Service-Learning Intergenerational Partnerships: Schools and Nursing Homes (Students' Research Link Included)

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes includes a chapter on service-learning intergenerational partnerships between schools and nursing homes.

What if I’m a student who needs mentoring, diverse experiences, and opportunities to share my skills with others? What if I’m a nursing home resident wishing I had some visitors, thinking I can still make positive contributions, looking forward to interacting with young people? If this sounds like a match between an itch and a scratch, you’ll understand why service-learning is so important.

Service-learning is a teaching and learning approach that connects learning with meeting community needs. It’s not the same as community service, although that’s another good service practice. Service-learning evolves from learning objectives in a school or community group setting. For example, after students learn how to write letters, service-learning would include writing letters to community people who would benefit from receiving their letters. Of course, service recipients might show their appreciation by writing students letters in response. The exchange is usually win-win.

Nursing homes are ideal places for students to visit and share what they are learning in school. Residents provide welcome audiences for students eager to perform their skits, songs, and poetry. Students can display and explain class projects and interview residents in supportive environments. Afterwards, they can mingle with residents and let the magic of intergenerational communication work to everyone’s mutual benefit. 

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’s okay. The word "dementia" can be added to their vocabulary with relevance and meaning. They are open to the experience of being with the elderly and the challenged. They take pride in the roles they play in enriching lives. After they return to school, students reflect on how the nursing home visit affected them, what they learned, and ways to share that information with others.

You can view our fourth graders' ageism research at the link below. This resulted from their partnership with nursing home residents: 

https://www.linkedin.com/pulse/intergenerational-service-learning-student-nursing-home-parker?trk=mp-author-card

Note: Winner of the National Service-Learning Partnership Trailblazer Award, Frances Shani Parker, an eldercare consultant, hospice volunteer, blogger, and former schoolwide service-learning principal, 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

Elderly Brain Health: It's Never Too Late to Exercise.

Do you really lose it if you don’t use it? Is it no pain, no healthy brain? That depends on the people you ask. Before you start asking, however, keep in mind the DNA factor that we all have when it comes to heredity. Aside from that, we can do a lot ourselves to keep from losing our capacities to stay sharp mentally and possibly keep dementia at bay. An important key is to start exercising our brains early when we are young, in preparation for when we get old. But it’s never too late to start.

Speaking of brain exercise, here’s one submitted by Javan at Braingle: Brain Teasers, Puzzles, Riddles, Trivia, and Games. Answers are at the end of this post:

Find out what the animals are! For example, "to run away or escape" would be a "flea.”

1. Hair-control foam
2. Very exposed
3. Telling falsities
4. A lamenting cry
5. A dull person
6. A precious or loved one
7. First, you get a parking ticket, and then you get this.
8. These make up a chain.

A study by Advanced Cognitive Training for Independence and Vital Elderly (ACTIVE), which included about 3,000 volunteers, concluded that after 18 instructional hours of varied thinking skills, participants were still better at those skills five years later. Learning to do new and challenging activities during old age has its benefits.

Even better is coming to old age with a history of being mentally active, with brain power in reserve. Good nutrition and physical exercise will enhance chances of success even more. One study showed that physical exercise by seniors increases brain power. Start crunching and doing that brain cardio. You can listen to more about maintaining a healthy brain in old age at the NPR.org Web site.

Okay, here are the animal answers:

1.Moose (Mousse)
2. Bear (Bare)
3. Lion (Lyin')
4. Whale (Wail)
5. Boar (Bore)
6. Deer (Dear)
7. Toad (Towed)
8. Lynx (Links)

Whether you have them all right or not, your brain is healthier for trying. Congratulations!


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

Hospice in Prison: Inmate Volunteers (Video 4:17 mins.)

Hospice volunteering continues to evolve and diversify. In previous posts, I have explored hospice volunteers for pets and hospice volunteer medical students. How about prison inmates as hospice volunteers? It’s a great solution, particularly for an aging prison population. If a terminally ill patient is in prison, attentive caregiving can be especially beneficial when given by familiar faces of those who have also experienced the prison system.

A partnership between the McDougall-Walker Correctional Institution and Hospice and Palliative Care of Connecticut trains inmates who volunteer for hospice service. Participants learn how to implement the hospice philosophy by using supportive strategies with fellow inmates who are dying. Inmates who volunteer realize that they may die in prison one day and would want quality end-of-life care for themselves.

