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Choosing a Nursing Home

Tuesday, November 24th, 2009

walker

If you are thinking about a nursing home for yourself or for a loved one, you might realize that this choice is both difficult and painful. Giving up a home to move in with others represents a loss of liberty to some individuals. But, to others, it may represent the beginning of a whole new life.

We’ve listed a few tips on how to choose a nursing home, along with more tips on what to ask when you visit.

Plan in advance. Do your investigation long before you may think you need a home, as it may take some time to visit these homes and to make a decision.
Get recommendations. You also may need help in filling out the various forms that nursing homes require.
Do not visit a nursing home alone. It may prove too difficult, and a friend or relative may help by asking questions that you may forget to ask.
Be open-minded. Accept that no nursing home is perfect, and that other people may provide care differently than you do. If you have a negative visit on one day, return on a different day to see if matters are different. Revisit those nursing homes you initially rejected for nonessential reasons.
Pick a convenient location first. A nursing home that is convenient and close at hand will be easier for you to visit.
Observe the buildings and staff. Is the building clean and relatively odor-free, well lit and attractive? Are safety features such as fire extinguishers and smoke detectors obvious and in good order?
Observe the patients or clients: Do they seem satisfied, if not happy? Are they well dressed, or sloppy in appearance (hair not combed, etc.). Does it appear that these clients are tended with care?

Questions and Observations:

Look at size. Larger nursing homes may be surprisingly less expensive yet offer more activities and services.
Check about medical services. Are the costs included? Are visits from personal physicians allowed? Is a registered nurse on the premises at all times, and is a doctor in-house or on call? Is the nursing home close to a hospital if needed?
Ask about residential services. Is there a special unit for patients who suffer from Alzheimer’s disease? Is patient variety important, or would you or your loved one prefer to live with residents from similar ethnic or religious backgrounds?
Ask about admission. Is there a waiting list? Can you fill out forms in advance? Is a physical examination required for admission, and who should conduct that exam?
Ask about financing. This is especially important if a nursing home is an immediate need. Is that home eligible for Medicare and/or Medicaid? What services are included in the cost, and what services cost extra?
Ask about food. Is a dietitian on staff and are the portions big enough? Is the food good and good for you? Is there help for individuals who may have trouble eating?
Ask about activities. Does the home provide activities for clients who can participate?
Ask about the living facilities. Can the client bring personal furniture, pictures, plants or other objects? Is there a closet and chest of drawers and privacy for dressing? Is there an available phone? How many people reside in one room?

You can visit the Medicare site, where they offer ideas about how to choose a nursing home. If the home you choose has a Web site, look the site over before you visit. The Web site may answer some questions above, so all you need to do on your visit is to confirm that the Web site was correct.

Tags: Medicaid, Medicare, nursing home
Posted in Caregivers, Patients | No Comments »

Symptom Relief for Terminal Illness

Thursday, November 19th, 2009

Caring for a loved one.

If you are a caregiver, you may have had training in symptom relief for terminally ill patients. But, many family members now take care of their loved ones at home, and training may come through experience only. If you are one of those latter individuals, spend some time at the library, as many books about caregiving can be found on the book shelves. Also, calls to local hospice organizations or training programs offered by hospitals can help provide information as well.

Some basic information about symptom relief is listed below, and these solutions apply to any person at any age — even if they do not have a terminal illness. These problems may frighten a caregiver at first, but they are common problems, and solutions are available. Remember to rely on a trained hospice worker, a trusted nurse or a doctor for specific directions for your ‘patient’ before you take extreme measures.

Constipation: This is a common problem during the last stages of terminal illness, because the patient may not be physically active. Some solutions include increasing fiber in the diet with foods such as prune juice and bran cereal. Sufficient fluids also help to resolve the problem in many instances. Only give stool softeners or laxatives as a doctor may recommend. He or she may recommend them, as constipation can be a side effect of some medications. The warning sign for severe problems – one that warrants a call to the doctor – is constipation for more than three days or blood in the stool.

