Hospice Patient Discharge (Research, Long-Term Care Story)

Hospice does not speed up death. If two terminally ill patients had identical issues, the one in hospice care would probably live longer. During my years of hospice volunteering in Detroit, Michigan nursing homes, I rarely had patients leave hospice alive.

Who leaves hospice alive? Discharges can occur when patients decide to resume curative care, when their conditions improve beyond hospice guidelines, or when hospices inappropriately use live discharge to avoid costly hospitalizations. A national study of live discharges from hospice stated that approximately 1 in 5 hospice patients is discharged alive with variation by hospice programs and by geographic regions. Connecticut has the lowest rate, and Mississippi has the highest. Not-for-profit hospices and older hospices have lower rates of live discharge.

From the perspectives of patients and family members, what are the experiences of adults discharged from hospice programs due to decertification related to ineligibility or extended prognosis? A hospice discharge research study reported that two primary themes emerged. One theme was suffering, and the other theme was the paradox of hospice discharge. Subthemes included abandonment, unanswered questions, loss of security, loneliness, uncertainty, anger and frustration, physical decline, bearing exhaustive witness, having and needing support, mixed feelings, not dying fast enough, and hospice equals life. Clearly, more study about the hospice discharge experience is needed for healthcare providers to offer appropriate support to patients and families.

People are often surprised when I speak about patients leaving hospice alive, especially when I tell them Raynell’s story. Raynell, my diabetic hospice patient with dementia, shared a room with four other patients at the nursing home. Her fourth roommate was actually an imaginary admirer named Robert, whom she loved like the devil loves holy water. One day, she surprised me with talk about leaving hospice care and the nursing home:

Raynell requested my help by saying, “I was wondering if you could help me find another apartment. I’ve been thinking about looking for a new place to stay, maybe a place closer to where I used to live. This apartment building is too noisy. Just close your eyes and listen to all the talking, buzzers, and everything. People come into my place without even knocking. They just walk right in and go through my closet and drawers. It’s not right. Three ladies even moved in with me when I wasn’t looking. Now, I can’t get them out.”

I responded, “Whoa! That’s a surprise! I didn’t know you wanted to leave here. Are you sure moving is the best thing to do while you’re not feeling well?”

“Lately, I’m feeling much better. I need a change. Even Robert (annoying imaginary boyfriend) had to leave, so you know it’s bad. But I’m very glad about that. He’s gone to live in California. I don’t think he’ll be coming back again.”

“A lot sure has happened since I visited you last week. You never said you wanted to move before or that the other people who live here bothered you so much. All this really shocks me.”

I thought about this interesting conversation.  It was the first time Raynell ever mentioned moving to an apartment and, even more astonishing, the first time she never said Robert was hiding under her bed, and she needed me to chastise him for her. Two weeks later, she was released from hospice care because her health really had improved. She moved to another nursing home near her son’s house. I guess Robert knew his time was almost up and decided to leave before he was left.

© Excerpt above from Becoming Dead Right

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 Romance: Internet, Speed Dating (Research, Video 4:34)

If you’re an older woman seeking a male dating partner, the choices get slimmer with time. Perhaps you have considered lowering the bar in terms of your preferences. Perhaps not, especially if you’ve grown to love the freedom and carefree lifestyle of single living without a partner. Older men, on the other hand, look around and see more possibilities available among potential women to date as they age. Options like Internet dating and speed dating add new flavors to old traditions. Seems like choosing romantic partners is much different from the days when they were all younger. But are older adults similar to young people today in their dating choices?

Research on Internet dating profiles for 100 older adults and 100 younger adults indicate that older adults (and especially older women) were more selective than younger adults when it came to the age, race, religion, income, and height of a prospective dating partner. Perhaps these older adults are more selective because of lessons they learned through the years. Being a little picky can be a good thing when one doesn’t feel desperate.

But older adults can’t be viewed as a homogeneous group. They include such a wide range of ages and types that their quest for romantic love has to be categorized in three divisions: the young-old, the middle-aged old, and the old-old. In terms of courtship, the young-old and middle-aged old are more likely to mention adventure, romance, sexual interests, and seeking a soul mate and less likely to mention health in their preferences.

