When Older Adults, Seniors Want to Die (Hospice Nursing Home Story, Research)

Some people think being around dying patients must always be sad because everybody fears death, and no one really wants to die. As a hospice volunteer, I have had several patients who could prove them wrong. These nursing home residents actually stated they looked forward to death and gave reasons that had nothing to do with depression. This is what hospice patient Rose said to me about her upcoming death:

“How old did you tell me I was?” Rose asked.

“You’re ninety-nine, and you’ll be a hundred years old on your next birthday.”

“A hundred years old is too old. I don’t think I want to be that old.”

“There are three other ladies in this nursing home who are older than that. One is a hundred three. We talked to her last week during your wheelchair ride.”

“How much longer will it be before I make a hundred? I don’t know if I want to wait too much longer.”

“It’s only one more month. I remember you said you had spiritual talks with your minister. If you decide to wait, I’ll get you a big balloon that looks like a birthday cake.”

“I guess I could wait. Yes, I think I will wait. That way I can celebrate my hundredth birthday. When I do get to heaven, I can tell everybody I lived to be one hundred.”

And that’s exactly what she did.

(Excerpt from Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes)

But wanting to die is not always that simple. According to this VU University Medical Center research study in Amsterdam about older adults’ death thoughts and wishes, 81.3% never had them. Among those who did, 67% had depressive symptoms, and 20% suffered from a depressive disorder. Wanting to die was associated with depressive symptoms, a depressive disorder, lower perceived mastery, financial problems, loneliness, small network, involuntary urine loss, being divorced, and having a speech impediment.

What can we learn from this research? Certain situations increase the likelihood that an older person wants to die. Although the desire to die may not be related to depressive symptoms, depression should be cause for investigation about death wishes and should be treated.

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.

Hospice and Nursing Homes Blog

Massage Therapy in Hospice and Palliative Care (Research, Video 3:35)

When I reached over and held my hospice patient’s hand, she smiled saying, “Now, that’s nice.” This simple meeting of skin and energy represented her treasure for the day, week, month, or whatever amount of time had passed since her last encounter with physical affection from another human being. For many patients in nursing homes, these moments seldom came.

Although little research on the use of touch with older adults has been done, it is obvious that touching can be a positive form of communication. But touch can do so much more. When used during massage therapy with older adults, particularly those receiving hospice-palliative care, touching can improve their quality of life significantly on several levels. The Gerontology Department at the University of Kentucky compared self-reported health outcome scores among older adults regarding their use of massage therapy. Those who reported massage therapy usage in the past year had significantly better health outcome scores in the following domains:

1)  Emotional well-being 

2)  Limitations due to physical issues  

3)  Limitations due to emotional issues

These research results reinforce the beneficial role massage can play in hospice-palliative care.

This video from Everflowing showcases a touch exercise during a hospice caregivers’ training workshop. Irene Smith, who believes the healing of touch is reciprocal, narrates “The Language of Touch.” 

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers in America and other countries and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Hospice-Palliative Volunteers Support Patients’ Social Activities

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes by Frances Shani Parker is now published in e-book form at Amazon and Barnes and Noble booksellers.

Hospice-palliative patients are not always able to participate in many social activities, but they should be encouraged to become involved when they can. Social interactions can improve their sense of belonging, distract them from being depressed, and bolster their independence. Sometimes they can watch from the sidelines while still expressing their opinions and creativity.

As a hospice volunteer in Detroit nursing homes for many years, I found it very rewarding being a catalyst for patient involvement at festive gatherings. The following excerpt from Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes (paperback and e-book editions) demonstrates an important role volunteers can play in supporting patients’ participation:

Richard, my hospice patient in his eighties, seemed depressed some days, as if leaving his room to spend time with others was too much of a bother. I focused on ways to help him turn his indifference inside out, even as death’s footsteps quickened down his path. After a great deal of motivating conversation, I finally convinced him to allow me to give him a wheelchair ride to a theatrical performance at the nursing home.

