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Tuesday, April 22, 2014

Good! Maybe She'll Wake Up! Part 2 of 3

Yesterday on this blog I ended by talking about the essential role as “advocate” for anyone who has some responsibility for an elder in a nursing home through some appointed position or because of the bonds of relationship. I promised to answer the question of where one goes to gain that knowledge necessary to be an effective advocate.

I offer the following as a partial fulfillment of that promise. My day gave me the opportunity to address the concept of advocacy in a way I wish I did not have to do. My sister-in-law has found herself in a nursing home following a fall which resulted in a fractured hip and subsequent surgery. That fall happened over a month ago. My sister-in-law is in a kind of limbo because she needs rehabilitative therapy, but that cannot be provided until her surgeon says it is okay to put weight on the affected leg.

So her three adult and devoted children are looking for a nursing home that is closer to them rather than to the surgeon – one that will provide the best rehab therapy, provide the best services for their mother who needs increased support in her daily life, one that will honor her dignity, her individuality, her needs and her preferences. The three of them are visiting nursing homes closer to their home. My nephew called today with that news and with information about a couple they were looking at. I offered to provide some things they should look for or be aware of as they visit these nursing homes.

I include them here as issues that any good advocate should be cognizant of for any nursing home resident for whom they hold some sort of responsibility through appointment or the bonds of love and loyalty.

I told my nieces and nephew to look for and be aware of these things. And this is just an initial list:

1. Are there ‘slumpers’? These are elders who slump in their wheelchair, sleeping or totally unaware and unengaged in their environment. BAD. They have escaped an intolerable environment and gone to their own inner world. (Not my analysis. Read the book OLD AGE IN A NEW AGE by Beth Baker.)
2. Are there elders lined up in wheelchairs or circling the nurses’ station? BAD. It means there is no meaningful engagement for individual residents.
3. What is the tone of the relationship evident between the staff and the residents? Does the staff even see the resident? Does she meet their gaze, address them? Is it patronizing or is it genuine, expressing a sense of mutuality in their relationship?
4. What is the tone of the caregivers (CNAs and licensed nurses) when they are interacting with the residents? Is it person-to-person or is it more impersonal, task oriented, and schedule-bent?
5. If you are able to be there at lunch time you can observe how the serving staff and the kitchen staff interact with the residents.
6. Are residents “parked” in the dining room for a long time (30 minutes is a long time) waiting for the scheduled meal time to take place?
7. Does everyone wear a bib? DON’T LET THEM DO THIS TO YOUR MOTHER! As your instinct will tell you, this is a dignity issue. She has the right to say no. Or better yet, Hell no.
8. Is there any conversation at the individual tables or is there a sense of disengagement or low level depression expressed in utter silence and isolation?
9. How is the food served? Is it appealing in color and arrangement on the plate? Would you consider the style of the meal service more like a restaurant, a home or a hospital?

if these events or the ambiance within the nursing home are present, the residents need good advocates who will address these issues. Knowledge of the regulations, called the "Minimum Standards of Care" are important. But there are some things that are so obvious that when we see them we know they are not right. In my beginning days within the traditional nursing home culture, I was troubled by much of what I saw. Because I was totally ignorant of 'the system' I thought, "I guess that's just the way it is." I learned soon that the words of an early mentor rang true and still ring true: "If you think it is not right, it probably isn't. Never get used to poor care."



Monday, April 21, 2014

Good! Maybe She’ll Wake Up!

This is a true story told to me many months ago by a woman I’ll call Sylvia. Sylvia got a call from the nursing home where a long-time friend of hers was living. Sylvia was not power of attorney for this nursing home resident, but the nursing home knew she was a close and long-time friend and that she was planning an out-of-town trip. Staff called to tell Sylvia that her friend was being put on hospice care.

In a sense it was not a surprise to Sylvia. Through the course of her faithful visits, her friend had “deteriorated” cognitively. She did not always recognize Sylvia; often she could not engage in meaningful conversation or call Sylvia by name. On more than one occasion Sylvia could not rouse her friend. “Dementia” the nursing home said.

“I’m going to be out of town for four days,” Sylvia said with some anxiety. “It’s okay”, she heard the voice reply. “She’s stable now. We are enlisting hospice and we will be taking her off her routine meds.”

To her later amazement, Sylvia heard her say to the staff person, “Good. Maybe she’ll wake up.”

She did!

The nursing home resident is no longer on hospice. She is alert, always recognizes Sylvia and calls her by name; she shares stories of earlier days when they lived on the same block in a tight-knit neighborhood. She laughs. She asks about this one and that one as if -- as if -- she is actually engaged with life again!!

Such is the tragedy of over-medication, or possibly drug interactions resulting from what is called polypharmacy. The topic of over medication has been addressed in the blog many times. It is a major concern to governmental regulatory agencies that have strict guidelines about the use of “Unnecessary Drugs”.

