Friday, December 31, 2010

Poem About Loneliness in Older Adults/ Seniors

She waited, grasping like a New Year's resolution...

Festive holidays have brought cherished opportunities for many older adults to enjoy some visitors they seldom see during most of the year. Whether at home or in institutions, loneliness can be both difficult and dangerous for their overall health. Too many of them endure the negative impact of loneliness daily.

“Missing” is one of sixteen original poems at the end of each chapter in Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes. A hospice volunteer, I wrote it after witnessing the sadness of lonely nursing home residents who were missing the missing. They coped with ongoing loneliness that could easily have been avoided with gifts of time. But some relatives and friends kept putting off visiting them until it was too late.

As this new year begins with resolutions for change, consider making every effort to visit those who are ill or alone. Don’t sentence them to another year of missing you.


She waited,
hoping her years of caring
endured in grown-up minds,
rested in distant hearts,
conveyed how much she missed them.

She waited,
living real-time movies
of restless nights, anxious days
with inhaled hopes of fellowship,
exhaled sighs of deep despair.

She waited,
wishing nostalgic winds
flowed through cotton curtains,
brought relatives and friends
she cherished through the years.

She waited,
grasping like a New Year's resolution,
like a second suspended in time
until her clock stopped ticking
for visitors who never came.

© Frances Shani Parker

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, December 24, 2010

Hospice-Palliative Care Diversity Outreach: Asian Culture (Chinese American Video 1:32)

Meeting the cultural needs and preferences (ethnic and religious beliefs, values, and practices) of hospice-palliative care patients is an important part of quality health care. People view the world through their cultures and values. To ignore this fact and impose one’s own culture and values on others caters to miscommunication and alienation. With respect and sensitivity, bridges can be built that help people connect at human levels, regardless of their differences. The availability of more language interpreters at healthcare institutions can facilitate this communication and bonding. Ongoing education on the culture and traditions of various populations, along with the understanding that varied beliefs exist within each group, must be increased throughout the healthcare system to improve service to diverse groups.

Many Asians prefer family caregiving of their aging, terminally ill relatives. In addition to being reluctant to place their elders in nursing homes for hospice care, they may also be reluctant to discuss specifics about illnesses with those in their care to keep them hopeful and without worry. Some Asian cultures consider direct eye contact, particularly with someone considered a superior to be inappropriate. Healthcare providers should gather more knowledge of Asian culture, including input from Asians, in order to promote benefits of hospice and palliative care.

In the following video, Nellie Kwan, a hospice clinical supervisor who works for Self-Help Hospice in San Francisco, describes cultural concerns regarding end-of-life care and Chinese Americans. According to her, most Chinese Americans do not understand hospice at all. This video is part of the Hospice Foundation of America “HFA Cares” series:

Frances Shani Parker, Author

Thursday, December 16, 2010

Healthcare Workers: Choirs Sing Holiday Music (Research, Video 3:56)

Happy Holidays From Frances Shani Parker

Years ago when I was a teacher, several co-workers decided to organize a staff choir. The announcement circulated quickly, and, to my great joy, anybody, even average shower singers like I was, could join. We met after school each week and slowly became acquainted with more layers of ourselves than my grandma’s lasagna. It was magical how music could so easily remove everyday distractions of the world.

Because music is so universal, I thought about this when I read research about healthcare workers of the Staff Christmas Choir of the Peter MacCallum Cancer Centre ("Peter Mac") in Australia. Peter Mac is a world leader in cancer treatment, research, and education. I wondered if their choir had teased one another like we had, joked about the challenges of harmonizing, and if they generally had a great time just singing. Most of all, I wondered if they were swept into the magnificence of inspiring and healing themselves and others through song.

Research indicates they definitely accomplished the latter. Seven performances were given at Centre locations which included inpatient wards, outpatient waiting areas, and a cafeteria. In order to evaluate performances, oncology inpatients, outpatients, and visitors were given anonymous, semi-structured questionnaires during and after performances. Of the 111 responses, including some from people with Jewish, Hindu, and atheist backgrounds, 93.7 % were favorable. Several people described “transformative thoughts and physical reactions, felt affirmed by the Christmas spirit or message, and/or appreciated the peaceful or enlivened and social atmosphere.” The importance of "enjoying the moment" was also a recognized benefit.

