Friday, November 28, 2008

Hospice and Nursing Home Christmas Story

Have you ever celebrated Christmas in May? A hospice volunteer in Detroit nursing homes, I shared a wonderful Christmas in May experience with one of my patients. Sometimes patients needed me to help them solve problems. One day, Inez and I had an especially great visit. I had been thinking about how to find a key for a music box her niece had given her for Christmas. She loved that music box and liked to have it on display, so she would have a good excuse to talk about it. She had never heard it play because the key was missing when she received it. She said her niece had tried to find a key, but with no success.

The music box was a lovely piece of handiwork. A wooden base supported a clear glass container. Inside the container lay a beautiful butterfly resting on a small floral bouquet. Underneath the box was a hidden switch that made the seasonal display enchant with spurts of brightness. Inez, my ninety-two year old patient, said that she often sat and watched the softly glowing scene blink on and off. One night, she and I quietly watched it together. That's when I realized how much this silent little music maker meant to her. Unfortunately, neither of us knew what song it was supposed to play. We imagined the Christmas song we thought it should play and hoped one day we could solve the mystery.

Getting the music box to play became my project, but I knew I would need some help. The next day, I explained the problem to Burton, a teacher at my school. He decided to become a part of the solution by checking out some stores that might have the missing key. It sounded like the search for Cinderella's shoe. After looking for two weeks, Burton finally found a matching key at a large toy store. The sales lady was so touched by his story about Inez's "musicless" box that she gave him the key free of charge. We couldn't believe our good fortune, which became Inez's thrill maker.

In the second week of May with spring showing off nature's fashion makeover from winter, Inez heard her cherished music box play for the very first time. She picked it up gently and carefully placed it near her hearing aid. The song we had wondered about for months, the song that had driven us to discover its name finally played the sweetest version of "Joy to the World." Just hearing the music box fulfill its purpose felt like a miracle. Inez grinned widely, thanked me, and told me to thank the nice man who found the missing key that made her music box come alive.

The mystery had been solved, and Inez was ecstatic. I thought nothing else that day could outdo the pleasure of hearing the music box play, but I was wrong. After Inez set her mechanical miracle on the window sill, so we could admire it playing and revolving, something wonderful occurred that surprised us both: The brightly colored butterfly started moving, slowing creeping up to the opening red flower. Inez and I gave each other eerie "Twilight Zone" looks. Then we shared rainbow smiles about the joy in our own little 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.

Monday, November 24, 2008

Hospice Care Perceptions of Nursing Home Staff

In my book “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” there is a chapter titled “Healthier Hospice.” This chapter gives detailed explanations, based on my research and experiences as a hospice volunteer, regarding ways to improve hospice services in general. Included are variables that can improve hospice implementation in nursing homes. Nursing home staff members who are focused on curing patients may not embrace the hospice philosophy of non-curative care. It is critical that they commit to enhancing and maintaining their expertise in certain hospice practices.

The quality of end-of-life care for any patient depends on the context in which the care is given. In the context of a nursing home, perceptions of staff members regarding the hospice philosophy and the implementation of that philosophy greatly impact a potential hospice patients’ experience. This includes the referral or non-referral of patients to hospice care and the timing of those referrals.

In a study at Southern Illinois University Edwardsville, an understanding of factors influencing hospice referrals, nonreferrals, and timing of referrals was researched. Cross sections of staff members from seven nursing homes and two hospices were interviewed with the following results:

1) Nursing home staff members’ recognition of terminal decline, beliefs about hospice, and the initiatives they took “significantly influenced” patients’ referrals to hospice care and the timing of their referrals.

2) When death was perceived as unexpected (familiar signs not recognized by staff members), hospice referrals were delayed.

3) When nursing home staff members believed that hospice care was only for a crisis at the end of life or that hospice care did not add to nursing home care, hospice referrals were delayed.

4) Patients received longer hospice care when staff members believed hospice care complemented nursing home care and when staff members took the initiative to raise the option of hospice care.