It is a concern for those long-term care practitioners who sincerely want to execute that part of the nursing home reform statute (commonly called OBRA ’87) that mandates that their organization “must” provide the necessary care and services to enable the resident “to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”

A resident cannot attain or maintain her highest practicable level of functioning when she is medicated to the point of obvious sedation, or sometimes even to the point of being so sedated that she cannot be roused, cannot open her eyes or even lift her head which is at a 90 degree angle to her body as she sits in her wheelchair.

It’s not right. It's that simple. I hope that anyone reading this blog who has some responsibility for or bond with a nursing home resident will be on the lookout for such obvious markers of over medication. The response should be that of an advocate. A strong, loving advocate.

If one would hire a person as an attorney who has no knowledge of the law, how smart would that be? The answer is obvious. The same is true when we are called to advocate for another. If it is a resident in a nursing home, then the advocate must know what the standards of care are before an issue can be adequately addressed.

Where does one go to learn what the minimum standards of care are? And do these minimum standards matter if the person in the nursing home is not in a licensed nursing home? Tune in tomorrow!

Thursday, March 27, 2014

Sister Klaryta

Back in September I posted an entry on this blog about Sisters’ obituaries. ("Never throw away old pantyhose") I contrasted the obituary that merely lists certain facts of a Sister’s life and the obituary that shares who that Sister was, what qualities described her, why people loved or admired her, what difference she made in the world because she was here, why she will be missed.

When I read the following obituary, I thought it portrays exactly those factors and consequently honors Sister Klaryta. Coincidentally, I met Sister Klaryta last November when I was at her convent in Santa Maria, CA. During a discussion on aging and the potential life holds for growth and development through our last breath, Sister Klaryta was an engaged participant, offering reflective, life-experience comments pertinent to our topic. Two months later Sister was diagnosed with cancer and died on March 17th

I invite you to read this obituary about this extraordinary woman -- an orphaned holocaust survivor, an advocate for justice --

From the Santa Maria Times March 19, 2014


Sister Klaryta Antoszewska OSF
1932 – 2014

Sister Klaryta (Ida Antoszewska) was born April 14, 1932 in Poniewierz, Lithuania to Wtadystaw Antoszewska and Maria Radziwilowicz. She died March 17, 2014 at Marian Convent, Santa Maria, CA. Sister was a Holocaust survivor, humanitarian, philologist, speaker of numerous languages, peace maker and protester of unjust causes, forever educating others in a life dedicated to service for those in need.

At a young age her family moved to Lodz, Poland, where a younger brother, Chesla, and sister, Wanda, were born. During the Holocaust her doctor father Wtadystaw was sent to Siberia and her mother, Maria, was captured and killed so that 12 year old Ida assumed responsibility for her younger siblings.

At the end of the war the children were separated: her brother off to Siberia in search of their father and her sister adopted by a Dutch couple. Ida then entered school, and eventually joined the Franciscan Sisters in Chojnice and helped them in various hospital activities. At the age of 20 she entered religious life with the Sisters of St. Francis of Penance and Christian Charity in Orlik and was given the name Sister Klaryta.

Early on Sister Klaryta taught in various schools in Poland and completed studies in philology. She eventually went to Rome in 1969 where she worked at the Vatican in the Office of Peace and Justice. In 1976 she accompanied Sister Rosemary Lynch of the same religious community to the United States and moved to Las Vegas to work in the movement protesting nuclear warfare and working for peace and justice at the local test site.
Sister Klaryta had a special love for refugees and immigrants, and for many years was the driving force in the Sisters of Saint Francis Social and Refugee Program in Las Vegas. Beloved by many whom she helped, she was always willing to do what she could for the many families and friends who came to the area with little or no economic means. The home she shared with Sister Rosemary was a haven for many people in need.

Sister Klaryta moved to Santa Maria in 2013, where she lived with her other Franciscan Sisters at Marian Convent. Despite her failing eyesight, Sister was always willing to help in any way she could. Her spirit of acceptance of all that God gave her was once again shown when she was diagnosed with cancer early in 2014. She was more than ready to be with her family and Sister Rosemary once again.

Monday, February 10, 2014

A gift only available to those who have already received the gift of years

Recently Oprah Winfrey interviewed Diana Nyad on her weekly program, “Super Soul Sunday.” Oprah quoted the first verse of this following poem as a response to a statement by Diana. I found the poem on the Internet and share it here.

I won’t interfere with your reading of this poem by sharing my own thoughts as I read it. Only this: Sit, read, enjoy, smile, reflect, read again . . . . .

Love After Love

The time will come
when, with elation
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other's welcome,

and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you

all your life, whom you ignored
for another, who knows you by heart.
Take down the love letters from the bookshelf,

the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

Derek Walcott

Thursday, January 16, 2014

Drugs and Dementia Care: Unnecessary, Ineffective and Costly

I've learned the sad truth that a hard drive can be like an attic or a basement: It too can get very cluttered. I've spent several evenings thinning out and organizing files in "My Documents." This evening I came across the article below. I believe I wrote it with the intention of posting it. However, I do not see it listed in my 6 years of blog posting, so here it is! It was written in 2010 prior to the publication of Dr. Al Power's marvelous book, DEMENTIA BEYOND DRUGS.
-- -- -- -- -- --
Isn’t it amazing how often compassion and common sense aren’t validated until there is an official study or series of studies that address the issue involved.