Frances Shani Parker, Author

Friday, December 10, 2010

The Long and Short of Hospice Time in Nursing Homes (Research)

As a hospice volunteer in Detroit nursing homes, I have had hospice patients stay as short as one day and as long as three years. With little quiet or privacy, almost all of them shared rooms with one to three non-hospice residents. My three-year patient was 94 years old. Having few visits from relatives and friends who lived out of town, her biggest fear was the possibility of being released from hospice care and the nursing home. I’ve also had rare happy patients who were released from hospice because their health improved.

One patient with dementia seemed to have a premonition that she would be leaving soon when she said to me one day, “I was wondering if you could help me find another apartment. I’ve been thinking about looking for a new place to stay, maybe a place closer to where I used to live. This apartment building is too noisy. Just close your eyes and listen to all the talking, buzzers, and everything. People come into my place without even knocking. They just walk right in and go through my closet and drawers. It’s not right. Three ladies even moved in with me when I wasn’t looking. Now, I can’t get them out.” I had never heard her say anything about leaving before. Two weeks later, she was released from hospice care and moved to a nursing home near her son’s house.

Are there characteristics of nursing homes and residents that are associated with long and short hospice stays? Using 13,479 residents enrolled in hospice care, researchers at Harvard Medical School looked for answers to this question. Research results indicated the following:
1)    Nursing home characteristics were not statistically significant predictors of long stays.

2)    The probability of a short stay increased with the facility's nurse staffing ratio and decreased with the share of residents covered by Medicaid.

3)    Men (relative to women) and blacks (relative to whites) were less likely to have a long stay and more likely to have a short stay.

4)    Those 70 years or younger (relative to those 81-90) and residents with Alzheimer's disease/dementia were more likely to have long stays and less likely to have short stays.

5)    Fourteen percent of hospice users were discharged before death because they failed to meet Medicare hospice eligibility criteria. These residents on average had longer lengths of stays.
If you work with hospice patients in nursing homes, have you noticed these occurrences? Researchers concluded “high rates of discharge before death that may reflect a less predictable life trajectory of nursing home residents suggests that further evaluation of the hospice benefit for nursing home residents may be needed.”
Frances Shani Parker, Author

Friday, December 3, 2010

Eldercare Robot: CareBot Companion and Caregiver for Older Adults (Video 2:19)

We can pretend that robots are only for sci-fi movies, but they are already being created to make life easier for older adults. Artificial intelligence of robots makes them especially good companions for older adults living alone or those in need of caregiving attention. What is artificial intelligence? This means the robot not only has the ability to navigate safely in its surroundings, but it also has the intelligence to do meaningful caregiving.  Maybe that’s why they are called CareBots.

The GeckoSystems CareBot is a robotic eldercare system that allows family members to care for older adults from afar. According to Martin Spencer, President/CEO of GeckoSystems, CareBot is a new kind of companion that “always stays close to the care receiver, enabling family and friends to care for them from afar. It tells them jokes, retells family anecdotes, reminds them to take medication, reminds them that family is coming over soon (or not at all), recites Bible verses, plays favorite songs and/or other music.” Even the voice can be customized.

From a security point of view, a CareBot alerts family members when unexpected visitors or intruders are present. It notifies designated caregivers when a potentially harmful event has occurred such as a fall, fire in the home, or even if no one has been present for too long. It responds to calls for help and notifies those persons that the caregiver has designated.

Referred to as Emily, the CareBot in this video serves as a helpful companion to Doris by keeping track of her taking medicines, reminding her about TV shows, and performing other tasks that improve the quality of Doris’ life.

What do you think about having Emily or another CareBot living with you or helping an older adult in your family?

Frances Shani Parker, Author

Monday, November 29, 2010

Palliative Care Professionals Change Through Shared Stories (Research, Hospice Video 2:16)

Never underestimate secondhand life experiences. I know how someone else’s story can grab me by the collar, drag me into a clear day on a stormy night. When writing for others, I have wandered through high weeds of words, while seeking a path of truth behind the noise of my thoughts. True stories sometimes come drenched in life-changing powers. I wish more people would tell and listen to stories the way children do with wide-eyed openness for learning. That’s why I am pleased to report this research about palliative care professionals telling true stories about their work.

