Impact of Death Rattle Sounds on Hospice Workers (Research, Video 3:27)

Anyone who works closely with dying patients may have heard death rattle sounds. Hospice workers, including volunteers, who have heard these sounds in the presence of patients’ relatives and friends may feel the need to explain to them what the patient is experiencing and reassure them.

According to Wikipedia, a “death rattle is a gurgling or rattle-like noise produced shortly before or after death by the accumulation of excessive respiratory secretions in the throat. Those who are dying may lose their ability to swallow, resulting in such an accumulation. While it is medically established that the death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex. It is sometimes misinterpreted as the sound of the person choking to death. In terminal care, drugs may be used to reduce secretions and minimize this effect.”

A study reported in Palliative Medicine was done to see how the death rattle sounds impacted hospice staff and volunteers. Most expressed negative feelings about hearing the sounds. Many felt the need to intervene to end the sounds using a therapeutic option. The study concluded that “doctors and nurses need to consider why, when and how they intervene and the consequences of that intervention.”

You can read more about this study here and more recent 2015 research here.

This video below features signs of a person approaching death:

Visit here for more research and other information about the death rattle experience, including a recording of actual death rattle sounds.

It would be interesting to read firsthand information from hospice workers, healthcare staff members, and other caregivers regarding their personal experiences with a patient during a death rattle experience.

Please scroll down to many comments below.

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.

Hospice and Nursing Homes Blog

BlogTalkRadio Interview with Frances Shani Parker and Viki Kind (30 mins.)

Recently, I was interviewed by Vikki Kind, a bioethicist and medical educator who specializes in end-of-life issues. A hospice volunteer with Hospice of the Conejo in Thousand Oaks, California, Viki is also host of the BlogTalkRadio Show “Kind Ethics.” BlogTalkRadio is the social radio network that allows users to connect quickly and directly with their audiences. Using an ordinary telephone and computer, hosts can create free, live, call-in talk shows.

Viki Kind and I covered several topics during our 30-minute interview. They included the following:

1) Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
2) Writing
3) Urban Nursing Home Issues
4) Cultural Diversity
5) Racial-Ethnic Healthcare Disparities
6) Healthcare Research
7) Service-Learning (Definition, Implementation)
8) School-Nursing Home Partnerships
9) Ageism
5) Semi- Sensory Deprivation
6) Honoring Patients’ Histories

You can listen to the "Kind Ethics" interview here.

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

Wii Fit and Wii Sports for Senior Rehab (Video 2:17 mins.)

Nintendo Wii Fit and its older sibling Wii Sports continue to enhance the world of rehabilitation by exercising entire bodies of seniors and others. The newer Wii Fit uses the Wii Balance Board, a pad that players stand on while doing various types of exercise, including calisthenics, yoga, and balance games.

Baseline tests established with Wii Fit keep track of patients’ individual progress. This direct feedback from the game is a big plus because it always keeps patients abreast of how well they are doing. With variety, tracking, and personalized fun provided by the Wii games, more seniors can look forward to rehab with “old school” opportunities to hula-hoop and twist.

Patients at St. Mary’s Medical Center in San Francisco are pleased with both Wii products when used in recovering strength and balance from traumatic injuries or surgery. This video shows Wii Sports and Wii Fit being used by patients at St. Mary’s Medical Center.

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

Hospice Cultural Diversity: Share What Your Hospice Organization Is Doing

It is no secret that hospice services are underutilized nationally among people of color. While several barriers to utilization have been studied, solutions always include the necessity of more outreach to racial-ethnic groups by hospice organizations.

Promoting cultural diversity requires sincere commitment to hire more people of color at all staff levels, more 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 media, particularly in their languages. Hospice workers must take proactive outreach roles in presenting the benefits hospice provides, while making recipients of their services feel welcomed and respected.

These are examples of what two hospice organizations are doing:

Julie Cranz
Hospice Volunteer Coordinator
Hospice of Western Kentucky
Owensboro, KY

Our hospice started an ACCESS committee in order to identify, educate, and serve populations that we do not currently serve. We have contacted the local NAACP president, who has forwarded information about us to all minority churches in our city. We will be making a presentation at an NAACP meeting and offering free health screenings at local minority churches. We also changed the photos on our brochures to ensure that a diverse population is represented.

Monica Escalante
VP of Volunteers, Community Education and Outreach
Montgomery Hospice
Rockville, MD

We have done quite a bit regarding cultural diversity. We have prioritized the work within the agency. MH has diverse staff, and our senior management is also very diverse (ethnically and also in terms of professional backgrounds and experience). Developing cultural competency is an important part of staff orientation, and we also have engaged our experienced staff in an annual discussion about culturally competent care. Finally, we have language interpretation services provided over the phone and available 24/7.

For outreach, we have done the following:

The Spanish Outreach
We offered bereavement groups, translated many flyers, and have a Spanish information page on our website (with several articles): http://www.montgomeryhospice.org/patients/indexSPANISH.php
We also participate in the Latino Health initiative and many festivals they organize.

The Asian Outreach
We participate in health fairs for all minority groups. Last year, we connected with a series on “Working with Asian Populations at End of Life” organized by a truly influential grass roots association.

African American Outreach
A bereavement counselor attends the Black Ministers conference on a monthly basis and our Manager of Outreach has a MH booth at every African American event in the county.

We are in constant communication and provide helpful information to the faith community (we have a huge email list), and through them, we reach another diverse segment of the population.

All our communications, flyers, and other tools are tested for cultural competency; we do that using our own diverse staff, who happen to love providing this kind of feedback.

Surely, more hospice organizations have cultural diversity best practices to share that others can explore. Quality end-of-life care is an entitlement for everyone. That is the hospice philosophy. What is your hospice organization doing to promote cultural diversity? Please comment below.

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.

Hospice and Nursing Homes Blog

Nursing Home Staff Shortage: Patient Neglect and Abuse (Video 2:07 mins.)

One reason I wrote Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is to relate, not only cozy stories that depict the positive side of my hospice volunteer experiences in nursing homes, but to also convey those seldom mentioned negative aspects in need of improvement. The reality, supported by research, is that the quality of life for all patients, whether at home or in institutions, depends on the context of their care. Among other variables, that context includes policy makers, staff, equipment, race, and location. That context also includes me, and that’s why I advocate for patients.

Book Excerpt:

“Sometimes a shortage in staff had harmful consequences for patients. This included being left in unchanged beds, not being fully clean, and not being assisted when help was required for eating. Some patients tried to feed themselves, using their hands when they couldn’t see their eating utensils. Patients waiting for help sometimes stared at their food while it turned cold. Those with depression or dementia often had little interest in food. They needed someone to motivate them throughout the meal.”

Staff shortages in nursing homes negatively impact patients around the country. There is no excuse for patient neglect and abuse, especially when it is criminal. According to the National Citizens' Coalition for Nursing Home Reform (NCCNHR), it is a violation of state and federal law for any person, including facility staff, volunteers, visitors, family members or guardians, or another resident, to neglect or abuse a resident.

Neglect and abuse can be reported to the following:

1) The nursing home’s administrator, director of nursing, and social worker
2) The state or local ombudsman
3) The local police or state law enforcement
4) A Protection and Advocacy or Adult Protective Services agency
5) The state survey agency that licenses and certifies nursing homes (often in the Health Department)
6) A citizen advocacy group, or other church or community group that visits regularly

This video about alleged patient neglect and abuse in some New York nursing homes indicates that critical staff shortages can be a contributing factor.

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