Monday, February 26, 2007

Service Learning: Hospice Volunteer Medical Students

Service learning is a teaching and learning approach that connects classroom learning with meeting community needs. It is not the same as community service, another excellent practice. Service learning evolves from the classroom curriculum. For example, after students learn how to write a letter, they write a real letter to nursing home residents and possibly receive a letter response.

A former school principal, I have been a national service-learning consultant for many years and have been instrumental in implementing service-learning in school districts across the country. My book Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes includes a chapter on intergenerational partnerships between schools and nursing homes. I know the positive impact it has on students, both academically and affectively. A win-win activity, it also positively impacts service partners.

The research article I’m about to address made me smile after I read it, not because it is funny, but because I knew what the outcome would be. Published by the “American Journal of Hospice and Palliative Care,” the article explains research using first-year, service-learning medical students to serve as hospice volunteers.

Hmmm, understaffed nursing homes with future doctors working as hospice volunteers --sounds like a perfect marriage. My thoughts were confirmed when I read, “There is evidence of the educational benefits of exposing medical students to hospice patients and practices.” The article states further, “It appears to be an efficient way to satisfy the need for volunteers, while contributing to the education of the involved students.”

Service learning is a great practice that is long overdue in this research context. I definitely hope that service as hospice volunteers in nursing homes will become a regular part of training for medical students.

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

Thursday, February 22, 2007

Louisiana Road Home Program and Seniors

A New Orleans native, I want to share information on what is really going on there, particularly with senior citizens. Keep in mind that the U. S. Army Corps of Engineers has admitted that their failure to construct the levees properly is what caused the flooding of New Orleans, not Hurricane Katrina.

With the hoopla of the Mardi Gras season over, major parts of the city remain in ruins. I recently spoke with a young woman who volunteered for three weeks with the rebuilding there earlier this month. She said she was shocked by how much of the cleanup still hasn’t been done. Less than half of the population before Hurricane Katrina has returned.

What is the Road Home Program?

Briefly, it is the hurricane housing grant program established by Louisiana Governor Blanco in August 2006, a year after Hurricane Katrina. The purpose of the program is to provide assistance to the state’s eligible homeowners who suffered Hurricane Katrina and Rita damage to their homes. To help these homeowners find the “Road Home” as soon as possible, they would be compensated up to $150,000 for their losses. Criteria for eligibility are based on FEMA (Federal Emergency Management Agency) guidelines, depending on damage and other aid they receive. Grants for homeowners who do not reinvest in Louisiana property are docked 40%.

What about senior citizens?

In October 2006, the governor announced that senior citizens (homeowners 65 years and older) who apply for Road Home assistance will not be penalized if they sell out, move out of the state or rent within the state.

Is the “Road Home” really open for immediate access?

These latest program statistics can be viewed at the Road Home News Room Web site: At this rate, it will take years before all applicants receive the financial assistance they have desperately needed since fall 2005. Many seniors will have died waiting for the "Road Home" to open for them.

Frances Shani Parker
Hospice and Nursing Homes Blog

Sunday, February 18, 2007

Final Exam Book Review By Detroit Hospice Volunteer

Dr. Pauline Chen, author of Final Exam: A Surgeon's Reflections on Mortality, is a doctor who "gets" it. She understands that doctors can only do their best, that they won’t save every patient and that, in the natural order of life, they have not failed when their patients die. She realizes that doctors are just like other people and that in our common humanity, we often share similar needs. Finally, she knows that death can be a difficult journey, but consoling words can be powerful rest stops along the way.

In Final Exam, Dr. Chen takes the reader through her evolution with perceptions of death and mortality. She discusses personal feelings regarding her first dissection of a human cadaver. Later, she assumes responsibility for the accidental death of a patient in her care. Ultimately, she concludes that the role of doctors with patients and their loved ones should include more of the emotional comfort that traditionally has been missing too often. She adds that medical schools should educate doctors more in these caregiving strategies.

