Predicting Death of the Terminally Ill: End-of-Life Care (Research and Video 2:55 mins.)

Consider that almost half of the people over 85 years old die annually in nursing homes across America. Even when they don’t share what they think, family members, friends, and the nursing home staff often develop their own individual perspectives about when terminally ill patients will actually die. Unfortunately, because it is not always easy to predict how close to death someone is, inaccurate guesses are made that may deny end-of–life care to those who might benefit from it. Although the predicted time of death for hospice patients is within six months, I have had hospice patients ranging from dying immediately after being assigned to hospice to those staying in hospice for years.

What do people consider when they set out to predict death? A research study that included 45 residents was set up to create a framework for organizing social interactions related to end-of-life care and to characterize the social construction of dying in two nursing homes. The resulting framework included five categories related to the possibility of death:

1) Dying allowed

2) Dying contested

3) Mixed message dying

4) Not dying

5) Not enough information

Based on predictions, over half the resident cases were classified as mixed message dying or not enough information. This indicates the ambiguity regarding residents’ care plan goals found in the two nursing homes in the study. These results imply the importance of residents, family, staff, and physicians working together to determine the dying status of residents as it relates to social interactions and healthcare the resident receives. Shared conversations about goals of care, and how these goals will be reached are important in determining the quality of care residents receive. You can read more about this research study from the "Gerontologist."

While on the subject of predicting death, many of you probably remember reading in the news two years ago about a cat named Oscar that predicted deaths of nursing home residents. Oscar has even received a hospice award. In this video titled “Cat Is Harbinger Of Death (CBS News),” Oscar’s death predictions are discussed.

Many healthcare staff members who work with dying patients will tell you they have had patients share stories about seeing dead people, ghosts, spirits they recognize, and angels. View this post for my personal story and an informative video: https://www.linkedin.com/pulse/end-of-life-seeing-dead-people-angels-frances-shani-parker?trk=mp-author-card

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

YMCA SilverSneakers Senior Fitness Program: Research Shows Benefits (Video 2:20 mins.)

Several of my friends are big fans of the YMCA SilverSneakers fitness program for seniors. SilverSneakers, which originated in 1992, is the nation’s leading exercise program designed exclusively for older adults. Held three days a week at many YMCAs, classes provide excellent opportunities for seniors to reap all the rewards of staying fit while reinforcing relationships with other participants.

Research shows that SilverSneakers benefits participants in general, especially those who have diabetes and or depression. These studies were funded by Centers for Disease Control and Prevention (CDC) and conducted by Group Health and the University of Washington (UW). Over 5,000 participants were studied. Among results of the studies are these important conclusions:

1)    Lower total health care costs

Older Medicare beneficiaries with diabetes who participated in SilverSneakers had notable reductions in total annual health care costs after both one year in the program (-$1,633) and two years in the program (-$1,130) compared with non-participants. Even those who visited less frequently in year two still saw health benefits.

2)    Lower risk of depression in year two

At least two visits per week to SilverSneakers classes during the first year were significantly associated with a lower risk of depression in year two.

3)     -29% Lower hospitalization rate

The cost savings were largely attributable to fewer hospital admissions and lower inpatient care costs with those hospitalizations.

4)    Greater savings with more participation

SilverSneakers participants who made an average of two or more visits a week in year one had significantly lower adjusted total health care costs in year two (-$2,141) than those who made fewer than two visits per week.

5)    Increased preventive care

SilverSneakers members utilized more preventive services.

This video highlights rewarding experiences seniors have while participating in the SilverSneakers program.

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Physician-Assisted Suicide: Interview with Dr. Jack Kevorkian (Research and Video 4:59 mins.)

Feb. 6: 1991: Physician-assisted suicide advocate Dr. Jack Kevorkian poses with his “suicide machine” in Michigan. (Northwestern University Library)

Dr. Jack Kevorkian, also referred to as Dr. Death, is best known for his public support of patients’ right to physician-assisted suicide. He admits to having participated in at least 130 suicides. After being tried in court several times and shown on national television deliberately causing a man to die, Kevorkian was ultimately convicted of second-degree murder. In prison, he served eight years of a 10-25-year sentence. His parole includes not helping anyone else die.

