Tuesday, October 27, 2015

Death Ritual Celebrations: Holidays, Jazz Funeral (Video 7:39)

Fall is a time of the year when many people engage in formal and informal rituals celebrating loved ones who have died. Honoring the deceased is not a single act, but a unique personal journey that may consist of various tributes. People often rely more on grief expressions to help them cope in their daily lives and maintain their continuing connections with those who have gone.

Latin American communities hold Day of the Dead celebrations that include decorative altars, prayers, food, and other festivities that keep the spirits happy. Folk art skeletons and sugar skulls are prominent. All Saints’ Day is celebrated to honor saints, particularly those who do not have their own feast days. This day and All Souls’ Day, a day of prayer for deceased loved ones and others, often include families attending special masses and visiting cemeteries to decorate graves, pray, and light candles. For most people, remembrance activities are endearing declarations that sustain them during their long-term adjustment to loss.

In New Orleans, a jazz funeral is a death homegoing celebration with the deceased going home, crossing over to the other side. Mourners come prepared to render a dynamic farewell. 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, the hearse slowly enters for final services where they “cut the body loose” as it 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.

As this video illustrates, Juanita Brooks, a popular traditional jazz and gospel singer who died, must have been ecstatic with the large turnout of well-wishers expressing such jubilation in her send-off.

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.

Tuesday, October 20, 2015

Hospice Care: Nursing Home Staff Views (Research)

Staff views about healthcare play major roles in what they do, why they do it, and how they affect others. Nursing home staff perspectives regarding hospice care are particularly important because lives are literally at stake. As a hospice volunteer for many years in nursing homes, I was very aware of this relationship and the powerful impact of attitudes on resident care. More research in this area is both welcome and needed.

This research on nursing home staff hospice perspectives included views of 1,229 certified nursing assistants (CNAs), nurses, and social workers toward hospice care in 52 Indiana nursing homes. They responded to questions and open-ended prompts with these results:

1)  A majority of staff responded favorably regarding hospice care in nursing homes.

2)  About one-third of nursing home staff rated coordination of care lower than other aspects. Many comments highlighted examples of hospice being non-responsive to residents' needs. These represented important opportunities for improvement.

Based on my own readings and experiences as a hospice volunteer and former school administrator, three ways for improving hospice in nursing homes include more staff education, implementation, and monitoring of hospice practices. This must be ongoing, particularly in nursing homes with high staff turnover. 

Nursing home staff members who are focused on curing hospice residents may not readily embrace the hospice philosophy of non-curative care. For some, this is a major paradigm shift in thinking. It is critical that they commit to enhancing and maintaining their expertise in hospice practices. This includes the referral or non-referral of residents to hospice care and the timing of those referrals.

The quality of end-of-life care for any patients depends on the context in which the care is given. In the context of a nursing home, views of staff members regarding the hospice philosophy and the implementation of that philosophy greatly impact hospice residents’ experiences. Collaboration can work when hospices and nursing home leaders commit to operating strategically using communication, flexibility, and skills to match staffing to the nursing home environment. 

Read about who leaves hospice alive. Discharges can occur for several reasons:

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.

Tuesday, October 13, 2015

Older Adult Health, Friendships: Horse Lessons (Research, Video 4:48)

Although it’s well known that social relationships and trust are associated with psychological well-being and physical health, a researched-based reminder and video can still be helpful. This study on older adult social health included 149 community-dwelling adults aged 65 years and older (68 men, 81 women). Activities of daily living, social cohesion and trust, depression, subjective quality of life, current medical status, past medical history, and health behaviors were assessed in face-to-face interviews. Even neurobehavioral physical functions were assessed.

What were the research results?

As expected, scores for activities of daily living and Geriatric Depression Scale were significantly correlated with social cohesion and trust. Social cohesion and trust were significantly correlated with all subjective quality of life items. In addition, a strong correlation was observed between social cohesion, trust, and relationships with friends. Values for social cohesion and trust were significantly associated with both subjective sense of health and subjective happiness.

How does this influence our assessment of older adults?
Social cohesion and trust are important variables that influence self-rated health and happiness, independently of activities of daily living, age, and sex. When assessing geriatric psychological function, social cohesion and trust should be examined more carefully, given the association with a subjective sense of health, happiness, depression, and physical function.

What do horses have to do with this?
Plenty. If you’re like I am and don’t know jack about horse relationships, this video is a great introduction. Meet Arthur, William, and Harry in this delightful video. Savor what they teach us about friendship and trust at any age.

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