Tone, the first terminally ill inmate to benefit from the hospice volunteer program speaks favorably about the activities he shares with his volunteer. He appreciates not having to feel isolated at such a critical time in his life. If he is still alive after he has served his sentence, he will continue in hospice care outside the prison system with a new volunteer.

At a more recent blog post, you can read about and view a video showcasing hospice volunteer inmates at the Louisiana State Penitentiary.

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

Culture Change in Nursing Homes: Sexual Orientation (LGBT)

A supporter of culture change in nursing homes, Barry Berman, the executive director of the Chelsea Jewish Nursing Home Foundation, says his organization sees a need for skilled-nursing services and care targeting the lesbian, gay, bisexual, and transgender (LGBT) market. The building of what will probably be the first skilled-nursing home LGBT facility in America will address that concern.

Due to misunderstandings or intolerance by others, elders of the LGBT community are sometimes made to feel uncomfortable about their sexual orientations and lifestyles. In some nursing home environments, they may be criticized or ostracized for doing what heterosexuals consider normal for themselves during everyday living. This includes such practices as spending time with their partners, reading LGBT materials, and freely sharing personal opinions.

The Chelsea Jewish Nursing Home Foundation will begin construction next year on a $26 million nursing home complex, which will have specialized units for the elderly with specific diseases and needs. Targeted health areas include Lou Gehrig’s disease (ALS), blindness, and multiple sclerosis. One ten-bedroom unit will be used by elderly LGBT residents. The LGBT unit, which should open in 2009, will be called the Elsie Frank House, named after a famous openly gay political leader and the late mother of U.S. Rep. Barney Frank (D-Newton). You can read this “Boston Herald” news article for more information about this specialized implementation of culture change in nursing homes.

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

Cemetery Technology: After Death – What would Grandma say?

Remember the good old days when you went to the cemetery with relatives to clean Grandma’s grave and leave flowers? Nowadays, this visitation takes on a whole new meaning. With all the pictures and symbols etched into stone, some granite headstones look more like scrapbooks. After all, a cemetery is about remembering. Now, there’s the Memory Medallion, a memory chip embedded into Grandma’s headstone, plaque, or monument, so you can see her picture while she tells you about her life and dishes out some old-school advice. In addition to this, hyperlinks can give you access to more information, photographs, videos, etc. that can be viewed on your hand-held computer or laptop.

Don’t feel like walking around graves? Go to a drive-by cemetery with low, tilted monuments that you can read while passing through. No need to get out of the car when you can look out the window. Don’t even worry about the time of day. Grandma’s tombstone glows in the dark.

Prefer not leaving home at all? Try one of several Web cemeteries like the World Wide Cemetery on the Internet. Grandma can rest in peace there with over 30 million other people keeping her company. Some cemeteries include pets. After entering through the virtual gate entrance, you can add family photos, sounds, hyperlinks to other sites, and your personalized memorial text. Did I mention you can leave flowers and a donation? Just give the okay. Checks and credit cards are respectfully accepted.

Finally, do you just want to connect with Grandma and not deal with cemeteries at all? No problem. Grandma can write plenty of e-mails addressed to you before she dies and arrange to have them delivered to you periodically after her death. It’s just another way to reach out and touch.

Death really hasn’t changed much. But our approaches to memorializing it have. Some say all this technology trivializes death and takes away from the spirituality. Others say it customizes their true feelings and the spirit of the deceased. My, my, what would your grandma say about all this?

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

Hospice Care and Advance Directives

Advance directives are important legal documents that can be completed long before a patient is ill. The healthcare power of attorney, also known as the durable power of attorney for healthcare, designates the healthcare proxy, who is the person assigned to make medical decisions for the patient when the patient is no longer able to do so. The living will states the patient’s wishes regarding the administration of end-of-life medical treatment when the patient cannot state them.

Advance directives are available at hospitals, physicians’ offices, legal offices, state health departments, and on the Internet. All states do not have the same forms. People can register completed forms at the U.S. Living Will Registry, which makes their requests available to hospitals and healthcare providers across the country 24 hours a day.

In a national research study on advance directives, the Journal of the American Geriatrics Society reported that of the 1,587 who died in nursing homes, hospitals, and at home, 70.8% had Advance Directives. Hospice patients were more likely to have them. Patients with Advance Directives were less likely to use a feeding tube or respirator during the last month of life. Among other conclusions, the study determined that Advance Directives were associated with greater use of hospice and fewer concerns with physician communication and information about what to expect.

