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
Tuesday, April 24, 2007
Wednesday, April 18, 2007
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
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
Thursday, April 12, 2007
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
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
Thursday, April 5, 2007
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
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
Friday, March 30, 2007
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
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
Saturday, March 24, 2007
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
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
Thursday, March 15, 2007
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.
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog
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:
Frances Shani Parker, AuthorBecoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog
Saturday, March 10, 2007
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.
Tuesday, March 6, 2007
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.
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.
Friday, March 2, 2007
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
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
Monday, February 26, 2007
Service Learning: Hospice Volunteer Medical Students
Service learning is a teaching and learning approach that connects classroom learning with meeting community needs. It is not the same as community service, another excellent practice. Service learning evolves from the classroom curriculum. For example, after students learn how to write a letter, they write a real letter to nursing home residents and possibly receive a letter response.
A former school principal, I have been a national service-learning consultant for many years and have been instrumental in implementing service-learning in school districts across the country. My book Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes includes a chapter on intergenerational partnerships between schools and nursing homes. I know the positive impact it has on students, both academically and affectively. A win-win activity, it also positively impacts service partners.
The research article I’m about to address made me smile after I read it, not because it is funny, but because I knew what the outcome would be. Published by the “American Journal of Hospice and Palliative Care,” the article explains research using first-year, service-learning medical students to serve as hospice volunteers.
Hmmm, understaffed nursing homes with future doctors working as hospice volunteers --sounds like a perfect marriage. My thoughts were confirmed when I read, “There is evidence of the educational benefits of exposing medical students to hospice patients and practices.” The article states further, “It appears to be an efficient way to satisfy the need for volunteers, while contributing to the education of the involved students.”
Service learning is a great practice that is long overdue in this research context. I definitely hope that service as hospice volunteers in nursing homes will become a regular part of training for medical students.
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog
A former school principal, I have been a national service-learning consultant for many years and have been instrumental in implementing service-learning in school districts across the country. My book Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes includes a chapter on intergenerational partnerships between schools and nursing homes. I know the positive impact it has on students, both academically and affectively. A win-win activity, it also positively impacts service partners.
The research article I’m about to address made me smile after I read it, not because it is funny, but because I knew what the outcome would be. Published by the “American Journal of Hospice and Palliative Care,” the article explains research using first-year, service-learning medical students to serve as hospice volunteers.
Hmmm, understaffed nursing homes with future doctors working as hospice volunteers --sounds like a perfect marriage. My thoughts were confirmed when I read, “There is evidence of the educational benefits of exposing medical students to hospice patients and practices.” The article states further, “It appears to be an efficient way to satisfy the need for volunteers, while contributing to the education of the involved students.”
Service learning is a great practice that is long overdue in this research context. I definitely hope that service as hospice volunteers in nursing homes will become a regular part of training for medical students.
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog
Thursday, February 22, 2007
Louisiana Road Home Program and Seniors
A New Orleans native, I want to share information on what is really going on there, particularly with senior citizens. Keep in mind that the U. S. Army Corps of Engineers has admitted that their failure to construct the levees properly is what caused the flooding of New Orleans, not Hurricane Katrina.
With the hoopla of the Mardi Gras season over, major parts of the city remain in ruins. I recently spoke with a young woman who volunteered for three weeks with the rebuilding there earlier this month. She said she was shocked by how much of the cleanup still hasn’t been done. Less than half of the population before Hurricane Katrina has returned.
What is the Road Home Program?
Briefly, it is the hurricane housing grant program established by Louisiana Governor Blanco in August 2006, a year after Hurricane Katrina. The purpose of the program is to provide assistance to the state’s eligible homeowners who suffered Hurricane Katrina and Rita damage to their homes. To help these homeowners find the “Road Home” as soon as possible, they would be compensated up to $150,000 for their losses. Criteria for eligibility are based on FEMA (Federal Emergency Management Agency) guidelines, depending on damage and other aid they receive. Grants for homeowners who do not reinvest in Louisiana property are docked 40%.
What about senior citizens?
In October 2006, the governor announced that senior citizens (homeowners 65 years and older) who apply for Road Home assistance will not be penalized if they sell out, move out of the state or rent within the state.
Is the “Road Home” really open for immediate access?
These latest program statistics can be viewed at the Road Home News Room Web site: At this rate, it will take years before all applicants receive the financial assistance they have desperately needed since fall 2005. Many seniors will have died waiting for the "Road Home" to open for them.