Within the past year or so there has been one news report after another indicating the prevalence of nursing home residents with dementia being prescribed anti-psychotics. This exists in the face of Black Box Warnings by the FDA indicating that elderly residents with dementia are at an increased risk of death when certain anti-psychotics (Seroquel is a big one) are part of the drug regimen.

Recent Research
A study in Australia was reported in the September issue of Caring for the Ages. The residents in that study all had progressive dementia “with persistent behaviors that made it difficult for staff to care for them.” One group of caregivers was provided two-day training in person-centered care with dementia residents. The residents were tested with scientifically valid check lists to indicate their level of agitation at the beginning of the study and then at four and at eight months after the beginning of the study.

Results
After four months, those residents with dementia receiving “usual care” showed an increase of agitation of almost 9 points on the scales that were used. By contrast, those residents who were cared for in the person-centered care model, showed a decrease of 9 points on the same agitation scale.

So there’s the scientific proof --- medical professionals refer to it as “evidence-based” approach to care –

Drugs prescribed for patients with dementia are not always unnecessary. But it is clear that reaching for a prescription pad the moment a behavior is observed is not good medicine even though it is a prevalent practice in too many nursing homes. Dr. Al Power is a geriatrician and certified medical director who practiced at St. John’s Home in Rochester, NY. He has a book that will be published in the early part of 2010 on this very topic of non-pharmacological approach to dementia care. In his own nursing home practice, Dr. Power told me, an average of six percent of his dementia patients at St. John’s were on anti-psychotics. That’s a wonderful contrast to the national average among nursing home residents with dementia of twenty-eight percent

The call to liberate our elders
When this evidence-based, person-centered approach is used, these elderly residents have been set free from the shackles of unnecessary drugs. Let the work go on!



Tuesday, January 14, 2014

My Mother . . . . Mama

Recently I received an e-mail from an acquaintance, Lucille I’ll call her, after a long gap in our communications. It was a one-line message: “My mother will probably die today or tomorrow. Please pray.” I responded immediately, sending my prayers and my support. My message included the following: “Regardless of the path there has been in any mother-daughter relationship, I feel it is always the little girl in us who loses her mother.”

Later that same morning I received another e-mail from this woman: “Mama just died at 11:15.”

Consciously or unconsciously, I felt that Lucille had affirmed my feelings about a daughter’s loss of her mother. No longer ‘my mother’, but ‘Mama” what we as children called our mother.

Among the many emotions surrounding my grief at my own mother’s death was one of loss, and the knowledge of the unremitting absence of death that the “little girl” in me felt so keenly. My mother died while she was a resident in a nursing home in the Dallas metroplex. At the time I was living and working as a community organizer in South Carolina and received a shocking phone call one evening from my brother with the news that my mother had died. I had spent an extended period of time with my mother just six weeks prior, as I did regularly and periodically.

My first morning back in Dallas I went to the nursing home as soon as possible. I wanted to learn as much as I could about my mother’s last day. As I walked from the entrance down the hallway, the administrator, Mrs. Wesley, saw me; she left her office, met me, put her arm around my waist and walked me back to her office. I don’t remember a single word of our conversation in her office. I only remember her warmth, compassion and empathy.

For those of us who work in aging services, we walk this path with so many families as they lose a parent. It is part of the day-to-day tasks in our line of work. May we never allow these events to fall into the category of the ordinary lest we not be ready to share our warmth, compassion and empathy with an adult child who just lost his/her Mama.

Wednesday, December 18, 2013

If the doctor says this to you, RUN!

This is a recounting of true events, a telephone conversation I had just yesterday. Names have been changed. The woman I spoke with had just lost her husband to a short-lived diagnosis and a painful death. She told me that her husband’s physician encouraged good nutritional habits and exercise. That’s a good thing. However, when her husband continued to complain of ongoing symptoms such as los of energy, loss of stamina and arthritic pain, the doctor’s response, according to this woman, was not to investigate his complaints further, but to say to her husband, “You’re just getting older, George.”

Ageism – alive and well in the medical profession – alive and well in too many of those in whom we place our trust and, indeed, our lives. So yes, if any health care provider uses your age, or the age of anyone for whom you advocate, as the overriding explanation for expressed concerns RUN!! Run to find another physician. Before you run, fire your physician.

