End-of-Life Racial Disparities in Nursing Homes: Hospice, Hospitalization, Advance Directives (Research, Video 3:00)

Healthcare disparities refer to inequalities that exist in the quality of healthcare among groups such as racial and ethnic populations. Causes for the inequalities may be access to good health care, community obstacles, and personal behaviors.  In America, racial-ethnic disparities have continued to persist, even when income, health insurance, and access to care are the same among various racial-ethnic groups. This post focuses on research on end-of-life racial disparities in nursing home residents who are deceased.

Nursing homes certified for Medicare or Medicaid reimbursement were included in this study. Assessed were advance directive measures, hospice use, and hospitalization with these results:

1)   Across different types of advance directives, black, Hispanic, and Asian nursing home residents were significantly less likely to have these documented in their files.

2)   Compared with white residents, Asian residents were also significantly less likely to receive hospice services during their last year of life, whereas Hispanic residents were more likely to receive services.

3)   Finally, all racial-ethnic groups were more likely to experience hospitalization within 90 days before death, regardless of whether they had documentation of a do-not-hospitalize order.

These results indicate a great need for more education of healthcare workers and community members as well as more monitoring and accountability to eliminate disparities.

You can read more about cradle-to-grave African American healthcare disparities here: https://www.linkedin.com/pulse/african-american-pain-treatment-disparities-emergency-parker?trk=mp-author-card

An explanation of racial inequalities in healthcare is featured in this video:

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 and Barnes and Noble.

Hospice and Nursing Homes Blog

Prison Inmate Hospice Volunteers: Can They Change? (Video 2:55)

Thousands in need of end-of-life caregiving die in prison every year. Some people ask, “So what? Did these prisoners treat their victims with dignity? Why be concerned about their death journeys?” One response is that society should be held to a higher standard of treating prisoners better than they treated victims. At several prisons, inmate hospice volunteers serve as caregivers for terminally ill inmates. There are those who say this is the ultimate test for inmates to prove whether they have changed or not.

Serving Life, a film that premiered on the Oprah Winfrey Network (OWN), documents a hospice program inside the Louisiana State Penitentiary, a maximum-security prison at Angola. Award-winning actor Forest Whitaker narrates and produces this film. Hospice volunteer inmates viewed as hardened criminals care for dying fellow inmates at this prison where inmates have average sentences of more than 90 years. Can these inmates find redemption through caregiving involvement with hospice care?

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 and Barnes and Noble .

Hospice and Nursing Homes Blog

More Healthcare Humor Needed (Nurse-Patient Research)

This cartoon is an example of a humorous exchange between a patient and a healthcare worker. Whether the patient was pretending to be serious or really was serious, the idea of breakfast with a cocktail and dessert is just funny for many people. While funny stories are not uncommon in the healthcare field, healthcare workers would probably have many more humorous stories to tell if they initiated more humor themselves. 

Research on healthcare humor reports that humorous exchanges with patients are important and should be encouraged. With four patient focus groups participating in interviews, Lancaster University UK researchers explored patients’ perspectives on humor. Conclusions indicated that there is a gap between what patients want in healthcare humor and what they receive. Why is this? Initiating humor involves a risk factor that many healthcare workers may be reluctant to take.

Here are three healthcare jokes for starters:

Patient: "Nurse, I just swallowed my pillow!" 


Nurse: "How do you feel?" 


Patient: "A little down in the mouth"


Nurse in Kentucky to Patient: “How did you like your breakfast this morning?’

Patient: “I really enjoyed it, except for the Kentucky jelly. I‘m not used to the taste.”

Nurse: That’s interesting. Let me see it.

Patient: The man showed her a foil packet labeled “KY Jelly.”

A man walks into a doctor's office. He has a cucumber up his nose, a carrot in his left ear, and a banana in his right ear.
"What's the matter with me?" he asks the doctor. The doctor replies, "You're not eating properly."

Do you know any jokes or stories about healthcare workers and patients that you can share? (Surely, you can do better! lol)

You can read funny hospice caregiving stories here.      

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 and Barnes and Noble .

Hospice and Nursing Homes Blog

Older Adult Obesity: Marriage, Gender, Diabetes (Research, Video 2:28)

Question: If marriage promotes health and increases longevity, are fewer married older adults obese?

Not according to this research on older adult marriage, gender, and obesity. Using the Health and Retirement Study (HRS) including men and women aged 51-70, marriage is associated with weight gain. Leaving a marriage is associated with weight loss.

What other theories about older adult obesity should be considered?

1)    Shared risk factors, such as social obligations regarding meals, increases weight for married couples, but does not last for marriage duration.

2)    Marital transitions, not marital status, determine differences in body fat. Short-term effects are seen for divorce, but not for the persistent weight gains associated with marriage or the persistent weight loss following widowhood.

Question: Based on marriage and gender, who are the heaviest older adults?

3)    Prominent gender differences in late middle age reveal the heaviest group is unmarried women and the lightest is unmarried men.

4)    Pressures of the marriage market in combination with gendered preferences regarding partner body fat may account for differences found in this data.

Obesity is related to many health problems that reduce the quality of life for older adults. Type 2 diabetes, the most common form, is more prevalent as people grow older and gain more weight.

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

Poem Honoring Naomi Long Madgett, Poet Laureate of Detroit, Michigan

Frances Shani Parker (left) poses with Naomi Long Madgett near the sculpture of Madgett on display at the Charles H. Wright Museum of African American History in Detroit, Michigan.

April is National Poetry Month. I am honored to recognize Naomi Long Madgett, my friend and Poet Laureate of Detroit, Michigan. Naomi will be 90 years old on her July 5th birthday in 2013. She continues to inspire others with her rich legacy of achievements. Join me as I salute her with a poem I wrote about a true experience we shared years ago.

Naomi

She said, “Just call me Naomi”

like that would be easy as breathing,

as if that word could dance

from my mouth doing a solo hustle,

as if I could first-name somebody

whose life poem includes the Roaring

Twenties, the Harlem Renaissance,

and the Great Depression.

My Louisiana roots knew better.

That would be like smelling myself. *

This golden light of a lady

named Naomi Long Madgett,

this awesome oxymoron of petiteness

and greatness doesn’t realize

when she looks up to talk to me,

I still look up to her when I look down.

Generations of word lovers

inspired by her talent use her

as their beacon to guide them

across waters to future possibilities.

Her glowing array of achievements

includes illuminating poetry, publishing,

and teaching. She beams brilliance

on rooftops of human potential,

through windows of curiosity,

anywhere words can ignite minds.

Life’s looming landscape continues

to be enhanced with legacies

emitted from her radiant rays

of kindness, integrity, and dedication.

She said to call her Naomi.

Detroit’s poet laureate can’t be denied.

I stir that word in my mouth

like a vintage Starlite mint, chew

until southern discomfort dissolves,

swallow its savored sweetness.

The next time I see Ms. Madgett,

I greet her like the enlightened

queen elder she is and say,

“Hi, Nnnnnnnaomi!”

© Frances Shani Parker

* “Smelling myself” is primarily an African American idiom for being conceited. 

  

You can read Naomi Long Madgett's biography.

You can read Naomi Long Madgett's review of my book Becoming Dead Right.

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