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

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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

.

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

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

Adding End of Life to Care Management Agency- Advanced Directives

February 7, 2021

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When Does A Care Manager Begin if Terminal Diagnosis?

Once the terminal diagnosis is known with an elderly client, the care manager who has added end of life services to their agency is often the one who will initiate and guide advance care planning discussions. As difficult as these discussions may be, the burden on the family is significantly lessened if decisions about advance care planning are made before the client’s condition worsens.

Hopefully, advanced care planning has already been done but many people put it off for fear of death. A recent study found that less than 50% of severely or terminally ill patients had an advance directive in their medical record.

Advance Directives

 Advance directives are legal documents that allow clients to make decisions about their health care and finances in advance of when they are not mentally or physically able to do so. These documents must be signed, dated, and witnessed naming another person to make decisions for you.

Your job as a care manager is the make sure the dying client has these documents:

• A durable power for attorney for healthcare 

• A living will 

• A do not resuscitate order DNR (efforts to restart the heart after it has stopped 

If the client does not have these legal documents and wishes to create them, the Geriatric Care Manager will suggest that the documents be put in place with the oversight and consultation of an elder law attorney.

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

iStock_000063346301_Medium-1.jpg

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

Sign Up 

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

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

 

 

 

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Filed Under: advanced directives& COVID-19, Aging, Aging Community & Covid-19, aging family crisis, Death and Dying, Death and Dying Care Management, End of Life, End of Life Care manager, End of life documents, Hospice, Hospice Care, Palliative care manager Tagged With: adding end of life services, Advanced Directives, aging life care manager, death and dying, death and dying in COVID-19, durable power of attorney, end of life, end of life care, geriatric care manager, Hospice at end of life, Navigation through END of LIfe

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