The Five Wishes document is unique among all other living will and health agent forms because it looks to all of a person's needs: medical, personal, emotional and spiritual. This document helps people express how they want to be treated if they are seriously ill and unable to speak for themselves. Click here for more information on the Five Wishes document.

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

Elderly Hurricane Katrina Evacuee (Video 1:27 mins.)

What happens when you’re ninety-two years old and a Hurricane Katrina evacuee? For many of the elderly, the hardships of evacuating and relocating have been overwhelming. The loss of family, friends, possessions, and a way of life, along with chronic insecurity about the future, have taken a serious toll on them physically, mentally, and emotionally. While not listed in the official hurricane death count, it’s common knowledge that significant numbers of the elderly who have died during the two years after the hurricane were victims whose deaths were escalated by hurricane related causes.

Many of the elderly have survived with battered spirits and bodies. One elderly man’s story is told in this video titled “St. Bernard Project Rebuilding New Orleans Post-Katrina.”

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

Nursing Home Neglect and Abuse

What causes a staff person in a nursing home to neglect or abuse a patient? There could be several reasons. But there is still no excuse for neglect or abuse. I once saw a patient slap a nurse aide so hard, I thought she would fall to the floor. To the nurse aide’s credit, she stopped, took a deep breath, and walked away. Another nurse aide took over. The patient, who had dementia, probably didn’t remember the incident later. I bring up this case to illustrate the kind of stress under which many staff members operate. Working in some nursing homes is not an easy job, especially when staff shortages and increased workloads are often the norm. But stress is not the only reason for neglect and abuse.

All staff members need ongoing training in patient care, as well as ongoing strategies for coping with the kinds of problems that are inherent to their positions. I know nursing home staff members who love their jobs and genuinely care about their patients’ well being. But working in a nursing home requires a special kind of person. Employees who have demonstrated an inability or unwillingness to perform their duties correctly should be held accountable and not allowed to continue working. The same goes for nursing homes that continue to get cited for violations.

Nursing home abuse includes behaviors such as residents being verbally degraded and physically punched, slapped, and even kicked by staff. Sexual abuse has also been reported. Nursing home residents are very vulnerable and sometimes cannot or will not report abuses. That’s why it is so important for caregivers and others to be to be watchful, protective advocates for patients, particularly those with dementia. They should look for signs of abuse, ask patients and other staff members questions, and vary the times of frequent visits.

Most of all, patient advocates should follow through until they get satisfactory results when abuse or neglect takes place. This can be accomplished by reporting what happened to appropriate authorities such as the nursing home administration, the state ombudsman, and the state health department that investigates complaints. Private legal action can be taken against the nursing home. Staff should be aware that certain forms of patient abuse are felonies that will result in prison time.

For more information, contact the Nursing Home Abuse and Neglect Resource Center.

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

Dementia and Jewish Holocaust Survivors (Audio)

Dementia refers to a group of conditions that gradually destroy brain cells and lead to mental decline. Many conditions can cause dementia, but Alzheimer’s (Ahlz-high-merz) disease is the leading cause. Most people who have the disease are over sixty-five, with eighty being the average age of diagnosis. There is no cure for patients with dementia, and they need complete care eventually.

Survivors of the Holocaust, in which six million Jews were killed, experience special challenges with dementia. At eighty-two years old, Fred Festinger is one of sixty-five Holocaust survivors at the Los Angeles Jewish Home for the Aging. He can still recall being brought to a Nazi concentration camp at the age of sixteen. His main goal in life then was to reach the age of twenty. Two months after he turned twenty, he was liberated.

Like numerous survivors, Fred’s liberation was only a physical one. Because many of the survivors’ trauma was never treated through therapy or medication, they still suffer with flashbacks and nightmares. Dementia has resulted in even less control for them over anxiety symptoms caused by blurred realties of the past and present. You can listen to more about Fred’s life in this podcast at the NPR Web site.

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

Elderly Healthcare Almost Two Years After Hurricane Katrina (Audio)

This is an update on healthcare of the elderly and others in New Orleans, my hometown, almost two years after Hurricane Katrina. What New Orleans needs most in the area of healthcare is a workforce. There is a severe shortage in medical doctors. In one Mid-City neighborhood, five doctors remain of the 120 practicing there before the hurricane.