This book has important implications for hospice care. If doctors embrace Dr. Chen’s way of thinking, they will replace their feelings of failure when patients can no longer be cured with feelings of commitment to non-curative hospice care. They will recommend these options to patients more readily and increase the number of patients receiving quality health care at the end of their lives. In other words, they will “get” it and be comfortable with that knowledge.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Wednesday, February 14, 2007

Celebrating Nurse Aides, CNA’s and Nursing Assistants

They go by several names. During my hospice volunteer rounds in Detroit, I tend to say “nurse aide,” maybe because it’s older and easier to pronounce. But no matter what they are called, they are called often, sometimes too often when there’s a staff shortage. They are generally first responders meeting patients’ needs. Patients frequently think of them first when they evaluate their nursing home experience.

These are two comments I have heard nurse aides express to me about their jobs:

1) “I love working here. It’s not perfect, but we try to work as a team. I treat my patients like they are my family. For some of them, I’m the only one they can really talk to about their true feelings. I know what I do matters.”

2) "This place is depressing. I usually have more patients than I’m supposed to, and nothing I do is enough. It’s low pay with high pressure, but I need the job. It’s not right the way nurse aides and patients are treated here. When I try to make suggestions, nobody listens. I’m really frustrated."

Like people, all nursing homes are not good, and all are not bad. But dedicated nurse aides, no matter where they are, do hard work for low pay and often with little appreciation. A work climate suffers greatly when large numbers of staff stay discontented. Nobody benefits from a negative environment.

Some serious problems that plague nursing homes will require major systemic reform at local, state and federal levels. But administrators of individual nursing homes with negative climates can initiate certain changes themselves by committing to basic reform in staff, patient and caregiver relationships. Welcoming constructive input from all stakeholders validates everyone. Oral or written words of appreciation, when deserved, can go a long way in healing trampled self-esteem. Ongoing opportunities to improve job skills encourage professionalism. An added benefit will be decreased staff turnover. When the word gets around, more nurse aides will choose a nursing home where they feel respected.

As former principal of an urban public school with a high poverty level for many years, I know that setting a positive tone, even under stressful conditions, is a good beginning in changing the culture of any institution. I celebrate everyone who is doing a fine job working in nursing homes, but this post especially celebrates nurse aides, CNA’s and nursing assistants. Cheers to you!

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

Sunday, February 11, 2007

Alzheimer's Association Safe Return Program

I have had many hospice patients with Alzheimer’s disease or other forms of dementia. One thing I have learned is that I never know the boundaries of what they will or won’t do. So I’m always surprised when I meet caregivers who think they can accurately predict the behavior of their relatives who have dementia.

When a disease is progressive, it is moving at an unpredictable pace. A friend of mine left her husband in the car, while she ran into a store to make a quick purchase. Upon returning, she became frantic when she discovered the car was gone. Her husband had noticed the car keys, started the car and driven off, something he had not done in years, something she figured he would no longer do. Fortunately, the police found her husband several blocks away sitting in the parked car. But the story could have had a tragic ending.

The Alzheimer's Association Safe Return Program has been around for years, but I keep finding people who have never heard of it. This program provides safeguards, at a reasonable cost, for incidents, such as the one where my friend’s husband drove off. These safeguards include a national information and photo database that operates 24 hours a day, seven days a week, with a toll-free crisis line. Partnerships with law enforcement and other emergency responder agencies increase its effectiveness.

Identification products that have a toll-free number are provided. Products include necklaces, bracelets, wallets and clothing labels. When the phone number is called about a missing person, a caregiver is contacted through the Safe Return database. If necessary, the missing person’s photograph and information will be faxed to local law enforcement agencies. Nursing home patients, who might wander or get lost on trips, could also benefit from these products. One product I particularly like is worn by the caregiver to alert others that he or she is responsible for someone with dementia. If the caregiver is hurt, etc., others can help to get supervision for the patient. For more information, visit the Alzheimer's Association Web site. If you or anyone you know has used the services of this program, your comments are welcome.

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

Wednesday, February 7, 2007

Hospice Volunteer Cemetery Story

This story is from my book Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes.