Reported in the “Journal of Interprofessional Care,” this research consisted of a series of six interprofessional palliative care meetings held in facilitated small groups. The 28 participants, which included doctors, nurses, social workers, and emergency care practitioners shared stories about their professional experiences. Evaluations of the meetings were done via telephone interviews with 19 of the participants reporting. Findings resulting from their shared discussions included this statement:
“Five months after the end of the course, many participants described changed professional behavior which they believed led to improved patient outcomes.”

Now, that was some great storytelling!

Frances Shani Parker, Author

Wednesday, November 24, 2010

Engage With Grace: Discuss End-of-Life Wishes During Holidays

For three years running now, many of us bloggers have participated in what we call a “blog rally” to promote Engage With Grace, a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes. The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage With Grace are five questions designed to get conversations about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important. Believe it or not, most people find they actually enjoy discussing their answers with loved ones. The key is having these conversations before it’s too late.

This past year has done so much to support our mission to get more and more people talking about their end-of-life wishes. We’ve helped make this a topic of national importance. We commend everyone who has taken this topic so seriously. 

Happy holidays and thank you to all who have done so much to spread the word, including sharing questions from The One Slide below:

Frances Shani Parker, Author

Friday, November 19, 2010

Holiday Coping With Grief: Bereavement Support After a Loved One Dies (Hospice Video 2:27)

Some people dread the holidays. They view them as slices of life that bring painful reminders of losing a loved one. They associate holiday traditions with familiar people and places that are incomplete and no longer fulfilling. These bereavement suggestions offer support for those coping with grief during the holidays:

"Mourners have to decide the best ways they can adjust to the holidays. One option is to create new holiday traditions. If holidays were celebrated as a family, new traditions can be planned as a family, so everyone can have input. This will give family members an opportunity to discuss their feelings about the deceased loved one and possibly include something in the new tradition that commemorates that person in an uplifting manner. This could be a type of memorial that adds pleasure to holidays in the future, something that would have pleased the deceased.

Whether celebrating the holidays alone, with others, or not at all, people should always follow their hearts and do what feels best for them. There is no one way for everyone. There are different ways that work well for different people. Some people who found the holidays stressful, phony, or too commercial before their loved one died may want to redirect their holiday focus. They might choose to participate in an activity that is calmer and more meaningful to them such as volunteering at places where they can help others or sharing with others in another capacity. Others may want to celebrate alone or with a few friends, take a trip to another state or country, or just be involved with something they enjoy doing that may or may not have anything to do with the holidays, but everything to do with their own quality of life."

In this Hospice of the Florida Suncoast video titled “Hospice Care and Grief Counseling: Coping With Holidays After a Loved One's Death,” Sandi Sunter shares more suggestions for coping with holiday grief.

Frances Shani Parker, Author

Friday, November 12, 2010

Christmas and New Year: Death Risk Factors

Back in late August, I noticed a store clerk setting up Halloween decorations. After I commented that Halloween was really coming soon, the clerk casually mentioned that the Christmas decorations were already up on the other side of the shelf. In the sales world, that’s called getting customers in the holiday spirit early, so they’ll spend more money. Decorations may start them thinking about holiday foods, parties, trips, gifts, and death. Did I say death? That’s probably the last thing most people connect with the holidays.

Should people be thinking about holiday deaths, too? Research from the University of California confirms that they should. Using official U.S. death certificates in various hospitals around Christmas and New Year, researchers examined daily mortality rates. Results indicate that mortality from natural causes is highest in dead-on-arrival (DOA) and emergency department (ED) settings on Christmas and New Year. There are more DOA/ED deaths on 12/25, 12/26, and 1/1 than on any other days for each of the top five disease groups. Yes, Christmas and New Year are risk factors for deaths.

Although the research article didn’t explain precautions people should take that might keep them or their loved ones from being part of holiday death statistics, earlier research reported at “WebMD Health News” presented these recommendations from Dr. Alice Jacobs, president of the American Heart Association:

1) Don't skip regular appointments because of the holidays. Reschedule if needed.
2) Stick to your healthy habits through the holidays, and help your family do the same.
3) Be sure you have enough of your usual medications.
4) Check out the medical facilities where you'll be traveling.
5) Ask your doctor to recommend someone you could see if you need a doctor away from home.
6) If you have symptoms, don't ignore them.