 “Along the way, Richard greeted other patients and staff members who were headed down the hall in the same direction. Some shuffled along with canes and walkers, while others moved with little or no assistance. Caressing her blanket, a white-haired woman with dementia told Richard she was on her way to the airport to catch a plane. A man broke out in song with “We’re Off to See the Wizard.” I couldn’t help rolling my eyes in disbelief when Richard started telling people to hurry, so we wouldn’t be late. With each turn of his wheelchair, I could feel his energy growing as we approached the big blue room, a place that made him feel good.

 Exhilaration ignited as the show started. Accompanied by the soft thunder of drumbeats, speakers shared stories and poems in praise of their elders. Residents were given small instruments to play and were coaxed to join in singing lively songs. Dances from back in the day inspired some audience members to sway in their seats. For a soul-stirring while, the nursing home disappeared. We were all transported to a fabulous planet where euphoria was our oxygen. I watched a radiant Richard wave at people he recognized, holler when the emcee gave the signal, and clap like his life depended on it. And the quality of his life really did.”

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.

Hospice and Nursing Homes Blog

Curative Medical Care vs. Non-Curative Hospice Care: Two Men in Love with the Same Woman

Curative medical care and non-curative hospice care are like two men in love with the same woman. The curative man, who has enjoyed many wonderful years with her, is reluctant to let her go. But their joy together has declined with time. While she appreciates the fulfillment they shared in the past, she now feels a lack of commitment to him and an urgency to move on with her life. The hospice man, the new love in her life, fills the void she is experiencing and brings an essential enhancement to her well being. He longs to stay with her because their relationship has reached a mutually meaningful level. The woman he loves embraces the happiness his hospice presence brings.

Unfortunately, many experience this love triangle in varied ways. Patients may resist the prediction of death within months and the prospect of involving outsiders as caregivers. Some doctors and caregivers may be reluctant to admit that a patient cannot be saved. Medical staff focused on curing all patients may not totally commit to the hospice philosophy of non-curative care when working with hospice patients.

Love triangles like this that exist in nursing homes and other institutions must be resolved with focus on the best interests of patients. In order to improve treatment of the terminally ill, institutions that have hospice programs must be dedicated to promoting staff expertise in hospice practices. This commitment must include clear administrative support with ongoing education and monitoring of staff practices. This will ensure that hospice patients receive services appropriate to their non-curative condition. 

What’s love got to do with it? Everything. In some institutions where these positive partnerships have been implemented, hospice practices such as better pain management have naturally become part of the care given to terminally ill patients who are not in hospice programs. True love can be contagious like that.

Can two men be in love with the same woman? Sure, if they respect each other’s boundaries, strive for a healthy relationship including the woman’s needs, and understand that, when lovers lose their mutual joy and loyalty, moving on can be love’s greatest expression.

Frances Shani Parker, Author

"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”

“Hospice and Nursing Homes Blog”

Perspectives on Dying from Hospice Patients and Healthcare Professionals: (Video 4:28 mins.)

Too often, I talk to adult children who haven't discussed death matters with their elderly parents. Sometimes when they try, parents won’t participate in the discussion. Most people die in institutions, and planning ahead is very important. Advance directives, wills, and other death-related documents should be completed before a crisis occurs and should be readily available.

A research study by the University of Georgia Institute of Gerontology focused on end-of-life preparations and preferences of elders and adult children of elders. Interviews were held with the two groups. The study determined that barriers to discussions about end-of-life preparation and preferences were fear of death, trust in others to make decisions, family dynamics, and uncertainty about preferences. Factors that promoted these discussions were acceptance of the reality of death, prior experience with death, religion or spirituality, and a desire to help the family.

Casually approaching end-of life discussions and creating written records of preparation and preferences were considered successful strategies for expanding communication on this sensitive topic. Knowing good solutions to overcome obstacles and promote these discussions can assist healthcare professionals in encouraging elders and their families in planning ahead.

What are the needs of the dying? How can the end of life be integrated as a natural and sacred human process? This video titled “Solace: Wisdom of the Dying” presents perspectives on dying from hospice patients and healthcare professionals.

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