Cathy Cress

Expert in Aging Life and Geriatric Care Management

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How Does Atul Gawande View Quality of Life in Dying ?

September 15, 2021

 

   A good life to the very end 

Atul Gawande’s acclaimed book, “Being Mortal“ opened our eyes to the medical way of death. He showed millions of readers how the quality of life and human interaction while dying trump the number of years gained through questionable painful procedures and dying in an institution.

He tells us that “our ultimate, goal, after, is not a good death but a good life to the very end

 

Quality of Life Can Be There to the End of Life

GCM Nina Herndon brings you that same quality of life message- about dying –where an elder can still live the end of life with joy. Her chapter “Supporting Clients’ Quality of Life: Drawing on Community, Informal Networks, and Care Manager Creativity” in the Handbook of Geriatric Care Management 4th edition is a geriatric care management Nina has devoted her career to giving elders a care plan for a happy life and a happy life to the very end.

 Bringing Joy in the here and now of Dying

 Bringing joy in the here and now of dying can be done through using quality of life tools- Spiritual, emotional, intellectual, creative, and physical quality of life. Increasing the spiritual quality of life can mean for a person is dying and wishes to return to a spiritual group she knew before, connecting them to the faith they are familiar with. Even homebound clients can have visits from members of a religious community or a prelate. They can have hymns sung, prayers said or whatever religious ritual their spiritual group follows, like communion, at home. Care providers can be trained to engage them by reading religious texts or playing hymns.

The Power Reminiscence at End of Life

Spirituality can be the environment. I once had a client who was in a nursing home dying of cancer and wanted to go home to die with hospice and 24-hour care. Hisgrandma_holding_rosary_shutterstock_40017103-255x255.jpg spirituality was the environment and he had been a lead volunteer to build a trail in Santa Clara California from Los Gatos up the steep winding highway 17 over the Santa Cruz mountains to the Lexington Reservoir. He had no family so the care manager asked the volunteers he had worked with if they would visit him at his home. They happily agreed and 300 volunteers took shifts, 24 hours a day to sit with him reminisce, tell stories and sing while he died over several weeks. This is what joy that bringing a spiritual quality of life can offer in dying.

Tools for Reminicance at End of Life

Friends emailing short personal videos with good wishes and memories, that a family member can show on a phone or computer- can bring emotional joy at end of life. Sending notes, not of condolences but great memories can be a salve to dying. Volunteering to give respite to family members, if visiting is allowed during COVID or post the pandemic, can give an opportunity to share old memories or look at old photos and give family respite. You may have thought those old photo albums should be dumped but they can bring the joy of reminiscence if shared at end of life or with seniors at any time.

 

 

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Filed Under: Aging, Aging Family, Aging Life Care, aging life care manager, care manager, case manager, Death & Dying, Death and Dying, Death and Dying Care Management, death and dying care manager, End of Life, End of Life Care manager, Families, Geriatric Care Management Business, Geriatric Care Manager, geriatric social worker, Good Death, Hospice, Hospice Care, Hospital care manager, nurse advocate, nurse care manager, Photo Albums& Reminicance, Quality of Life, Quality of Life and Reminicance, Quality of Life for elders, Quality of Life in Death, Quality of Life in Dying Tagged With: aging family, aging life care manager, aging parent crisis, assessing for quality of life, Atul Gawande, Being Mortal, black aging family, black american geriatric care managers, Black Entrepreneurs, Black geriatric care managers, Black Nurse Entrepreneurs, Black start-up geriatric care management, Black travel nurses, care manager, case manager, death and dying, geriatric care manager, Handbook of Geriatric Care Management, nurse care manager, Quality of Life at end of life, quality of life in dying, Reminicence Therapy, Reminiscence at End of Life

Can You Give a Good Death without” Rage, Rage Against the Dying of the Light”?

March 9, 2021

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Dylan’s Thomas warns us in his poem

 

Do not go gentle into that good night,
Old age should burn and rave at  close of day;
Rage, rage against the dying of the light.

 Give a good death – not a cold terrifying dying of the light.

