Friday, March 30, 2007

Hospice and Palliative Care for the Homeless

Every urban city has them somewhere. Viewed too often as invisible humanity, they watch their cardboard requests for help filter through society’s windshields. Shivering in countless layers of clothing, they roam while preaching to unseen characters. They are homeless people who may or may not have lived in the past like any reader of this blog.

But what happens or should happen to millions of homeless people when they are terminally ill? Those with bodies racked with years of substance abuse can only last so long, especially when strong social supports and medical insurance are lacking. When each day is a struggle to meet basic needs, the odds of detailed planning of end-of-life care are slim.

“The Journal of the American Medical Association” discusses how to serve the terminally ill homeless population with these summary conclusions:

1) Needs of the homeless can best be met with a multidisciplinary team that addresses their complex needs.

2) Those who continue to abuse drugs must have frequent clinic visits, specific dosages of long-acting pain medications, and a written pain agreement.

3) Their end-of-life concerns must be discussed with them and documented.

4) Due to lack of finances, homes, and social supports, the homeless rarely receive inpatient hospice care. However, inpatient palliative care at hospitals can enhance the quality of their end-of-life experience.

Like everyone else, homeless people are entitled to all the benefits of dignified death journeys.

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

Saturday, March 24, 2007

Hospice Volunteers for Pets: Pet Food Recall

With the recent mass recall of toxic dog and cat food, pet owners across the country have agonized over their pets’ health. Many owners bombarded veterinarians with requests for guidance in preventing kidney failure and death of their animals. While many pets were determined to be fine, some died, leaving owners devastated.

Pets are loved unconditionally by millions of pet owners. The same inspiration that compels owners to protect and cherish humans also stirs them to want peaceful death journeys for their pets. Fortunately, hospice care for pets has become a reality at the Colorado State University Argus Institute for Families and Veterinary Medicine. Visiting the homes of pet owners, hospice volunteers, who are veterinarian students, help terminally ill animals that are expected to live three months or fewer. Like hospice volunteers for humans, they also offer emotional support for pet owners.

I think this application of the hospice philosophy will develop in more places and positively impact human hospice care by strengthening understanding of its meaning. As more hospice conversations take place, the word “hospice” will become more embedded in everyday language and more appealing to the general public. You can read more about hospice care for pets here. What do you think about this form of end-of-life care for pets?

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

Thursday, March 15, 2007

Nursing Home Technology

Part of the culture change that many look forward to seeing in more nursing homes is supportive of technology as a means of providing residents with more independence and dignity in daily living. Of course, the human touch still remains primary in patient interactions with others.

A major problem in implementing more technology is cost. Cuts in funding for nursing homes only make an already difficult situation worse. But we must still address the possibilities, particularly since many technological accommodations are already on the market. Five examples are these:

1) A vacuum assisted sponge that promotes blood circulation at the wound site and sucks out the infection

2) Robots that perform basic tasks that will allow staff to spend more hands-on time with patients and that remind residents of tasks they should do

3) Computer touch screens for nurse aides and others to update patient data at the point of care for immediate access and use elsewhere

4) Remote sensing technology that monitors motion, temperature, pressure on floors, chairs and beds, how patients walk, when they fall, restlessness in bed, as well as patients’ pulse and respiration

5) Wireless call systems that allow residents to call for assistance anywhere in the facility by pressing a button they wear that sends a message to a computer

The reality is that technology is needed to free more staff to handle the increasing numbers of patients who are living in nursing homes. Millions of baby boomers will need services in the very near future. In order to support our aging society, America needs more discussions and funding relating to technology.

At the age of 91, Naomi Long Madgett, Poet Laureate of Detroit, MI, enjoys using technology. Her good choices with the "new stuff" enhance her quality of life. You can read more about Naomi and iPad research with older adults here:
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog

Saturday, March 10, 2007

Hospice Volunteer Humor

Whenever I tell people I’m a hospice volunteer, they usually respond with strong empathy for the difficult and sad work I must be doing. They also imply that I'm close to sainthood for even doing it. This always amuses me because I don’t find hospice volunteering difficult or sad. In fact, most days are pretty upbeat with challenges that are usually interesting. I’m a regular person doing what everybody can do in their own ways, and that is service.

Humor has a lot do do with the kinds of interactions my patients and I share. People say I'm funny, but my terminally ill patients are often funnier, not only with me, but with others with whom they have contact. A very engaging patient remembered many hilarious stories about her life. Some days she’d just reminisce and have us both cracking up, especially when she talked about the bear chasing her in circles around her house. A male patient and his roommates teased one another so much, it was unlimited laughter every time I visited. Did I mention the two ladies having a pretend fight from their wheelchairs? Oh, and the bedside birthday party with a menu of fried chicken livers, red velvet cake, and ice cream was another winner!

