Dysfunctional Families Facing Death Wreak Havoc at End of Life

August 3, 2023

What do Dysfunctional Families do at the End of Life?

Dysfunctional families facing death and dying have flawed fractured family conversations. Often they do not communicate at all or engage in destructive accusations lobbed at others. They see one another as enemies. They demonize one another!

Dysfunctional families facing death are feuding families, escalating the pain of death to a chaotic war room. They blame each other instead of locking arms in a crisis.

Dysfunctional families facing death sabotage resolution.

Facing Fractured Family Communication

What are some of the struggles that these aging dysfunctional families facing death with fractured family communication can face?

Aging parents who lack the capacity to make decisions have no advance directives, DPOA

health-care proxy, and adult siblings, who must make end-of-life decisions, can’t agree

Withdrawal of life support with no designated health care agent then dysfunctional families facing death the adult children and/or spouse disagree

Pain management Dysfunctiona families facing death adult children and/or spouses disagree.

Answer to Fractured Family at End of Life – Mediation.

Mediation is a tool that fractured families can be a good resource for dysfunctional families at the end of life. It can help with these difficult families facing the death of a parent without fracturing the entire family. It can allow an older person to die without pain inflicted by their own aging dysfunctional families.

Understand the Dysfunctional Aging Family System you must enter to get care for elders in aging dysfunctional families
Understand 11 Warning Signs You Are Working with Dysfunctional Family

Master 10 Clinical Tools Professionals Must learn before they work with These Difficult Families
Learn how to solve dysfunctional family problems like End of Life family chaos after you master these tools for aging dysfunctional families
Get care for aging family members when the dysfunctional family members resist
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What Good Life to The Very End Can a Care Manager Bring ?

January 18, 2023

Bringing Good Life to The Very End

What Good Life to the very end can you bring -in the terminal phase of life -? Here is a wonderful example

Bill died at the home of his son after he had accepted that he was to die of liver failure and stopped all lifesaving treatment, like dialysis at the hospital and entering hospice. The decision was made that he would die at his son’s home with 24 care from his Care Management agency Livhome and his ongoing care manager Mary Brennan.

After his coming to terms with his death, Bill and his family, sons, grandchildren, and great grandkids were able to say their goodbyes and offer the unconditional love that they had been fearful to express before his acceptance of death. A feeling of light & joy permeated his room, a family room overlooking the garden, where his hospital bed was set up. Great-grandchildren brought pictures and marveled at “grandpa grandpa “ high up in a hospital bed.

The Good Life to The Very End -Joy of Hearing

His son put headphones with a mike on and William could hear and speak, as he had not in years. It was like the wonderful film and concept Alive Inside. Hearing was a gift that gave him such joy in his last weeks of life.

The Good Life to the Very End- Let Family Just be Family

The family could just be family because they had care providers to care for bill. His 24-hour caregivers were gifted loving care providers from a GCM agency Livhome. 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 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. His sons, grandchildren great grandchildren, and nephew ate meals, chitchatted, and welcomed each new family member coming in to see William, as he remained in the center in his hospital bed, the fulcrum of the gathering.

The Good Life to the End of a Great Care Manager

The geriatric care manager, GCM Mary Brennan, from Livhome, a seasoned powerful and so kind LCSW, adjusted here and there, with care providers, and family needs. Bill’s needs 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 so at the end.

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. They gave him that good life till the very end.

If you want to add an End of Life service and other services, plus all the forms necessary, go to my website, and check out GCM Manual

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Join me on January 24 2023 and learn why End of Life Services re a perfect new se

Learn to guide the patient/family through the five stages of death. Understand how to help clients be active participants in their care. Give the family caregivers tools to manage care. Find out how to provide family-centered care to caregivers and families. Learn to choose the right support services for the client through all stages of death.
Introduce Hospice and Palliative care to the client earlier and work with their team.
Find out how to Use COVID -19 family coaching for GCM. Discover the role of Death Doula at end of life.

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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. His 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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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.

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

Reminiscence and Story Telling

Elders sharing stories means passing on history.

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

What is reminiscence therapy?

Dementia and Reminiscence of Easter

Reach Cathy in Social Media

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