School-Nursing Home Partnerships (Service-Learning, Dementia)

I have had many occasions as an educator to implement and consult on intergenerational partnerships between schools and nursing homes. This was done through service-learning, a teaching and learning approach that connects learning with meeting community needs. Included in curriculum learning objectives, service-learning is used by many schools and community organizations. For example, after students learn how to write letters at school, service-learning could include writing letters to nursing home residents who would benefit from receiving them. Students can also do school performances at nursing homes.

A growing body of service-learning research shows that students benefit academically and affectively from service-learning. Because teachers prepare students well before their nursing home visits, students know what to expect. If a resident falls asleep or cries, students understand why that is okay. Dementia is understood with relevance and meaning. Students are open to the experience of being with the elderly and the challenged. They take pride in the roles they play as visiting caregivers who enrich lives. They empathize with the realities of residents living with dementia.

After students return to school, they reflect on how their nursing home visit affected residents and  themselves, what they learned, and ways to share that information with others. While students' reflections can take many forms (written, oral, dance, music, art), the poem below is an example of a student’s poetic reflection. My book, Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes, includes a chapter on intergenerational partnerships between schools and nursing homes. 

A Student's Service-Learning Reflections

I know you erase your

roommate sometimes, 

take distant trips in your mind, 

see me as a short brown blur

when I visit your nursing home.

I know your childhood

friends whisper secrets,

your favorite dress has ruffles,

my cards touch you with sunshine,

you love the stories I tell.

I know that carrots

make you frown,

my visits swing you higher,

loneliness glues you down,

you miss your friends who died.

I know your words 

make me feel better,

feed my heart with praise,

help me care about others

the way you care about me.

© Frances Shani Parker

Note: Winner of the National Service-Learning Partnership Trailblazer Award, Frances Shani Parker, a hospice volunteer, writer,  eldercare consultant, and retired Detroit Public Schools principal, has been instrumental in implementing service-learning in school districts across America.

You can read about fourth graders' nursing home research on ageism stereotypes 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 online and offline booksellers. Visit Hospice and Nursing Homes Blog and Frances Shani Parker's Website.

Nursing Home-School Similarities, Connections (Video 2:40)

Years ago, I was principal of a schoolwide, service-learning school where all staff and students performed service in the community. Students' service was connected to the school curriculum, giving them opportunities to use what they learned to improve the community. For example, fourth graders learned how to write biographies by interviewing residents of a local nursing home. Later, each resident was given a booklet with all the residents’ biographies so they could learn more about one another.

My own service included weekly hospice volunteering in Detroit, Michigan nursing homes. It didn’t take long before I observed that nursing homes and schools have several important similarities. Both have cultures that impact people in institutions. A paradigm shift in how these institutions are often perceived, not only by the public, but also by those who work in them, was long overdue. This needed transformation is often referred to as person-centered culture change, a movement that focuses on values and practices that respect the input of everyone involved with the institutions.

Through the eyes of an educator and hospice volunteer, I focused on person-centered care with residents. In order for a person-centered climate to fully enhance quality of life in nursing homes and other residential institutions for older adults, residents must have experiences similar to what students should have in schools. Like students, residents must first know that the nursing home is a real “home” where they are welcomed and cherished at all times. They must feel that their environments are safe, that trustworthy employees care about them and listen to them with their hearts. Residents must know that their progress as individuals with specialized needs is the primary motivation for everything that goes on. Those with dementia should be challenged to learn new skills in non-threatening ways.

Residents must know that the personal histories they bring matter. These life stories help create who they are, not labels like “dementia” which are too often used to judge them and put them in stereotypical categories during their later years. They need ongoing encouragement to use their strengths in productive ways to improve their self-esteem and enhance lives of others. Their talents and accomplishments should be shared with the larger group so they can be appreciated and praised. Finally, their “graduations” (deaths) should be recognized as revered events.