Eating and Drinking: Smaller and more frequent meals may resolve the eating problem. Some physical activity, if the patient can tolerate it, also helps stimulate appetite. Fluids are, sometimes, the most important issue. Dehydration can develop rapidly in people who do not drink enough fluids. Use a straw or offer ice chips to suck. Be aware that too many fluids also are dangerous and providing intravenous fluids to a person who is dying may result in respiratory distress. Follow a doctor’s instructions on how much food and fluid is ‘normal’ for your patient’s situation.

Breathing Problems: Breathing problems can occur during the final stage of any illness and may require oxygen. Another way to help open breathing passages is to elevate the head of the patient’s bed or to move the patient to a recliner. A doctor may prescribe small doses of liquid morphine or bronchodilator drugs. Follow orders for these prescriptions carefully. Opening a window on a mild day or running a fan in the patient’s room also can help improve air circulation.

Nausea and Vomiting: This problem may occur as a side effect of some medications or as a result of the disease. Do not force a nauseated person to eat. Use ice chips instead of drinking to help retain body fluids. Overt vomiting is an issue, however, as the patient may not be able to keep down medication. A doctor may order medication in suppository form if the patient continues to be nauseated.

Dry Mouth: A dry mouth can be caused by medication or by the disease or by a lack of fluids. Go by the doctor’s advice on the amount of fluids to provide, and if the patient continues to have dry mouth, contact the doctor. You may need to provide glycerin swabs or artificial saliva for the inside of the mouth and a lit coating of lip balm for dry or cracked lips.

Itching: Dry skin, a new reaction to a laundry product, medications or the disease may cause rashes, dry skin and discomfort. To stop the itching, you can apply a soothing skin cream (alcohol-free, as alcohol-based products can further dry the skin) or calamine lotion to itchy areas. Cornstarch, baking soda or baby powder may work, too. Use a humidifier during the fall and winter when heat is used to help moisten the air. You may need to experiment if none of this solutions work. Change laundry detergent or avoid dryer sheets to see if those solutions help.

Tags: at-home care, caregiver, Hospice, Terminal illness
Posted in Caregivers, Hospice, Hospice Basics, Patients | No Comments »

Tips for Taking Care of Prescriptions for Elderly

Wednesday, October 28th, 2009

Pills that are different colors can be helpful in organizing medications.

Are you helping to take care of an elderly person? Many older people must take several different prescription and nonprescription drugs every day. Because these drugs often are taken during different times of the day, it can become easy for an elderly person (or even a stressed younger person) to become confused about which medication to take at what time.

This confusion can create a situation where an individual may skip a dose or overdose on a particular drug. The following tips can help alleviate some of these issues and more, and can help your loved one manage his or her medications as easily as possible.

Make a list of all medications, including over-the-counter drugs, that the person is taking and keep it up to date. This list is useful both for the patient and for that patient’s doctor.
Keep a medication schedule in the form of a calendar and check off each dose as it is taken.
If the person has trouble remembering to take medications, try associating doses with specific times of day, such as breakfast, lunch and dinner, or waking up or before going to bed.
Use a divided container to prepare a person’s doses for an upcoming week. Containers designed for this purpose are inexpensive (often free) and found at local drugstores.
Be sure that the person takes his or her medications as prescribed. For instance, some medications must be taken between meals, and others must be taken with food or before eating. See #3 to help with association for these medications.
If the patient has problems digesting certain drugs, ask the doctor or pharmacist if other forms are available. In other words, a pill may be hard to swallow, but that pill may be available in liquid, too.
Use containers with easy-open lids rather than child-resistant lids to ease opening the bottle for someone who might suffer from arthritis. These easy-open lids are perfectly appropriate when children no longer reside in the house.
Never transfer drugs from one container to another unless that second container has been labeled appropriately.
When you pick up medicine from the pharmacy, read the label to make sure you understand the dosage required and when that medicine should be taken. If you have questions, it’s easier to ask when you receive the medication than to call later.
Avoid keeping medicines on a bedside table. More than one overdose has been attributed to patients taking drugs too often when he or she is not fully awake. Additionally, the possibility of taking the wrong medication increases in this situation.
Keep medications up to date. If a medication is to be renewed, be sure to let the doctor or pharmacist know about a week before the expiration on the current bottle. This way, you can rest assured that the medication can be continued without a lapse due to holidays, running out at night, etc.
Dispose of all unused and expired prescriptions properly. Unfortunately, disposing of pills and medicines down the drain can increase the chances that local water supplies become contaminated. Keep the medications in the bottles with lids on and dispose of the bottles in the trash. This latter solution is not the best one, but until these bottles and their medications can be disposed of in an environmentally-safe way, people have little choice in how to eliminate the medicines from the household.
Make sure that all pills are accounted for and that the patient is 1) not taking medications that belong to others, and 2) that the patient is not giving away medications.