AARP The Magazine carried an article addressing this very problem in its August/September 2013 issue. It is good reading and I highly recommend the article: “Is It Time to Find a New Doctor?”


http://www.aarp.org/health/conditions-treatments/info-08-2013/physician-patient-relationship.html




Friday, December 6, 2013

"It just isn't right" . . . Nelson Mandela

There has been uninterrupted comment on cable TV about Nelson Mandela following his death less than twenty-four hours ago as I write this. Mandela was profoundly driven by his dream of a democratic South Africa where all its people would be treated as equals. This dream, this passion permeated his being and was the molding force of all his actions. One fact in particular about this man of deep integrity and persistence has moved me deeply. I learned from Charlayne Hunter-Gault that Mandela’s consistent response to the existence of apartheid was simply: “It’s just not right.”

His deep passion for freedom and democracy expressed itself in that simple phrase and was trhe motivation for his life’s work. I have thought about how our society views aging and how this negative attitude of aging, called ageism, expresses itself too often in the oppression of our elders.

How does ageism show itself even among the most well-intentioned and loving people?

-- In the institutional approach to aging services where tasks are carried out and regulations/policies are implemented without spirit and without the priority of person-before-task;

-- In decisions that are made for and about elders based solely on their chronological age or their place of residence;

-- In the society-accepted practice of segregating elders from the rest of society. Carter Catlett Williams spoke eloquently of this from her own experience when she convened the annual Conference of the Pioneer Network this past August; http://pioneernetwork.net/Events/2013Conference/Convener

-- In any policy that is directed to persons solely on their chronological age;

-- In loving, middle-aged adult children who are convinced that they know what is best for Mom or Dad and force these decisions on the older parents;

-- The same attitude can prevail in well-meaning, good-hearted individuals who by election or appointment have some dimension of authority/responsibility for elders.

In every instance of ageism, of impersonal, institutional responses to elders, we must be that contingent who says, “It just isn’t right” and then follows that conviction with strong, appropriate, persistent advocacy, be that advocacy for ourselves or for others.

Friday, November 15, 2013

Reading and Re-reading

Earlier this week when I was enjoying the wonderful opportunity to make some homemade bread, I took advantage of the opportunity to listen to some podcasts on my MP3 player as I prepared and kneaded the dough. This particular podcast was from a program that originally aired on NPR’s TALK OF THE NATION back in March, 2011.
Rachel Hadas, author, poet, and professor was the guest. The topic was her book, STRANGE RELATION: A MEMOIR OF MARRIAGE , DEMENTIA AND POETRY which tells of her life as the wife of a brilliant man, George, professor of music at Columbia University and composer, diagnosed at age 61 with dementia.

A few things struck me in this fascinating 30-minute interview

Rachel used her intimate, long-lived knowledge of George in evaluating and analyzing the changes in his life and his ongoing needs. Rachel , in other words, took on the role of advocate for her husband. This reflected her role while he still lived at home and when she found it necessary to place him in a long-term care ‘facility’ as she calls it.

Rachel provides the podcast audience with a wealth of resources from classical and modern literature which describe and/or apply to the reality of dementia in a person’s life. I found Rachel’s descriptions of these literary references quite illuminating. In particular I appreciatede her reflections on the poem, “Walls” by the Greek poet, Cavafy.

With no consideration, no pity, no shame,
they have built walls around me, thick and high.
And now I sit here feeling hopeless.
I can’t think of anything else: this fate gnaws my mind—
because I had so much to do outside.
When they were building the walls, how could I not have noticed!
But I never heard the builders, not a sound.
Imperceptibly they have closed me off from the outside world.

She continues: “Clearly those walls beg for a figurative reading and you could say they are depression or old age or illness, isolation. But this time around the walls looked like dementia.”

Rachel also commented early in the interview that anything worth reading is worth re-reading. She says we miss most of the content in the first reading. Hearing that, I immediately thought of the Constitutions of Religious Institutes of women and men. When we go back to those documents and read them with new eyes we see visionary and challenging calls to read the signs of the times.

One of the signs of the times is the current demographics of the membership of Congregations of men and women religious. What if we read our Constitutions and other significant documents in the context of our present signs of the times? How would that change how we view the ministry of service to our own elder members?

If you are interested in hearing this podcasst, go to the following URL:

http://www.npr.org/2011/03/10/134428733/Spouses-Dementia-Leaves-Poet-A-Strange-Relation


Friday, November 8, 2013

Not quite clear on the concept?

In yesterday’s issue of my local paper, the St. Louis Post-Dispatch, there was a brief notice about a celebration. It is put on annually by a locally based agency that provides aging services as well as management and consulting services spanning the continuum of support needs for aging adults to communities and individuals .

This gala will honor 19 adults over the age of 75 “who are living active and vital lives.” Wonderful and commendable!

The website describing the event goes on to say that it is this agency’s “signature event, honoring 20 individuals and couples each year who are celebrating life and redefining aging.” Wonderful, commendable, a teaching moment!

