, Michigan nursing homes with residents who had dementia, I was delighted to find research about volunteers “befriending” people with this disease. This study included a small group of nine volunteers who were younger and older adults. Responding to interview questions, they shared their friendship experiences in detail. They emphasized numerous complex and unique processes that generated issues of power, equality, and boundaries. These are some of the rewards they received from volunteering. Remember, good volunteering is always win-win:

1)   Making friends with people who have dementia was described as “a deeply personal and human experience, often with emotional power and profound meaning.”
2)   Volunteers were able to see past dementia stereotypes.
3)   Volunteers’ personal assumptions and boundaries were challenged.
4)   Volunteers became more reflective about love, life, and humanness.

This research concluded that future studies should consider the experiences of those receiving the volunteer service, ways of making the mutual friendship more effective, and more exploration of volunteer difficulties and support.

The recommendation that I would make to all volunteers and anyone else making friends with people who have dementia is based on what I have learned while making friends with my hospice patients and others who have dementia. I have included this advice in number four of my list titled Hospice Volunteer Success in 10 Steps:” 

4) Try other doors.

Patients will have challenges such as dementia that may not respond to your usual front-door communication. Try other doors and even windows. Obstacles are enrichment opportunities in your partnerships with patients. Touch, music, pictures, stories, and fantasies are a few entry points. Let patients help you navigate your way into their world.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog