Cathy Cress

Expert in Aging Life and Geriatric Care Management

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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

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 Does a Care Manager Do Before End of Life Diagnosis?

February 28, 2021

End of Life has 5 Phases       

Before the end-of-life diagnosis, the ALCA or GCM care manager helps clients be an active participant in their care and gives the family caregiver the tools to manage the care.            

The geriatric care manager serves older adults before they find they are dying. GCM’s work with chronic care clients, sometimes for years, who eventually succumb to their illness. But they also work with clients who come to them facing the end of life issues.

 The process of acceptance and adjustment to terminal illness has five phases:

 

before the diagnosis,             

 

  • the acute phase ­

 

  • the chronic phase

 

  • the recovery phase

 

  • the terminal phase 
  • Geriatric Care Managers Tasks Before the diagnosis

  • Schedule medical  appts
  • Help family ask questions  of medical professionals
  • Before visiting  the client maintain an updated medication list and a list of any drug allergies
  • Assist the family in organizing all  Advanced care planning documents documents

  • Go to medical appointments with the client or train family member make a list of questions have ready
  • Set up personal health records.       
  • Assist family members in setting up and use of a calendar to keep a log of important medication information, questions, and things out of the ordinary that happens to the ill person
  • https://youtu.be/vHfuzkTcpMs  
  •  
  • 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

Filed Under: 5 Stages of Dying, 5 stages of End of Life, Advanced Directives, Advanced Directives and Covid-19, Aging, Aging Life Care, aging life care manager, Blog, Death and Dying, End of Life, End of life documents, Families, FREE WEBINAR, Geriatric Care Management Business, Geriatric Care Manager, geriatric social worker, Hospice, nurse advocate, nurse care manager, Palliative Care, Quality of Life in Dying Tagged With: 5 stages of death, adding end of life services, aging family, aging life care manager, aging parent crisis, ALCA in End Of Life, care manager, case manager, end of life care manager, GCM Family Coaching end of life, GCM in Death and Dying, geriatric care manager, Hospice at end of life, Navigation through END of LIfe, nurse advocate, nurse care manager, Tools to manage end of life, webinar end of life

Do You Do Cultural Assessment With an End Of Life Client?

February 13, 2021

 

 

 Each Culture Has Different Customs and Beliefs in End of LifeiStock_000063346301_Medium-1.jpg

There may be cultural differences in end-of-life decision making as a result of underlying cultural values with disclosure of a terminal illness and very critically -use of life-sustaining medical treatment. With the widespread availability of advanced medical technology in the United States, people are encouraged to do everything possible to seek a cure for a life-threatening medical condition or sustain life. However, there are many other cultures for whom quality of life is more important than the length of life.

Other Cultures Do Not Follow US Medical Model ChiCheng_hmpgHdr.jpg

There are some societies, such as Japan, where a terminal illness may not be disclosed to a patient and it is culturally inappropriate to discuss impending or imminent death. For instance, among some Chinese, it is considered bad luck to discuss death because such talk may cause death to occur. Sometimes the ethnic elder is not expected to make healthcare decisions and the responsibility may be based on a traditional family hierarchy. For instance, in many Filipino families, there may be a designated decision-maker who is not the patient (e.g., the oldest son or a daughter or son who is a health professional) and who articulates the wishes of the elder or family.

Some Cultures Follow Religious  Customs and Beliefs in Death & Dying

Other end-of-life decisions are based on religious tenets. In many Catholic immigrant communities, there may be strong resistance to an advance directive because the document would signify a “loss of hope” or be interpreted as suicide, which is against church doctrine. These beliefs may also influence the use of hospice services.

