Person-Centered Bathing: Long-Term Care Culture Change (Research)

Do you remember how special bath time was when you were a child? Did you have toys floating on the waves of your rolling sea? Were there bubbles sometimes adding magic to the experience of getting fresh and clean? Maybe you still have certain rituals like music, fragrance, and candlelight that take bathing to another level when you want to pamper yourself. These simple treasures can add so much to uplifting spirits. While bathing may seem like a universal activity, individual preferences add personal joy. Shouldn’t nursing homes be sensitive to residents’ personal preferences when they can be implemented?

A research study by the Yale School of Medicine examined the bathing experiences, attitudes, and preferences of older persons through in-depth interviews. Three themes emerged:

1) The importance and personal significance of bathing to older persons

2) Variability in attitudes, preferences, and sources of bathing assistance

3) Older persons' anticipation of and responses to bathing disability

Clearly, their attitudes and preferences are important when person-centered interventions for bathroom design are considered.

My book "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” has a chapter titled “Baby Boomer Haven,” which takes readers on a tour of an imaginary nursing home that incorporates best practices currently being used in nursing homes today, but not nearly enough. Of course, innovative bathing systems meeting residents’ needs continue to be invented. The tour is led by a resident in a wheelchair. This excerpt from the tour addresses bathrooms:

“This might be a little unusual, but I just have to show you one of our bathrooms. Using the bathrooms is a pleasant experience here. We have choices about whether we want a shower, a bath, or a sponge bath, and when we choose to take them. The Jacuzzi tubs and music are great motivators to come here. Deodorizers keep our bathrooms smelling fresh at all times. Notice the bright artwork that colors the walls and even the ceilings, so we can admire beauty when we are in reclining positions. We can soak in beauty everywhere we look. These simple touches tell us that somebody thought we were worth the effort.”

Isn’t that what quality of life is all about?

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Medical Student Training: Hospice Patients and Staff (Research)

I was sitting on a hospital examining table while contemplating when I could get dressed and escape. That’s when a doctor walked in with ten medical students in tow, all eager to hear about this new exhibit—me.  A former school principal, I totally support minds being terrible things to waste and nobody being left behind. But having a group of strangers walk in unannounced under these circumstances was uncomfortable. And I wasn’t even a hospice patient.

How do hospice patients feel about being participants in the training of medical students? Is it annoying being scrutinized by groups of students while patients struggle with their own health issues? What about the healthcare staff? Do they welcome opportunities to participate in educating others through patient contact, or do they view these experiences as inconvenient for them and intrusive to the terminally ill?

Hospice patients and staff were interviewed regarding their views on involvement in the training of medical students. The research results indicate that hospice patients are “strongly positive” about meeting medical students. Staff members carefully select patients based on specific issues. When done appropriately, training medical students with hospice patients and staff can be a win-win experience for everyone. 

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Television Viewing in Long-Term Care (Research)

                         

"I Love Lucy” Television Show

My grandmother loved watching the soaps on television. Home alone during the day, she laughed, cried, and wrung her hands with worry over strangers who took over her living room daily. But they weren't strangers to her. Like Lucy, she had plenty of explaining to do when I came home.

As a hospice volunteer, I wasn’t surprised at all when I visited nursing homes and saw the important role television played in many senior residents’ lives. Beverly, one of my patients, couldn’t hear very well. She disliked wearing her hearing aid as much as she disliked wearing her false teeth. But that didn’t stop her from eating her peanut butter sandwich crackers while watching television in her room. She listened carefully and tried to make sense of whatever she could. Later, she would ask me to unravel her confusion about a world that was nothing like she remembered. Even the weather was different. And why didn’t Oprah and Stedman just get married?

Some people have negative opinions about residents watching television in long-term care facilities. They think it makes them passive and less healthy. And they would be correct sometimes. I have certainly seen television used as a poor substitute for planned quality time. But watching television can be a positive experience under appropriate circumstances when it’s not used in excess. Research even supports this.

In a study of two nursing home settings, rural and urban, with residents aged 82 through 100, resident interviews and observations reported these results:

Television viewing contributes to structuring daily life, to satisfying old peoples' needs for reflection and contemplation, and to residents’ remaining socially integrated. (That certainly worked for my grandmother.)