While the general population is still far below previous numbers, it is much higher than the number of healthcare workers available. The few remaining hospitals are overcrowded. Large numbers of medical records were destroyed in the floods. Before the hurricane, 2,269 beds existed for acute care patients in Orleans Parish. Only 635 remain today. Many chronic mental patients who need hospital care have few services available. Besides depression, patients are suffering with post-traumatic stress disorder and substance abuse. The suicide rate has tripled.

New walk-in patients often show up with no medical records, no memory of prescriptions they had been taking, and no insurance. A significant number are elderly and on Medicaid. Chronic coughing, related to particles inhaled during cleanup and home renovation, is common. Treating patients is a stressful challenge to doctors, many whose own homes and private practices were destroyed.

As an incentive to increase the number of healthcare professionals, Louisiana is slated to receive a federal grant of $15 million dollars to provide up to $110,000 in payments to primary care doctors and other healthcare workers who move to New Orleans or surrounding areas. The government has a record of being extremely slow in disbursing financial aid in New Orleans.

Dr. Robert Travis Kenny, one of the five remaining Mid-City doctors, states, "I question why people with medical problems would return. Until you have enough hospital beds and the system gets up and running, it's a dangerous place to live for unhealthy people." Unfortunately, many unhealthy, elderly people have no other choice.

Most of the above information about healthcare in New Orleans came from an April 30, 2007 “Los Angeles Times” news article titled “A Post-Katrina Doctor Drought” by Ann M. Simmons.

You can listen to a more detailed account about the treatment of mental health patients in New Orleans at this June 11, 2007 interview titled “New Orleans Mental Health Crisis” at NPR.com

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

Nursing Home Technology: Wii Video Game (Video 58 secs.)

During the past year, something unexpected has enhanced the culture change in some senior citizen communities. That phenomenon is the playing of Wii (pronounced “we”), a Nintendo video game that leads the nation in sales. Why unexpected? Most of the players have never used a video game before.

This popular cross-generational game is played with a handheld remote control (cutely called a “Wiimote”) that is mounted to the wrist and includes a motion sensor. Players press buttons and move to translate their actions onto a television screen. As complicated as that sounds, the game is very user friendly. Unlike most video and computer games, Wii involves a pleasing combination of mental and physical exercise, along with positive social interaction. There are several digital versions such as bowling, tennis, golf, and baseball. The best way to understand how Wii works is to watch people play. Click here to see a
Wii bowling game in progress.

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

Hospice and Nursing Home Poem: "World Champion"

It occurred to me that I’ve never shared one of my hospice volunteer poems with you. A mute patient, whose legs were amputated due to severe diabetes, inspired me to write this poem. Although he endured several close calls with death, he repeatedly overcame them until he eventually died. Observers couldn’t understand why he didn't give up sooner. Because he had no legs and was such a determined survivor, I viewed him as an Olympic marathon runner.

World Champion

Your bedridden body
wins survival marathons,
breaks records in life's
Olympic Games.
I touch your skeletal chest,
feel spirit of an aging heart
that outruns the Grim Reaper
in back-to-back wins.

Some pity your amputated legs,
anguished moans, unexpected
comebacks when death
competes with bare existence.
No one claps or cheers
for your personal-best pace
toward the final race
when you clear each hurdle.

They don't understand
why you won't give up
when you defend each challenge
to clock more blocks of time.
Your laps for life press onward
as you struggle to the finish,
grin like a World Champion
each time you grab the gold.

© Frances Shani Parker

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

Hospice and Nursing Home Writing: Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes (Loving Healing Press, Sept. 2007)

For those who enjoy writing, hospice work can be a great source of inspiration. I have always been fascinated by the written word and the impact it has on readers. As I became more involved with hospice volunteering in Detroit nursing homes, I found myself writing poetry and prose about my experiences.

During poetry readings at various venues, I noticed that people approached me often to discuss a loved one who had been terminally ill. They seemed relieved to talk to someone who was open to discussing illness and death. Most people avoid talking about these topics. With our aging, diverse population, there is an urgency for more conversations on end-of-life care.

“Write what you know” is a common saying, and that’s what I did. Becoming Dead Right includes true stories, poems, “how to” advice, general information, and insights resulting from my hospice volunteer experiences. While universal concerns are covered, the often-ignored perspectives of people of color are included in this tour guide for navigating death journeys.