Dr. Kevorkian has been a very controversial public figure for many years. A popular HBO movie titled “You Don’t Know Jack” is based on his life. His ideas about euthanasia have important implications in discussions about end-of life care and medical ethics.

In a   research study done in Oregon,  where the Oregon Death with Dignity Act allows terminally ill patients to obtain physician aid in dying, it was reported that these persons were motivated by worries of “future physical discomfort and losses of autonomy and function.” Healthcare workers can help patients who have these concerns and express an interest in physician-assisted suicide by bolstering their sense of control, educating them, and reassuring them about managing future symptoms.

The following video includes CNN interviewer John Roberts and Dr. Jack Kevorkian. Discussion includes prison life, physician-assisted suicide, and Michael Jackson’s death.

Hospice-palliative volunteers bring a unique perspective to the ongoing debate about physician-assisted suicide. You can read their views here:

 https://www.linkedin.com/pulse/physician-assisted-suicide-hospice-palliative-views-parker?trk=mp-reader-card

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 Internet stores.

Hospice and Nursing Homes Blog

Seniors and Casino Gambling: Who’s Really Winning?

Across the country, the numbers of seniors visiting casinos are growing faster than any other age group. Casinos are estimated to take as much as 65% of their revenue from those aged 65 and older. Detroit, Michigan has three major casinos that get plenty of business from seniors in Michigan and beyond. They love to take field trips to casinos as a social activity, but is it really just social?

Research from the Institute of Gerontology at Wayne State University in Detroit causes serious concerns about seniors and casino gambling. Including 1,410 randomly selected adults, aged 60 and older, the study concluded that one in five older adults who enter a casino eventually displays problem gambling behaviors. Peter Lichtenberg, Ph.D., director of the Institute of Gerontology and one of two authors of this study published in the “Journal of Aging Studies” said, “Urban elders are especially vulnerable to problems because higher percentages of them have low income, few social supports, and poor mental and physical health.” Symptoms of problem gambling include compulsive gambling and lying about  time and money spent.

Findings from this study should be taken very seriously, particularly when considering serious health and financial problems among older adults in the future. Expected consequences related to seniors’ increasing participation in casino gambling are “financial loss, the erosion of personal relationships, depression, suicide, substance abuse, and personality disorders.” No winners there.

Full Article Citation:  

Zaranek, R. & Lichtenberg, P. (2008).  Urban elders and casino gambling:  Are they at risk of a gambling problem?  "Journal of Aging Studies," 22, 13-23.

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 in Assisted Living Facilities (Research, Video 2:51 mins.)

Many people have told me that they didn’t know hospice care exists in nursing homes. Even more would probably be surprised to know that it also exists in assisted living facilities (ALFs). I can’t emphasize enough that hospice care is available no matter where a person lives.

Reported in the “Gerontologist,” a study of hospice care in assisted living facilities was done to get detailed descriptions of end-of-life care provided by ALF medication aides, caregivers, nurses, and hospice nurses in urban and rural settings. Interviews were used to gather information. Having worked as a hospice volunteer in urban nursing homes for several years, I was interested in the results. They were very similar to what I would have expected from an urban nursing home or any other institutional care:

1)  The quality and nature of resident-staff and assisted living-hospice staff relationships are critical in promoting good end-of-life care for ALF residents.

2)   Length of the resident's stay in the facility and how well staff knew the resident were associated with the quality of the resident-staff relationship.

3)  Respectful collaboration, clear communication, use of complementary knowledge and skills of staff, and shared expectations about the care were associated with positive staff relationships.

4)  ALF administrative support for hospice patients was important.

Basically, ALFs and hospice organizations that are committed to working together with hospice programs must both support staff, patients, and families. If this sounds like an obvious conclusion, it is. Unfortunately, it is a reality that is still unrealized too often. There is a need for more successful models of this partnering system of care at both nursing homes and ALFs. From my own observations in nursing homes, especially regarding staff turnover, I know that the non-curative philosophy of hospice care requires ongoing staff inservice and monitoring to be implemented successfully.