This study confirms how important ongoing hospice training is for nursing home staff members. I emphasize ongoing because, in my experience as a hospice volunteer, regular staff turnover demands this. Without ongoing training, the quality of end-of-life care for potential hospice patients is jeopardized.

You can read more details about this important study here.

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

Monday, November 17, 2008

An Alzheimer’s Disease Support Group for Caregivers (Video 1:48 mins.)

My first encounter with unofficial hospice volunteering took place many years ago when HIV/AIDS was viewed as an early death sentence. I remember my patient saying, “But when I’m with my support group, they don’t care how I look. They can see past the ugliness of my outside. It’s like I’m fighting a war with other people like me on my side. We tell each other any information we know that will make our lives better. Even when it looks like I’m losing the war, they give me hope for the future. I give them hope, too.”

I knew that no amount of reading would ever make me know his pain and suffering. The support group was where he garnered much of his strength and improved self-esteem for dealing with the disease. Many people have a need to share their challenges with someone who has experienced what they are going through. That’s why I have great respect for well-run support groups. Caregivers often need respite time away from patients, so they can share their experiences, gain information from others, and relieve stress.

Frances Cooper is 87 years old. After years of caring for her husband, who had Alzheimer’s (Alz-high-merz) disease, she has accumulated a wealth of advice that can benefit others. She leads a support group that helps caregivers learn strategies for coping with the disease of their loved ones. For example, when her husband insisted that he wanted to go home (meaning the home where he was raised), she simply drove him around the block and returned to the house where they currently lived. This simple solution satisfied him. She also speaks about having her husband sort eating utensils, an activity that some patients with dementia find enjoyable.

You can view a brief clip of Frances Cooper’s Alzheimer’s disease support group for caregivers. Frances Cooper’s caregiver stories have been a source of inspiration and support for many.

If you are a caregiver who would like to share your written caregiver story with others or read stories by other caregivers, visit the website.

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

Sunday, November 9, 2008

Wii Physical Therapy Technology for Senior Veterans in Hospitals (Video 1:29 mins.)

There’s a reason Nintendo Wii Sports sells in the millions worldwide. It attracts many age groups in lively sports activities and encourages intergenerational participation. Recently, however, Wii Sports has become a fun technology prescription for senior veterans to improve their health. Physical therapists all over America are recommending these games that use the Wii remote to mimic actions of real life sports. The “Pentagon Channel Report” informs that senior veterans have become enthusiastic fans.

Wii technology fans at Veterans Hospital in Washington, DC have made bowling, tennis, and boxing their favorites of the five Wii game simulations. The other two are golf and baseball. All the games are played with simplified rules. Wheelchair veterans say playing increases their heart rates. Therapists find that patients arrive on time more when the games are their designated activities. Gaming is serious business for these veterans. And improved health is always a winner.

This video shows older veterans demonstrating that they’ve still got game.

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

Sunday, November 2, 2008

Culture Change in a Baby Boomer Nursing Home (Video 2:20 mins.)

In my book "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” Baby Boomer Haven refers to an imaginary nursing home based on best practices of some, but not nearly enough, nursing homes that exist today. In the last chapter, Ruth, a patient in a wheelchair, takes readers on a nursing home tour where residents and employees thrive in a culture where they feel empowered and respected. Many aspects of culture change are discussed and in evidence.

Roger Woodruff, Director of Palliative Care, International Association for Hospice and Palliative Care, Austin Health, Melbourne, Australia says of this book tour “I particularly enjoyed the guided tour, conducted from a wheelchair, of Baby Boomer Haven."

Book Excerpt:

“Management and staff have a great working relationship. Together they wrap us in a warm family quilt woven with reassurance. Everybody participates in decision-making and attends workshops, classes, and conferences to keep abreast of best practices in their fields. Various staff members are included in the hiring of new employees and, when appropriate, involved in their training. Periodic meetings are held with all shifts represented, so more in-depth information can be provided concerning patients. Employees take pride in their work and strive to continue our tradition of excellence. We’re all part of the same team, and we’re all cheerleaders.”

In this video, viewers are given an overview of how to implement resident-directed care.

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