Poem About Loneliness in Older Adults/ Seniors

                                         
She waited, grasping like a New Year's resolution...

Festive holidays have brought cherished opportunities for many older adults to enjoy some visitors they seldom see during most of the year. Whether at home or in institutions, loneliness can be both difficult and dangerous for their overall health. Too many of them endure the negative impact of loneliness daily.

“Missing” is one of sixteen original poems at the end of each chapter in Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes. A hospice volunteer, I wrote it after witnessing the sadness of lonely nursing home residents who were missing the missing. They coped with ongoing loneliness that could easily have been avoided with gifts of time. But some relatives and friends kept putting off visiting them until it was too late.

As this new year begins with resolutions for change, consider making every effort to visit those who are ill or alone. Don’t sentence them to another year of missing you.

Missing

She waited,

hoping her years of caring

endured in grown-up minds,

rested in distant hearts,

conveyed how much she missed them.

She waited,

living real-time movies

of restless nights, anxious days

with inhaled hopes of fellowship,

exhaled sighs of deep despair.

She waited,

wishing nostalgic winds

flowed through cotton curtains,

brought relatives and friends

she cherished through the years.

She waited,

grasping like a New Year's resolution,

like a second suspended in time

until her clock stopped ticking

for visitors who never came.

© 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.

Hospice and Nursing Homes Blog

Green House Living: Not Your Traditional Nursing Home (Video 4:25 mins.)

A Green House is an example of culture change in long-term care living. The Robert Wood Johnson Foundation provides grant funding for the Green House model on a national level. Green Houses are self-contained dwellings of seven to ten residents who thrive as families in homes built to blend in with the neighborhood. Residents add their personal decorating touches, greet the day when they feel like it, plan menus, and eat with the staff. Mealtimes prepared in an open kitchen are unhurried and socially rewarding. Each elder has a private room and bath with easy access to all areas of the home.

At Green Houses, skilled nursing assistants (CNA’s), referred to as “shahbazes,” coordinate all facets of eldercare life with the support of nurses and therapists. They focus on nurturing, sustaining, and protecting residents. Residents are encouraged to be independent. This video titled “Green House: A Place to Call Home” showcases advantages of Green House living.

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Young Nursing Home Residents: Person-Centered Culture Change Must Include Them

As quiet as it’s kept, young residents are often found in nursing homes. They are a growing population that many overlook when they think of nursing homes as “old people’s homes.” In many ways, traditional nursing homes are not designed with needs of young residents in mind.

The first young resident I came to know while I was hospice volunteering was a young woman named Velma. She appeared to be in her early twenties. She was often stationed in her wheelchair in the hall near the elevator. She was not my patient, but, as a volunteer in nursing homes, I came in contact with many people. Velma was mentally impaired and did not speak in sentences. But she was quite good at waving and laughing loudly when I showed her attention on the way to my patient’s room. We had a little game where, pretending not to notice her when I was leaving, I would get on the elevator and then peep back at her and wave before the doors closed. She thought this was hilarious, and she watched me closely whenever I headed in that direction.

Another young resident was one of several roommates who shared a room with my patient. Many of my hospice patients had multiple roommates. Imagine dying while living on a daily basis in a room with three other people with various illnesses, including dementia. Warren, who seemed to be in his early thirties, roamed freely around the nursing home. While he also did not speak in sentences, his grunting sounds were perfect. He had a habit of running up behind me in the hall, covering my eyes with his hands, and grunting loudly, “Who? Who?” Of course, nobody else I knew did that to me, including elementary and middle school students at my school where I was principal. I always guessed he was the “mystery” person. Then we would both fall out laughing as if each time were the first. Thinking about this ongoing scenario still makes me have a rainbow smile.

But there was a sadness about these young people and some others I have seen in nursing homes. These residents, particularly those severely challenged, didn’t appear to have much scheduled to enrich them creatively other than watching television and observing what was going on around them. Sure, there were overlapping activities in which all ages could participate. But ages twenty through one hundred have unique requirements. Young people often craved attention and clearly needed more engaging activities focused on their age groups. Their needs must be addressed if nursing homes are to become person-centered in providing quality of life for all residents.

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Mental Health Services in Nursing Homes after Disasters

Earthquakes like the recent one in Haiti and hurricanes like Katrina remind us of the devastating effects of environmental disasters. Living with the traumatic reality of being surrounded by many deaths, experiencing tremendous personal loss, and suffering physical injuries take a tremendous toll mentally on survivors. While physical needs receive more immediate attention, mental health intervention issues must also be addressed.

