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 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

How Does Atul Gawande View Quality of Life in Dying ?

February 21, 2021

iStock_000003595079_Medium.jpg

 

   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 new 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.

 

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

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

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, 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

The 2 Deadliest US Sites of COVID-19 Nursing Homes & Prisons

May 2, 2020

PRISON INMATES AND NURSING HOME PATIENTS NOT  6FT APART – 6 FEET UNDER

70% of inmates in federal prisons have COVID-19.  In Kansas, the Lansing Correctional Facility had a riot of inmates over COVID-19 lack of care or protection  It took the rebellion to get the coronavirus testing PPE and care. The  Bureau of Prisons in Kansas confirmed finally that 79 staff have coronavirus and 88 prisons and prisoners dead.   

Older residents in nursing homes cannot rebel like prisoners. Many can’t even walk. The Atlantic Magazine just published an article, We are Killing Elders Now. The writer states “In at least six states, these fatalities account for half of all COVID-19 deaths, and according to the World Health Organization, half of all coronavirus fatalities in Europe have been traced to nursing homes too. Some of this mortality is linked to long-term-care facilities that are shoddily run or that violate health standards. But most of them are doing the best they can with what they have. And they don’t have much”.

KAISER FOUNDATION NURSING HOME STAFFING AND USE OF PPE NOT REQUIRED IN MOST STATES

Kaiser reports -Staff Screening. It is more common for states to recommend rather than require daily screening of staff for illness in NFs (24 states recommend, 16 states + DC require)

Use of PPE. More states recommend (23 states) than require (7 states + DC) staff to use PPE

 Two States that require testing for coronavirus of ALL  residents of nursing homes are  Maryland where 556 have died as of the Washington Post article. and Tennessee 

THE FEDS HAVE NO CMS FEDERAL GUIDELINES OR REPORTING

We have no federal guidelines for safety testing according to an article by the Kaiser Foundation

It is now estimated that 16,000 deaths have occurred in nursing homes and that is without the federal government revealing any numbers and not making available any testing. But the numbers are probably huge- if we could just do testing. 

CMS announced it would have a meeting of a “panel” of experts “ sometime at the end of May”. After probably 20,000 older people died and the feds did nothing this shows their sense of urgency about this pandemic’s national “elder cleansing”.

WHAT CONNECTS PRISONS AND NURSING HOMES – CONCENTRATION CAMPS

So, what is the connection between the viral spread of COVID-19 in nursing homes and prisons- 6 feet ? Prisoners and residents, in nursing homes, and prisons cannot social distance. Jails and prisons have human beings crammed together with no choice. Nursing homes have 2 beds or if you are on Medicaid three to a room. Neither group has a choice to social distance. They are ” concentrated” as in concentration camps or death camps.

Do SOMETHING – HELP NURSING HOMES PREVENT MORE CARNAGE

So, as someone who has spent her career in aging, I am calling out to everyone, especially professional in aging – do something. Since the feds appear to be doing little- call your congressman, write a letter to the editor.

BE KIND LIKE RACHEL MADDOW REPORTS LA JEWISH HOME LA WAS

Rachel Maddow suggests calling your local nursing homes and see what they need. Be kind like the LA Jewish Home was to a smaller nursing home LA Brier Oaks. They wanted to test their residents and had no tests and the larger LA Jewish Home had tests and shared them with the smaller as a good neighbor. What they found was ravaging but it also showed caring and generosity. Care and be generous and show the helpless elders in nursing homes in your town you are opposed to -nursing home being prisons or concentration camps.

Filed Under: 4th of july, 7 touches marketing, adult child physical abuse, Adult children, adult emotional abuse, ADULT SIBling, Aging, Aging Alcohol Abuse, Aging Community & Covid-19, Aging deaths, Aging Family, aging family crisis, aging life business, Aging Life Care, Aging Life Care Assocaition, aging life care manager, Aging therapist, ALCA & Skilled Nursing Facility, ALCA Beneifits, ALCA business Loans, ALCA Cobtract, ALCA COVID-19 Crisis, ALCA Disaster Plan, ALCA Ethical Dilemma, ALCA Financial literacy, ALCA Products for COVID_19, ALCA sales, Alcohol Abuse and Aging, Angela Jolie, Aretha Franklin, Assisted Living, Assisted Living & Geriatric Care Managers, Assisted Living Crisis, Assisted Living sales, bankruptcy, Barack Obama, Benefits, Benefits of ALCA to Hospice, Benefits of Care Management, Benefits of Care Management to Hospice, Benefits of Geriatric Care Management, Benefits vs Features, Benifits & Assisted Living, Bill Clinton, billing, Billing 85%, billing 85% of GCM 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How Does a Geriatric Manager Rate Her Husband’s Discharge?