Sometimes older adult communities and schools have the great pleasure of bonding into something wonderful together. The following video features Providence Mount St. Vincent in Seattle, Washington. It is a typical community home to about 400 residents. What really sets this facility apart from many other communities like this is the preschool, the Intergenerational Learning Center, which provides children and older adults with opportunities to bond. These young children learn about acceptance of older adults while they are being nurtured. At the same time, the older adults develop a greater sense of self-worth and foster social interactions. That's a win-win relationship for everyone.

You can read about our fourth graders' nursing home research on ageism stereotypes here.

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Read “10 Rules of the Education Game for Educators” by Frances Shani Parker here.

Note: Winner of the National Service-Learning Partnership Trailblazer Award, Frances Shani Parker, a hospice volunteer, writer, and eldercare consultant has been instrumental in implementing service-learning in school districts across the country.

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

Win-Win Hospice Volunteering

By Frances Shani Parker

1) Remember why you serve.

There’s a reason you feel compelled to enhance lives of the terminally ill. Cherish that inspiration. Move forward committed to an amazing and rewarding healthcare adventure.

2) Believe it’s all win-win.

Providing end-of-life service is a privilege, not a calling to be a savior. You and those you support come together in relationships of mutual improvement. Honor your win-win journey.

3) Be present.

By all means, show up. But be present with patients after you arrive. Evaluate appearances, behaviors, surroundings, and interactions with others. Listen with your heart. Even silence speaks. Really try to understand life from their perspectives. Focus on advocacy for improving their quality of living.

4) Try other doors.

Patients will have challenges such as dementia that may not respond to your usual front-door communication. Try other doors and even windows. Obstacles are enrichment opportunities in your partnerships with patients. Touch, music, pictures, stories, and fantasies are a few entry points. Let patients help you navigate your way into their world.

5) Know your piece in the puzzle.

Adherence to rules of protocol and professional ethics should be routine. Be aware of boundaries such as confidentiality regarding yourself, your patients, and their loved ones. Follow guidelines of your hospice organization, and seek help when needed.

6) Untie your knots.

There may be times of doubt, confusion, sadness, and guilt. These are normal knots of the caregiving process. Untie them by seeking support for your total well-being. Maintain proper rest, nutrition, exercise, and balance in your own life. Do your best. Don’t be surprised when you discover reasons to kiss yourself.

7) Spread the word.

Be knowledgeable about hospice and palliative care. Share information so others can benefit from these specialized areas of healthcare. Encourage involvement in hospice and palliative care career and service activities.

8) Pick up a turtle.

If you see a turtle sitting on a fence post, you know somebody helped to put it there. Be on the lookout for turtles aiming for fence posts. Be a role model for other volunteers. Participate in organizations, conferences, workshops, and discussion groups where you can share best practices while learning new ideas.

9) Write death sentences.

Death will come no matter how often you avoid it or wrestle it to the ground. Have your advance directives, finances, and property in legal order. Urge others to do the same. Don’t burden loved ones later with important decisions you can record now. As you unfasten yourself from this life, be satisfied knowing your death sentences will be carried out according to your wishes.

10) Expect rainbow smiles.

Rainbow smiles hug you so tightly you can feel ribs of joy press against your essence. Hospice volunteering provides ongoing experiences for you to positively impact lives. When you do, rainbow smiles will come.

© Frances Shani Parker, author of 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

Hospice Volunteer Training Video: Caregiving, Dementia, Death, More (Video 30:16)

Frances Shani Parker, an eldercare consultant, writer and former school principal, has been a dedicated hospice volunteer for many years. In addition to serving nursing home residents, she is author of Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes (paperback, e-book) and writes a popular blog titled Hospice and Nursing Homes Blog. Featured in various eldercare media, she was interviewed on the television show Aging Well in America. She shares her experiences and general eldercare information that can benefit others, especially hospice and other healthcare volunteers. The video interview below covers these topics:

Hospice

Hospice Volunteer Training

Nursing Homes (Long-Term Care)