One way to help cut down on the number of prescriptions that a person might be taking is to ask the doctor or pharmacist if the medication can be combined. For instance, why take a cough medicine and a decongestant when both can be combined and purchased in one package? This type of packaging may save money as well as time, space and confusion.

Tags: elderly, prescriptions
Posted in Caregivers, Patients | No Comments »

Baxter’s Death Brings Attention to Therapy Dogs

Friday, October 23rd, 2009

Have you heard about dogs who provide comfort to patients in a hospice or hospital? Baxter, a dog who joined a hospice program with his owners about four years ago, died this past week. His death brings attention to how dogs can provide comfort to those who are engaged with the transition from life to death.

The story begins when Baxter’s owners decided to volunteer at the local hospice. They brought Baxter along for the orientation, and that’s when the owners learned about dog training and certification through Therapy Dogs International. Baxter was game, and – according to his owners - it was as though Baxter made the decision on his own to pass the training and certification at TDI well before he attended the course.

Therapy dogs offer unconditional love, non-judgment and accepting attention to humans. Dogs with a special talent for entertaining, comforting, or teaching show affinity for therapy work. In general, a therapy dog needs to be even-tempered and good natured, friendly and curious, well socialized and able to work with a variety of people. But there are two sides to this story.

The ideal therapy dog handler is a warm, caring, responsible person who is disability-aware and enjoys social interaction. If you are a friendly, giving person who loves your dog and would like to share him, as well as your time and talents, with others, therapy dog work may be for you. There are significant benefits to joining an existing, organized, recognized therapy dog organization. A quick search of the Internet may help you locate one in your area.

Unfortunately, Baxter was a geriatric dog, or an ‘elder’ when he became certified. Therefore, he had only four years to provide comfort to many patients, young and old at the San Diego Hospice and The Institute for Palliative Medicine and Palomar Pomerado Hospital in San Diego, California, before he died. But, his lessons live on to help educate people who own and love their dogs…he provides inspiration to those who might wonder if their pets are appropriate helpers for those who need their comfort.

If you are interested in becoming involved with Therapy Dogs International, visit their Web site to learn more about their processes. TDI was founded in 1976 in new Jersey and it is a non-profit organization. If you do not own a dog, perhaps you can donate to their cause if their mission moves you to do so.

You also can visit Baxter’s Web site or his blog to learn more about this special dog. Baxter lived to be nineteen years and six months old, and he provided a much-needed and welcome comfort to many people in his old age and an inspiration to anyone to help others who need comfort.

Tags: hospice training, therapy dogs
Posted in Caregivers, Death & Dying, Grief and Grieving, Hospice, Patients | No Comments »

Your Patient Responsibilities

Thursday, October 8th, 2009

Are you that bad patient?

In a previous post, we talked about patient rights. But, what are your responsibilities as a patient? the care you receive at any health care facility depends upon the care offered, but it also depends partially upon how you act as a patient. What are your responsibilities once you become a patient?

Although patient responsibilities may vary by state, the basics are outlined below. As a patient, you might think about:

Providing complete and accurate information to the best of your ability about your health and current medications, including over-the-counter products and dietary supplements and any allergies or sensitivities so you can be treated accordingly;
Making it known whether you comprehend the course of your medical treatment and what is expected of you for your recovery;
Following the treatment plan as prescribed;
Keeping appointments and notifying your health care center or physician when you cannot keep an appointment (many health care facilities require a 24-48 hour window for notification, and some facilities may charge you if you do not abide by this responsibility);
Enlisting a responsible adult to transport you to and from the health care facility and to remain with you if indicated in your treatment plan;
Accepting responsibility for your actions should you decide to refuse treatment or not follow your physician’s orders for treatment and/or recovery;
Accepting financial responsibility for your treatment when not covered by your insurance;
Following the health care facility’s policies and procedures, and;
Being respectful of all employees at any given health care facility as well as to other patients.