Frances Shani Parker
Hospice and Nursing Homes Blog
With the hoopla of the Mardi Gras season over, major parts of the city remain in ruins. I recently spoke with a young woman who volunteered for three weeks with the rebuilding there earlier this month. She said she was shocked by how much of the cleanup still hasn’t been done. Less than half of the population before Hurricane Katrina has returned.
What is the Road Home Program?
Briefly, it is the hurricane housing grant program established by Louisiana Governor Blanco in August 2006, a year after Hurricane Katrina. The purpose of the program is to provide assistance to the state’s eligible homeowners who suffered Hurricane Katrina and Rita damage to their homes. To help these homeowners find the “Road Home” as soon as possible, they would be compensated up to $150,000 for their losses. Criteria for eligibility are based on FEMA (Federal Emergency Management Agency) guidelines, depending on damage and other aid they receive. Grants for homeowners who do not reinvest in Louisiana property are docked 40%.
What about senior citizens?
In October 2006, the governor announced that senior citizens (homeowners 65 years and older) who apply for Road Home assistance will not be penalized if they sell out, move out of the state or rent within the state.
Is the “Road Home” really open for immediate access?
These latest program statistics can be viewed at the Road Home News Room Web site: At this rate, it will take years before all applicants receive the financial assistance they have desperately needed since fall 2005. Many seniors will have died waiting for the "Road Home" to open for them.
Frances Shani Parker
Hospice and Nursing Homes Blog
Sunday, February 18, 2007
Final Exam Book Review By Detroit Hospice Volunteer
Dr. Pauline Chen, author of Final Exam: A Surgeon's Reflections on Mortality, is a doctor who "gets" it. She understands that doctors can only do their best, that they won’t save every patient and that, in the natural order of life, they have not failed when their patients die. She realizes that doctors are just like other people and that in our common humanity, we often share similar needs. Finally, she knows that death can be a difficult journey, but consoling words can be powerful rest stops along the way.
In Final Exam, Dr. Chen takes the reader through her evolution with perceptions of death and mortality. She discusses personal feelings regarding her first dissection of a human cadaver. Later, she assumes responsibility for the accidental death of a patient in her care. Ultimately, she concludes that the role of doctors with patients and their loved ones should include more of the emotional comfort that traditionally has been missing too often. She adds that medical schools should educate doctors more in these caregiving strategies.
This book has important implications for hospice care. If doctors embrace Dr. Chen’s way of thinking, they will replace their feelings of failure when patients can no longer be cured with feelings of commitment to non-curative hospice care. They will recommend these options to patients more readily and increase the number of patients receiving quality health care at the end of their lives. In other words, they will “get” it and be comfortable with that knowledge.
In Final Exam, Dr. Chen takes the reader through her evolution with perceptions of death and mortality. She discusses personal feelings regarding her first dissection of a human cadaver. Later, she assumes responsibility for the accidental death of a patient in her care. Ultimately, she concludes that the role of doctors with patients and their loved ones should include more of the emotional comfort that traditionally has been missing too often. She adds that medical schools should educate doctors more in these caregiving strategies.
This book has important implications for hospice care. If doctors embrace Dr. Chen’s way of thinking, they will replace their feelings of failure when patients can no longer be cured with feelings of commitment to non-curative hospice care. They will recommend these options to patients more readily and increase the number of patients receiving quality health care at the end of their lives. In other words, they will “get” it and be comfortable with that knowledge.
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.
Wednesday, February 14, 2007
Celebrating Nurse Aides, CNA’s and Nursing Assistants
They go by several names. During my hospice volunteer rounds in Detroit, I tend to say “nurse aide,” maybe because it’s older and easier to pronounce. But no matter what they are called, they are called often, sometimes too often when there’s a staff shortage. They are generally first responders meeting patients’ needs. Patients frequently think of them first when they evaluate their nursing home experience.
These are two comments I have heard nurse aides express to me about their jobs:
1) “I love working here. It’s not perfect, but we try to work as a team. I treat my patients like they are my family. For some of them, I’m the only one they can really talk to about their true feelings. I know what I do matters.”
2) "This place is depressing. I usually have more patients than I’m supposed to, and nothing I do is enough. It’s low pay with high pressure, but I need the job. It’s not right the way nurse aides and patients are treated here. When I try to make suggestions, nobody listens. I’m really frustrated."