 

But today a care manager or geriatric social worker can help an older client go gentle into that good night, they do not have to burn and rage at the close of their day because you will be giving them as Atul Gawande suggests – a good death – not a cold terrifying dying of the light.

 

The terminal phase of any life-threatening illness is the time between diagnosis and the final decline when no cure or extension of life is in the offing. The individual confronts progressive decline and deterioration. Death is imminent. The care manager has a role.

The focus of doctors and patients now changes from attempting to cure the illness or prolong life to trying to provide relief from pain and to comfort the sufferer. Religious concerns such as what happens after someone passes away or how to handle the suffering at the end of life or how to give comfort to family members are the focus during this time as well as trying to tie up any loose ends.

Death to Rage About- Alone in the Hospital

But in the time of the plague, when  95.5 % of souls still die in the hospital and not at

home the care manager has a critical role with the family. High tech introduced by the care manager and at times the hospital with the care manager coordinating the family outsides and unable to touch their dying loved one – can make this death full of rage more gentle as the person passes into the night.

Care Manager tasks:

Make a referral to hospice if the family has not  already reached out

Partner with hospice and work under them

Monitor anticipatory grief needs

 Communicate that this is the end (and time to say goodbye)

 Assess spiritual needs and contact the appropriate religious-spiritual counselors to provide comfort and healing.

 Encourage family members to say The Four Things That Matter Most   “Please forgive me”, “I forgive you”, “Thank you”, and “I love you”.

Assess the need for paid caregivers to help the family or help family members share round the clock care among family and friends

 Support the family members in their need to grieve and have respite by continuing to assess for overload and burn out with a caregiver assessment tool 

Prepare family for the active phase of dying which can be loud and disturbing to someone who is not aware of what will occur

Bring in technology if death is alone in the hospital

 

Join me Thursday, March 11, and learn why End of Life Services Are a perfect new service for care managers 

Deliver a Good End of Life- Add Death and Dying to Your Care Management Agency

 

Serve Your Client Until Death Do You Part

 In this 1 ½ -hour webinar you will learn how to

 

 

1.Transition the patient/family through the five stages of death

2. Help clients be active participants in their care

3.Give the family/caregiver tools to manage care

4 Provide family center care to caregiver and family

5 Choose the right support services through all stages of death

6.Introduce Hospice and Palliative care and work with their team

7 Use ALCA End of Life Benefits During COVID

8.Use  COVID -19  Family Coaching for GCM

SIGN UP

 

 

If you really want to add End of Life to your care management business sign up for this webinar now

 

Gwendolyn LAZO Harris MA, CT, Seniors at Home, San Francisco and Diane LeVan MA both highly expert care managers, created a seminal chapter “Palliative Care and End of Life Care Manager ” in my book Care Manager’s Working With the Aging Family  

 

 

Filed Under: 5 Stages of Dying, 5 stages of End of Life, Aging, Aging Family, aging family crisis, aging life business, Aging Life Care, Aging Life Care Assocaition, aging life care manager, ALCA Role Death and Dying, Blog, care manager, case manager, Death & Dying, Death and Dying Care Management, death and dying care manager, elder care manager, End of Life, End of Life Care manager, End of life documents, Families, Five Stages of Death, geriatric care manager, Geriatric Care Manager, geriatric social worker, Good Death, nurse advocate, nurse care manager, Palliative care manager, Webinar, Webinar ALCA GCM Tagged With: 5 stages of death, adding geriatric care management, aging life care manager, ALCA &end of life, ALCA Death and Dying, Atul Gawande nurse care manager eldercare manager, Benefits Care Managers, Benefits of Care Managers To Hospice, care manager, case manager, death and dying, eldercare manager, end of life care, free webinar, geriatric care manager, Hospice at end of life, Hospice Care, Palliative Care, terminal phase of dying, US medicaization of Death

What is the GCM’s Role is the Recovery Phase of Death and Dying ?