In cases where you cannot meet these responsibilities, some health care facilities may refuse treatment or, in the case of incompetence, ask for a legally authorized responsible person, a guardian, next of kin or health care advocate to act in your behalf. This suggestion especially applies to minors and to patients who cannot care for themselves.

Tags: healthcare, patient responsibilities
Posted in Other Legal Matters, Patients | No Comments »

Your Patient Rights

Wednesday, October 7th, 2009

You have patient rights.

Have you had a surgery recently in a hospital or a clinic? Did you receive a paper that stated your rights as a patient before your surgery? Patient rights vary from state to state, so you may or may not receive information about your rights (or responsibilities) as a patient. For instance, if you live in Tennessee, you may receive notice that a facility will not honor DNR (Do Not Resuscitate) orders, but that they may honor a healthcare power of attorney.

While each state carries variations on a theme, for the most part, you might expect any facility across the nation to honor the patient rights listed below. Please note that these rights are general and that your healthcare facility may or may not abide by them all, or they may add some rights as well. The next article will deal with your responsibilities as a patient, which you are expected to honor. Your rights, no matter your age, race, gender, educational background or religious preference, include:

To be treated with respect, consideration and dignity;
To be treated in a safe environment that is free of physical or psychological threats;
To expect that any architectural barriers will be identified and modified or corrected;
To have the ability to access communication aids such as interpreters, sign language, etc. if needed;
To be provided with appropriate privacy and confidentiality concerning medical care;
To be free of restraint except when indicated to protect you or others from injury;
To have your questions, concerns or complaints addressed in good faith;
To expect continuity of care without being transferred or discharged to another facility or medical doctor without prior notice except in the case of a medical emergency and within the limits of legal regulations;
To be provided after-hour and emergency care;
To access necessary surgical and/or procedural interventions that are medically indicated;
To be able to obtain in information you need to provide informed concent before any treatment or procedure;
To be provided, to the known degree, complete and timely information regarding your diagnosis, evaluation, treatment and prognosis; however, when it is medically inadvisable to provide such information, the information is provided to a person designated by the patient or to a legally authorized person;
To make choices and decisions regarding your medical care to the extent permitted by law, including the right to refuse treatment;
To formulate advance directives and appoint a surrogate to make health care decisions on your behalf to the extent permitted by law, unless that provision is modified by the institution involved;
To have your disclosures and records treated confidentially and be given the opportunity to approve or refuse their release, except when release is required by law;
Receive, on request, and at a reasonable fee established by the facility involved, a copy of your medical record;
To know the services available at any facility;
To know the facility fees for services;
To request an itemized statement of all services provided to you through the facility, along with the right to be informed of the payment methodology utilized to formulate that statement;
To, at your own expense, have the ability to consult with another physician or specialist if those professionals are available;
To be informed of patient conduct and responsibilities rules for any given facility;
To refuse to participate in experimental research;
To know the identity, professional status, institutional affiliation and credentials of health care professionals providing your care and to be assured that these individuals have been appropriately credentialed according to policy and law;
To be informed of your right to change your provider if other qualified providers are available;
To be provided wiith appropriate information regarding the absence of malpractice insurance coverage, and;
To be informed about procedures for expressing suggestions, complaints and grievances, including any required by state and federal regulations.

Posted in Other Legal Matters, Patients, Wills & Estate Planning | 1 Comment »

Caregiving, Long Term Care Policy Proposal Discussions on Capitol Hill

Monday, September 21st, 2009

Howard Gleckman, senior research associate at the Urban Institute and moderator of the Genworth 2009 National LTC Symposium, and others look on as paid caregiver Ancil Alexander speaks.

“It’s more dangerous to be a home health aide than it is to be a coal miner.”* Howard Gleckman, senior research associate at the Urban Institute, said that as he described the state of home health care in the U.S. at Genworth Financial’s Fourth Annual Long Term Care Symposium on Monday, September 14, in Washington, D.C.

