Tuesday, March 27, 2012

Older Adult EnhanceFitness Exercise Program (Research, Video 3:12)

Whenever I talk to older adults about exercising, I usually hear comments like these:

1)   I attend a weekly hustle class that energizes me.

2)   Twice a week, I walk in the mall where I feel safe.

3)   I keep busy babysitting my grandkids every day.

4)   Mostly, I keep active going places and doing things around the house like gardening.

It doesn’t take long to conclude that many older adults associate exercise mainly with simply moving around. Unless they participate in strength training and flexibility exercises in addition to aerobic conditioning, many who are able to perform all of these activities are not benefiting from a total fitness program. Sometimes I wonder what would happen to those who lack strength training if they fell and were stuck on the ground with a good heart rate, but little strength to get up.

I was especially pleased when I read this strength training research done by Wayne State University in Detroit, MI. The purpose was to determine the effects of 16 weeks of strength training on measures of functional ability in elderly who are functionally limited. Divided into an exercise and control group, the 87 participants (ages 65-93) were living independently, but with functional limitations. Three days a week over a 16-week period, exercising participants attended 13 different strength training exercises using Thera-Band resistive bands. They exercised in a group setting once a week and were given a home exercise book to follow for two additional sessions per week.
Results showed significant upper-body strength improvement for the exercisers’ strength as measured by bicep curls and lower-body strength as measured by chair sit-to-stand. The control group participants achieved minimal changes. Having good functional ability is inversely correlated with short-term morbidity and the need for assisted living in older adults. It’s important that this population becomes more educated and receives more opportunities for resistance training to maintain their independence.
EnhanceFitness is a well-rounded exercise program implemented nationally in many older adult communities. An award-wining program backed by over ten years of scientific research, EnhanceFitness participants work out three days a week with certified instructors. Funders of the program like the low costs, the sustainability, and especially the positive outcomes. 

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.

Wednesday, March 21, 2012

Hospice Book Review Haunted by Death Monster

Don’t be afraid to read this. Death in American society is still a terminally ill taboo in great need of palliative-hospice care. Too many people avoid talking, hearing, writing, or even reading about the end of life. As an author and consultant on hospice and eldercare, I have been told on several occasions that the topic is just too depressing and final. If you’re a hospice worker, you may have noticed that people often think we’re a little strange because we choose to work with people who are dying.

This reluctance to deal with mortality visited a friendship of mine. I had given a casual friend a copy of my book Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes. Wanting to be sensitive  and not knowing her feelings about death, I decided not to talk to her about the book unless she brought it up. Eventually, she did. I’ll call her Alice. She approved my writing this post.

Because Alice works in the healthcare profession, I was somewhat surprised to discover that she feels strongly that death, a frightening stalker of her dreams, is her enemy. She shared that death has stolen too many of her loved ones, including pets. She helplessly dreads the thought of losing even more. My own acceptance of death, which comes across clearly in my conversations and writings, seems inappropriate to her. She finds my views too accepting of her enemy, too casual a regard for life. While she says she would consider hospice care along with other options in the future, she admits she could never be even an average hospice volunteer. It would be too painful.

What is her feedback regarding Becoming Dead Right? She loves the patients’ stories and my comments about interacting with various people in the nursing home world. The original poetry, which concludes each chapter and probably nudges her own poetic abilities, pleases her. She finds the discussions on hospice, nursing homes, caregiving, dementia, death, and bereavement informative. The explanations about intergenerational school-nursing home partnerships and the ideal nursing home described in the last chapter are particularly enjoyable. But she dislikes emphatically the premise that there is a “right” way to die.

I am not sure if her hostility toward death has changed much, but I hope that this book meeting with what she refers to as “the monster” has impacted her positively on some level. Those of us who embrace the topic of death will continue to be viewed with dismay by those who manage mortality through avoidance and resignation of themselves and loved ones as victims of death’s malicious powers.

Alice’s revelations reinforce the importance of promoting death as a natural part of life that should be experienced with dignity by everyone. I believe conversations and writings enhance lives of the naysayers one person at a time. These efforts empower them slowly with death acceptance even as they resist the message. I appreciate Alice’s frankness in sharing death’s distressful presence in her life and in giving feedback on my book. Most of all, I commend her willingness to become a ball of courage rolling into the high weeds where the death monster lives.

You can read book endorsements, excerpts, and more at my website.

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, March 16, 2012

Hospice, Long-Term Care, and Dementia Quiz

Hospice, Long-Term Care, and Dementia Quiz

What's your response to these statements?