Nursing home residents are often curious and eager to know about what is going on outside the nursing home world, even when they don’t agree with what they discover. In fact, disagreement can add to lively social discussions. Watching television and learning new information helps residents stay engaged with others and contributes to their wells of communication. Hmm, sounds like the same positive impact good television can have on people in general.

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Curative Medical Care vs. Non-Curative Hospice Care: Two Men in Love with the Same Woman

Curative medical care and non-curative hospice care are like two men in love with the same woman. The curative man, who has enjoyed many wonderful years with her, is reluctant to let her go. But their joy together has declined with time. While she appreciates the fulfillment they shared in the past, she now feels a lack of commitment to him and an urgency to move on with her life. The hospice man, the new love in her life, fills the void she is experiencing and brings an essential enhancement to her well being. He longs to stay with her because their relationship has reached a mutually meaningful level. The woman he loves embraces the happiness his hospice presence brings.

Unfortunately, many experience this love triangle in varied ways. Patients may resist the prediction of death within months and the prospect of involving outsiders as caregivers. Some doctors and caregivers may be reluctant to admit that a patient cannot be saved. Medical staff focused on curing all patients may not totally commit to the hospice philosophy of non-curative care when working with hospice patients.

Love triangles like this that exist in nursing homes and other institutions must be resolved with focus on the best interests of patients. In order to improve treatment of the terminally ill, institutions that have hospice programs must be dedicated to promoting staff expertise in hospice practices. This commitment must include clear administrative support with ongoing education and monitoring of staff practices. This will ensure that hospice patients receive services appropriate to their non-curative condition. 

What’s love got to do with it? Everything. In some institutions where these positive partnerships have been implemented, hospice practices such as better pain management have naturally become part of the care given to terminally ill patients who are not in hospice programs. True love can be contagious like that.

Can two men be in love with the same woman? Sure, if they respect each other’s boundaries, strive for a healthy relationship including the woman’s needs, and understand that, when lovers lose their mutual joy and loyalty, moving on can be love’s greatest expression.

Frances Shani Parker, Author

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

“Hospice and Nursing Homes Blog”

Stereotypes About the Elderly and Effects (Research and Video 2:27 mins.)

Like many of you, I belong to several social media networks. However, there is one I seldom use, due to the immaturity I have encountered there, particularly regarding the elderly. Below is a brief summary discussion on a life-threatening topic that I initiated there about seniors and the prevention of HIV/AIDS:

“According to the U.S. Centers for Disease Control, one-quarter of the one million HIV-positive people in the U.S. are older than age 50. Half are expected to be older than 50 by 2015. People tend not to think of HIV/AIDS as an illness of senior citizens, but it is. Seniors must be committed to not taking sexual risks.”

I received over a dozen responses, some too vulgar to print here, from various people, along with degrading, so-called funny photos of old people. None took this matter seriously. These are a few examples:

1) “You just made me throw-up in my mouth a little.”

2) “CUT IT OUT OR I WILL REPORT YOU!!!”

3) “What's considered a sexual risk for an old person? Not wearing a   diaper?”

4) “Sex also puts them at risk for hip fractures. That would seriously suck. A hip fracture and aids. Double whammy.”

5) “How about old people just stop having sex?”

So much for intelligent discussion. I am open to constructive, controversial debate, but that group “discussion” took blatant prejudice to another level. Truthfully, it is yet another example of negative stereotypes embedded in our society about the elderly. They are all over the media.

These and other stereotypes affect those who are victimized by them, and impact the elderly in detrimental ways. Research reported in Aging & Mental Health explains that negative aging stereotypes impact how the elderly see themselves and how they function. They become more dependent on others, have lower levels of risk taking, subjective health and extraversion, and higher feelings of loneliness. These are concerns we should keep in mind as we continue to advocate for eldercare improvements.

In this video titled “See the Person, Not the Age,” a young actress transforms herself into a senior and compares people’s reactions toward her. This experiment is part of the Scottish government campaign against ageism, an international problem.

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

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”