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

What is President Biden’s New Infrastructre Caregiver Plan?

April 14, 2021

President Biden announced the American Jobs Plan, a $2 trillion investment in infrastructure, jobs, and home care. It includes a $400 billion investment to expand access to Medicaid home and community-based services (HCBS)

Why This Plan for Home-Based Care?

Only 15% of U.S. seniors 80 or older receive care at home. In Switzerland, Denmark, Mexico, and Sweden, that figure is above 30%, with numbers even higher in Israel and Lithuania.

Medicaid has slowly evolved over the years, placing a greater emphasis on home- and community-based services. But the ground gained has been relatively minor compared to investments in other settings like nursing homes.

In 1995, Medicaid spent about 18 cents out of every long-term care dollar on HCBS services. Today, that number has reached 57 cents per dollar.

The Scale of the Problem is Mamouth

The number of seniors is projected to grow by more than 40 million, approximately

doubling, by 2050, while the population older than 85 will nearly triple. Unlike most other industrialized nations, the United States does not provide a public long-term-care benefit for all older adults.

Only10-15% of Americans can Afford Private Duty Homecare

Because Medicare does not pay for home care, only the top 10-15 % can afford private duty home care, while in many other nations it is a right and free to all through the government. What Biden’s new plan does is take a giant step in making home care possible a greater number of Americans.

The plan calls for expanding access to and quality of HCBS to help more older adults and people with disabilities live in the community and extending the Money Follows the Person program to help individuals who are in nursing facilities and other institutions return to the community. 

What The Pandemic Has taught us about Aging and Dying

at Home

What the continuing pandemic has painfully taught us is when we are ill- we want to be home in the arms of our family. When we are threatened with or facing death, we do not want want to be in a sterile hospital with only anonymous caring nurses and zoom to comfort us in our last minutes in this world. We want to be at home- in the arms of our family and loving caregivers.

Long before the COVID-19 emergency, health care policy experts have increasingly recognized the value of home-based health care. A recent AARP survey found that three in four adults 50 years and older would prefer to age in their homes and communities. And a growing body of evidence suggests it is less expensive to deliver care in the home.

Indeed, for years we’ve seen hospitalized patients more quickly returning to their homes and communities to heal and recover safely, reducing costs for themselves and the health care system.

The Plague of Isolation on top of the Plague of COVID -in Locked Down Nursing Homes

Home-based care addresses negative health effects of social isolation and loneliness, which drive poorer health outcomes that annually cost billions of excess health care dollars. 

Isolation is also equal to 15 cigarettes each day. Elders in a nursing home during the pandemic were isolated from the families and their fellow residents so much so that despair may have led to the 174000 deaths as of March 2021. 

So Biden has launched a bill the builds the infrastructure of home care for the lower 30% on Medicaid until in America’s future, Medicare and home care for all is reached.

 

Filed Under: Age at home, AGING IN PLACE, American Jobs Plan, Blog, COVID-19 Recover at Home Plan, COVID-19 Safety, Expanding Medicare to Home Care, FOLLOW THE MONEY, geriatric care management emergency proceduress, geriatric care manager, Geriatric Care Managers value, geriatric social worker, Good Death, Home Based Care, home care, Home Care for All, Home From the Hospital, LOSING CLients TO COVID, Monet Follows the Person Program, Quality of Life, quality of life -COVID-19, Quality of Life for elders Tagged With: aging life and geriatric care manager, aging life care management, aging life care start up, aging life geriatric care manager, aging life or geriatric care manager, American Jobs Plan, Biden's Home Care Plan, Biden's Infastructure Bill, Deaths in Nursing Homes, Expanding Home Care, Home and Community Based Care, Home Based Care, home care, Isolation in Nursing Homes, Medicaid & Community Based Care, Medicaid funded Home Care, Medicare for All, Money Flows to the Person, nurse advocates, nurse entrepreneur

How Can Someone with Dementia Have a Better Quality of Life on a Holiday ?