As aging baby boomers put unprecedented demands on the nation’s long term care resources, Gleckman, who served as moderator of the Symposium, also noted that 80 percent of the long term care giving taking place in the U.S. is done by informal caregivers, often family members or close friends who receive no financial compensation. As most people who require long term care services prefer to be taken care of at home rather than in a nursing or assisted living facility, Gleckman said that it is becoming critical that society acknowledge and address the stresses being placed on caregivers, most of whom have no formal training in providing care.

Genworth Financial’s Long Term Care Symposium is held annually to discuss and evaluate public policy issues surrounding the state of long term care across the nation. As Congress addresses healthcare reform and its many components, this year’s event emphasized the need for a national long term care strategy including funding, education and support for the caregiver. Additionally, the event served to highlight the viability of numerous legislative proposals in support of caregivers aimed at helping to solve the nation’s long term care challenges.

Part of the emotional strain facing many home care givers results from low wages paid for providing such services. According to Genworth’s “A Workforce to Care for our Aging” 2008 white paper, 19% of home care aides and 16% of nursing home aides are compensated at a level insufficient for them to rise above the poverty line. The report adds that the typical working family caregiver loses approximately $110 per day in wages and health benefits due to care giving responsibilities. Suzanne Mintz, co-founder of the National Family Caregivers Association (NFCA) added, “The wellbeing of family caregivers and direct care workers are inextricably tied together. As the wages of the latter go up, it makes it that much harder for family caregivers to purchase the services they need. The solution to this ironic situation is that easing the financial strain on family caregivers must go hand in hand with raising the wages of direct care workers.”

Recognizing the urgent need for a comprehensive national long term care strategy, Representative Charles W. Boustany, Jr., (R-LA) said in his opening remarks that, “We’ve got to do much more with regard to long term care and how it’s provided, how it’s financed.” He noted that “most seniors did not realize that Medicare doesn’t do much in terms of providing for long term care.”

Author and expert on aging Virginia Morris said national education campaigns – like Genworth’s “Let’s Talk” program (www.genworth.com/lets-talk), aimed at providing families with the planning tools necessary to prepare for future long term care obligations – “will be critical in the years ahead.”

To view excerpts from Genworth Financial’s Fourth Annual Long Term Care Symposium, visit http://genworth.edgeboss.net/download/genworth/5700_ltcsymp_akamai.wmv.

* Bureau of Labor Statistics, The injury rate for coal miners is 3.6 per 100 workers. The official rate is 4.1 for home health aides.

Tags: Caregivers, healthcare, Long-term care
Posted in Caregivers, Death Care News, Hospice Basics, Insurance Plans and Hospice Care, Patients | No Comments »

Wishes Aren’t Just for Kids…

Sunday, September 20th, 2009

Tiny Evelyn, from Joliett, IL had always wanted to ride a camel. The police department raised the money to have Einstein the Camel take her for a ride.

One day my father, in a fit of pique, stated, “Kids never ask their parents about their dreams.” I was floored…but, he was somewhat correct. On the other hand, parents often don’t share their dreams with their children, and sharing is what makes for closer connections. Now, however, I can meet my father head on if he ever ends up in an eldercare community or in hospice care – I can introduce him to Second Wind Dreams.

No, this is not a joke. Second Wind Dreams (SWD) was formed in 1997, and it grew from the work of geriatric specialist P.K. Beville, M.S. who co-authored Second Wind, a novel about people living in a nursing home. Over the last twelve years, SWD has become involved in more than 290 eldercare communities in 40 states, Canada and India. The mission that drives SWD is simple: through the fulfillment of dreams and the offering of innovative educational opportunities to caregivers and communities, SWD seeks to change the perception and experience of aging, empowering elders to age with dignity, hope and joy.

Browsing through the site is enough to make someone smile, as the dreams (or, wishes) are both fantastic and simple. Sometimes, people ask to relive a past experience, such as a visit to a favorite vacation place. Other dreams are longer-lasting, such as learning how to play the piano. According to the Web site, “An unbelievable 46 percent of dreams fulfilled are just for fun. Our recipients want to go to the Price is Right, ride a go-cart, a camel or a rollercoaster. This proves we never lose the ‘kid’ in us.”