Like people, all nursing homes are not good, and all are not bad. But dedicated nurse aides, no matter where they are, do hard work for low pay and often with little appreciation. A work climate suffers greatly when large numbers of staff stay discontented. Nobody benefits from a negative environment.
Some serious problems that plague nursing homes will require major systemic reform at local, state and federal levels. But administrators of individual nursing homes with negative climates can initiate certain changes themselves by committing to basic reform in staff, patient and caregiver relationships. Welcoming constructive input from all stakeholders validates everyone. Oral or written words of appreciation, when deserved, can go a long way in healing trampled self-esteem. Ongoing opportunities to improve job skills encourage professionalism. An added benefit will be decreased staff turnover. When the word gets around, more nurse aides will choose a nursing home where they feel respected.
As former principal of an urban public school with a high poverty level for many years, I know that setting a positive tone, even under stressful conditions, is a good beginning in changing the culture of any institution. I celebrate everyone who is doing a fine job working in nursing homes, but this post especially celebrates nurse aides, CNA’s and nursing assistants. Cheers to you!
Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog
These are two comments I have heard nurse aides express to me about their jobs:
1) “I love working here. It’s not perfect, but we try to work as a team. I treat my patients like they are my family. For some of them, I’m the only one they can really talk to about their true feelings. I know what I do matters.”
2) "This place is depressing. I usually have more patients than I’m supposed to, and nothing I do is enough. It’s low pay with high pressure, but I need the job. It’s not right the way nurse aides and patients are treated here. When I try to make suggestions, nobody listens. I’m really frustrated."
Like people, all nursing homes are not good, and all are not bad. But dedicated nurse aides, no matter where they are, do hard work for low pay and often with little appreciation. A work climate suffers greatly when large numbers of staff stay discontented. Nobody benefits from a negative environment.
Some serious problems that plague nursing homes will require major systemic reform at local, state and federal levels. But administrators of individual nursing homes with negative climates can initiate certain changes themselves by committing to basic reform in staff, patient and caregiver relationships. Welcoming constructive input from all stakeholders validates everyone. Oral or written words of appreciation, when deserved, can go a long way in healing trampled self-esteem. Ongoing opportunities to improve job skills encourage professionalism. An added benefit will be decreased staff turnover. When the word gets around, more nurse aides will choose a nursing home where they feel respected.
As former principal of an urban public school with a high poverty level for many years, I know that setting a positive tone, even under stressful conditions, is a good beginning in changing the culture of any institution. I celebrate everyone who is doing a fine job working in nursing homes, but this post especially celebrates nurse aides, CNA’s and nursing assistants. Cheers to you!
Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog
Sunday, February 11, 2007
Alzheimer's Association Safe Return Program
I have had many hospice patients with Alzheimer’s disease or other forms of dementia. One thing I have learned is that I never know the boundaries of what they will or won’t do. So I’m always surprised when I meet caregivers who think they can accurately predict the behavior of their relatives who have dementia.
When a disease is progressive, it is moving at an unpredictable pace. A friend of mine left her husband in the car, while she ran into a store to make a quick purchase. Upon returning, she became frantic when she discovered the car was gone. Her husband had noticed the car keys, started the car and driven off, something he had not done in years, something she figured he would no longer do. Fortunately, the police found her husband several blocks away sitting in the parked car. But the story could have had a tragic ending.
The Alzheimer's Association Safe Return Program has been around for years, but I keep finding people who have never heard of it. This program provides safeguards, at a reasonable cost, for incidents, such as the one where my friend’s husband drove off. These safeguards include a national information and photo database that operates 24 hours a day, seven days a week, with a toll-free crisis line. Partnerships with law enforcement and other emergency responder agencies increase its effectiveness.
Identification products that have a toll-free number are provided. Products include necklaces, bracelets, wallets and clothing labels. When the phone number is called about a missing person, a caregiver is contacted through the Safe Return database. If necessary, the missing person’s photograph and information will be faxed to local law enforcement agencies. Nursing home patients, who might wander or get lost on trips, could also benefit from these products. One product I particularly like is worn by the caregiver to alert others that he or she is responsible for someone with dementia. If the caregiver is hurt, etc., others can help to get supervision for the patient. For more information, visit the Alzheimer's Association Web site. If you or anyone you know has used the services of this program, your comments are welcome.
Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog
When a disease is progressive, it is moving at an unpredictable pace. A friend of mine left her husband in the car, while she ran into a store to make a quick purchase. Upon returning, she became frantic when she discovered the car was gone. Her husband had noticed the car keys, started the car and driven off, something he had not done in years, something she figured he would no longer do. Fortunately, the police found her husband several blocks away sitting in the parked car. But the story could have had a tragic ending.
The Alzheimer's Association Safe Return Program has been around for years, but I keep finding people who have never heard of it. This program provides safeguards, at a reasonable cost, for incidents, such as the one where my friend’s husband drove off. These safeguards include a national information and photo database that operates 24 hours a day, seven days a week, with a toll-free crisis line. Partnerships with law enforcement and other emergency responder agencies increase its effectiveness.
Identification products that have a toll-free number are provided. Products include necklaces, bracelets, wallets and clothing labels. When the phone number is called about a missing person, a caregiver is contacted through the Safe Return database. If necessary, the missing person’s photograph and information will be faxed to local law enforcement agencies. Nursing home patients, who might wander or get lost on trips, could also benefit from these products. One product I particularly like is worn by the caregiver to alert others that he or she is responsible for someone with dementia. If the caregiver is hurt, etc., others can help to get supervision for the patient. For more information, visit the Alzheimer's Association Web site. If you or anyone you know has used the services of this program, your comments are welcome.
Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog
Wednesday, February 7, 2007
Hospice Volunteer Cemetery Story
When Mamie Wilson (pseudonym) became my hospice patient, she had several unusual qualities that made me wonder. At sixty-five, she was the youngest patient assigned to me after years of volunteering. She had the same name as my grandmother, and I had her grandmother's name. When we made these discoveries during our first meeting, we took them as signs that we were destined to have a great patient and volunteer relationship. In time, I learned that the most unusual thing about Mamie was what she said.
“Is your mother alive?” Mamie asked me one day.
“No, she died a few years ago in her eighties,” I responded.
“You know, you can still be with her and talk to her if you want to.”
“Oh, I know we can still communicate.”
“No, I mean for real. You can be with her in person. Just get her clothes together and her shoes. Don’t forget her coat. They say it’s cold outside. Take them to the cemetery where she’s buried. Just set them on top of her grave and wait. She’ll rise out of her grave and put them on. Then you can take her home with you. In every way, she’ll be the same person you knew. Other people won’t be able to see her, but you will.”
“Hmm. I’ve never heard that before.”
“Most people haven’t. I know about it because I did it with my two grown sons. They were both murdered on the same day in a drive-by shooting. I didn’t know how I would get through the pain. Finally, I took their clothes to the cemetery and did what I just told you. Both of them came home with me. It was the best day of my life. I got my sons back.” Satisfied, she smiled.
Some people will dismiss this story as crazed comments of a demented woman. But if you really listen, you’ll hear the magnificent empowerment in her words.
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog
Sunday, February 4, 2007
Red Hats in Nursing Homes
Increasing numbers of nursing homes are opening up to creative ways for spicing up patients’ lives. But I was still a little surprised the first time I arrived at a nursing home and discovered a roomful of fun-loving ladies, all wearing red hats personalized with their own “hatitude.” For those of you who don’t know what hatitude is, let me explain. Hatitude is your hat's unique fashion statement about the self that is you. A hat will tell you how it has to be “worked” so it can show the world who you are, write your unwritten signature.
Why were all those ladies wearing red hats complemented by purple outfits? They had started their own Red Hat Society chapter. In recent years, these chapters have spread across the country like reality shows. The original Red Hat Society was started by Queen Mother Sue Ellen Cooper and a group of women celebrating their half-century rite of passage into middle-aged freedom. They officially committed to being carefree, silly and supportive of one another in sisterhood as they aged. Wow! Imagine that in a nursing home!
Red Hat Society chapters in nursing homes have joined the merrymaking with invigorating activities, such as tea parties, luncheons, beauty makeovers, cooking classes and trips. Games parties, of course, include Red Hat bingo with Red Hat door prizes. With names like Red Hat Hotties and Crimson Cuties, there’s no denying that their Red Hat presence casts a mystic spell. When nursing home ladies get serious about working their hats, while having a rousing good time, it’s a major spirit uplift for everybody wearing and watching red hats. Are any Red Hatters at nursing homes reading this? If so, what does your group enjoy doing?
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog
Why were all those ladies wearing red hats complemented by purple outfits? They had started their own Red Hat Society chapter. In recent years, these chapters have spread across the country like reality shows. The original Red Hat Society was started by Queen Mother Sue Ellen Cooper and a group of women celebrating their half-century rite of passage into middle-aged freedom. They officially committed to being carefree, silly and supportive of one another in sisterhood as they aged. Wow! Imagine that in a nursing home!
