Hospice Care: Nursing Home Staff Views (Research)

Staff views about healthcare play major roles in what they do, why they do it, and how they affect others. Nursing home staff perspectives regarding hospice care are particularly important because lives are literally at stake. As a hospice volunteer for many years in nursing homes, I was very aware of this relationship and the powerful impact of attitudes on resident care. More research in this area is both welcome and needed.

This research on nursing home staff hospice perspectives included views of 1,229 certified nursing assistants (CNAs), nurses, and social workers toward hospice care in 52 Indiana nursing homes. They responded to questions and open-ended prompts with these results:

1)  A majority of staff responded favorably regarding hospice care in nursing homes.

2)  About one-third of nursing home staff rated coordination of care lower than other aspects. Many comments highlighted examples of hospice being non-responsive to residents' needs. These represented important opportunities for improvement.

Based on my own readings and experiences as a hospice volunteer and former school administrator, three ways for improving hospice in nursing homes include more staff education, implementation, and monitoring of hospice practices. This must be ongoing, particularly in nursing homes with high staff turnover. 

Nursing home staff members who are focused on curing hospice residents may not readily embrace the hospice philosophy of non-curative care. For some, this is a major paradigm shift in thinking. It is critical that they commit to enhancing and maintaining their expertise in hospice practices. This includes the referral or non-referral of residents to hospice care and the timing of those referrals.

The quality of end-of-life care for any patients depends on the context in which the care is given. In the context of a nursing home, views of staff members regarding the hospice philosophy and the implementation of that philosophy greatly impact hospice residents’ experiences. Collaboration can work when hospices and nursing home leaders commit to operating strategically using communication, flexibility, and skills to match staffing to the nursing home environment. 

Read about who leaves hospice alive. Discharges can occur for several reasons: https://www.linkedin.com/pulse/leaving-hospice-alive-research-nursing-home-story-parker?trk=mp-reader-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

Older Adult Health, Friendships: Horse Lessons (Research, Video 4:48)

Although it’s well known that social relationships and trust are associated with psychological well-being and physical health, a researched-based reminder and video can still be helpful. This study on older adult social health included 149 community-dwelling adults aged 65 years and older (68 men, 81 women). Activities of daily living, social cohesion and trust, depression, subjective quality of life, current medical status, past medical history, and health behaviors were assessed in face-to-face interviews. Even neurobehavioral physical functions were assessed.

What were the research results?

As expected, scores for activities of daily living and Geriatric Depression Scale were significantly correlated with social cohesion and trust. Social cohesion and trust were significantly correlated with all subjective quality of life items. In addition, a strong correlation was observed between social cohesion, trust, and relationships with friends. Values for social cohesion and trust were significantly associated with both subjective sense of health and subjective happiness.

How does this influence our assessment of older adults?

Social cohesion and trust are important variables that influence self-rated health and happiness, independently of activities of daily living, age, and sex. When assessing geriatric psychological function, social cohesion and trust should be examined more carefully, given the association with a subjective sense of health, happiness, depression, and physical function.

What do horses have to do with this?

Plenty. If you’re like I am and don’t know jack about horse relationships, this video is a great introduction. Meet Arthur, William, and Harry in this delightful video. Savor what they teach us about friendship and trust at any age.

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

Caregiving Robot Provides Comfort, Independence (Research, Video 2:38)

Living alone as an older adult can be scary when you know you need help sometimes to care for yourself and your home. There are daily tasks that simply must be done. But suppose you had a robot to do specific tasks that you approve and keep you company as well. That could make all the difference in the world in providing you with peace of mind and independence you desire.

What could such a robot look like without being too intimidating? How will it move around your house while respecting your privacy? What can it do to keep your loved ones informed about your home life and health status? Robots, especially mobile manipulators, have the potential to answer all these questions.

Many of your needs are common to those of other older adults who want to live independently. During older adult robot research, twenty-one Americans (65-93 years old) who lived independently were asked about their preferences for and attitudes toward robot assistance. They were open to this assistance and generated 121 tasks they would want a robot to do in their homes. However, they were discriminating in their acceptance of assistance for different tasks. They preferred robot assistance over human assistance for tasks related to chores, manipulating objects, and information management. On the hand, they preferred human assistance to robot assistance for tasks related to personal care and leisure activities.

Meet Grandma Lea, a 94-year-old who lives alone with her robot named Mr. Riley. Her robot assists her with daily chores, monitors and collects data on her health, and allows her to have face-to-face conversations with loved ones and her doctor. Grandma Lea says Mr. Riley is a reassuring presence in her life. What do you think? Do you see living with a robot in your future? You can view this video about Grandma Lea on YouTube.

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

Long-Term Care Dementia, Alzheimer’s Violence: CNA Solutions (Research, Video 3:37)

Dementia is like a fluttering bee. As a hospice volunteer, I never knew when it would make honey or sting. There were times when nursing home residents with dementia were rude or violent. I have seen a resident slap a nurse assistant (CNA) in the face with such force I thought she would fall over. To her credit, the CNA took a deep breath and walked away while another CNA interceded. The resident probably forgot the incident soon afterward. During violent situations involving residents with dementia, caregivers had to protect themselves, restrain a resident if they could, but resist expressing rage and fighting back.