But here is where it gets confusing. The event is called “Ageless Remarkable St. Louisans 2013 Gala Event” Let's see -- an honoree has to be “over 75” years of age, and has to have done something at this age to merit recognition. Why would anyone refer to such honorees as “ageless”? Why do we want to deprive anyone of their age? It is precisely because one has lived this length of days that one might be eligible for the recognition of ‘celebrating life and redefining aging.’

I heard a popular speaker, a person trained in gerontology and psychology say he didn’t use the word “old.” He didn’t like that word he said. This man teaches and writes about faith-based ministry to mature adults. In spite of his professional training and experience, this man only reflected our culture’s view of, our fear and denial of aging. I quote a friend of mine whose response to this attitude is the same as mine: “Oh, don’t deprive me of my aging!”

Wednesday, October 30, 2013

Job postings and their impact on the organization

I find it fascinating to read ads announcing an opening for key positions in aging services. It’s sort of in the same vein in which I read obituaries, about which I wrote recently. An obit can tell ‘just the facts’ – birth, death, survivors, services, and which charities are preferred recipients of memorials. Such an obit reflects nothing of who the person was, how s/he influenced and touched those s/he loved, or what made him or her the unique person each of us is. The deceased person remains an unknown entity.

Job postings are much the same in certain respects, I believe. The content of job postings reflects the degree to which the organization is consciously mission-driven, and reflects the priorities of qualities the organization is looking for in candidates.

Here are two examples of postings for the position of Executive Director that I read just today. Each of these organizations is a church-sponsored, not-for-profit organization.

1.
A non-profit community with a strong foundation of faith and person centered care, is seeking a campus Executive Director who is responsible for leading and directing the community in accordance with resident needs, government regulations, and internal policies and procedures.

Successful candidate must possess a passion for serving older adults, Bachelor’s Degree (MS preferred), . . . . The post continues with a listing of educational requirements and nine skills the candidate should have.

2.
Historic CCRC with nearly 500 residents and 300 employees, on 100 acres, provides a modified Life Care program in the beautiful Shenandoah Valley

Applicants must possess skills in CCRC management, performance improvement and program development, finance and planning skills. Senior leadership experience essential. NHA and five years of experience required. MS preferred.

When the right people are not hired for key positions, an organization can and will face many difficulties, only some of which include high turnover, low morale among staff and executives, organizational listlessness, frequent crises that erupt because of the inadequate placement of key persons, and the list goes on and on. All are issues which affect daily life of staff and residents as well as the “bottom line” on the Income/Expense Statement.

On the other side of the coin, consider a good, qualified, value-laden candidate who is seeking a position. If you read each of these job postings through the eyes of such a candidate, which organization do you believe such a candidate would be drawn to?

Persons responsible for writing ads for job openings should consciously reflect on what the organization really needs most and see that those values and priorities are articulated in the job posting in order to attract quality candidates.

Friday, October 18, 2013

They get good care there

The New York Times has a blog entitled “the New Old Age.” Today’s posting, entitled, “A Beep in the Night”, recounts a daughter’s experiences with her mother during her mother’s last months. The column begins with the writer’s mother mimicking the doctors saying, “She’s confused; she’s confused.” That observation followed the mother’s awakening in her hospital bed at 3 a.m. and asking for coffee. “How hard could it be for someone to bring some decaf?” an aide says to the daughter.

The daughter, a physician herself, responds to this incident by taking every effort to assure that she is called at any time that her mother has any problem or is confused.

The column is a touchingly poignant account of a daughter’s solicitude for her mother at a time when her mother was so dependent on others. Reading the article brought to mind a phrase I often hear about nursing homes – spoken often – in a positive way – by people who have friends or family in the particular nursing home spoken of. “They get good care there.”

Of course we wouldn’t want any less for anyone we know, anyone we love, who is in a nursing home. We hope for and expect good nursing practices. What always gives me pause when I hear that phrase is another phrase: “Life is more than ‘care.’” Life is more than attention to the physical body. Life is about relationships,home,choice,respect, dignity,privacy, continuity of exercising preferences in daily life insofar as possible.

It is precisely these latter values that transformational culture change attempts to bring to life for residents in nursing homes. It is what “Culture Change” is all about. It’s putting the person before the task.

For more information on this transformational, humane movement to change the culture of aging and aging services, go to:

Pioneer Network
Culture Change Now
To read Dr. Feld’s post, go to A Beep in the Night

Sunday, September 22, 2013

Nancy Pelosi and Pope Francis

This statement from Nancy Pelosi on national TV was just too good not to pass on.

Nancy Pelosi represents San Francisco and when I lived in San Francisco, she was my congressional Representative. (Imagine my culture shock when, on moving to St. Charles, MO., I discovered that I was in Todd Akin’s district!!)

In addition to being the first woman Speaker of the House and a very progressive Democrat, Nancy is a strong Catholic.

Sunday morning on CNN’s “State of the Union” news program, host Candace Crowley interviewed Nancy about issues political of course. Then she asked Nancy, “As a prominent Catholic, what is your response to the Pope’s interview that has been so widely reviewed?” Nancy smiled broadly and said, “He’s beginning to talk like the nuns!”