Stringing thoughts together into written words can be challenging, pleasurable, and therapeutic. From places inside, words rise that affirm oneness with others, make sense of nonsense, and, hopefully, sweeten the world.

You can read a review of the book here.
You can listen to a podcast radio interview with me at www.AuthorsAudio.com.

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

Hospice-Palliative Care and Music Therapy (Audio)

Think of all the ways music positively impacts your life. Perhaps it spurs you on during an aerobics class, makes you smile when it whisks you to another world, heals your spirit after emotional or physical turmoil. Because music can have many favorable effects, I incorporate it during my hospice volunteering.

For those patients who can communicate their preferences, I provide music for them. Sometimes we listen to the radio and comment on the artists or the lyrics. Other times, we listen to CD’s. When patients are not able to communicate verbally with me, I refer to their information forms for clues as to what they might like. For example, I might play an old-time gospel song for a patient whose religion is listed as Baptist. Patients’ nonverbal responses often express their feelings.

On a more structured and prescriptive level, music thanatology is the movement providing consolation to patients in the final stages of dying. This form of music therapy has become a part of many hospice programs. The bedside services, which are performed by music-thanatologist practitioners, provide serenity and enjoyment for patients. Harp and voice music are often used. During these vigils, patients hear music tailored to their specific needs. You can read more about this form of therapy and listen to examples of harp music being used to provide interior and exterior comfort for terminally ill patients at the NPR news Web site.

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

Nursing Home Humor (Video 2:23 mins.)

So many negative stories circulate about nursing homes, sometimes we need to be reminded of the good times that happen there. From giggles to hysterical howls, the healing effects of laughter contribute positively to everyone’s health.

What makes people laugh in the nursing home world? Animals, children, and humorous situations involving people they know, both real and imaginary, can be hilarious. They laugh about the same things that tickle everybody’s funny bones. A suspense thriller, this video about a pug and a peacock shows why animals are so entertaining.

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

Caregiver Resources

Whenever I’m approached by local, frustrated seniors who need help and don’t know where to go, I recommend the Detroit Area Agency on Aging. The phone number there is (313) 446-4444. Caregivers can find a wide variety of support services available to them through this agency. Area Agencies on Aging (AAA) are located in just about every state. They can be found by calling the National Eldercare Locater at 800-677-1116 or going online at www.eldercare.gov.

Some of the services they provide are legal assistance, respite care, home health aide care, Meals on Wheels, transportation, and help with chores and repairs. Many of the services do not have an income requirement, so it’s best to check to see what’s available. Two helpful Internet resources for caregivers are AARP, which has extensive information, and the National Alliance for Caregiving, a non-profit coalition of national organizations focusing on issues of family caregiving.

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

Nursing Homes: Managers, CNA’s (Certified Nursing Assistants), Residents

Sometimes I read research that has fairly predictable results. But the fact that the results were discovered through research validates them more. Consider these words: nursing homes, managers, CNA’s, residents, satisfaction. There is a general thread that connects them in a nursing home setting.

It’s common knowledge that managers generally set the tone at the workplace. Having been a school principal, I know that to be true. This research focused on the role managers play in creating a person-centered workplace. In order to develop this kind of workplace, managers must interact with staff in ways that will encourage their satisfaction, loyalty, and commitment. When this is done successfully, residents benefit.

In this 2007 research study explained in the “Journal of the American Medical Directors Association,” CNA’s and residents’ families from 156 nursing facilities completed surveys to measure their satisfaction, loyalty, and commitment. I already knew CNA’s would have plenty to say on this, because these are popular topics when I talk to them at nursing homes I visit as a hospice volunteer. The survey responses were analyzed.

What was the conclusion of the research? You’re probably way ahead of me. The conclusion was that the work setting that managers establish greatly impacts the lives of the CNA’s. Caring managers who produce a person-centered workplace can inspire workers to become excellent caregivers who enhance the lives of patients. This principle is so simple and so important. It’s a shame it’s not practiced in all workplaces.

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

Hospice Care and Pain Management

As a hospice volunteer in urban nursing homes, I have seen dying patients in little or no pain. When cure was no longer the focus, the dying process, with its naturally evolving symptoms, was facilitated in a manner that brought beauty to their personal letting go. Death came with perfect closure to life.