This video relates the positive and negative transition concerns of an  elderly man (age 95) moving to an assisted living facility.

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Near-Death Experiences (NDEs) of Children and Adults (Video 2:23 mins.)

Wow! I saw a light!

With a focus on hospice, nursing homes, and seniors, I don’t get to post a child’s picture on this blog often. But today’s topic shares death-related concerns about children and adults. Like adults, children can also become critically ill and near death. Their near-death experiences (NDEs) are nearly identical to those of many adults. When they return to living, both children and adults perceive themselves as changed.

For nearly two decades, pediatrician Melvin Morse has been documenting near-death experiences of critically ill children. He says these children have perceptions that the light they saw during the NDE will be with them always. When they return from the brink of death, their understanding of life and death is unique.

Of course, discussions about near-death experiences inevitably bring up the possibility of immortality. Many people believe in life after death. For them, death is a comma, a pause proceeded by a dash into another dimension of life. Others say that life, as we know it while living, is all there is to existence. They consider death to be a period at the end of the final sentence in their life stories. Of course, a lot of people say they don’t know what to believe.

Scientific research on near-death experiences and other death-related phenomena continues to accumulate data to shed new light on discussions about life after death. Ultimately, people have to decide for themselves what they want to believe.

This video showcases the fascinating near-death experiences of young children who were critically ill. Several of their drawings and writings are explained.

Frances Shani Parker, Author

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

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”

Hospice, Nursing Home, and Terminal Illness Myths

Hospice and Nursing Home Myths

by Frances Shani Parker, Author

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

               

      1.  Myth: Death is a terrible thing.

Fact: Death is a natural part of life that everyone will experience. Accept, discuss, and prepare for becoming dead in your future.

2. Myth: It’s always better to die at home.

Fact: “Home” can be the presence of love and comfort wherever a terminally ill patient may be. Most people die in institutions.

3. Myth: Hospice speeds up death.

Fact: If two similar people had the same terminal illness, the one receiving hospice care would probably live longer.

4.   Myth: Pain is a natural part of aging and dying. Under-treated pain slows down the death process.

Fact: Pain medication is available to offer appropriate relief to patients. Under-treated pain worsens the process unnecessarily.

5.   Myth: Patients with dementia don’t miss visits from relatives and friends they don’t recognize.

Fact: Patients with dementia are often aware of their surroundings on some level. Loved ones should focus on patients’ abilities and make every effort to spend quality time with them.

      6.  Myth: Patients with dementia are always suffering.

Fact: Patients with dementia have varied days like everyone else. Happy memories and enriching activities can slow dance into their realities and fill them with joy.

       7.  Myth: Caregivers must only focus on their patients.

Fact: Caregivers must focus on their own care as well. They should seek supportive resources and monitor their sleep habits, irritability, and general health, always with a willingness to seek help when needed.

8.   Myth: Caregivers should not question decisions of healthcare professionals who are the experts.

Fact: Caregivers should be proactive as patient advocates. They should stay informed about patients’ symptoms, diseases, treatment purposes, and side effects.

9.   Myth: Nursing homes are not good places for children to visit.

Fact: Intergenerational experiences help children understand life’s passages. Children should experience opportunities that encourage them to become nurturing people, eliminate ageism stereotypes, and expose them to possible career choices.

10.  Myth: Hospice work is mostly depressing.

Fact: Millions of hospice workers view their involvement with patients as privileged occasions for mutual growth and fulfillment.

            © Frances Shani Parker

                www.francesshaniparker.com

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Depression, Suicide in the Elderly (Video 2:52 mins.)

Discussions about suicide usually don’t focus on the elderly, even though their rates of suicide are proportionately high. Depression, which is too often ignored and considered part of aging, often accompanies suicidal tendencies. The following are symptoms of depression which may be helped through diagnosis ruling out medications, counseling, and drug therapy:

1)   Persistent Sadness

2)   Feelings of Worthlessness

3)   Tearfulness

4)   Pacing and Fidgeting

5)   Excessive Worry

A study at the Medical College of Wisconsin, Milwaukee focused on risk factors for elderly suicide. An analysis in Caucasians found that “compared to married individuals, those widowed, divorced, or never married had a 2.5 to nearly 5-fold increase in risk of suicide death. Males aged 65-74 had almost a 7-fold increased risk compared to females of that age, and the risk increased for males as they aged, compared to females 65-74 years old.” Being single, male, and a male advancing in age are suicide risk factors. The most common method of suicide was firearm use (66.9%).