What a breath of fresh air! What a new breath from the Spirit!

In case you have not read the interview itself, I encourage you to do so. It can be accessed here:

http://www.americamagazine.org/pope-interview

Copy and paste this address into your browser address box.)

Monday, September 16, 2013

Ageism within the healthcare profession

The line from a physician, “What do you expect, you’re 75>” -- or 79 -- or 84 or --- is not just an innocent joke punch line. It may well reflect an ageist attitude on the part of the provider.

Ageism is alive and well within the medical field as evidence by research and all-too-common anecdotal accounts. The current issue of The AARP Magazine has an article entitled, “Signs it might be time to find a new doctor.”

The author reflects that many times older adults are hesitant to “fire” their doctor because of the respect that generation has for positions of authority and expertise. We are reminded that the doctor works for us.

Along with suggestions on how to leave your doctor graciously and respectfully, the following checklist is offered.

It’s good information for any of us personally and for those of us who care for older adults, including supervising medical care, or accompanying them on visits to their physician.

1. There needs to be “chemistry” and mutual respect between you and your physician. If there is no, “there’s an issue.

2. If a younger person accompanies you, does the physician address his/her remarks to “that person rather than you?

3. Does the physician dismiss every complaint, blaming age instead of considering other causes?

4. Does the physician insist that nothing can be done?

5. Does the physician write a prescription for medication without a thorough discussion, or without a workup to determine the need/efficacy of the prescription?

6. Does the physician describe a variety of medications and procedures, or keeps referring you to more specialists without your seeing any improvement?

Friday, September 13, 2013

Negative bias toward aging

I’ve pledged to respond to incidents of ageism when I am subjected to or exposed to them. An aspect of ageism includes statements that infer that the gift of years is a negative quality rather than a positive one. Clearly the negative bias toward aging makes no sense when one considers that the alternative to not growing older, not having another birthday is death.

So today I report experiencing negative bias toward aging in a public venue, in a situation in which a presenter addressed some 40 - 50 people, all of whom work with elders. It was an “innocent” enough statement. In her introductory remarks, the speaker asked how many in the audience were parents. Then she asked how many were grandparents, but quickly added, “Oh, no one here is old enough to be grandparents.” Clearly, the majority of the participants were old enough to be grandparents, and many of us old enough to be great-grandparents.

The speaker caved to the broader society’s value of the worship of youthfulness, to valuing youthfulness over maturity and old age. That is a negative bias toward aging. As such, it is an example of ageism.
I dare say that the vast majority of the participants did not recognize this “innocent” question as rooted in an, albeit unconscious, ageist attitude. To state again the obvious: Ageism is so prevalent and so deeply imbedded in our culture that we are not aware of it and we do not recognize its presence.

It is not logical to place a value, positive or negative, on a person based solely on their chronological age. Since most of our society’s biases toward aging are negative, those subject to ageism are devalued by this bias. This cohort of elders, seen through the bias, the prejudice, of ageism becomes marginalized and oppressed.

We cannot address this societal prejudice until we are first consciously aware of its pervasive presence.

Tuesday, September 10, 2013

"Never throw away old pantyhose"

The title here is a headline I saw earlier today at Yahoo.com. It is actually the first line of an obituary for Mary Maloney, a mother and grandmother and so much more, who died early this month in Wisconsin. The Yahoo article is quite moving as it quotes part of the obituary.

Explaining why the family created and published this unique obituary, Kevin, one of Mary’s sons said, “We wanted it to portray who she was and her love for people and just her funny ways of going about it. She was an extraordinary person in an ordinary way. ‘Survived by so and so and accomplished this and that didn't capture that.’"

I’ve often wondered why we Sisters don’t pay public tribute in a similar way when one of our own dies. When we note the passing of our own now, most of us in the community have known that Sister for 40 or 50 or 60 years. We’ve ‘grown up together. We experienced Vatican II and post Vatican II religious life together; we have sat in circles or at the breakfast table and talked about profound things and not so profound things; we have shared in the ups and downs of our birth families, sometimes of struggles and victories in our personal, professional or community life. We have prayed together, laughed and cried together. We have known how she was loved and appreciated by those she served in ministry, how she brought life to a local community - - - .I agree with Kevin Maloney, ‘Survived by so and so and accomplished this and that’ doesn’t capture that.

And from another perspective: is there not much to say about our cherished members, about the life they lived with grace and honor, the life and love they brought to us and to others throughout their lives? If a young woman reads an obituary which only states ‘daughter of’, ‘served in . . . ’, ‘services are . . . ’ would that obituary stir a curiosity or interest in religious life.

What if a young woman reads an obituary that includes this statement: “Sister will be remembered as a talented, innovative and caring teacher and a gifted poet.” And the statement from an alumna: “She left an indelible mark on the hearts and lives of our family."

