Thursday, January 29, 2009

Culture Change in Nursing Homes: What Works, What Doesn’t (Video: 1:59 mins.)

Most people agree that changes in the stereotypical, traditional nursing homes are long overdue. What makes a nursing home really feel like home? What needs to happen to make that a reality? What are some of the barriers that negatively impact progress? A University of Pennsylvania research study about culture change in nursing homes focused on these concerns. After staff interviews were done, three nursing homes reported these results:

Barriers to Change

1) Exclusion of nurses to culture change activity (While nursing assistants were not mentioned here, I’m inclined to believe they were also excluded.)

2) Perceived corporate emphasis on regulatory compliance and the "bottom line” (money)

3) High turnover of administrators and caregivers

Promoters of Change

1) A critical mass of "change champions"

2) Shared values and goals

3) Resident/family participation

4) Empowerment at the facility level

Clearly, changing nursing homes successfully involves input
from all levels of staff, residents, and community. Incentives encouraging achievement of new and shared goals are also effective.

You can read more details about this study here.

You can view this video on the importance of inclusiveness in culture change proceedings.

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.

Thursday, January 22, 2009

Healthcare Disparities: Do You Treat Patients Differently Based on Race or Culture? (Video 3:43 mins.)

During my healthcare research, I have repeatedly come across data revealing major disparities in America’s healthcare system. Overwhelming evidence indicates that these disparities negatively affect certain racial and ethnic groups. America’s long history of overt and covert racism, with all its stereotypes and discrimination, continues to pervade its institutions in ways underestimated by many people, including those who are victimized by it. In my book Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes, I address this urgent matter:

“The responsibility for changing attitudes that cause disparities within the healthcare system rests with that system. This is not only a healthcare issue, but also a moral one. This system cannot continue to sit down in the middle of an unjust road, cause harm to others, and not be held accountable. Healthcare providers must own the fact that a large amount of research on disparities in racial and ethnic minority healthcare is true and make every effort to demonstrate equitable practices.

Better education in racial and ethnic cultural sensitivity, however, is not enough. Negative stereotypes are activated with and without intent, particularly in high-pressure work environments. Serious accountability from healthcare providers must include rewards and penalties. Incentives should be offered to encourage healthcare institutions to work diligently at lowering their incidents of disparities negatively impacting racial and ethnic minorities, as well as women and low economic groups. Solutions must be implemented with ongoing monitoring. Disparities of the magnitude that exists now will not be willed away.”

There is a tendency among some healthcare workers to assume that the solution to this problem rests with leaders of the “institution” when, in fact, it belongs to each person making up the institution. The question “Do you treat patients differently based on race or culture?” is one that every healthcare worker must explore at a personal level with honesty. In spite of overwhelming research to the contrary, most responders still say, ”Oh, I’m colorblind. I treat everybody the same.” Recognition of the problem is the first step toward improvement. Racial and ethnic disparities must be eliminated before America will ever realize true equality in healthcare among its diverse populations.

You can read more about cradle-to-grave African American healthcare disparities here:

This video defines and addresses the need for healthcare cultural competency:

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

Wednesday, January 14, 2009

Rural and Urban Hospice Financial Comparisons

If I asked you which hospices, rural or urban, face the most financial disadvantages, which would you say? According to reported research in the “Journal of Pain Symptom Management,” rural hospices fare no worse financially than urban hospices, at least in California.

In the California study, 144 hospices were urban and 44 were rural. Adjustments were made in financial performance factors such as size, years of operation, profits, insured patients, etc. Compared with urban hospices, rural hospices were at least as profitable per patient-day, and they were determined to be “significantly” more profitable than urban hospices when charitable donations were excluded. This study concluded that rural hospices fared no worse financially than urban hospices. These results indicate a need to look further into comparisons of rural and urban hospices on a national level. If any of you have reasons to disagree with or support these results, please let me know.

You can read more details about this study here.


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

Wednesday, January 7, 2009

Hispanics: Caregiving and Diabetes Research (Video 1:49 mins.)

As a hospice volunteer in Detroit nursing homes, it was not unusual for me to have regular contact with patients who had dementia. One patient named Raynell (pseudonym) is particularly memorable because she had both dementia and diabetes. This excerpt from my book “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” describes how she attributes her diabetic symptoms of tingling and numbness in her legs to an imaginary man named Robert who was in love with her.

“Robert was an imaginary man who passionately loved Raynell, my eighty-year-old hospice patient. It could be said that he shared a room with Raynell and her three roommates. His presence demanded my attention many days when I went there to visit her. He stole sweetness from the moment by repeatedly pinching Raynell’s stout legs. He made her feet rise by pushing up her mattress. Strategically positioned near the foot of her bed, he escaped under it quite easily. That’s how Raynell explained the turmoil he caused her. I pulled up a chair in her world each week and made myself at home. While I respected her condition, often letting her take the lead in our discussions, I always remained mindful of my role as volunteer.“

© Frances Shani Parker

“Medical News Today” reports results of a study released by the United Health Group's Evercare® organization and the National Alliance for Caregiving (NAC) with these results:

1) In America, more than one third of Hispanic households (36 percent) have at least one family member caring for an older loved one. This is a larger percentage than other U.S. households.

2) More than four in 10 Hispanic caregivers (41 percent) have changed their work situation either by cutting back on hours, changing jobs, stopping work entirely, or taking a leave of absence. This is compared to 29 percent among non-Hispanic caregivers.

3) Most Hispanic caregivers are taking care of loved ones with diabetes, including 23 percent of loved ones with a form of dementia.
A 2007 Centers for Disease Control and Prevention national examination survey indicated that Mexican Americans are twice as likely as non-Hispanic whites to be diagnosed with diabetes and 50 percent more likely to die from diabetes as non-Hispanic whites

4) Reasons for Hispanic caregivng included family obligation (84%) and religion (93%).

This video titled “UMTV Latinos Living With Diabetes” showcases the Institute of Minority Health Education and Research founded by Patty Larraga.

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

Thursday, January 1, 2009

Hospice Care: Can Miracles Save Lives? (Video 1:01 min.)

Do you believe in miracles? If so, you share company with many others. As a hospice volunteer, I noticed early on that many patients held strong religious and spiritual beliefs. These beliefs were important to them when making decisions about their medical care.

Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), has a community outreach guide titled “It’s About How You LIVE – In Faith" to help hospice organizations engage faith communities with end-of-life issues. This guide, done in collaboration with the Duke Institute on Care at the End of Life, is available at the NHPCO website for free downloading.

In this Fox News video clip, viewers witness the miracle of Val Thomas, a woman who was technically dead for almost 18 hours after two heart attacks. Rigor mortis had even set in. Yet, she lives!

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