Volunteering

Caregiving

Dementia

Death Preparations

Intergenerational Partnerships

Older Adult Stereotypes

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 editions at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Frances Shani Parker and Anne Marie Gattari Television Interview: Aging Well in America (Video 30:16)

Frances Shani Parker, an eldercare consultant, former school principal, hospice volunteer, and author of Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes, was featured guest on Aging Well in America, a television show hosted by Anne Marie Gattari. The interview covered these topics:

Hospice

Nursing Homes

Volunteering

Caregiving

Dementia

Death Preparations

Intergenerational Partnerships 

Older Adult Stereotypes

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

Community Service By Older Adults Living in Nursing Homes, Assisted Living

Lettie Miller Frye, an assisted living resident of Greenfield makes quilts to raise funds for the Edinburg Volunteer Fire Department. Photo by Rich Cooley/Northern Virginia Daily News

When I was writing my book Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes, I created a chapter about a nursing home called Baby Boomer Haven based on best practices of various nursing homes, but not nearly enough, around America. This imaginary nursing home includes older adults performing community service. In this book excerpt, Ruth, a wheelchair –riding resident, takes readers on a tour and explains some of the service activities they perform:

“At Baby Boomer Heaven, I mean Haven, we emphasize win-win community service. We’ve learned that when we join with the community and put all of our notes together, we create some fine songs. Of course, we appreciate service from others, but we want to serve people, too. We want to feel like we are doing our part to make the world a better place now and for future generations.

Our gift shop sells crafts we make to help fund service projects.  Among several services we provide, residents help Fetching Feasts provide meals delivered to seniors at their homes. We perform tasks here that make the process easier for them. We sew blankets for newborns. We often tutor and read to children at our childcare center."

Ruth goes on to explain other service activities in which residents demonstrate their reciprocal partnership with the local community. Do you have community service activities to share about residents in older adult communities?

If you would like to know more about positive and negative aspects of nursing home life and how families can transition loved ones to long-term care facilities, Jonathan Rosenfeld, writer of Nursing Homes Abuse Blog recommends ten helpful resources there that can assist you.

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.

A Nursing Home is Like a School: Person-Centered Culture Change (Video 3:06)

I started hospice volunteering in Detroit nursing homes while I was a public school principal. It didn’t take long before I observed that nursing homes and schools have several important similarities. Both have cultures that impact people in institutions. A paradigm shift in how some of these institutions are often perceived, not only by the public, but also by those who work in them, is long overdue. This needed transformation is often referred to as person- centered culture change, a movement that focuses on values and practices that respect the input of everyone involved with the institution. Through the eyes of an educator, I will mainly address culture change regarding residents.

In order for a person-centered climate to fully enhance quality of life in nursing homes and other residential institutions for older adults, residents must have experiences similar to what students should have in schools. Like students, residents must first know that the nursing home is a real “home” where they are welcomed and cherished at all times. They must feel that their environments are safe, that trustworthy employees care about them and listen to them with their hearts. Residents must know that their progress as individuals with specialized needs is the primary motivation for everything that goes on. Those with dementia should be challenged to learn new skills in non-threatening ways.

Residents must know that the personal histories they bring matter. These life stories help create who they are, not labels used to judge them and put them in stereotypical categories during their later years. They need ongoing encouragement to use their strengths in productive ways to improve their self-esteem and enhance lives of others. Their talents and accomplishments should be shared with the larger group so they can be appreciated and praised. Finally, their “graduations” (deaths) should be recognized as revered events.

For many institutions, person-centered culture change may seem overwhelming. But the rewards are immense when sincere efforts begin with everyone’s ongoing commitment to succeed. 