But I have also witnessed patients in pain. In a study reported in a 2006 “Journal of Pain Symptom Management,” severe pain was reported at least once by 20.3% of 156,887 hospice patients, although overall pain was mild. A 2006 report in “The Gerontologist” states the obvious regarding pain management in nursing homes: “Care is dependent upon the context in which it is provided.”

I have concluded from my own observations and readings that the certainty of hospice care providing a pain-free, end-of-life experience is increased significantly when several safeguards are in place:

1) Appropriate pain medication and management procedures must be prescribed by a doctor with expertise in this area. Really listening to feedback of patients regarding their pain is crucial. Patients need others to advocate for them when their pain is under treated.

2) Medical personnel must be knowledgeable in how to implement appropriate pain management procedures that the doctor prescribes. This includes informing CNA’s (nurse assistants) of their roles related to the hospice philosophy and pain management. Like any other important procedure, pain management requires ongoing monitoring and adjustment, particularly when staff attendance and schedules are irregular.

3) Attitudes of everyone, including doctors, regarding how pain is being treated must be explored honestly. Staff education on transitioning from a total focus on cure to one of non-curative quality of life must also be addressed. In addition, some families need help in understanding that chronic severe pain is not a necessary part of dying. Ultimately, everyone involved in hospice care must be committed to pain-free death journeys.

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

Nursing Home Reminiscence Groups: Video

For some, they were the good old days. For others, they were just the old days. Either way, they are who we are today, and we can’t seem to get rid of them completely. Everywhere we go, we push them around in mental shopping carts. Sometimes we think we’ve lost a few items permanently. Then they turn up when we least expect them. They are our memories. Lately, they are becoming topics for group sharing in facilities where seniors congregate.

Reminiscence groups, which are a form of therapy, are sessions with seniors sharing memories. They aren’t quite the same as lounge-talking get-togethers, however, because conversations are guided by a trained facilitator such as a social worker. This person presents topics and helpful comments when they are needed.

The purpose of reminiscence group sessions is to trigger brain responses through nostalgia and socializing. This is similar to the way bingo and socializing might give the mind a workout. Reminiscence also helps seniors analyze their lives by reviewing where they were, where they are, and how they want to respond to those reflections. Hospice patients often benefit from life-review forms of closure.

In our pressured world of multitasking and fast living, how fulfilling it sounds to meet with a group and talk to them about our memories. How supportive it must feel to open our hearts while listening to theirs.

If you’d like to sit back and enjoy a visual-musical portrait of one nursing home resident’s life, I invite you to reminisce, along with this video (3:48 mins.) titled “Look at Me.”

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

Hospice: AIDS Drug Too Late Again

Years ago, before I became a certified hospice volunteer, I found myself in the unexpected position of giving ongoing assistance to two men with AIDS. I was a hospice volunteer then and didn’t know it. The first man died. The second man, who was diagnosed with AIDS a year later, had the great fortune of living with AIDS during the same time that protease inhibitor drugs revolutionized treatment of the disease. The multi-drug "cocktail" changed AIDS from being an automatic death sentence to a chronic, but manageable, disease. The number of AIDS-related deaths decreased. Unfortunately, the prevalence of AIDS continued to increase. Infected people were living longer. New cases continued to develop, with particularly high rates among African Americans.

I thought the new drugs would be successful in helping everyone who had AIDS. But a January 2, 2007 news article by James Ricci titled “AIDS drug offers hope, but too late for one man” in the “Los Angeles Times” reports otherwise. Warren Ratcliffe and Mark McClelland are two men among an estimated 40,000 Americans whose illness could not be controlled by modern drugs. They'd developed resistance to them. Their only hope was to stall the virus by receiving “salvage therapy” to stay alive until a new drug was discovered that could help them.

That amazing new drug, an integrase inhibitor, was finally discovered in 2006. While it came in time to save McClelland, it came too late for Ratcliffe, who died at age 59 of AIDS-related cancer. Once again, a man and many others, died before they could benefit from a new drug discovery. So far, McClelland seems to be responding well to the drug. Dr. Steven Deeks, a UC San Francisco salvage therapy authority, hopes that during 2007, other surviving salvage therapy patients will develop immune systems that can rebuild themselves.
Note: See comments section to view AIDS videos.

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

Hospice and Palliative Care for the Homeless

Every urban city has them somewhere. Viewed too often as invisible humanity, they watch their cardboard requests for help filter through society’s windshields. Shivering in countless layers of clothing, they roam while preaching to unseen characters. They are homeless people who may or may not have lived in the past like any reader of this blog.