It seems to me that this latter example of an obituary accomplishes more than one purpose: it shows due honor to a cherished member of the congregation. Really, aren’t we more than where we taught or what we taught? What schools or hospitals we administered? This more personal obituary also puts a spotlight on a single life of love and service, lived uniquely and received uniquely by those whom she served and the Sisters with whom she shared her life.

My gratitude to the Religious of the Sacred Heart, Atherton, California for the obituary I just quoted. It appeared in the St. Louis Post-Dispatch on August 21, 2013, marking the death of Sister Anna Mae Marheineke, RSCJ


(If you want to read the entire obituary of Mary Maloney, a tribute to and beautiful portrait of an undoubtedly loving, lovely and special woman, you can copy and paste this link into your browser: http://www.feerickfuneralhome.com/notices.php?id=1036 )

Monday, September 9, 2013

Relationships -- it's all about relationshps

One of the heroines in my life is Carter Catlett Williams, a geriatric social worker. She has also been a tireless advocate for elders, going back some 30 years or more. It was a visit to a nursing home resident, a man, who was sitting in a wheelchair restrained with a posey vest that set her on her quest. His words to Carter haunted her and would not let go of her: “It’s a terrible thing for a man to lose his freedom.”

Armed with these words and their implications, Carter began speaking of restraint-free care at every opportunity. She was always told by health care providers that physical restraints were necessary to keep frail elders safe. On one speaking engagement, there was a physician from Sweden in Carter’s audience. He invited Carter to “come see how we do it in Sweden.”

The “Untie the Elderly” was one campaign in the late 1980s which was sparked by Carter’s advocacy. Today, I say with much gratitude and joy, there are young professionals working in the field of aging services who have never seen a posey vest!! Cater was a pioneer in raising a professional consciousness that tying people to their chair or their bed did not keep them safe, but in fact, caused damage to every system in their body as well as to their spirit.

Another core value of this noted social worker is embodied in her statement, “Relationships are the heart of life.”
Just one application of this central value is reflected in a recent article by Megan Hannan of Action Pact. Megan reflects on the role and value of pets in our life, and especially for elders living with dementia. She shows that living with pets provides opportunities for both giving and receiving. This is the link. I encourage you to paste the link in your browser and read it.

http://blog.actionpact.com/2013/06/07/caring-for-a-pet-helps-meet-essential-human-needs/

Saturday, September 7, 2013

The role of advocacy in our life

A Sister-friend who works in a Catholic health care system sent the following reflection to me earlier this week. For any of us who have family members or friends in any aging services community (nursing home, assisted living, independent living) we should consider seriously the primary role of advocacy our relationship with them imposes. This reflection sets advocacy in a broad context that I thought was worth sharing.



Reflection on Advocacy
• There is no reason to believe that advocacy belongs to specialists such as attorneys, educators, social workers, clergy and public officials. To advocate for someone is simply to speak out with strength, knowledge and wisdom on his or her behalf. We do that all the time, whether or not we are aware of it: in conversations at work, in our children’s schools, in our places of worship, in our neighborhoods. To advocate for another person is to know what you want the world to be like - and to be willing to stand by that.

• Advocacy misses the mark when it is not a course of action we have chosen consciously in order to make an explicit point. Busy, too attentive to long-range goals at the expense of the momentary opportunity, or afraid of the fallout from an unfavorable response, we give up too easily. Advocacy by default is weak, unclear, often misconstrued. You can’t advocate effectively for someone unless you are willing to take the time to know what he or she really needs. Many of the actions we do initiate lack focus, miss the bigger picture, and fail to communicate what we believe to be the valuable core messages of our lives. To advocate for someone is to paint with conviction, with a wide brush, on the canvas you have been given.


• When you advocate effectively for another person you are acting out of your deepest integrity and clarifying your sense of mission. The Sufi mystic poet Rumi, in speaking about the transformative power of advocacy, compared it to the single-minded quest of a wild animal for the nourishment to sustain life: Think that you’re gliding out from the face of a cliff like an eagle. Think you’re walking like a tiger walks by himself in the forest. You’re most handsome when you’re after food. Spend less time with nightingales and peacocks. One is just a voice, the other just a color. The safest and most reliable way to learn who you are meant to be is by finding your place in genuine community. To advocate for someone is to find your true voice and your true colors.

• You don’t think anyone wants to hear your opinion?
• 1. If you don’t express your opinion, it’s as though you don’t have it.
• 2. Be sure your opinion is worth being expressed – do you need to give it more time and thought to ensure that it won’t cause more harm than good?
• 3. If you have expressed your opinion clearly and respectfully - in the right place, at the right time and to the right person – you have begun to be an advocate.
• 4. The next step is to double-check how you are being perceived and understood. If you’re not sure, ask.
• 5. In general, try to avoid making assumptions about a person or a situation, because a wrong guess or poorly developed theory can end up invalidating the good points you are raising.
• 6. Taking the trouble to establish your credibility can give your advocacy a surprising influence. To advocate effectively empowers you for future service to others.