Research from the University of South Florida on mental health services in nursing homes after hurricanes provides helpful information about how residents should be treated after disasters. Representing two-thirds of Florida's counties, a questionnaire was administered to 258 directors of nursing, administrators, and owners of nursing homes. Residents stated their mental health needs and service use. In addition, focus group meetings with 22 nursing home administrators evaluated residents' use of services.

Results revealed that disaster-related mental health services were not routinely provided to residents. When residents involved in a disaster did receive treatment, it was more likely to come from facilities where they were taken after the disaster, not the facilities from which they were evacuated.

This mental health research indicates a serious need for training nursing home staff members in the delivery of disaster-related mental health intervention. They also need training in the procedures for making referrals for follow-up evaluation and formal intervention. Mental health training would be beneficial in healing many disaster survivors who suffer from depression, grief, and post-traumatic stress disorder.

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Hospice Chaplain Planned Detroit Nursing Home Memorial Service

The need to honor the deceased in an atmosphere of healing and support from others has been a common manner for mourning the dead. But sometimes people die without family and friends available to handle funeral or memorial services that recognize, honor, and bring closure to death. Such was the case with my hospice patient named Lelia, whose memorial service was planned by the hospice chaplain:

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

A small group gathered in the recreation room at the nursing home. Most people present were other patients who knew Lelia. Essie, Lelia’s sister, came with a friend named Nola. The hospice chaplain opened the memorial ceremony with a prayer and a reading. Taking turns, we shared our memories of Lelia. Some comments were hilarious, while others revealed Lelia’s demons. We all discovered new layers of Lelia that came together in a mental mural of colorful qualities.

Essie spoke last, “I’m sitting here in shock listening to what you all said about my sister. I can’t believe we knew the same person. The Lelia I knew hardly ever said anything funny, and she sure wasn’t thoughtful, at least not to me. Even when I helped her get into this nursing home, she still acted like she hated me. She was grouchy and liked to criticize people all the time. Nobody was really close to her. To tell you the truth, nobody in our family was close to anybody else in the family. There was just too much drama going on all the time. That’s why I’m the only one here. I started not to come myself, but now I’m glad I did. I learned something new today. I feel better about Lelia after hearing your stories.”

Although the chaplain hadn’t known in advance how many would attend the ceremony, she had brought twelve helium balloons, the exact number needed for each person present to have a balloon to release later. Like colorful hula dancers swaying from strings tied to a chair, the balloons added a festive energy to Lelia’s homegoing. Riding down with the group on the elevator, Nola mentioned that she and Essie were both singers. We all agreed they should lead us in song when the balloons were released during our tribute to Lelia.

Our humble circle stood in the front yard of a Detroit nursing home to perform our final death ritual for Lelia. People riding by in cars on a busy street observed a lively group of ecstatic mourners looking upward, enthusiastically singing “Going to Shout All Over God’s Heaven.” Passionate voices resonated like rockets. We released our buoyant balls of bliss floating in a hurry to get somewhere. I imagined Lelia looking on, bobbing her head to the gospel beat. She grinned her toothless rainbow smile that colored our hearts with joy from the Other Side of Through when we all yelled, “Bye, Lelia! Have yourself a good time!”

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

Nursing Home, Long-Term Care Trends: Robotic Technology of the Future (Video 2:04 mins.)

                               

                                         Humanoid Service Robot REEM-B

Many people, particularly the graying pre-baby boomers, probably assume they won’t be around in the next 50 years. But with the speed of technological inventions nowadays, who really knows? Longevity continues to increase while fertility rates decrease. Social Security, Medicare, and Medicaid struggle with ongoing adjustments as demographics evolve into a future we can only predict. Fortunately, research from the University of Louisville School of Nursing in Kentucky gives us a glimpse into the future with results reported in "Nursing Clinics of North America.” These are the predicted trends for long-term care:

1) Future years will see a more diverse population with increased aggressive treatment of chronic illness.

2) Consumers of health care and their family caregivers will take more active steps to manage and coordinate their own care.

3) Housing trends that produce more senior-friendly
communities will encourage independent living rather than
seniors having to move into institutions.

4) Increased incentives for use of home and community-based care
will allow people to stay longer in their own homes in the community.

5) Technological advances, such as the use of robots serving as companions and assistants around the house, will also decrease
the need for institutional living.

This video gives a visual glance into the potential of robotics in the future with a demonstration by a humanoid robot built by Pal Technology. Robots like this could provide service at home to those who are unable to perform these actions themselves.

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

Video Poem: “Living Colors” (Nursing Home, Staff Shortage, Poor Vision, Alzheimer’s Disease, Hospice) 2:56 mins.