 

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

 

 

 

 

 

 

 

 

 

Filed Under: Advanced Directives, advanced directives& COVID-19, Aging, Aging Life Care, aging life care manager, ALCA Role Death and Dying, Benefits of ALCA to Hospice, Cultural Assessment, Cultural Assessment Death, Cultural Beliefs in Death, Death & Dying, Death and Dying, Death and Dying Care Management, death and dying care manager, End of Life, End of Life Care manager, End of Life Cultural Assessment, End of life documents, Families, FREE WEBINAR, GCM role Death and Dying, Geriatric Care Management Business, Geriatric Care Manager, Geriatric Care Manager Cultural Assessment, geriatric social worker, Good Death, Hospice, Hospice Care, nurse advocate, nurse care manager, Palliative Care, Palliative care manager, SNF death COVID-19, US Medicalization of Death Tagged With: 5 stages of death, Acceptance Phase of Death, adding end of life services, Aging Life Care Association, care manager cultural assessment, chronic phase of death, COVID-19 Deaths, cultural assessment, Cultural Beliefs in Death, Cultural Customs in Death, cultural diversity, death and dying in COVID-19, geriatric care manager, Hospice at end of life, Palliative Care at end of life, US medicaization of Death

What Is a Care Manager’s Role in the Hospital during COVID in End of Life

February 2, 2021

Care managers cannot meet dying  COVID-19 patients and their bereft children in the emergency room or Hospital. They are not allowed in due to COVID restrictions. However, care Managers play a big role in end of life issues, while family remains in the community and the client is isolated from them in the hospital.

Procedures for the family when loved one in the hospital.

The care manager was help by

1.creating a communication plan from the outset and figuring out who’s the “medical quarterback” in charge of monitoring a loved one. Typically, this is a specialist, such as a hospitalist, critical care medicine doctor, or intensivis2.

 2.Facilitating family meeting for family while loved one in the hospital

3.Suggesting technology family can use to communicate with loved one and with other family members or friends

4.. Help family understand the part family can play I admissions- preparing a go binder ahead of time etc.,

  1. By designating one person to speak for the whole family- the process to improve family getting information from overloaded hospital staff

6 Preparing family & loved one’s medical team for communication death in the hospital – what care manager can do to assist

7.. Supporting the family member when they are dying while not being present

8.. Bereavement of family post-death- use of hospice

Care Managers are their navigators through all five stages of dying

They many times can introduce palliative care or hospice and often GCM’s can help the family and client to bring in hospice or palliative care long before the average time, which is the last month or 15 days before death.

 The final passage through life can be emotionally charged.  

If the family is following a long labyrinth to the end, the blind alleys may be blocked by cultural, religious, and moral beliefs and now COCID -19 regulations. Care managers can find an opening through this maze.  Money, family dynamics, and fear of dying can all explode a fraught crisis of care in dying. When the important end-of-life decisions need to be made, the stress of the responsibility and the seriousness of the situation can break a wave of distress fear and anxiety over the “whole family system” the dying elder. The geriatric care manager specializes in this whole family system.

 Care Managers can often help facilitate throbbing discussions

They can facilitate family members coming together to work as a functional

unit.  Understanding the differing viewpoints is critical.  Knowing what a parent wants and does not want during the last days and hours of life help define and simplify the role of the family.  It relieves the family of the burden of having the responsibility of making decisions that may not be what their parents want. Turning this around can also avoid family conflicts when adult children may have differing values.

Helping family Legally plan for Death

 Proactive discussions and legal planning building a circle of care can help to reduce some of the potential conflicts. Good legal guidance can also help to pay for care when an adult child wants to finance in-home care. They can point the family to legal guidance to prepare end of life documents, that are so important, especially now with COVID when death can come so quickly but geriatric care managers do much more with clients and families who are facing the end of life

 

 

Free Webinar-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  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,Seniors at Home , San Francisco and Diane LeVan MA both highly expert care managers, created a seminal chapter on Palliative Care and End of Life Care Manager in my book Care Manager’s Working With the Aging Family 

Filed Under: Aging, Aging Life Care, aging life care manager, Blog, care manager, case manager, Death and Dying Care Management, death and dying care manager, elder care manager, Families, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, geriatric social worker, ife care manager, nurse care manager Tagged With: 5 stages of death, adding end of life services, aging family, aging life and geraitric care manager, aging life care manager, aging parent care, aging parent crisis, ALCA COVID benefits, death and dying, death and dying in COVID-19, disputes at end of life, elderly at end of life, end of life care manager, end of life family meeting, Fighting and Feuding at end of life, GCM Family Coaching end of life, geriatric care manager, Hospice at end of life, Hospice Care, hospice for elderly parent, nurse advocate, nurse care manager, Palliative Care at end of life, support services in death, Tools to manage end of life

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