But what happens or should happen to millions of homeless people when they are terminally ill? Those with bodies racked with years of substance abuse can only last so long, especially when strong social supports and medical insurance are lacking. When each day is a struggle to meet basic needs, the odds of detailed planning of end-of-life care are slim.

“The Journal of the American Medical Association” discusses how to serve the terminally ill homeless population with these summary conclusions:

1) Needs of the homeless can best be met with a multidisciplinary team that addresses their complex needs.

2) Those who continue to abuse drugs must have frequent clinic visits, specific dosages of long-acting pain medications, and a written pain agreement.

3) Their end-of-life concerns must be discussed with them and documented.

4) Due to lack of finances, homes, and social supports, the homeless rarely receive inpatient hospice care. However, inpatient palliative care at hospitals can enhance the quality of their end-of-life experience.

Like everyone else, homeless people are entitled to all the benefits of dignified death journeys.

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

Hospice Volunteers for Pets: Pet Food Recall

With the recent mass recall of toxic dog and cat food, pet owners across the country have agonized over their pets’ health. Many owners bombarded veterinarians with requests for guidance in preventing kidney failure and death of their animals. While many pets were determined to be fine, some died, leaving owners devastated.

Pets are loved unconditionally by millions of pet owners. The same inspiration that compels owners to protect and cherish humans also stirs them to want peaceful death journeys for their pets. Fortunately, hospice care for pets has become a reality at the Colorado State University Argus Institute for Families and Veterinary Medicine. Visiting the homes of pet owners, hospice volunteers, who are veterinarian students, help terminally ill animals that are expected to live three months or fewer. Like hospice volunteers for humans, they also offer emotional support for pet owners.

I think this application of the hospice philosophy will develop in more places and positively impact human hospice care by strengthening understanding of its meaning. As more hospice conversations take place, the word “hospice” will become more embedded in everyday language and more appealing to the general public. You can read more about hospice care for pets here. What do you think about this form of end-of-life care for pets?

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

Nursing Home Technology

Part of the culture change that many look forward to seeing in more nursing homes is supportive of technology as a means of providing residents with more independence and dignity in daily living. Of course, the human touch still remains primary in patient interactions with others.

A major problem in implementing more technology is cost. Cuts in funding for nursing homes only make an already difficult situation worse. But we must still address the possibilities, particularly since many technological accommodations are already on the market. Five examples are these:

1) A vacuum assisted sponge that promotes blood circulation at the wound site and sucks out the infection

2) Robots that perform basic tasks that will allow staff to spend more hands-on time with patients and that remind residents of tasks they should do

3) Computer touch screens for nurse aides and others to update patient data at the point of care for immediate access and use elsewhere

4) Remote sensing technology that monitors motion, temperature, pressure on floors, chairs and beds, how patients walk, when they fall, restlessness in bed, as well as patients’ pulse and respiration

5) Wireless call systems that allow residents to call for assistance anywhere in the facility by pressing a button they wear that sends a message to a computer

The reality is that technology is needed to free more staff to handle the increasing numbers of patients who are living in nursing homes. Millions of baby boomers will need services in the very near future. In order to support our aging society, America needs more discussions and funding relating to technology.

At the age of 91, Naomi Long Madgett, Poet Laureate of Detroit, MI, enjoys using technology. Her good choices with the "new stuff" enhance her quality of life. You can read more about Naomi and iPad research with older adults here:

https://www.linkedin.com/pulse/selfie-detroit-poet-laureate-techie-91-ipad-research-parker?trk=mp-reader-card

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

Hospice Volunteer Humor

Whenever I tell people I’m a hospice volunteer, they usually respond with strong empathy for the difficult and sad work I must be doing. They also imply that I'm close to sainthood for even doing it. This always amuses me because I don’t find hospice volunteering difficult or sad. In fact, most days are pretty upbeat with challenges that are usually interesting. I’m a regular person doing what everybody can do in their own ways, and that is service.

Humor has a lot do do with the kinds of interactions my patients and I share. People say I'm funny, but my terminally ill patients are often funnier, not only with me, but with others with whom they have contact. A very engaging patient remembered many hilarious stories about her life. Some days she’d just reminisce and have us both cracking up, especially when she talked about the bear chasing her in circles around her house. A male patient and his roommates teased one another so much, it was unlimited laughter every time I visited. Did I mention the two ladies having a pretend fight from their wheelchairs? Oh, and the bedside birthday party with a menu of fried chicken livers, red velvet cake, and ice cream was another winner!