Some older adults concerned about the passage of time are using speed dating when they want to quicken the dating process. After losing her husband of 47 years over a year ago, Roz tries speed dating in her quest for friendship or romance. View this video to see her results:

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

Afterlife Beliefs: Mourning Older Adult Spousal Death (Research, Video 4:25)

Do you believe in life after death? Do you think death is the end, and there is no afterlife? Many people have varied ideas about this topic, and their beliefs can impact their psychological adjustment to a loved ones’ death.

Afterlife research indicates that symptoms such as anxiety, depression, intrusive thoughts, and yearnings of recently bereaved older spouses are affected by whether they believe in an afterlife or not. After a loss, uncertain or bleak views about the afterlife were associated with various aspects of distress, including symptoms similar to post-traumatic stress (PTSD). With no expectation of ever being reunited with a loved one, many have had greater difficulty adjusting, even months after the loss.

Apparently, beliefs in an afterlife help older adults cope with spousal loss better than they would if afterlife beliefs are uncertain or pessimistic. These findings are consistent with other recent work regarding “continuing bonds” with the deceased.

Doctor Jeffrey Long, a radiation oncologist, says he has scientific evidence of an afterlife and explains his findings on the “Today Show” in this video. Mary Jo Rapini, who says she has had a personal near-death experience, joins him:

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

Tribute to a Nun with Alzheimer’s Dementia

When I travel back in time, I find them. They were teachers, mentors, neighbors, caring people who crossed my path at various stages of my journey through life. They were village members who loved me, people who offered their unique support and understood that every child belonged to them. Listening with their hearts and hearing me were their special strengths. Introducing me to possibilities I never considered was an added bonus. I look back in awe at these role models who set a high bar and challenged me to prove them right.

I was born and raised in the segregated Jim Crow South where every day was a reminder of my unimportance to the larger society. Back in the day, I met a wonderful nun named Sr. Mary who became part of a growing circle of individuals who helped me know I mattered. Although she was never my classroom teacher at school, she taught me a lot about life when unanswered questions invaded my childhood thoughts. Young and vibrant, she strolled the playground during recess, while happily initiating nurturing discussions with students. I welcomed conversations with this engaging guru whose encouragement lifted me higher.

Years later, I located and phoned Sr. Mary to express my appreciation, find out how she was doing, and introduce her to the adult I had become. A former school principal, she was living at a convent in another state where she served hospice patients and the elderly. Of course, she was elated to know I had also become a school principal and was a hospice volunteer who had authored a book about hospice and eldercare. Time passed with long-distance calls and snail-mails about our busy lives. In more recent years, Sr. Mary developed Alzheimer’s disease, the most common form of dementia. Living in a nursing home, she continues to decline physically and mentally, but her warm heart remains wrinkle-free.

Savoring memories, I celebrate Sr. Mary, one of numerous dedicated nuns who have inspired countless others in an unending ripple effect that enhances the world. At a time when multitudes search for moments to fall in love with something, somebody, or some place, I am assured that an incredible woman who now has dementia favored me with goodness long ago.

Having known many people with dementia, I understand what really matters is the spirit of our friendship, not whether she remembers my name or identity. Regardless of how she appears or behaves on her roller coaster of reality, Sr. Mary will never be Sr. Alzheimer's. And when this well deserved tribute is shared with her, perhaps she will smile and enjoy this standing ovation from someone in her loving village, someone offering unique support, someone to whom she belongs.

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.
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Hospital Emergency Department Treatment for Older Adults (Research, Video 3:47)

How was your last visit to the hospital emergency department (ED)? Were you satisfied with your wait time before and after you were placed in a room? Could this time have been used in a more productive manner while you waited? What about your interactions with healthcare providers? Do you think they showed you genuine concern? Consider the general environment. Did it meet your particular needs in terms of comfort and practicality? Was your experience one that you would recommend for older adults? These are the kinds of questions that need to be addressed to meet the unique needs of this population.

Hospital emergency department research using audio-taped encounters of patients was done to assess the proportion of time that patients spent in conversation with providers during emergency department visits. Analysis revealed that patients with older age, longer visits, and those requiring a procedure had more talk-time. Overall results indicated that approximately 75% of patients’ time in care areas is spent not interacting with providers. That is a large amount of time that could be better spent in ways that can both enrich the process and educate patients.

Highland Hospital in Rochester, New York is featured in this video as an example of a hospital that says it exhibits geriatric friendliness through protocols and physical changes in the emergency department.

