Monday, July 27, 2009

Culture Change: Nursing Home Dining (Video 2:13 mins.)

Broadwater Health Center (above) in Montana has cooked-to-order breakfasts and multiple-entree noon and evening meals.

The Centers for Medicare and Medicaid Services (CMS) guidelines for state surveyors give detailed information on accessing nursing home compliance with regulations. Recently, the CMS added that nursing homes must support residents' preferences and other efforts to transform nursing homes into homelike environments. Changes mentioned are both environmental and resident-centered. They include activities such as dining, scheduling, bathing, sleeping, and many more beneficial changes that will advance reform in nursing homes.

A hospice volunteer in Detroit nursing homes, I am aware of the great need for reform. Across America, best practices in many nursing homes are far ahead of those in too many others. But improving nursing homes requires much more than environmental enhancements and enrichment activities. Changing the culture of nursing homes successfully requires major shifts in thinking with input from all levels of staff, residents, and community. Incentives encouraging achievement of new and shared goals are also effective. A helpful resource is the National Consumer Voice for Quality Long-Term Care. This organization was formerly the National Citizens' Coalition for Nursing Home Reform (NCCNHR).

In this video titled "Culture Change Dining - Restaurant Style,” we see how residents and staff of Ballard Healthcare have implemented improvements in the dining program.

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

Wednesday, July 22, 2009

Video Poem: “Reflections of a Hospice Volunteer” (Hospice, Nursing Homes, Eldercare) 3:25 mins.

“Reflections of a Hospice Volunteer” is one of sixteen original poems included at the end of each chapter of "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes.” With poems, stories, and general information, "Becoming Dead Right" explores hospice care, urban nursing homes, caregiving, dementia, death preparations, and bereavement. Strategies for improving eldercare and nursing homes are examined.

Dedicated hospice volunteers everywhere enhance quality of life during patients’ final days. This poem expresses the win-win experience of many volunteers.

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

Sunday, July 19, 2009

Hospice Volunteer Training: End-of-Life Communication Issues

Sooner or later, hospice volunteers experience or observe communication concerns relating to patients or their families. In a research study by the Communications Department at the University of Utah, hospice volunteers reported that denial was the most common communication issue for patients, family members, and caregivers. The second most reported communication problems related to negative feelings and family conflicts. At personal levels, volunteers reported that their most common communication problems centered on interacting with patients who had diseases such as Alzheimer's or Parkinson's disease that impaired conversations. These results suggest that volunteer training programs should include more information to support volunteers in their communication efforts.

Personally, I enjoy coming up with ways to bridge gaps in communication. I never assume patients cannot hear me, unless they have been officially diagnosed as hearing impaired. I talk to them the way I would talk to hearing patients. I tell them what's going on at the nursing home and other news. Even when their eyes are closed, but I know they are awake, I tell them who else is in the room and say something positive about them to those present, so patients can feel included in the conversations.

I check their assignment forms and talk to their caregivers to find out what their backgrounds and interests are. This gives me more sources for topic ideas. If patients are able to leave the room, I take them on walks or wheelchair rides. I read to them, play music I think they will enjoy, touch them to reinforce my presence; I feed them, play games, sing, play the radio, and watch television with them, regularly making comments and always analyzing their body language to see if I'm making connections.

When I do a good job of this, I see signs that we are making progress. There may be smiles, alertness, something in their eyes that tells me our communication gaps are getting smaller, that we are forging relationships enhancing our lives. That's when the beauty of hospice volunteering sweeps me up like a great piece of music.

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.

Saturday, July 11, 2009

Video Poem: “Pieces of Our Minds” (Dementia, Alzheimer’s Disease, Hospice, Nursing Homes)

"Pieces of our Minds" is one of sixteen original poems included at the end of each chapter of my book "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes.”

Dementia refers to a group of conditions that gradually destroy brain cells and lead to mental decline. Various conditions can cause dementia, but Alzheimer’s (Ahlz-high-merz) disease is the leading cause. There is no cure for patients with dementia, and eventually they need complete care. Their quality of life improves when they receive effective healthcare and support.

As a hospice volunteer in Detroit nursing homes, I learned that dementia is like a fluttering bee. I never knew when it would make honey or sting. I participated in adult fantasies often. An important lesson I learned is that I don’t know the extent of anyone’s mental boundaries. One thing I know for sure is that I visited their Oz weekly and became a better person.

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

Monday, July 6, 2009

Hospice Worker Strategies When Families Expect Miracles

The terminally ill and their families often expect miracles. What can hospice workers do when families firmly hope for miraculous recoveries of dying patients? Doctors are particularly challenged when families continue to speak of divine intervention after all earthly procedures have failed. Respect for the spirituality and religions of others is important during healthcare treatment. Knowing how to walk that fine line of balance can weigh heavily on the quality of death journeys.

Research by the University of Pennsylvania School of Medicine, USA has provided a practical approach to this concern that allows families' beliefs in miracle healings to coexist with practices of good medicine. The following strategies applied to meet the unique needs of families are involved:

1) Exploring the meaning and significance of miracles

2) Providing balanced, nonargumentative responses to families' expectations of miracles

3) Negotiating patient-centered compromises while demonstrating respect for families' spirituality and doing what is medically appropriate.

Using these strategies can provide a means for hospice workers to maintain good relationships with families expecting miracles while medical practices are implemented. Patients are always the first priority.

This Fox News video clip is an example of why many people believe in miracles, regardless of a medical prognosis. 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”