March 7, 2021

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The recovery phase of death and dying 

This occurs when people finally are able to cope with the mental, social, physical, religious, and financial effects of their disease, a heavy load  In the disease process and acceptance process, this is the period of time after a medical procedure such as chemotherapy, radiation or surgery. The client’s response to treatment is being monitored. Recovery does not always mean remission, but instead, it is the ability to accept and deal with the struggles of their illness

A Story About the recovery phase

William died at the home of his son after he had accepted that he was to die of liver failure. He was hospitalized and had not signed a Do Not Resuscitate because he actually did want everything done to save him. He had new twin grandsons a grandaughter he adored and loved life. He was having dialysis to treat his symptoms. A care manager knew that the doctors suspected cancer but believed the procedure to find out would kill him. But they felt their hands were tied by the DNR and the hypocritic oath. The care manager, finally, after talking to a nun on the staff of the Catholic hospital who said she would help,  and talked to the lead physician and asked that he order palliative care. He did and all 4 physicians talked to Bill gently and about removing the dialysis and signing a DNR. He did and after a family meeting lead by palliative care and hospice, William came home with 24-hour care.

The Recovery Phase Begins

After his coming to terms with his death, he and his family, sons, and grandchildren were able to say the goodbyes and offer the unconditional love that they had been fearful to express before his acceptance. A feeling of light joy permeated his room. For almost a month he lived in the family room overlooking the garden, where his hospital bed was set up. Great-grandchildren brought pictures, marveled at “grandpa grandpa “ high up in a hospital bed. His son put a  headphone with a mike on and William could hear and speak, as he had not in years. His 24-hour caregivers were gifted loving care providers from a GCM agency  Livhome. 

Home Care and Care Management in End of Life

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The 24-hour shifts included a nurse of 18 years from Central America and a man finishing his Ph.D. from the Congo. They cared for him with great warmth, so his family could just be his family, relaxing in their love and surrounding him, as if in a circle, that swirled with 4 generations, going every which way while he watched, really loved, and melted into his last stage. They ate meals, chitchatted, and welcomed new family coming in to see William, as he remained in the center in his hospital bed, the fulcrum of the gathering.

End of Life Geriatric Care Management Well Done

The geriatric care manager, GCM Mary Brennan, from Livhome, a seasoned powerful and so kind LCSW,  was an orchestra leader in Bill’s death. She adjusted here and there, with care providers, family needs, Bill’s needs, and followed the guidance of hospice, who were slowly increasing the pain meds, and supporting his health and medical care needs in death. The geriatric care management agency worked as a partner supplying 24 care and support for the family.

Bill was able to have again, a magical care provider from Livhome, who had been with him for almost two years and was there at the end as were all his sons – a life fully lived and a good, good death.

You are only as strong as your weakest link- those are the care providers.

These people were the raft that floated bill up while the family, offered love and hospice provided medical and end of life support. Together they buoyed Bill into his last stage of dying, knowing that his family was the fabric of every step he took toward forward towards death.

 

Deliver a Good End of Life- Add Death and Dying to Your Care Management Agency

 

Serve Your Client Until Death Do You Part

 

Join me Thursday, March 11, and learn why End of Life Services Are a perfect new service for care managers

 

In this 1 ½ -hour webinar you will learn how to

 

 

1.Transition the patient/family through the five stages of death

2.Help clients be active participants in their care

3.Give the family/caregiver tools to manage their care

4.Provide family center care to caregiver and family

5.Choose the right support services through all stages of death

6.Introduce Hospice and Palliative care and work with their team

7.Use ALCA End of Life Benefits During COVID. 