A study on hospice and humor in “The American Journal of Hospice & Palliative Care” revealed that humor was present in 85 percent of 132 observed nurse-based hospice visits. The real clincher is that hospice patients initiated humor 70 percent of the time, regardless of the hospice setting. Reflecting my own hospice experiences, this study confirms that many of the terminally ill continue to maintain a comic state of mind. And that’s no joke!

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

Michigan Hospice Volunteers: A Documentary (Audio)

Hospice Chronicles: Care for the Patient and Family is an audio documentary produced by Dan Collison and Elizabeth Meister of Long Haul Productions. It follows two southwest Michigan hospice volunteers who have completed their volunteer training and are visiting their first patients. Because their patients live at home, I listened with a focus on similarities and differences between their hospice volunteering and my own in Detroit nursing homes.

Volunteer Joe Haase essentially provides respite (relief) for caregiver Betty Bennett, whose husband Preston has Parkinson’s disease and early-stage dementia. Respite care gives her time away from home to do errands and take a break from the pressures of caregiving. Betty sounds overwhelmed with meeting Preston’s needs, but she continues to keep him at home because she promised him she would.

While people don’t generally think of hospice volunteers in nursing homes as providers of respite for staff, we are. More than once, I have had a frazzled and overworked nurse aide say she was glad I was there to feed my hospice patients who needed assistance. If my patients happened to be eating at a table with several other patients, it was not unusual for me to monitor their feeding, as well. Mealtimes can be extremely busy at an understaffed nursing home when many patients need assistance at the same time.

In the second documentary scenario, volunteer Betty Elsas visits patient Mamie Matthews, who is 97 years old and slowly deteriorating. Because Betty has a healthcare background, she mentions how visiting a patient “cold,” with little information, puts her at a disadvantage.

When I am assigned a new patient, I receive a form with minimal patient information such as name, age, religion, illness and caregiver. Probably because it’s all I’ve ever had, I adjusted easily. Like Betty, there were a few times I wanted to know more, for example, hobbies. These were times with patients who had difficulty communicating or who had paid guardians who knew little about their backgrounds.

I think hospice volunteers would find these conversations interesting for discussion, along with commentary from seasoned volunteers with residential and nursing home experience. The audio documentary can be heard at www.npr.org Hospice Chronicles: Care for the Patient and Family.

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

Sex Offenders in Nursing Homes (Audio)

Around the country, public awareness grows regarding registered sex offenders’ whereabouts, including the fact that many live in or work as staff among vulnerable nursing home populations. Because their presence there can lead to dangerous consequences, this is a serious problem that must be addressed to provide security for staff, residents and visitors.

The 2006 “U. S. Government Accountability Office (GAO-06-326 Highlights) Report” identifies about 700 registered sex offenders living in nursing homes across the country. Keep in mind this is an underreported crime, and numbers continue to increase. States have broad discretion on how to implement notification of sex offenders. Nursing home administrators are not always aware of sex offenders’ previous convictions. Even when they are, due to the Privacy Rule, they are not sure if they can share that information with others. Known sex offenders are usually evaluated on their demonstrated behavior and not separated from other residents.

A 2007 NPR.org news article titled “Sex Offenders Fill Geriatric Wards of U.S. Prisons” by Laura Sullivan, refutes a common belief that elderly sex offenders are not as threatening as young offenders. In actuality, sex offenses are more likely to be repeated as offenders age. Although the geriatric sex offender population discussed in the article is in a prison, the information has important implications for nursing homes. The following are definitely worthy of mention:

1) Offenders typically sexually abuse children because they are the easiest targets (similar to many nursing home residents).

2) Susan King, the prison psychologist at Laurel Highlands and director of the sex-offender program, says that some older men become sex offenders as they age. One man said he started when he was in his 50’s. Another man was first arrested at age 74.

3) Some sex offenders refuse to admit their crimes or receive counseling. Statistically, sex offenders in this category have a higher rate of repeating sexual offenses. Whether counseling will keep sex offenders from repeating their offenses is still controversial.

4) Two studies conclude that sex offenders are more likely to start committing crimes or keep repeating them in their old age.

You can read the entire news article and listen to the related “All Things Considered” podcast at the NPR.org Web site.

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