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

Dolls and Other Dementia Therapy (Research, Video 2:32)

 “What’s your baby’s name?” I asked while exploring my hospice dementia patient’s reality. Susan and her doll stared at each other, grinning as if they knew secrets from ancient times. And maybe they did. She looked at me, pointed to her doll and said, “She’ll tell you her name when you come back with cookies.”  (excerpt from my book Becoming Dead Right)

Patients with dementia find various stimuli engaging, some more than others. It’s important for caregivers to know which approaches are more likely to be successful when working with patients. The Research Institute on Aging of Charles E. Smith Life Communities in Maryland did research to determine stimulus engagement with193 residents of seven Maryland nursing homes. These results were reported in the American Journal of Geriatric Psychiatry:

1)      One-on-one socializing with a research assistant, a real baby, personalized stimuli based on the person's self-identity, a lifelike doll, a respite video, and envelopes to stamp were the most engaging stimuli.

2)      Refusal of stimuli was higher among those with higher levels of cognitive function and related to the stimulus' social appropriateness.

3)      Women showed more attention and had more positive attitudes for live social stimuli, simulated social stimuli, and artistic tasks than did men.

4)      Persons with comparatively higher levels of cognitive functioning were more likely to be engaged in manipulative and work tasks, whereas those with low levels of cognitive functioning spent relatively more time responding to social stimuli.

5)      The most effective stimuli did not differ for those most likely to be engaged and those least likely to be engaged.

Caregivers, particularly those in long-term care facilities, can use these dementia therapy research results when planning engagement stimuli and one-on-one socialization schedules for residents with dementia. This will help caregivers maximize benefits for patients.

As a hospice volunteer in Detroit nursing homes, I observed how easily many patients with dementia enjoyed their close relationships with dolls and stuffed animals. In this video, a daughter does doll therapy with her mother, who is past middle stage dementia. I found this video particularly interesting because, unlike many patients I have observed, this mother freely admits she knows her doll is not a real baby. But she still enjoys nurturing the doll and pretending it is real. The daughter wonders if the doll therapy is truly age appropriate for her mother. This video shares the mother’s response.

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

The Long and Short of Hospice Time in Nursing Homes (Research)

As a hospice volunteer in Detroit nursing homes, I have had hospice patients stay as short as one day and as long as three years. With little quiet or privacy, almost all of them shared rooms with one to three non-hospice residents. My three-year patient was 94 years old. Having few visits from relatives and friends who lived out of town, her biggest fear was the possibility of being released from hospice care and the nursing home. I’ve also had rare happy patients who were released from hospice because their health improved.

One patient with dementia seemed to have a premonition that she would be leaving soon when she said to me one day, “I was wondering if you could help me find another apartment. I’ve been thinking about looking for a new place to stay, maybe a place closer to where I used to live. This apartment building is too noisy. Just close your eyes and listen to all the talking, buzzers, and everything. People come into my place without even knocking. They just walk right in and go through my closet and drawers. It’s not right. Three ladies even moved in with me when I wasn’t looking. Now, I can’t get them out.” I had never heard her say anything about leaving before. Two weeks later, she was released from hospice care and moved to a nursing home near her son’s house.

Are there characteristics of nursing homes and residents that are associated with long and short hospice stays? Using 13,479 residents enrolled in hospice care, researchers at Harvard Medical School looked for answers to this question. Research results indicated the following:

1)    Nursing home characteristics were not statistically significant predictors of long stays.

2)    The probability of a short stay increased with the facility's nurse staffing ratio and decreased with the share of residents covered by Medicaid.

3)    Men (relative to women) and blacks (relative to whites) were less likely to have a long stay and more likely to have a short stay.

4)    Those 70 years or younger (relative to those 81-90) and residents with Alzheimer's disease/dementia were more likely to have long stays and less likely to have short stays.

5)    Fourteen percent of hospice users were discharged before death because they failed to meet Medicare hospice eligibility criteria. These residents on average had longer lengths of stays.

If you work with hospice patients in nursing homes, have you noticed these occurrences? Researchers concluded “high rates of discharge before death that may reflect a less predictable life trajectory of nursing home residents suggests that further evaluation of the hospice benefit for nursing home residents may be needed.”

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”