8.Use  COVID -19  Family Coaching for GCM

Sign Up

If you really want to add End of Life to your care management business sign up for this webinar now

Filed Under: Aging, Aging deaths, Aging Life Care, aging life care manager, Benefits of ALCA to Hospice, Benefits of Care Management to Hospice, Benefits of Geriatric Care Management, Death & Dying, death and dying care manager, elder care manager, End of Life, End of Life Care manager, End of life documents, FREE MARKETING WEBINAR, FREE WEBINAR, GCM Clinical Tools, Good Death, Home From the Hospital, Hospice, Hospice Care, Hospital care manager, nurse advocate, nurse care manager, Palliative Care, Palliative care manager, Private Duty Home Care, Quality of Life in Dying, Recovery phase of death Tagged With: end, end of life care, end of life family meeting, free webinar, geriatric assessment for end of life, geriatric care manager, Good Life to the Very end, Hospice, Hospice at end of life, Livhome, Navigation through END of LIfe, recovery, recovery phase of death, recovery stage of dying, webinar end of life

Video of GCM Role in 5 Stages of Death

March 5, 2021

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 A Care Manager Can Navigate to a Good Death

Create an end-of-life care management service that provides a service in the 5 stages of death. Every stage of dying can be part of a good death, including the difficult point called the chronic phase if a care manager is a navigator for the dying person and their family.

The chronic stage of death is the time of loss

The Chronic stage is the time between the diagnosis and the result of treatment. During the phase, the dying person tries to cope with the demands of daily life while also going through necessary medical treatment, “often having to struggle with the sometimes brutal side effects of their treatment”.Chronic illness may also involve repeated episodes of deterioration in which the patient confronts and adjusts to these losses. Examples of these losses include cognitive function, sexuality, toileting, the ability to ambulate, eat and dress, and the indignity of losing all your hair. The focus of life for both the family and the patient needs to be redefined, shifting from hope for a cure to coping with the illness

Geriatric care manager tasks:

  1. Assist family to determine the type of long-term care which may  be safest and healthiest for the loved one: institutional: hospital chronic care or nursing home care, in-home nursing care or family care and make arrangements
  2. Co-ordinate help from community organizations through the continuum of care
  3. Assist client and family connect with support groups in death and dying
  4. Assist in learning management of disease skills such as from health care staff, videos, manuals, or brochures.
  5. Monitor anticipatory grief needs
  6. Learn about the disease in order to help the patient make good decisions about his/her care and to help family members monitor their expectations
  7. Monitor caregiver burden: encourage family caregivers to take time for selves, take breaks, get rest get to medical appointments, for grief needs
  8. Assess client’s non-medical needs: transportation, physician’s appointments, household tasks, personal care  if hospice  involved- medical if not involved
  9. Assess family caregiver for overload, burnout, educational supports, home care supplement or family replacement care

 Free Webinar to Deliver a Good End of Life-

Add Death and Dying to Your Care Management Agency

 

Join me Thursday, March 11, and learn why End of Life Services Are a perfect new service for care managers 

 

In this 1 ½ -hour  free webinar you will learn how to

1.Transition the patient/family through the five stages of death

2.Help clients be active participants in their care

3.Give the family/caregiver tools to manage care           

4 Provide family center care to caregiver and family

5 Choose the right support services through all stages of death

6.Introduce Hospice and Palliative care and work with their team

7 Use ALCA End of Life Benefits During COVID

8.Use  COVID -19  Family Coaching for GCM

Sign Up 

If you really want to add End of Life to your care management business sign up for this webinar now

 

 

Gwendolyn LAZO Harris MA, CT, and Diane LeVan MA both highly expert care managers created a seminal chapter “Palliative Care and End of Life Care Manager ” in my book Care Manager’s Working With the Aging Family  

 

 

 

 
 

Filed Under: Acute Stage of Dying, Aging, Aging Life Care, aging life care manager, Blog, care manager, case manager, Death and Dying, Death and Dying Care Management, death and dying care manager, elder care manager, End of Life, End of Life Care manager, Families, Five Stages of Death, GCM role Death and Dying, GCM Start -Up, Geriatric Care Management Business, geriatric care manager, Geriatric Care Manager, geriatric social worker, Good Death, Hospice Care, nurse advocate, nurse care manager, Palliative Care, Palliative care manager Tagged With: 5 stages of death, acute phase of dying, adding end of life services, aging family crisis, aging life care manager, anticipatory grief, chemo hair loss, chronic phase of death, death and dying, eldercare manager, end of life care manager, geriatic care manager, geriatric care manager, hospice care manager hospice, nurse advocate, nurse care manager

What are the Ten Steps The Care Manager Takes in The Acute Phase of Death ?