As for simplicity, wishes for something as simple as a cupholder for a wheelchair or a dress so you can attend church again can mean much to an elderly person.

In addition to fulfilling thousands of dreams, Second Wind Dreams has built an award-winning program that includes training and support for Dreamweavers, educational programs for eldercare professionals, a quarterly newsletter, a web site, and ongoing publicity efforts with local and national media. Support for making wishes come true is available through individual donations and through special events sponsored by SWD. SWD also is creating an option to sponsor a dream, if that’s your cup of tea.

Not only is the SWD site a great place to spend some time browsing, it’s a wonderful resource to learn more about what your elderly loved ones may want. This means a lot – especially to kids who have a parent who never shared his dreams (dad!).

Tags: assisted living, eldercare
Posted in Caregivers, Hospice, Patients | No Comments »

25 Top Hospice, Death Care and Eldercare Blogs

Friday, August 21st, 2009

Portrait of old woman sitting by a window by Chalmers Butterfield.

Are you seeking expert advice on how to work with an elderly parent? Do you want to find information about your own aging? Many experts, including lawyers, hospice nurses and nursing home advocates, have taken to the Web to offer their advice and knowledge through the following up-to-date blogs. Their information may be what you need to answer your questions about aging, deathcare and eldercare.

The following list of hospice and eldercare blogs are listed in alphabetical order to show readers that we do not favor one blog over another:

AARP: Can’t live with out AARP if you are age 50 or older. This site provides advocacy, information, resources and even a game section. It’s more of a portal than a blog, but it’s a raging good resource.
About.com Palliative Care: This site is designed for patients, families, and caregivers who are faced with life-threatening illness and are seeking information about palliative care or hospice.
Caregiver List: This blog focuses on resources for caregivers for the elderly.
Death Care Law Blog: William Stalter focuses his law practice on preneed and death care compliance, serving banks, funeral homes, crematories, and cemeteries. He has written multiple published articles on the subject of preneed and is a member of The International Cemetery, Cremation Funeral Association.
Dethmama Chronicles: This hospice nurse is off the charts – funny, intense, philosophical and nurturing, she provides an insider’s perspective into death care.
Eldercare ABC Blog:If it requires a village to raise a child, then what does it take to care for an aging parent? This blog tries to answer that question with a myriad of resources.
Eldercare Diary: This site is more of a portal than a blog, but it does contain a blog as well as a forum, articles and resource directory.
ElderCare Expert Blog: “Dr. Cheryl” is an owner of a Geriatric Care Management business in Southern California, and she offers information on eldercare advocacy and information for caregivers and for eldercare professionals.
GeriPal – A Geriatrics and Palliative Care Blog: This blog is a forum for discourse, recent news and research, and freethinking commentary. They welcome the perspectives of generalists, specialists, gerontologists, palliative care clinicians, and anyone else interested in care of the elderly or palliative care.
Hospice Blog: This blog is dedicated to all of the hard working hospice professionals across the nation.
Hospice and Caregiving Blog: Sponsored by the Hospice Foundation of America, this blog offers stories and articles about the end-of-life experience.
Hospice and Nursing Homes Blog: Frances Parker is a consultant, hospice volunteer and former school principle, and her blog focuses on Parker’s experiences and knowledge about hospice care.
Hospice Physician’s Blog: This fellowship-trained and board-certified hospice and palliative medicine physician shares insights into patient experiences from a hospice and palliative care point of view.
How We Die: Ok, so this is not a blog – but, it’s a “can’t miss” site that may hold you spellbound. The founders explore how our most personal experiences have shaped what we believe about death and dying, and about the decisions we make for ourselves, for loved ones, or for patients at the end of life. The site welcomes stories from patients, their families, loved ones and friends, and doctors and healthcare professionals.
Inside Eldercare: One man’s mission – to educate and inspire readers to make their elder care experience a positive. Ryan is the creator of the “by families, for families” approach to elder care which teaches families how to make elder care a positive experience.
Lasting Tribute: This blog celebrates the lives of family, friends and people in the public eye who are no longer with us. It also allows members of the public to leave their own personal messages and upload photos.
Medical Futility Blog: Thaddeus Pope tracks judicial, legislative, policy, and academic developments concerning medical futility and the limits on individual autonomy at the end of life.
My Better Nursing Home: Dr. Eleanor Barbera frequently lectures on subjects related to psychology, aging, and nursing homes. Read her blog to gain insight into those topics.
My Elder Advocate: Jack Halpern has held several key leadership roles during his 30 years in the nursing home industry, and he shares his current perspectives on eldercare with readers.
Palliative Care Success: Tim Cousonis is a certified health care executive who has worked for the past 20 years to improve end-of-life care in the U.S.
Pallimed: This blog is a hospice and palliative medicine blog that focuses on education about the hospice movement and industry.
Risa’s pieces: This blogger is a palliative care provider who writes about his experiences with death and dying individuals.
The Good Death: Jessica Knapp is a PhD student and freelance writer who wants to help people better handle all facets of death and dying. Her posts are filled with facts, questions and many links to other resources.
The New Old Age: This New York Times’ blog focuses on Baby Boomers who face the challenge of parents who are living longer.
The Nursing Home Administrator: Learn more about nursing home matters from Matthew Maupin, who writes about topics ranging from diseases to tech tools.