A study on hospice and humor in “The American Journal of Hospice & Palliative Care” revealed that humor was present in 85 percent of 132 observed nurse-based hospice visits. The real clincher is that hospice patients initiated humor 70 percent of the time, regardless of the hospice setting. Reflecting my own hospice experiences, this study confirms that many of the terminally ill continue to maintain a comic state of mind. And that’s no joke!

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.

Tuesday, March 6, 2007

Michigan Hospice Volunteers: A Documentary (Audio)

Hospice Chronicles: Care for the Patient and Family is an audio documentary produced by Dan Collison and Elizabeth Meister of Long Haul Productions. It follows two southwest Michigan hospice volunteers who have completed their volunteer training and are visiting their first patients. Because their patients live at home, I listened with a focus on similarities and differences between their hospice volunteering and my own in Detroit nursing homes.

Volunteer Joe Haase essentially provides respite (relief) for caregiver Betty Bennett, whose husband Preston has Parkinson’s disease and early-stage dementia. Respite care gives her time away from home to do errands and take a break from the pressures of caregiving. Betty sounds overwhelmed with meeting Preston’s needs, but she continues to keep him at home because she promised him she would.

While people don’t generally think of hospice volunteers in nursing homes as providers of respite for staff, we are. More than once, I have had a frazzled and overworked nurse aide say she was glad I was there to feed my hospice patients who needed assistance. If my patients happened to be eating at a table with several other patients, it was not unusual for me to monitor their feeding, as well. Mealtimes can be extremely busy at an understaffed nursing home when many patients need assistance at the same time.

In the second documentary scenario, volunteer Betty Elsas visits patient Mamie Matthews, who is 97 years old and slowly deteriorating. Because Betty has a healthcare background, she mentions how visiting a patient “cold,” with little information, puts her at a disadvantage.

When I am assigned a new patient, I receive a form with minimal patient information such as name, age, religion, illness and caregiver. Probably because it’s all I’ve ever had, I adjusted easily. Like Betty, there were a few times I wanted to know more, for example, hobbies. These were times with patients who had difficulty communicating or who had paid guardians who knew little about their backgrounds.

I think hospice volunteers would find these conversations interesting for discussion, along with commentary from seasoned volunteers with residential and nursing home experience. The audio documentary can be heard at Hospice Chronicles: Care for the Patient and Family.

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.

Friday, March 2, 2007

Sex Offenders in Nursing Homes (Audio)

Around the country, public awareness grows regarding registered sex offenders’ whereabouts, including the fact that many live in or work as staff among vulnerable nursing home populations. Because their presence there can lead to dangerous consequences, this is a serious problem that must be addressed to provide security for staff, residents and visitors.

The 2006 “U. S. Government Accountability Office (GAO-06-326 Highlights) Report” identifies about 700 registered sex offenders living in nursing homes across the country. Keep in mind this is an underreported crime, and numbers continue to increase. States have broad discretion on how to implement notification of sex offenders. Nursing home administrators are not always aware of sex offenders’ previous convictions. Even when they are, due to the Privacy Rule, they are not sure if they can share that information with others. Known sex offenders are usually evaluated on their demonstrated behavior and not separated from other residents.

A 2007 news article titled “Sex Offenders Fill Geriatric Wards of U.S. Prisons” by Laura Sullivan, refutes a common belief that elderly sex offenders are not as threatening as young offenders. In actuality, sex offenses are more likely to be repeated as offenders age. Although the geriatric sex offender population discussed in the article is in a prison, the information has important implications for nursing homes. The following are definitely worthy of mention:

1) Offenders typically sexually abuse children because they are the easiest targets (similar to many nursing home residents).

2) Susan King, the prison psychologist at Laurel Highlands and director of the sex-offender program, says that some older men become sex offenders as they age. One man said he started when he was in his 50’s. Another man was first arrested at age 74.

3) Some sex offenders refuse to admit their crimes or receive counseling. Statistically, sex offenders in this category have a higher rate of repeating sexual offenses. Whether counseling will keep sex offenders from repeating their offenses is still controversial.

4) Two studies conclude that sex offenders are more likely to start committing crimes or keep repeating them in their old age.

You can read the entire news article and listen to the related “All Things Considered” podcast at the Web site.

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