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

March 9, 2021

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

What are the Ten Steps The Care Manager Takes in The Acute Phase of Death ?

March 3, 2021

What Does a Care Manager Do In Acute Stage of Death?

What does a care manager do after a terminal diagnosis has been given by a physician and the older person and their aging family have moved on to the ” Acute Phase”?

The acute phase of death and dying begins at the time of diagnosis. The person has heard their terminal diagnosis from a doctor or other medical staff person and is then forced to try and understand their situation. Many people can’t absorb or understand their diagnosis the first time they hear it.

Most People Who Are Threatened With Dying Are Immobilized – in Shock

Shock is often the first reaction to this acute phase of death. People are immobilized and temporarily shut down. This makes concentration and listening next to impossible. They may also want to avoid acknowledging the illness. People need time to process such news.

The care manager can help clients cope with shock by encouraging them to talk things out. Unless a decision needs to be made immediately, decision-making should be postponed until there has been some time to talk things through. If the family caregiver’s inability to perform family tasks interferes with timely medical treatment, then the care manager needs to intervene. They can organize another family to share care or help hire private duty home health care if this is affordable. The care manager can also do a mixture of both.

Ultimately decisions must be made regarding his or her medical care and available treatment options. Once treatment begins, the reality of the illness becomes a part of the family’s life, and adjustments and accommodations need to be made. At this point, the family is hopeful that a cure can be found.

Care Manager Tasks in Acute Phase:

Arrange for private duty home care if needed and approved
Arrange for durable medical equipment, if needed
Coordinate and facilitate family meetings about sharing care if needed
Visit the older client on a regular basis to monitor their symptoms, care, and support and update medication list and care plan
Send weekly monthly report on the status of the client to all family members making them so they all know the status of the elder’s care and the arc of dying.
Schedule medical appointments for the client so they can see the various doctors
Drive client to medical appointments to advocate take notes and make list questions to ask to best use those 10 minutes of a typical doctor’s visit
Assist family, in continuing to get questions answered by health care professionals about next steps after a terminal diagnosis
Provide a “Whole Family Approach” to centrally update all family members and meet their emotional needs around the older person now that a terminal diagnosis- perhaps their worst fear is here

Assist in compiling and organizing documents needed for advance care planning.

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

In the only book on Clinical Geriatric Care Management, Care Manager’ Working With The Aging Family Gwendolyn LAZO Harris MA, CT, Diane LeVan MA both highly expert care managers, created a seminal chapter on Palliative Care and End of Life Care Manager

Do You Know How to Use Whole Family Approach to End of Life Issues ?

February 10, 2021

Family Working Together as a Unit

The whole family approach is critical with death and dying. Care managers are often engaged to help facilitate the discussions at end of life, and help family members come 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 which may not be what their parents want, and can also avoid family conflicts when adult children may have differing values.” Proactive discussions and legal planning can help to reduce some of the potential conflicts.

Major Family Issues at End of Life

I found myself with a family member dealing with end of life issues. The

issues were: money as the elderly man would need to have 24-hour care to return home to die and where he would return home, as although the son was unsure, everyone agreed that the son’s home where all the grandchildren and great-grandchildren gathered was the best place.

The most important was should the elderly man withdraw dialysis and extreme measures that were not saving his life. He was competent and had chosen this.

Issues Solved by A FamilyMeeting

All, these problems were solved by two things. The man’s physicians helped him understand the dialysis would not save him from dying. Then a family meeting with hospice and his care managed home care agency LivHome the son and his wife, and myself was set up using the whole family approach.

Hospice facilitated the discussion. The end result was to move to the son’s home, with 24-hour care and Hospice, where the entire family, were gathered in and out all day and the old man died a ” Good Death” knowing that his family surrounded him.

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

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

April 9, 2020

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.

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 suggest – a good death – not a cold terrifying dying of the light.

https://www.forbes.com/sites/johnkoetsier/2020/04/02/elder-tech-how-to-keep-seniors-connected-safe-happy-in-the-coronavirus-era/#3443c2dc66cf

Care Manager tasks:

Make referral to hospice if 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 active phase of dying which can be loud and disturbing to someone who is not aware of what will occur

How Can a Care Manager Bring Joy to a Dying Client ?

June 22, 2017

A care manager can bring joy in the terminal phase of dying and give a good life to the very end.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. After 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, a 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. 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.

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 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.

The geriatric care manager, GCM Mary Brennan, from Livhome , a seasoned ,powerful and so kind LCSW, 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 heath 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.

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