March 1, 2020

Discharge Before The Affordable Care Act

Families leaving the hospital used to scramble to get mom or dad home from the hospital safely – often quickly. and chaotically. In some parts of the country, families were given notice that the following day – or perhaps in two or three days – the older adult would be ready to leave the hospital.

Word of the discharge sets the family in motion – seeking resources, exploring options, and lining up care- that shockingly may be themselves. For many families, this is the beginning of confusion and horror from the cost of care, the difficulty finding advice, the myriad health, functional, and safety needs to address, and finally the challenges of finding peace of mind after the discharge.

As a result, many older American were readmitted to the hospital between 30 and 90 days- doubling the discharge, the family confusion and often ending the older person in a nursing home

When the Affordable Care Act was passed, Medicare lashed at that huge problem. They began fining hospitals and all that began to slowly change. Hospitals paid more attention to hospital discharge.

 You can see that at Stanford University Hospital where my husband just had open-heart surgery for a defective valve.

His discharge is today after being here 7 days including today. He has had incredible care as I have documented in my last blog. We knew about discharge from day one. It may have helped that I am a geriatric care manager and knew this would be a critical transition so I asked about it. At Stanford, they have a unique discharge process and I was prepared for it.

Instead of one discharge planner, we will have three. The first is what I have been advocating since I wrote the chapter on  Care Managers and Hospital Discharge in Care Managers Working With the Aging Family. She is

our hospital care manager, Christine Harris BS BSN who has followed all our transition and been to see us every day, will be here to go over the discharge with Pete and me.

The second was a Cardiac RN coordinator who was with us yesterday and spent an hour going over-discharge and care in the first few months post-discharge with a binder that she reviewed at the meeting and we will have to take home.

Stanford Cardiac Discharge made physicians’appointments for the next month with the primary physician in a week and Pete’s cardiac surgeon in a month followed by a cardiologist who will be Pete’s follow from now one. Home Health through Medicare was set up by the appointment and we will have an RN, PT, and OT coming to our home post-discharge.

 All are at Stanford by Pete’s choice because we want to stay within one medical system although we live an hour away in Santa Cruz. We also have a primary physician 5 minutes away that he will see next week and use for any emergencies. Both systems communicate well already. A list of these appointments is in the binder

The third discharge planner is a Stanford pharmacist who will meet with us to go over the medication that will go home with my husband I already have a complete list that was prescribed.

Here are some steps that a care manager should follow in discharge that Stanford already implements

  • Help the family determine whether the family caregiver is willing and able to deliver care-
  • Pete has me my daughter Jill and her partner Tom McKay, who is a Ph.D. RN. We are all willing
  • OR suggest organizing other family members to deliver care-
  • Our family have a great team now
  • OR suggest hiring private duty care providers-
  • we do not need care Pete is walking, on limited meds stable after heart surgery
  • Advocate for the family to be included in the discharge meeting-
  • We were very included
  • Involve family in Home Care
  • We were very included
  • Request that the discharge planner share the hospital discharge list-
  •  We have an entire booklet plus will have met with 3 discharge planners
  • Assess the family caregiver’s willingness and ability to deliver care –
  •  We are willing
  • Reassess the client with comprehensive functional, psychosocial, depression, mental status- that was done by Cardiac Nursing Dept, Pt, OT, Respiratory and I will have reports
  • Measure the risk of readmission-
  • Pete has a slight risk. He never had any pain, moved out of ICU in a record 20 hours, and out of step down ICU but his heart rate in high so slight risk
  • Help the family determine whether the family caregiver is willing and able to deliver care
  • we are willing and able
  • OR suggest organizing other family members to deliver care-
  • no need but have friends delivering meals every two days
  • OR suggest hiring private duty care providers-
  • not needed
  • More after discharge

Filed Under: Aging Life Care, Aging Life Care Assocaition, aging life care manager, Blog, cardiac care manager, Hospital care manager, Stanford Hospital care manager Tagged With: Affordable Care Act, aging family crisis, aging life and geriatric care manager, Care manager at discharge, Discharge, discharge plan, Discharge Planner, DRG, elder hospitalization, Hospital care manager, spouse as caregiver, Stanford Cardiac, Stanford hospital, Stanford Hospital care manager, Stanford Hospital discharge care manager

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