“Living Colors” is one of sixteen original poems included at the end of each chapter of "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes.” With poems, stories, and general information, "Becoming Dead Right" explores urban nursing homes, hospice care, caregiving, dementia, death preparations, and bereavement. Strategies for improving eldercare and nursing homes are examined.

This poem was inspired by one of my hospice patients who had Alzheimer’s disease and poor eyesight. More sight problems could be corrected in nursing homes if residents received vision care regularly. My patient needed assistance to eat, but there was a staff shortage that day. Staff shortages in nursing homes negatively impact patients across the country. Using her fingers, she started feeding herself. I arrived to find her with food smeared around her mouth. After wondering what that experience might have been like for her, I wrote this poem:

Living Colors



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

Culture Change: Nursing Home Dining (Video 2:13 mins.)

Broadwater Health Center (above) in Montana has cooked-to-order breakfasts and multiple-entree noon and evening meals.

The Centers for Medicare and Medicaid Services (CMS) guidelines for state surveyors give detailed information on accessing nursing home compliance with regulations. Recently, the CMS added that nursing homes must support residents' preferences and other efforts to transform nursing homes into homelike environments. Changes mentioned are both environmental and resident-centered. They include activities such as dining, scheduling, bathing, sleeping, and many more beneficial changes that will advance reform in nursing homes.

A hospice volunteer in Detroit nursing homes, I am aware of the great need for reform. Across America, best practices in many nursing homes are far ahead of those in too many others. But improving nursing homes requires much more than environmental enhancements and enrichment activities. Changing the culture of nursing homes successfully requires major shifts in thinking with input from all levels of staff, residents, and community. Incentives encouraging achievement of new and shared goals are also effective. A helpful resource is the National Consumer Voice for Quality Long-Term Care. This organization was formerly the National Citizens' Coalition for Nursing Home Reform (NCCNHR).

In this video titled "Culture Change Dining - Restaurant Style,” we see how residents and staff of Ballard Healthcare have implemented improvements in the dining program.

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

Video Poem: “Reflections of a Hospice Volunteer” (Hospice, Nursing Homes, Eldercare) 3:25 mins.

“Reflections of a Hospice Volunteer” is one of sixteen original poems included at the end of each chapter of "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes.” With poems, stories, and general information, "Becoming Dead Right" explores hospice care, urban nursing homes, caregiving, dementia, death preparations, and bereavement. Strategies for improving eldercare and nursing homes are examined.

Dedicated hospice volunteers everywhere enhance quality of life during patients’ final days. This poem expresses the win-win experience of many volunteers.



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

Culture Change in Nursing Homes: What Works, What Doesn’t (Video: 1:59 mins.)

Most people agree that changes in the stereotypical, traditional nursing homes are long overdue. What makes a nursing home really feel like home? What needs to happen to make that a reality? What are some of the barriers that negatively impact progress? A University of Pennsylvania research study about culture change in nursing homes focused on these concerns. After staff interviews were done, three nursing homes reported these results:

Barriers to Change

1) Exclusion of nurses to culture change activity (While nursing assistants were not mentioned here, I’m inclined to believe they were also excluded.)

2) Perceived corporate emphasis on regulatory compliance and the "bottom line” (money)

3) High turnover of administrators and caregivers

Promoters of Change

1) A critical mass of "change champions"

2) Shared values and goals

3) Resident/family participation

4) Empowerment at the facility level

Clearly, changing nursing homes successfully involves input
from all levels of staff, residents, and community. Incentives encouraging achievement of new and shared goals are also effective.

You can read more details about this study here.

You can view this video on the importance of inclusiveness in culture change proceedings.

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

Hospice Care Perceptions of Nursing Home Staff

In my book “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” there is a chapter titled “Healthier Hospice.” This chapter gives detailed explanations, based on my research and experiences as a hospice volunteer, regarding ways to improve hospice services in general. Included are variables that can improve hospice implementation in nursing homes. Nursing home staff members who are focused on curing patients may not embrace the hospice philosophy of non-curative care. It is critical that they commit to enhancing and maintaining their expertise in certain hospice practices.

The quality of end-of-life care for any patient depends on the context in which the care is given. In the context of a nursing home, perceptions of staff members regarding the hospice philosophy and the implementation of that philosophy greatly impact a potential hospice patients’ experience. This includes the referral or non-referral of patients to hospice care and the timing of those referrals.

In a study at Southern Illinois University Edwardsville, an understanding of factors influencing hospice referrals, nonreferrals, and timing of referrals was researched. Cross sections of staff members from seven nursing homes and two hospices were interviewed with the following results:

1) Nursing home staff members’ recognition of terminal decline, beliefs about hospice, and the initiatives they took “significantly influenced” patients’ referrals to hospice care and the timing of their referrals.