Tags: deathcare, Hospice, nursing homes, Palliative care
Posted in Caregivers, Death & Dying, Grief and Grieving, Hospice, Hospice Basics, Patients, Traditions | 2 Comments »

New Reports: Caregivers, Doctors and Patients on Dying

Thursday, June 18th, 2009

Nearly two-thirds of Americans [PDF] believe the law should empower terminally-ill, competent patients to choose how they will end their lives. Yet, the AMA’s (American Medical Association) outspoken opposition to aid in dying has been cited by the Supreme Court and influences lower courts, state medical societies, and most important, legislatures.

The AMA claims to speak for doctors, and the media often echo that assertion, yet barely a quarter of the nation’s physicians are AMA members. Many medical and public health organizations have policies that support aid in dying, including the American Medical Women’s Association, the American Medical Student Association, the American College of Legal Medicine and the American Public Health Association. Still, according to a study recently conducted by Georgetown University Hospital, nurses, doctors and patients all feel some frustration, fear and abandonment during the end-of-life cycle for a patient in a hospital setting.

Nurses, in particular, who completed an End-of-Life Nurse Consortium Course, were asked about their training. Surprisingly, about 52 percent of nurses in the study said they never received this training, yet 43 percent reported they had been involved in one to three end-of-life situations within the previous six months.

Over 100 nurses attended the course, and while survey results are still pending, there have been some changes. All newly-hired nurses at the hospital now receive the training, and all of inpatient oncology and hematology nurses are required to take the end-of-life training course. The study found nurses that receive end-of-life education and training can positively impact the lives of patients and families facing difficult times, according to the report at WFTV. According to the news story:

Another study shows patients who are dying and their families report that feelings of abandonment by their physicians at the end-of-life have two components: a loss of continuity of care before death and a lack of closure near death or afterward. “Early on, patients and family caregivers fear that their physician, whose expertise and caring they have come to depend on, will become unavailable,” the authors write. Most physicians are not consciously aware of having abandoned their patients. Instead, they report lack of closure or a feeling of unfinished business. The report could help physicians structure care to maintain the professional value of non-abandonment, including use of non-hospice palliative care or closure-promoting communication strategies involving nurses and other members of the health care team. As end-of-life approaches, physicians should offer assurances that they’ll still be available and should maintain contact with the patient and caregiver, according to Anthony Back, M.D., of the Seattle Cancer Care Alliance, and colleagues.

Interestingly, patients with advanced cancer who discuss end-of-life care with their physicians appear to have lower health care costs in the final week of life than those who do not, according to a report in the Archives of Internal Medicine. Formal and informal caregivers who were interviewed after the patients’ deaths reported that those with higher costs also had a worse quality of death in their final week.

Tags: cancer, deathcare, doctors, end-of-life, nurses
Posted in Caregivers, Death & Dying, Death Practices, Hospice, Patients | No Comments »

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