Resident-to-resident violence in nursing homes, unfortunately, is common and may involve victims who are too fragile to protect themselves. Some have even died as a direct result of being physically assaulted. This research on nursing home resident violence explores strategies developed by certified nurse assistants to prevent and manage resident to resident violence in nursing homes. The main theme is "Putting Residents First," a conscious effort by CNAs to put themselves or a beloved family member in the place of the resident while administering care.

Based on interviews and data analysis, the following themes are featured and suggested for formulating strategies for managing and decreasing resident to resident violence through the ability of the CNAs to empathize with the residents in their care. These strategies may provide a foundation for the development and testing of interventions aimed at preventing and managing resident to resident violence in long-term care.

(a) Knowing the Residents

(b) Keeping Residents Safe

(c) Spending Quality Time

In this video, Shirlee Engel reports on how dementia can cause aggression and how many nursing homes struggle to cope.

 

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

Recruiting Older Adults, Caregivers for Research (Research, Gerontology Video 1:57)

Recruiting older adults for research can get complicated if those being recruited can’t drive, have no transportation, don’t feel well, are easily confused, have busy caregivers, and distrust strangers asking them certain questions. One place to start is to decide on the best way to deliver a recruitment appeal that would entice them to respond and cooperate. Letters and phone calls come to mind.

This study on recruiting older adults for research compared the results of using two versions of a letter followed by two versions of a phone call with the cooperation rate of their doing face to face surveys. A total of 2,014 caregiving units (composed of an older adult, a family member and a home care worker) were randomly sampled from a list of long-term care insurance beneficiaries. Of this group, 74.32% of the sampled caregiving units were eligible to participate in the study. These are the three types of appeals used:

1)   Group 1 received formal written and oral appeals and an advanced letter followed by a recruitment phone call.

2)   Group 2 received the original formal letter, but a revised, more personal recruitment phone call that included broader and more positive information.

3)   Group 3 received both a revised advanced letter and a revised more personal recruitment phone call.

What were the results in terms of cooperation?

1)   Group 1: The cooperation rate for the formal written and oral appeal was about 50% for the entire caregiving unit.

2)   Group 2: The revised advanced letter and revised, more personal recruitment phone call yielded an increase of 20-25% in the cooperation rate for the entire caregiving unit.

3)   Group 3: Using the original advanced letter and the revised, more personal recruitment phone call yielded an increase in the cooperation rate only among migrant home care workers.

    Conclusion: By changing the format of appeal, the cooperation rate of older adults and their caregivers in a research survey can be increased. This study also pointed out the importance of sending an advance letter.

The Institute of Gerontology at Wayne State University in Detroit, Michigan brings together science and service to advance the cause of aging research. Its multidisciplinary faculty, post-doctoral fellows, and pre-doctoral trainees focus on the social and behavioral aspects of lifespan health and cognitive development. Dedicated to promoting successful aging, the Institute of Gerontology combines research and outreach to make life better for older adults everywhere. This video features many fine aspects of the program.

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

Lesbian, Gay, Bisexual, Transgender, Asexual (LGBTA) Aging (Research, Video 1:45)

For many older adults who are LGBTA, life now can be horrendous living in communities where they are excluded and harassed in long-term care, assisted living, and in receiving home care from healthcare workers. Consider how many of them feel when they depend daily on bigoted caregivers who resent their presence. Imagine being isolated socially by fellow residents regularly or only being included when they hide a major part of their identity. Either way, damage to their emotional and physical health has been so devastating that some LGBTA residents have resorted to suicide, just as some teens have done. But are these matters improving? Does it really get better?  Can LGBTA teens seriously look forward to futures where their lives are improved as older adults? 

The “It Gets Better Project,” is a suicide prevention video project and website to give hope to young people being bullied due to sexual orientation issues. Teens are told that high school and its bullies will not last forever. They are encouraged to look forward to happier futures because things will get better. Will they really? 

This is what the research about an adolescent sexual orientation study reports. This study included a racially-ethnically diverse sample of 231 LGBTQ (Q for Queers) adolescents aged 16-20 years over 3.5 years. While early experiences of stress did impact their mental health, both psychological distress and victimization decreased across adolescence and into early adulthood.” Yes, it really did get better.

In this video, Ellen Degeneres speaks out about the tragic suicides among teenagers due to gay bullying. Hopefully, more people's minds will change. She says things do get better, and young people deserve to have better lives when they become older adults.

 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

Prison Hospice Success Secrets (Research, Video 2:54)

It is estimated that 20% of America’s prison population will be elderly by 2025. Many will eventually need quality end-of-life care. More prisons are establishing hospice programs for an aging prison population. Inmate hospice volunteers play an important role. 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.

What makes a successful hospice prison program? Research on the Louisiana State Penitentiary Prison Hospice Program, a long-running model of care, reports on what is needed to develop a successful program. Based on field observations and in-depth interviews with hospice staff, inmate volunteers, and corrections officers, these are the five essential elements credited with the long-term operation of this program:

     1.     Patient-centered Care

     2.     Inmate Volunteer Model

     3.     Safety and Security

     4.     Shared Values

     5.     Teamwork

This video trailer of the film “Serving Life” documents an extraordinary hospice program where hardened criminals care for dying fellow inmates. The prison, a former slave plantation the size of Manhattan, is Louisiana's maximum security prison at Angola where the average sentence is more than 90 years.

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