March 3, 2021

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What Does a Care Manager Do In Acute Stage of Death?

What does a care manager do after a terminal diagnosis has been given by a physician and the older person and their aging family have moved on to the ” Acute Phase”?

 The acute phase of death and dying begins at the time of diagnosis. The person has heard their terminal diagnosis from a doctor or other medical staff person and is then forced to try and understand their situation. Many people can’t absorb or understand their diagnosis the first time they hear it.

 Most People Who Are Threatened With Dying Are Immobilized – in Shock

Shock is often the first reaction to this acute phase of death. People are immobilized and temporarily shut down. This makes concentration and listening next to impossible. They may also want to avoid acknowledging the illness. People need time to process such news.slide-worried-manjpg.jpg

The care manager can help clients cope with shock by encouraging them to talk things out. Unless a decision needs to be made immediately, decision-making should be postponed until there has been some time to talk things through.  If the family caregiver’s inability to perform family tasks interferes with timely medical treatment, then the care manager needs to intervene. They can organize another family to share care or help hire private duty home health care if this is affordable. The care manager can also do a mixture of both.

 

Ultimately decisions must be made regarding his or her medical care and available treatment options. Once treatment begins, the reality of the illness becomes a part of the family’s life, and adjustments and accommodations need to be made. At this point, the family is hopeful that a cure can be found.

 

 

Care Manager Tasks in Acute Phase:

 

  1. Arrange for private duty home care if needed and approved
  2. Arrange for durable medical equipment, if needed
  3. Coordinate and facilitate family meetings about sharing care if needed   
  4. Visit the older client on a regular basis to monitor their symptoms, care, and support and update medication list and care plan
  5. Send weekly monthly report on the status of the client to all family members making them so they all know the status of the elder’s care and the arc of dying. 
  6. Schedule medical appointments for the client so they can see the various doctors
  7. Drive client to medical appointments to advocate take notes and make list questions to ask to best use those 10 minutes of a typical doctor’s visit    26patient_600-1.jpg
  8. Assist family, in continuing to get questions answered by health care professionals about next steps after a terminal diagnosis 
  9. Provide a “Whole Family Approach” to centrally update all family members and meet their emotional needs around the older person now that a terminal diagnosis- perhaps their worst fear is here 

 

  1. Assist in compiling and organizing documents needed for advance care planning.

Deliver a Good End of Life- Add Death and Dying to Your Care Management Agency

 

Serve Your Client until Death Do You Part

 

Join me Thursday, March 11 and learn why End of Life Services Are a perfect new service for care managers

 

In this 1 ½ -hour webinar you will learn how to

          

 

1.Transition the patient/family through the five stages of death

2.Help clients be active participants in their care

3.Give the family/caregiver tools to manage care             

4 Provide family center care to caregiver and family

5 Choose the right support services through all stages of death

6.Introduce Hospice and Palliative care and work with their team

7 Use ALCA End of Life Benefits During COVID

8.Use  COVID -19  Family Coaching for GCM

 

Sign Up 

If you really want to add End of Life to your care management business sign up for this webinar now


In the only book on Clinical Geriatric Care Management, Care Manager’ Working With The Aging Family  Gwendolyn LAZO Harris MA, CT,  Diane LeVan MA both highly expert care managers, created a seminal chapter on Palliative Care and End of Life Care Manager 

Filed Under: Aging, Aging Life Care, aging life care manager, Blog, case manager, Death and Dying Care Management, death and dying care manager, elder care manager, End of Life Care manager, Families, Geriatric Care Management Business, geriatric care manager, Geriatric Care Manager, geriatric social worker, nurse advocate, nurse care manager, Palliative care manager, Private Duty Home Care Tagged With: acute phase of dying, Advanced care planning, aging life care manager, aging parent crisis, care manager, case manager, death and dying, geriatric care manager, Hospice, nurse acre manager, nurse advocate, Palliative Care, terminal diagnosis

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