Knowing risk factors for elderly suicide can assist healthcare workers, caregivers, and others in recognizing early signs and providing approporiate intervention. You can read more here about the Wisconsin research.

This "NBC New York Nightly News" video titled “Segment on Elderly Depression”  highlights the relationship between elderly depression and suicide.

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Hospice-Palliative Care Volunteers: Why Families Like Them (Research, Video)

You’re a hospice-palliative care volunteer. You were drawn to serve patients and their families during  journeys of terminal illness. You do your best, always hoping you have fulfilled their needs. Best of all, many seem to appreciate your being a part of their lives.

What is it about hospice-palliative care volunteers that makes them appealing to families? Researchers at Mount Allison University in Canada asked this same question and went straight to family members for answers. A survey of 22 family members whose deceased loved ones had used the services of a hospice-palliative care volunteer reported these results in order of importance:

1)   Opportunity to take a much-needed break from the demands of caring for their loved one

2)   Emotional support

3)   Shared time with the volunteer

4)   Information provided by the volunteer

Family members were satisfied with volunteers and rated them highly. The majority of families (85%) rated their volunteers as well trained. In addition, family members (95%) did not feel that volunteers had invaded their privacy or patients’ privacy. Sounds like lots of volunteers are successful at fulfilling many patient and family needs through service. This video poem expresses the win-win experiences of many hospice-palliative care volunteers:

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Cremation Process and Storage of Cremains (Video 2:32)

We’re all going to die. That is a fact. Everyone should make plans regarding disposal of their bodies after death. Instead of being buried in a cemetery, increasing numbers of people are choosing cremations, in which intense heat and flames reduce bodies to bone fragments in less than two hours.

Not only are cremations selected because they are less expensive than traditional burials, some prefer them for the ease in spreading the ashes later and the convenience in incorporating cremated remains or cremains, as they are called, into death rituals. Sometimes families are allowed to be present at cremations and incorporate religious practices. Most religions accept cremations and permit the cremains at memorial services.

Cremains are often stored by families who keep them in urns that vary in their uniqueness. These may include such containers as vases with pedestals or even personalized teddy bears with hidden pouches. Among other uses, cremains of loved ones are being used in jewelry, shotgun shells, and fireworks. In terms of other destinations, cremains can be stored in a cemetery plot, mausoleum, or scattered in a garden or a body of water. For $5,300 cremains can be sent aloft into outer space, while $13,000 can send them into luna orbit. With so many choices available, everyone should make plans regarding disposal of their bodies. What will happen to your body after death?

In this video, funeral director Elisa Krcilek explains the cremation process.

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 Internet stores.

Hospice and Nursing Homes Blog

Massage for Caregivers of Terminally Ill Patients (Research, Video 3:35 mins.)

Many say that what caregivers need most is caregiving. Relatives caring for the terminally ill at home are particularly in need of support to improve their own quality of life. One form of nurturing for caregivers that reduces their levels of stress is soft tissue massage (hand or foot). This strategy has demonstrated beneficial results for caregiving relatives of patients receiving palliative home care.

In research reported in the “Journal of Clinical Nursing,” nineteen relatives received soft tissue massage nine times (25 minutes) in their homes. After all the sessions were completed, relatives participated in a tape-recorded interview about their massage experiences. They reported that the soft-tissue massages gave them feelings of being cared for, body vitality, and peace of mind. For a while, they experienced the freedom of being worry-free.

These positive results from having massages were experienced by all participants. Soft tissue massages can play an important role in palliative care by providing supplementary benefits in supporting caring relatives.

This video titled “Hand Massage Lesson by Health-Choices Massage School” demonstrates how a hand massage is done.

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”