It’s not too early to plan ahead for holiday death risk factors. Have safe and happy holidays!

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

Friday, November 5, 2010

Older Adults Make Safe Sex Video (2:22)

You know what’s frightening? Nearly one-third of all people living with HIV/AIDS are aged 50 and older. According to the Centers for Disease Control, 115,000 of the 475,000 people living with HIV/AIDS in the United States are 50+. That’s nearly double the number in 2001. The real numbers are likely higher because many people with HIV/AIDS remain undiagnosed.

Undiagnosed and infected people are estimated to cause two-thirds of infections.  Because many senior women are postmenopausal, they may not use condoms with the vigilance they would for preventing pregnancy. More sexual experimentation among seniors, including some increased by drugs like Viagra, also promote the likelihood of unprotected sex. 

You know what’s great? More seniors and others are paying attention to these statistics. They are understanding that rising rates of HIV/AIDS in their population require diligently using condoms, no sharing of needles, testing for HIV, and discussing HIV/AIDS with their doctors and others. They can make good use of resources available such as the National Institute on Aging.

But so much more can and should be done to get the message out about safe sex for seniors. Like any change, people can begin wherever they are to become part of the solution.

Frances Shani Parker, Author

Saturday, October 30, 2010

Hospice Volunteers With No Patients (Video 1:34)

I have heard so many people say they admire what hospice volunteers do, but they couldn’t do that kind of work themselves. Maybe they don’t know that there are other ways they can provide admirable hospice service more appropriate to their personal comfort zones.

My class in training to become a hospice volunteer consisted of a dozen students from varied backgrounds. All of us were eager to learn what hospice entailed and what our future responsibilities might be. That class taught me the basics of what I would need in my role as a volunteer supporting patients and their families. I felt comfortable making a commitment to serving patients in inner-city Detroit nursing homes, instead of private homes. After I started volunteering, I thrived in that environment just as I had while working in inner-city schools.

But a few months later, I noticed a member of my former training class working at the front desk of the hospice organization. When we talked, she explained that she had been unhappy working directly with terminally ill patients. She especially didn’t like working in nursing homes, but service in private homes was also not attractive. When she mentioned her concerns to the hospice coordinator, she was given other service options. Those options included involvement with office work, community outreach, and fundraising. She chose office work and said she felt fulfilled and productive supporting hospice in this manner. She especially liked communicating with visitors.

Ultimately, we had both found our respective niches where we could make our best contributions as volunteers. I encourage anyone considering hospice volunteering to keep in mind that there are various ways to serve. Hospice organizations can give you a variety of options from which to choose. They could not function without the dedicated services of thousands of volunteers and the diverse talents they bring.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many online and offline booksellers and in e-book form at Amazon and Barnes and Noble online stores.

Saturday, October 23, 2010

Comfort Feeding for Dementia Patients

A friend of mine was shocked and upset when he visited his mother recently. She has dementia and has only been in a nursing home a few weeks. Walking into her room, he found her being fed with a feeding tube. Although he is her primary caregiver, this decision had been made without his knowledge or approval.  His mother is in relatively good physical health for her age, and he felt this had been done because tubal feeding would be easier for the staff. He immediately set about changing her feeding back to hand feeding.

Although evidence suggests that feeding tubes do not improve survival or reduce risk of aspiration, they are used often on nursing home residents with dementia. Unfortunately, most residents have no documentation regarding their wishes on the use of artificial hydration and nutrition. One reason is that families may confuse the order of “do not feed” with meaning no artificial feeding. Nursing home staff members fear that they will be in trouble if residents lose weight and a feeding tube hasn’t been used.

The “Journal of the American Geriatrics Society” addresses these concerns. One solution is having residents’ wishes regarding goals of care clearly stating an individualized feeding plan that supports the residents’ comfort and wishes. The phrase “comfort feeding only” through careful hand feeding presents an alternative to imposed orders to end artificial hydration and nutrition.