Red Hat Society chapters in nursing homes have joined the merrymaking with invigorating activities, such as tea parties, luncheons, beauty makeovers, cooking classes and trips. Games parties, of course, include Red Hat bingo with Red Hat door prizes. With names like Red Hat Hotties and Crimson Cuties, there’s no denying that their Red Hat presence casts a mystic spell. When nursing home ladies get serious about working their hats, while having a rousing good time, it’s a major spirit uplift for everybody wearing and watching red hats. Are any Red Hatters at nursing homes reading this? If so, what does your group enjoy doing?
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog
Thursday, February 1, 2007
Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
A recently published book that stands out in my mind these days is Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (Doubleday) by Harriet A. Washington. This book struck me as profound and groundbreaking in the information it presents relative to America’s health care system and statements I made in a previous blog about hospice care and people of color.
Medical Apartheid goes far beyond the well known Tuskegee Institute Syphilis Experiment, in which the U.S. Public Health Service allowed almost 400 black men with the disease to go untreated, while pretending to treat them. Ultimately, the men died and unauthorized autopsies were done as part of the experiment.
This book reveals numerous documented atrocities of involuntary experimentation targeting black people, including those in military and prison environments. Some incidents occurred as late as the 1990’s, such as the injection of Fenfluramine into black children in New York. This drug made up half of the deadly, discontinued weight-loss drug Fen-Phen and was used by Columbia researchers investigating the genetic origins of violence. Further emphasizing racial and ethnic disparities, the author mentions experimental research in Africa, Asia, and Latin America.
So many abusive incidents are mentioned, including several even worse than the Tuskegee experiments, it is little wonder that many people of color still regard the health care system, including hospice programs, with deep distrust. I agree with the author’s intent to present this well researched information, particularly those previously unpublished incidents, so we can all be more informed, vigilant, and empowered in our dealings with researchers and health care institutions.
You can read more about cradle-to-grave African American healthcare disparities at this blog post I wrote: https://www.linkedin.com/pulse/african-american-pain-treatment-disparities-emergency-parker?trk=mp-author-card
Medical Apartheid goes far beyond the well known Tuskegee Institute Syphilis Experiment, in which the U.S. Public Health Service allowed almost 400 black men with the disease to go untreated, while pretending to treat them. Ultimately, the men died and unauthorized autopsies were done as part of the experiment.
This book reveals numerous documented atrocities of involuntary experimentation targeting black people, including those in military and prison environments. Some incidents occurred as late as the 1990’s, such as the injection of Fenfluramine into black children in New York. This drug made up half of the deadly, discontinued weight-loss drug Fen-Phen and was used by Columbia researchers investigating the genetic origins of violence. Further emphasizing racial and ethnic disparities, the author mentions experimental research in Africa, Asia, and Latin America.
So many abusive incidents are mentioned, including several even worse than the Tuskegee experiments, it is little wonder that many people of color still regard the health care system, including hospice programs, with deep distrust. I agree with the author’s intent to present this well researched information, particularly those previously unpublished incidents, so we can all be more informed, vigilant, and empowered in our dealings with researchers and health care institutions.
You can read more about cradle-to-grave African American healthcare disparities at this blog post I wrote: https://www.linkedin.com/pulse/african-american-pain-treatment-disparities-emergency-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.
Thursday, January 25, 2007
Hospice Care and People of Color
An African American, I am aware of many healthcare disparities experienced by people of color. Recognized and documented by the American Medical Association, the Centers for Disease Control and Prevention, and numerous others, these disparities, which are based on racial and ethnic factors, result in disproportionate numbers of people needing hospice care in these groups.
Hospice is underutilized nationally, particularly among people of color. Due to personal and collective historical experiences, many people of color are suspicious of healthcare services that are new to them, especially those related to death. They often come from a culture that stresses the importance of family members only being taken care of at home by other family members. They may not be comfortable with the idea of “outsiders” coming in with an end-of-life plan for dying. The idea of hospice services in a nursing home could create even more reluctance. Some people of color might think that pain associated with death is normal.
