Sunday, January 28, 2007

State of New Orleans and the Elderly after Hurricane Katrina—January 2007

New Orleans is where my life story started. It is a place that I own and a place that owns me on many levels. Even though I've lived most of my adult life in Detroit, I speak proudly of my New Orleans roots. The "Big Easy," a name I never heard “colored” people use when I was growing up, was never easy. Still, there were exhilarating chapters that swept us into sweetness the way great New Orleans music does.

Much of that ended in August 2005 when Hurricane Katrina and broken levees submerged the city in disaster. The elderly poor were disproportionately affected. Most residents in nursing homes were not evacuated before the levees broke. As flood waters rose rapidly, destroying many facilities, elderly and frail patients, often wheelchair-bound, bedridden or dependent on generators for oxygen, were moved to higher floors in nursing homes with that option available. Drinking water, food, medical supplies and electricity became scarce, as desperate hours evolved into nightmarish days with dead patients.

Most of those who died as a result of Hurricane Katrina were over 60 years old. Many of the elderly who were not in nursing homes drowned or died from other causes, including dehydration and starvation. Those who survived were among the hundreds of thousands forced to leave what was left of their homes, if anything. They relocated elsewhere, sometimes to locations where they knew no one. Many of the displaced elderly will die aching for home and familiar faces scattered across the country.

Almost a year and a half after one of the worst natural disasters in American history, progress in physically rebuilding New Orleans has been miserable, along with a near-epidemic of depression, post-traumatic stress disorder and tripled suicide rates. Affordable housing, senior centers, health care and crime prevention remain severely lacking. Many of the elderly who returned live in precarious conditions where each sunrise signals another struggle. By every humane evaluation, the overall suffering among the elderly and many others in this city rates beyond extreme. Yet the recent “State of the Union” address by President George W. Bush made no mention at all of New Orleans.

Visit Frances Shani Parker's "New Orleans Memories" Web Site.

Frances Shani Parker
Hospice and Nursing Homes Blog

Thursday, January 25, 2007

Hospice Care and People of Color

An African American, I am aware of many healthcare disparities experienced by people of color. Recognized and documented by the American Medical Association, the Centers for Disease Control and Prevention, and numerous others, these disparities, which are based on racial and ethnic factors, result in disproportionate numbers of people needing hospice care in these groups.

Hospice is underutilized nationally, particularly among people of color. Due to personal and collective historical experiences, many people of color are suspicious of healthcare services that are new to them, especially those related to death. They often come from a culture that stresses the importance of family members only being taken care of at home by other family members. They may not be comfortable with the idea of “outsiders” coming in with an end-of-life plan for dying. The idea of hospice services in a nursing home could create even more reluctance. Some people of color might think that pain associated with death is normal.

In order to bridge the gaps in trust and understanding that discourage some people of color from accepting hospice care, hospice staff members must take a more proactive outreach role in presenting the benefits they provide. This requires more than a presentation. It requires a sincere commitment to hire more people of color at all staff levels, more welcome 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 use of the media, particularly in their languages. Quality end-of-life care is an entitlement for all. That is the hospice philosophy.

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

Tuesday, January 23, 2007

Changing the Culture of Nursing Homes

As a hospice volunteer in Detroit nursing homes for nine years, I have become very familiar with the kind of culture that is predominant in many nursing home facilities. When I speak of culture in this manner, this is what I mean: Whenever we enter a building, a certain climate or culture greets us. Depending on what that culture is, we sense the possibility of the kind of experience we will have. If unpleasant sights, odors and sounds greet us after we enter, we will certainly draw negative conclusions about what to expect. And we will probably be correct. On the other hand, a culture that nourishes and stimulates appropriately makes us feel welcome, happier and encouraged to return.

Too many nursing homes have structured, unexciting and tense cultures that impact staff, patients, caregivers and other visitors poorly. Among other practices, patients are expected to eat and sleep at the same times on a daily basis, although most people would readily agree that people's natural schedules are not that aligned. The ongoing boredom and loneliness, along with excessive focus on rules and medical procedures, have lost sight of peoples' overall human needs. In addition, there is a layer of anxiety regarding compliance, or lack of compliance, with all the various rules that must be followed, regardless of how they impact people. In urban areas, particularly those that serve low income and racial-ethnic minorities, these factors are especially noticeable.

Fortunately, growing groups of reform-minded individuals are making their voices heard regarding the need for change in nursing home culture. They are not pushing cosmetic changes, but real changes in how people live and work together with a common goal. The focus is primarily patient-centered and encourages their independence. The following are a few of the alternative practices they are promoting to improve nursing homes:

1) Personalized schedules
2) Independent "houses" composing a nursing home
3) Family atmosphere with plants and small pets indoors
4) Regular contact with children through on-site daycare centers and after-school programs
5) More activities and decreased medication

As millions of baby boomers become senior citizens, we will be hearing more about these reforms. Our support will be needed to make these changes real and available to all patients, regardless of where their nursing homes are located. What do you think about changing the culture of nursing homes?

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