Frances Shani Parker, Author

Friday, October 22, 2010

Frances Shani Parker and Susan Baida Interview: BlogTalkRadio “Empowering Family Caregivers”

Recently, I was interviewed on “Empowering Family Caregivers,” a BlogTalkRadio show run by Susan Baida and John Mills, co-founders of This show focuses on issues of care providers, long-term care and advanced aging. It features expert speakers on aging, long-term care, dementia and other illnesses and issues typically associated with aging in America. The website provides comprehensive information, tools and resources to help those seeking and providing long-term care.

Susan Baida and I covered several topics during our 30-minute interview. They included the following:
2) Negative Impact of Children Serving as Major Caregivers
3) Nursing Homes and Certified Nursing Assistants (CNAs)
4) Eldercare Blogging
5) Hospice and Palliative Care
6) Pain Management
7) Dementia
8)  Holiday Caregiving Suggestions
9) Nursing Home Culture Change
10) Racial-Ethnic End-of-Life Healthcare Disparities
11) Death Preparation
12) Baby Boomer Haven Nursing Home
13) Homegoing Death Ritual

You can listen to the Empowering Family Caregiversinterview.

Frances Shani Parker, Author

Sunday, October 17, 2010

Hospice Racial-Ethnic Outreach for Cultural Diversity (Research)

It is no secret that hospice services are underutilized nationally among racial-ethnic minorities. While several barriers to utilization have been studied, solutions always include the necessity of more outreach to racial-ethnic groups by hospice organizations. For example, a study on the willingness of older Korean-American adults to use hospice services highlights the importance of prior knowledge in shaping attitudes toward hospice care. Researchers stress the need for  “community education and outreach programs for racial and ethnic minorities, with specific emphasis on dissemination of information and greater awareness of hospice services.” Sharing successful racial-ethnic outreach practices can be a great strategy for hospices in promoting cultural diversity.
These are a few examples of outreach practices implemented by two hospice organizations:
1)  Starting a committee to identify, educate, and serve populations not being served
2)  Offering free health screenings at local minority churches
3)   Changing photos on brochures to reflect diverse populations
1)  Making cultural diversity an important part of staff development and recruitment
2)  Having language interpretation services provided over the phone and available 24/7
3)   Participating in Latino health initiatives, festivals, and African American events
Many hospice organizations have cultural diversity best practices to share that can benefit other organizations in their quests for cultural diversity. Quality end-of-life care is an entitlement for everyone. That is the hospice philosophy. What is your hospice organization doing to promote racial-ethnic outreach? 

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.

Friday, October 8, 2010

New Orleans Jazz Funeral: Homegoing Celebration With Second Line Dancing (7:39)

In New Orleans, my hometown, a jazz funeral is considered a homegoing celebration because the deceased is going home, crossing over to the other side. Emotions often run high as mourners are moved by the music and spiritual energy building up as the service progresses. Although there is sadness because the loved one is no longer physically available, there is joy in knowing that the deceased has gone to a better place where there will be no more sorrow and where they will be reunited one day with loved ones who went home before them.

Mourners come prepared to render a dynamic farewell. Death is an event that requires rejoicing. After services at the church or funeral home, a grand marshal leads a brass band and an assembled group of mourners, along with the hearse, in a procession to the cemetery to “drop the body.” The band plays solemn music at this time.  Stepping unhurriedly with the beat, participants walk a route down city streets. When they reach the cemetery, they “cut the body loose” as the hearse slowly enters for final services where the body is laid to rest.

After the procession of mourners leaves the cemetery, a rousing celebration begins with the band playing an upbeat song like “When the Saints Go Marching In.” The funeral procession continues, growing in size with many community members collectively called “second liners,” who join in the joy with curious bystanders. A spirited dance called the “second line” is prominent among the celebrants. Many participants bob umbrellas, some brightly decorated, and wave handkerchiefs in the air to the hot-sauce beat of the music. Surely, the deceased must be ecstatic with the large turnout of well-wishers expressing such jubilance in the send-off.

This video features part of the homegoing celebration of Juanita Brooks, who was a prominent jazz and gospel singer. Wanda Rouzan, a popular performing artist known as the Sweetheart of New Orleans, serves as grand marshal. The focus is on the musical transition from slow and somber to spirited as the funeral procession progresses with second liners.

You can learn more about New Orleans at my New Orleans Memories website.

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 booksellers such as Amazon.