In order to bridge the gaps in trust and understanding that discourage some people of color from accepting hospice care, hospice staff members must take a more proactive outreach role in presenting the benefits they provide. This requires more than a presentation. It requires a sincere commitment to hire more people of color at all staff levels, more welcome input from people of color on what their needs really are, and more hospice recruitment in their communities at churches, schools, recreation centers, events, etc., along with use of the media, particularly in their languages. Quality end-of-life care is an entitlement for all. That is the hospice philosophy.
Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog
Hospice is underutilized nationally, particularly among people of color. Due to personal and collective historical experiences, many people of color are suspicious of healthcare services that are new to them, especially those related to death. They often come from a culture that stresses the importance of family members only being taken care of at home by other family members. They may not be comfortable with the idea of “outsiders” coming in with an end-of-life plan for dying. The idea of hospice services in a nursing home could create even more reluctance. Some people of color might think that pain associated with death is normal.
In order to bridge the gaps in trust and understanding that discourage some people of color from accepting hospice care, hospice staff members must take a more proactive outreach role in presenting the benefits they provide. This requires more than a presentation. It requires a sincere commitment to hire more people of color at all staff levels, more welcome input from people of color on what their needs really are, and more hospice recruitment in their communities at churches, schools, recreation centers, events, etc., along with use of the media, particularly in their languages. Quality end-of-life care is an entitlement for all. That is the hospice philosophy.
Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog
Tuesday, January 23, 2007
Changing the Culture of Nursing Homes
As a hospice volunteer in Detroit nursing homes for nine years, I have become very familiar with the kind of culture that is predominant in many nursing home facilities. When I speak of culture in this manner, this is what I mean: Whenever we enter a building, a certain climate or culture greets us. Depending on what that culture is, we sense the possibility of the kind of experience we will have. If unpleasant sights, odors and sounds greet us after we enter, we will certainly draw negative conclusions about what to expect. And we will probably be correct. On the other hand, a culture that nourishes and stimulates appropriately makes us feel welcome, happier and encouraged to return.
Too many nursing homes have structured, unexciting and tense cultures that impact staff, patients, caregivers and other visitors poorly. Among other practices, patients are expected to eat and sleep at the same times on a daily basis, although most people would readily agree that people's natural schedules are not that aligned. The ongoing boredom and loneliness, along with excessive focus on rules and medical procedures, have lost sight of peoples' overall human needs. In addition, there is a layer of anxiety regarding compliance, or lack of compliance, with all the various rules that must be followed, regardless of how they impact people. In urban areas, particularly those that serve low income and racial-ethnic minorities, these factors are especially noticeable.
Fortunately, growing groups of reform-minded individuals are making their voices heard regarding the need for change in nursing home culture. They are not pushing cosmetic changes, but real changes in how people live and work together with a common goal. The focus is primarily patient-centered and encourages their independence. The following are a few of the alternative practices they are promoting to improve nursing homes:
1) Personalized schedules
2) Independent "houses" composing a nursing home
3) Family atmosphere with plants and small pets indoors
4) Regular contact with children through on-site daycare centers and after-school programs
5) More activities and decreased medication
As millions of baby boomers become senior citizens, we will be hearing more about these reforms. Our support will be needed to make these changes real and available to all patients, regardless of where their nursing homes are located. What do you think about changing the culture of nursing homes?
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog
Too many nursing homes have structured, unexciting and tense cultures that impact staff, patients, caregivers and other visitors poorly. Among other practices, patients are expected to eat and sleep at the same times on a daily basis, although most people would readily agree that people's natural schedules are not that aligned. The ongoing boredom and loneliness, along with excessive focus on rules and medical procedures, have lost sight of peoples' overall human needs. In addition, there is a layer of anxiety regarding compliance, or lack of compliance, with all the various rules that must be followed, regardless of how they impact people. In urban areas, particularly those that serve low income and racial-ethnic minorities, these factors are especially noticeable.
Fortunately, growing groups of reform-minded individuals are making their voices heard regarding the need for change in nursing home culture. They are not pushing cosmetic changes, but real changes in how people live and work together with a common goal. The focus is primarily patient-centered and encourages their independence. The following are a few of the alternative practices they are promoting to improve nursing homes:
1) Personalized schedules
2) Independent "houses" composing a nursing home
3) Family atmosphere with plants and small pets indoors
4) Regular contact with children through on-site daycare centers and after-school programs
5) More activities and decreased medication
As millions of baby boomers become senior citizens, we will be hearing more about these reforms. Our support will be needed to make these changes real and available to all patients, regardless of where their nursing homes are located. What do you think about changing the culture of nursing homes?
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog
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