Certified Nursing Assistant (CNA): End-of-Life Care in Long-Term Care (Research, Video 1:51)

As a hospice volunteer working directly with patients, I had many opportunities to observe and communicate with certified nursing assistant (CNA) staff members. They provided most of residents’ daily care and were often first responders in meeting residents’ needs that required immediate attention. Many exhibited dedication and genuine concern for residents, in spite of their own expressed problems on the job such as low pay and high staff turnover resulting in increased workloads.

The success or failure of quality in the lives of residents always depends on the context in which it is given. That context includes everything and everybody involved. Because of their active roles in residents’ lives and the frequency of death in long-term care facilities, the importance of excellence in preparation of CNAs should be mandatory. What are the characteristics of the residents, CNAs, and the care context associated with preparedness for residents’ deaths?

Research on the CNA preparedness role included in-person interviews with 140 CNAs about their experiences regarding residents' deaths. These experiences included characteristics such as care preferences, status perceptions of residents, and the caregiving context with emotional and informational preparedness. These were the results:

1)    CNAs who reported that residents were "aware of dying" or "in pain" expressed higher levels of both emotional and informational preparedness.

2)    CNAs who endorsed an end-of-life care preference of wanting all possible treatments regardless of chances for recovery were likely to report lower emotional preparedness.

3)    More senior CNAs, both in regard to age and tenure, reported higher preparedness levels.

4)    Greater support from coworkers and hospice involvement were associated with higher levels of both facets of preparedness, the latter in particular when hospice care was viewed positively by the CNAs.

This research concludes that more information about the status of residents and more exchange opportunities within the care team around end-of-life care-related challenges may help CNAs feel more prepared for residents' deaths and strengthen their ability to provide good end-of-life care. Creating this kind of context requires ongoing commitment, implementation, and monitoring.

In this video, a CNA explains her passion for hospice care and her role on the interdisciplinary team.

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

10 Life Steps to Good Death

1. Accept death as part of life.

Death will come when it comes, no matter how often you avoid the topic or how forcefully technology wrestles it to the ground.

2. Listen to the universe.

Some call it the universe, while many use Higher Power, God, or other names. If you believe you are part of an infinite enlightenment, be still and listen.

3. Expect rainbow smiles.

Rainbow smiles are joyous, healing, memorable moments that come more often when you anticipate them.

4. Live a healthy lifestyle.

Practice habits of good health. Commit to including them in your daily living.

5. Be informed and proactive.

Keep abreast of what’s going on. When circumstances arise that can benefit from your knowledge, apply what you know.

6. Do your best.

You can’t solve every problem or be everything to everybody. Just do all you can.

7. Give service to others.

Complement others by fulfilling needs through service. Both server and recipient benefit from this partnership.

8. Be grateful for blessings.

Blessings come like wondrous celebrations held in your honor. Let appreciation reign!

9. Put healthcare, financial, and property death decisions in writing.

Fulfillment of your end-of-life wishes will often depend on what you discuss and record now.

10. Have a dignified death journey.

Breathe in your final phase of life with contentment. Experience a dying process that brings beauty and calm to your personal letting go.

Copyright © Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes

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

Alzheimer's, Dementia in Prison: (Research, Video 2:28)

When people think about older adults with dementia, they usually think about them living at home or at institutions other than prisons. But the reality is that many older adults with Alzheimer's disease and other forms of dementia live as prison inmates. The United States puts more people in prison than any other country in the world. Over a three-year period, the number of prisoners from ages 65 and older grew 94 times the rate of the overall prison population. This is due to an aging population, longer prison sentences, and stricter parole laws.

This very vulnerable population is particularly challenging because early detection of Alzheimer’s and other dementias are difficult to diagnose and treat. Many prisoners live with serious risk factors for dementia such as depression. With no prison-specific guidelines, clinicians must be innovative in meeting these inmates’ needs in order to provide quality care.

The research community focused on dementia must include studies using the prison populations across the country and develop better guidelines for their treatment. This video features the challenges of the American prison system in dealing with older adult prisoners with dementia.

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

Young Volunteers Needed for Older Adults (Video 5:31)

In 2020, one in six Americans will be an older adult. Younger volunteers are increasingly needed to provide services for this rapidly growing population. My earliest memory of feeding a nursing home patient was not after I became an adult hospice volunteer. It was during my high school days when I joined a school club that encouraged me to make a positive difference in people's lives through service. Many times long-lasting seeds for service are sown with the young. Fortunately, I had opportunities to see service encouraged and modeled.

High school and college volunteers can benefit greatly in win-win partnerships that serve older adults. They often learn about career choices they may not have considered. On college resumes, potential employers look for service as an indication of good character. Some hospices and other healthcare facilities have teenage and young adult volunteers doing the following assignments:

1. Perform in-office work including filing, faxing, and preparing admission packets.

2. Host tea parties, movies, and other social events at nursing homes.

3. Provide one-on-one time and attention by reading to, writing letters for, playing games with, or simply talking and listening to patients.

4. Videotape, record, or make booklets of patients’ life reviews.

5. Assist families with yard work, cleaning out the garage, planting flowers, small paint jobs, and home-building projects (i.e. wheelchair ramps).

6. Assist patients and families by doing errands, walking dogs, picking up groceries, etc.

Little Brothers -Friends of the Elderly is a national network in America of non-profit volunteer-based organizations committed to relieving isolation and loneliness among the elderly. It serves those who are sixty and older who have no support in their immediate area. Their most important service is the Friendly Visiting Program where a volunteer is matched with an older adult friend. In this video, a 23-year-old volunteer shares his positive experiences with his “10 grandmas and 10 grandpas.” 

If you know other organizations that primarily serve older adults through volunteers, please mention them in the comments.

Note: Winner of the National Service-Learning Partnership Trailblazer Award, Frances Shani Parker, a national service-learning consultant, hospice volunteer, and former school principal, has been instrumental in implementing service-learning in school districts across the country. Service-learning is a teaching and learning approach that connects academic learning with meeting community needs. Her book includes a chapter on intergenerational partnerships between schools and nursing homes.

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