By Frances Shani Parker, Author
1)   Death is a terrible thing.

Fact: Death is a natural part of life that everyone will experience. Accept, discuss, and prepare for becoming dead in your future.

2)   It’s always better to die at home.

Fact: “Home” can be the presence of love and comfort wherever a terminally ill patient may be. Most people die in institutions.

3)   Hospice speeds up death.

Fact: If two similar people had the same terminal illness, the one receiving hospice care would probably live longer.

4)   Pain is a natural part of aging and dying. Under-treated pain slows down the death process.

Fact: Pain medication is available to offer appropriate relief to patients. Under-treated pain worsens the process unnecessarily.

5)   Patients with dementia don’t miss visits from relatives and friends they don’t recognize.

Fact: Patients with dementia are often aware of their surroundings on some level. Loved ones should focus on patients’ current abilities and make every effort to spend quality time with them.

6)   Patients with dementia are always suffering.

Fact: Patients with dementia have varied days like everyone else. Happy memories and enriching activities can slow-dance into their realities and fill them with joy.

7)   Caregivers must only focus on their patients.

Fact: Caregivers must focus on their own care as well. They should seek supportive resources and monitor their sleep habits, irritability, and general health, always with a willingness to seek help when needed.

8)   Caregivers should not question decisions of healthcare professionals who are the experts.

Fact: Caregivers should be proactive as patient advocates. They should stay informed about patients’ symptoms, diseases, treatment purposes, and side effects.

9)   Long-term care facilities are not good places for children to visit.

Fact: Intergenerational experiences help children understand life’s passages. Children should experience opportunities that encourage them to become nurturing people, eliminate ageism stereotypes, and expose them to possible career choices.

10) Hospice work is mostly depressing.

Fact: Millions of hospice workers view their involvement with patients as privileged occasions for mutual growth and fulfillment.

© 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, March 9, 2012

Assisted Living Facilities Provide Hospice Care (Research, Video 3:48)

Many people have told me that they didn’t know hospice care exists in nursing homes. Even more seem surprised to learn that hospice care can be provided for residents in assisted living facilities. I can’t emphasize enough that hospice care is available no matter where a qualified person lives at home, in an assisted living facility, in a hospital, and even in prison.

What does good quality care at the end of life look life for hospice-enrolled residents in assisted living facilities? A study was done by the Oregon Health & Science University to get detailed descriptions of end-of-life care provided by medication aides, caregivers, nurses, and hospice nurses in urban and rural settings. Interviews were used to gather information. Having worked as a hospice volunteer in urban nursing homes for several years, I was interested in the results. They were very similar to what I would have expected from a nursing home or any other institutional care:

1)   The quality and nature of resident-staff and assisted living-hospice staff relationships are critical in promoting good end-of-life care for residents.

2)   Length of the resident's stay in the facility and how well staff knew the resident were associated with the quality of the resident-staff relationship.

3)   Respectful collaboration, clear communication, use of complementary knowledge and skills of staff, and shared expectations about the care were associated with positive staff relationships.

4)   Administrative support for hospice patients in assisted living facilities was important.

Assisted living facilities and hospice organizations that are committed to working together with hospice programs must both support staff, patients, and families. There is a need for more successful models of this partnering system of care to meet the needs of our growing population of older adults.

This video titled Hospice: At Home, In Assisted Living, In Hospitals relates the positive experiences of patients receiving hospice care in different settings:

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.

Wednesday, March 7, 2012

Person-Centered Care: Nursing Home Culture Change (Photograph Research, Video 4:00)

Change is not always easy, especially if there is widespread acceptance that practices are working well the “wrong” way. Fortunately, the growing movement of nursing home culture change across America is transforming beliefs in what the “home” part of nursing home really should look and feel like. In many cases, reluctant staff members who resisted change at first are seeing the benefits, particularly regarding improvements in residents’ health.

Even something simple like automated historical digital displays of residents' photographs to remind staff of each resident’s personhood can positively impact patient-staff communication. Researchers at the University of Kansas School of Nursing displayed residents’ historical photographs in digital frames in their rooms. They compared audio-recorded staff-resident conversations before this intervention with conversations afterwards. Results indicated increased staff person-centered talk and less task-oriented talk. Residents spoke more about interpersonal topics. Their engagement and reminiscence improved. Implementing low-cost historical photo displays in residents' rooms enhanced person-centered communication. 

Many other interventions can advance person-centered care in nursing homes. Staff members who have made the paradigm shift from traditional nursing home settings to nursing homes with person-centered environments and practices can best explain the transformations of themselves and residents. 

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.