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

Mardi Gras in America: Older Adults in Long-Term Care Have a Ball (Video 1:57)

No matter where they live, older adults in cities across America  love participating annually in the popular celebration of Mardi Gras. That wonderful day known also as “Fat Tuesday” will fall on the day before the Christian season of Lent starts. Older adults celebrating this world-famous Carnival season often have parties and small parades. In New Orleans, street parades attracting thousands of local residents and curious tourists occur daily. Parades are held during the day and at night.

Growing up in New Orleans, I loved this magical season. Mardi Gras parades created wonderful memories for me. The excitement of swimming in an ocean of festivity, the buoyancy from living fantastic fantasies thrilled my senses. They connected me with the same wave of wonderment flowing through every child who ever lived on this planet.

I store my New Orleans memories in a marvelous, mental, treasure chest painted with purple, green, and gold brush strokes, the official colors of Mardi Gras. All grown up, I still smile when I look inside. No doubt, many older adults will be smiling during Mardi Gras season this year and in the future.

Upcoming Mardi Gras Dates:

Mardi Gras can fall on any Tuesday between February 3 and March 9.

These are upcoming Mardi Gras dates. Keep in mind that Mardi Gras isn't just one day. It's a season with numerous parades, balls, and parties starting on January 6.

• February 13, 2018
• March 5, 2019
• February 25, 2020
• February 16, 2021
• March 1, 2022
• February 21, 2023
• February 13, 2024
• March 4, 2025
• February 17, 2026
• February 9, 2027
• February 29, 2028
• March 5, 2030
• February 25, 2031,
  February 10, 2032
  March 1, 2033
  February 21, 2034
  February 6, 2035
  February 26, 2036
  February 17, 2037
  March 9, 2038
  February 22, 2039
  February 14, 2040
  March 5, 2041
  February 18, 2042
  February 10, 2043
  March 1, 2044
  February 21, 2045
  February 6, 2046
  February 26, 2047
  February 18, 2048
  March 2, 2049
  February 22, 2050

Through the years, I have featured older adults celebrating in various cities. Join residents in this Mardi Gras celebration at McMahon Tomlinson Nursing Center in Lawton, Oklahoma. Let’s hear it for Oklahoma! They had a ball with a parade, dancing, and great music from the 77th Army Band. The parade has started! Have some punch! As they say in New Orleans (and sometimes in Oklahoma), “Laissez le bon temps rouler! Let the good times roll!”

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 Abuse: Multicultural Attitudes, Intervention (Research, Video 2:16)

Abuse toward older adults continues to be a major concern in terms of barriers for prevention and treatment. Some barriers are due to how members of this population from different racial-ethnic backgrounds perceive, experience, and try to solve problems related to their own mistreatment. Multicultural focus group discussions on older adult abuse case vignettes in the United States reveal the following attitudes of African Americans, English-speaking Latinos, Spanish-speaking Latinos, non-Latino Whites, and African American caregivers for older adults:

1)    While older adult abuse definitions were similar across various racial-ethnic groups, Latino participants introduced additional themes of machismo, respect, love, and early intervention to stop abuse. These themes indicate that beliefs about mistreatment are determined by culture in addition to race and ethnicity.

2)    Most attitudinal differences occurred within the groups, suggesting that perceptions about abuse vary among individuals in addition to culture and racial-ethnic backgrounds.

3)    In identifying abuse scenarios, some participants felt that particular forms of mistreatment are actually the continued persistence of intimate partner violence into old age.

4)    Participants also shared that victims sometimes tolerate abuse and refuse to report it in exchange for perceived benefits such as companionship, security, and fear of placement in institutions.

This research reveals the important need for person-centered forms of intervention that include cultural and racial-ethnic factors as well as individual preferences and care needs when addressing solutions to problems of abuse toward older adults.

Older adult abuse includes not only physical and emotional mistreatment, but also neglect, sexual abuse, and financial exploitation, which alone victimizes one out of 20 older adults in the United States. For more details regarding financial exploitation, refer to the Lichtenberg Financial Decision-Making Screening and Rating Scales information posted by the Wayne State University Institute of Gerontology directed by Dr. Peter Lichtenberg. 

Theft and fraud by loved ones are on the rise. The following WXYZ-TV Detroit video segment led by Sherry Margolis features Arthur Green who was financially exploited by his granddaughter.  

You can read more about financial abuse and the trust factor in what experts refer to as the crime of the 21st century here.


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