When Mamie Wilson (pseudonym) became my hospice patient, she had several unusual qualities that made me wonder. At sixty-five, she was the youngest patient assigned to me after years of volunteering. She had the same name as my grandmother, and I had her grandmother's name. When we made these discoveries during our first meeting, we took them as signs that we were destined to have a great patient and volunteer relationship. In time, I learned that the most unusual thing about Mamie was what she said.

“Is your mother alive?” Mamie asked me one day.

“No, she died a few years ago in her eighties,” I responded.

“You know, you can still be with her and talk to her if you want to.”

“Oh, I know we can still communicate.”

“No, I mean for real. You can be with her in person. Just get her clothes together and her shoes. Don’t forget her coat. They say it’s cold outside. Take them to the cemetery where she’s buried. Just set them on top of her grave and wait. She’ll rise out of her grave and put them on. Then you can take her home with you. In every way, she’ll be the same person you knew. Other people won’t be able to see her, but you will.”

“Hmm. I’ve never heard that before.”

“Most people haven’t. I know about it because I did it with my two grown sons. They were both murdered on the same day in a drive-by shooting. I didn’t know how I would get through the pain. Finally, I took their clothes to the cemetery and did what I just told you. Both of them came home with me. It was the best day of my life. I got my sons back.” Satisfied, she smiled.

Some people will dismiss this story as crazed comments of a demented woman. But if you really listen, you’ll hear the magnificent empowerment in her words.

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

Sunday, February 4, 2007

Red Hats in Nursing Homes

Increasing numbers of nursing homes are opening up to creative ways for spicing up patients’ lives. But I was still a little surprised the first time I arrived at a nursing home and discovered a roomful of fun-loving ladies, all wearing red hats personalized with their own “hatitude.” For those of you who don’t know what hatitude is, let me explain. Hatitude is your hat's unique fashion statement about the self that is you. A hat will tell you how it has to be “worked” so it can show the world who you are, write your unwritten signature.

Why were all those ladies wearing red hats complemented by purple outfits? They had started their own Red Hat Society chapter. In recent years, these chapters have spread across the country like reality shows. The original Red Hat Society was started by Queen Mother Sue Ellen Cooper and a group of women celebrating their half-century rite of passage into middle-aged freedom. They officially committed to being carefree, silly and supportive of one another in sisterhood as they aged. Wow! Imagine that in a nursing home!

Red Hat Society chapters in nursing homes have joined the merrymaking with invigorating activities, such as tea parties, luncheons, beauty makeovers, cooking classes and trips. Games parties, of course, include Red Hat bingo with Red Hat door prizes. With names like Red Hat Hotties and Crimson Cuties, there’s no denying that their Red Hat presence casts a mystic spell. When nursing home ladies get serious about working their hats, while having a rousing good time, it’s a major spirit uplift for everybody wearing and watching red hats. Are any Red Hatters at nursing homes reading this? If so, what does your group enjoy doing?

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

Thursday, February 1, 2007

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

A recently published book that stands out in my mind these days is Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (Doubleday) by Harriet A. Washington. This book struck me as profound and groundbreaking in the information it presents relative to America’s health care system and statements I made in a previous blog about hospice care and people of color.

Medical Apartheid goes far beyond the well known Tuskegee Institute Syphilis Experiment, in which the U.S. Public Health Service allowed almost 400 black men with the disease to go untreated, while pretending to treat them. Ultimately, the men died and unauthorized autopsies were done as part of the experiment.

This book reveals numerous documented atrocities of involuntary experimentation targeting black people, including those in military and prison environments. Some incidents occurred as late as the 1990’s, such as the injection of Fenfluramine into black children in New York. This drug made up half of the deadly, discontinued weight-loss drug Fen-Phen and was used by Columbia researchers investigating the genetic origins of violence. Further emphasizing racial and ethnic disparities, the author mentions experimental research in Africa, Asia, and Latin America.

So many abusive incidents are mentioned, including several even worse than the Tuskegee experiments, it is little wonder that many people of color still regard the health care system, including hospice programs, with deep distrust. I agree with the author’s intent to present this well researched information, particularly those previously unpublished incidents, so we can all be more informed, vigilant, and empowered in our dealings with researchers and health care institutions.

You can read more about cradle-to-grave African American healthcare disparities at this blog post I wrote:

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.