2) When death was perceived as unexpected (familiar signs not recognized by staff members), hospice referrals were delayed.

3) When nursing home staff members believed that hospice care was only for a crisis at the end of life or that hospice care did not add to nursing home care, hospice referrals were delayed.

4) Patients received longer hospice care when staff members believed hospice care complemented nursing home care and when staff members took the initiative to raise the option of hospice care.

This study confirms how important ongoing hospice training is for nursing home staff members. I emphasize ongoing because, in my experience as a hospice volunteer, regular staff turnover demands this. Without ongoing training, the quality of end-of-life care for potential hospice patients is jeopardized.

You can read more details about this important study here.

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

Culture Change in a Baby Boomer Nursing Home (Video 2:20 mins.)

In my book "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” Baby Boomer Haven refers to an imaginary nursing home based on best practices of some, but not nearly enough, nursing homes that exist today. In the last chapter, Ruth, a patient in a wheelchair, takes readers on a nursing home tour where residents and employees thrive in a culture where they feel empowered and respected. Many aspects of culture change are discussed and in evidence.

Roger Woodruff, Director of Palliative Care, International Association for Hospice and Palliative Care, Austin Health, Melbourne, Australia says of this book tour “I particularly enjoyed the guided tour, conducted from a wheelchair, of Baby Boomer Haven."

Book Excerpt:

“Management and staff have a great working relationship. Together they wrap us in a warm family quilt woven with reassurance. Everybody participates in decision-making and attends workshops, classes, and conferences to keep abreast of best practices in their fields. Various staff members are included in the hiring of new employees and, when appropriate, involved in their training. Periodic meetings are held with all shifts represented, so more in-depth information can be provided concerning patients. Employees take pride in their work and strive to continue our tradition of excellence. We’re all part of the same team, and we’re all cheerleaders.”

In this video, viewers are given an overview of how to implement resident-directed care.

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

Nursing Home Sex Offenders: Predators Living with Prey (Video 6:05 mins.)

Virginia Thurston, almost eighty years old and suffering from dementia, was sexually assaulted by another resident in her Jacksonville, Florida nursing home. The rapist, who had been sent to the home after being found homeless, had a twenty-page criminal record that included sexual assault and child molestation. A judge had declared him vulnerable and in need of protective care.

Unfortunately, most nursing homes are only required to do criminal background checks on employees. Residents with criminal records can be assigned to nursing homes with no one knowing their dangerous histories. Wes Bledsoe, an elder rights advocate, says he has tracked over 1600 sex offenders living in nursing homes. Most homes do not impose different supervision or separation requirements on residents who are known sex offenders.

The man who raped Virginia Thurston was found incompetent to stand trial and placed in a state home. What about all the other predators who remain? While some say that knowledge of residents’ criminal history does not determine their current conditions, others say sexual offenders should be in separate nursing home facilities. Oklahoma is the first state that takes registered sex offenders requiring long-term care out of standard nursing homes. In the meantime, caregivers must be vigilant in checking their patients for signs of emotional or physical abuse and personality changes. They should also be proactive in dealing with nursing home safety measures, including behavioral and physical patient assessments.

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

Eden Alternative for Nursing Homes (Video 6:52 mins.)

The following includes an excerpt from my book, "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes.” The chapter titled “Baby Boomer Haven” takes readers on a tour through an imaginary nursing home based on best practices of some, but not nearly enough, nursing homes that exist today. Animals and children are important additions to culture change of many nursing homes that are moving away from the stereotypical, traditional model.

“Watch out for Diva Dog over there, one of several resident pets. She’s just looking you over to make sure you look her over. In her spare time, she’s a certified psychologist. Other indoor animals on the site are located in our aviaries of brightly colored birds and in our aquariums with fish that mesmerize us with their antics. We have more animals outdoors such as horses and rabbits. It’s fascinating watching how all of our animals relate. They’re a lot like people, you know, and have much more sense than we think they do.

Employees seem to love working here as much as we love living here. Most have years of seniority, and hardly anybody is ever absent. Low staff turnover saves considerable money in overtime and in hiring temporary help. Two things all employees like are our flexible scheduling and childcare on the premises. This allows them to personalize their time and accomplish more at home and at work with fewer worries. If you look to your left through the window of the childcare center, you can see two employees having lunch with their children. The older gentleman is a resident reading to a small group. I love spending time with the little ones. I jokingly call them my little “ankle biters” when they aren’t around. Some of them call me, “Grandma,” and a few like to say “Big Mama,” which really tickles me because that’s what I called my grandmother.”

© Frances Shani Parker

There are several models of culture change for nursing homes. This video examines an approach known as the Eden Alternative.

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