April 2, 2021

 

Reminiscence and Story Telling

 

This Easter holiday is the perfect occasion to engage elders with dementia. The role of storytelling and reminiscence is very important for elders, as they look back on their life and holidays bring strong long-term memories. It gives them a chance to socialize as they tell their story. It also means someone usually listens or documents. That magically gives the elder social interaction and connectedness. So many Easter rituals can prompt stories for elders with some level of dementia. The ritual of dying easter eggs, finding easter baskets on Easter morning, dressing up for the local Easter Parade, eating ritual foods at Easter dinner or at Easter Brunch. Whether the older person is actually participating or watching, these rituals can prompt stories from their long-term memory.

 

Elders sharing stories means passing on history.

This gives the older person a chance to give the larger picture of their life and family history to children and grandchildren or extended family, who may have not heard all the details of their grandparents or parents’ life before- what they cooked, what they did on holidays like Easter. So the quality of the older person of both the older person and the aging family is increased through oral history and reminiscence

The aging professional can suggest family or friends just sitting down and prompting a story or oral history using  technology like your phone

Even elders with Alzheimer’s can find new joy with Reminiscence

When an elderly person develops Alzheimer’s or other forms of dementia, the short-term memory is frequently affected but long-term memories can remain as intact and vivid as they have always been during the course of the patient’s life. As a result, a family can use a practice called reminiscence therapy to help combat the frustration, confusion, and depression that can often accompany dementia and even bring joy to the older person

What is reminiscence therapy?

 Reminiscence therapy is like a therapy session where the elderly person will spend time recalling memories of his or her life, perhaps telling stories about things that happened and events the person can recall.

Sometimes senior experts or family members can use photos, familiar objects, or other such things to help jog the memory of the patient. Some therapists and family members can a scrapbook of a person’s life, including photos, letters, and other such personal memorabilia. This becomes a visual biography of the patient’s life and helps the older person remember who he or she is.

How does this quality of life therapy help? Almost all elderly men and women can start feeling discouraged and frustrated with their memory issues. Reminiscence can give peace and acceptance of the current situation by helping the person remember that he or she has had a good and full life. It also prompts communication skills of elderly people who otherwise may not feel very compelled to open up and share anything with anyone else.

Dementia and Reminiscence of Easter

So this Easter holiday try reminiscence. People with dementia can receive a richer quality of life when people actually listen to them. They feel as their thoughts and feelings actually matter. For anyone who has an elderly loved one suffering from dementia, this benefit alone can make reminiscence therapy a form of joy for a very confused elder. So when you dye Easter eggs, create easter baskets, do an Easter egg hunt, serve an Easter brunch or dinner, get them involved, let them watch, allow them to help if possible, serve them ritual food or to taste it and ask when how they experienced these rituals, when they were young. If you have old albums of pictures from their childhood of them at Easter, look and the photos with them. Then listen.

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Filed Under: Adult children, Aging, Aging Family, Aging Life Care, Aging Life Care Assocaition, aging life care manager, Dementia, Dementia & Holidays, Easter, Easter and Reminiscence, Easter Rituals, Emotional Quality of Life, Families, GCM Working With Aging Family, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, Good Death, Holiday Rituals in Aging Family, nurse advocate, nurse care manager, Quality of Life on Easter Holiday, Quality of Life with Dementia, Reminiscence Therapy, Spiritual Quality of Life Tagged With: aging family, aging parent, aging parent care, aging technology, ancrestory.com, assessing for quality of life, care plan, care plan interventions, family caregivers, Family Caregivers using technology, flip video, genealogy, geriatric care management, geriatric care manager, geritaric care manager, grandfather, grandmothers, grandparents, increasing quality of life, LCSW, oral history, oral history and quality of life, oral history and You Tube, parent care, Quality of Life, quality of life assessment, reminicence and elder, Reminiscence and 4th of Jul;y, Reminiscence and Dementia, Reminiscence on the Holidays, storytelling and elders, technology for caregivers, You Tube, You Tube and storytelling

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

March 9, 2021

slide-worried-manjpg.jpg

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

photo.JPG

 

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

.

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

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