• American poet Emily Dickinson wrote: If I can stop one heart from breaking, /I shall not live in vain;/ If I can ease one life the aching,/ Or cool one pain,/ Or help one fainting robin/ Unto his nest again,/ I shall not live in vain. At its most basic, advocacy is the ability to recognize the worth of another person and act out of love for the sake of his or her well-being without counting the cost. To advocate for the healing of another person, even one, ensures that your life’s meaningfulness will contribute to the healing of the wider world. – Rev. Enid L. Ross
God is in the slums, in the cardboard boxes where the poor play house. God is in the silence of a mother who has infected her child with a virus that will end both their lives. God is in the cries heard under the rubble of war. God is in the debris of wasted opportunity and lives, and God is with us if we are with them. – Bono, lead singer of U2

The world is a dangerous place, not because of those who do evil, but because of those who look on and do nothing. – Albert Einstein


Only those who respect the personality of others can be of real use to them. – Albert Schweitzer



Thursday Reflection Service at University Medical Center Brackenridge
September 5, 2013

Saturday, August 31, 2013

THIS HAS JUST GOT TO STOP!

Yes, we’ve just got to put a stop to ageist remarks and attitudes. Like every ‘ism’ ageism unfairly characterizes a group of people because it judges all of these people based on one characteristic: chronological age.

Melissa Harris Perry has a two-hour program on MSNBC on Saturday mornings and I watched it this morning. I like MHP for her political views and her ability to bring a fresh perspective to many social and cultural issues. A remark that Melissa made, which I’m sure was totally unscripted, stunned me. Stunned because her comment was so blatantly ageist.

I’ve reached the point where I can’t just shrug such incidents away. I feel an obligation to address ageism just as emphatically as I would address examples of racism. I wrote the following letter to Melissa. If she responds, I’ll post her response.

Dear Melissa,

This morning you asked a guest to explain to the “75-year-old little old ladies” what a particular sports phrase meant. Please, please do not stereotype people by their chronological age. Ageism is so pervasive and so deeply entrenched in our culture that we do not recognize it. I know you meant no harm and that you did not mean to disparage women 75 – or older. But the term “little old lady” is especially pejorative and reflects a negative bias toward persons based solely on their chronological age.

Senator Dianne Feinstein of California is 80 years old. Would you refer to this woman, or does the Senator deserve to be characterized by anyone as a “little old lady?”

One of the highlights of my leisurely Saturday mornings is to watch your program, Melissa. I have a high regard for the work you do in your position to raise awareness and to critique so many social and cultural issues. Your remark this morning was way out of step with your usual sensitivity to those very issues. I know you understand the power of language to create or change a culture and I implore you to monitor your use of phrases that reflect an ageist attitude.

Thank you so much.

Sister Imelda Maurer

Tuesday, May 28, 2013

Does the Nursing Home You Visit Sound Like Home?

What sounds do you hear in your home?
Soft music from the CD player or digital cable TV?

Bird songs from the yard?

A dog barking in the distance – or maybe right there in your front room?

Cars passing by?

Children’s exuberance at play next door?

A public address system announcing through amplifiers throughout the house that you have a phone call?

Bells and harsh-sounding alarms going off at any time with no apparent rhyme or reason?
Are those last two probabilities of sounds heard in your home jarring? Such would be a natural response. Of course we don’t want those kinds of disturbances in our home. They shouldn’t be part of the environment either for people who live in nursing homes, or in any community setting that provides aging services. For the last three or four years there has been a growing clamor to remove bed and chair alarms, used all too often under the guise of preventing falls and keeping residents “safe.”
Research – and common sense – reveals that alarms do not keep residents safe and that, far from preventing falls, alarms may increase the risk for falls. As with any restraint, and these alarms ARE restraints, whatever the State Regulators say, every single system in the body is adversely affected as is the emotional and mental well-being of a person fearful of moving lest that *$%@*# noise go off again.

Adding to the harm of such alarms, all too often the common response by poorly-trained staff when an alarm goes off is to say, “Mrs. Johnson, sit down,” rather than try to determine what Mrs. Johnson needs or wants, and then accommodate her needs or preferences.
Progressive nursing homes are eliminating these alarms and realizing that individuals are doing much better and that the number of falls is decreasing. An article in The Patriot Ledger, Quincy, MA just this morning details such a move.

If you want to read this short article and the reasons why alarm restraints are being eliminated, this is the link.

http://www.patriotledger.com/topstories/x863235157/A-GOOD-AGE-Silencing-the-alarms-in-long-term-care#axzz2Ub9TJ5ey


Monday, April 22, 2013

HUGE things happening in the small town of Perham

Much has been written about the documented dangers of prescribing antipsychotic drugs to elders diagnosed with dementia. This off-label use of these powerful drugs are often prescribed to "manage" "behavioral problems." Several of these commonly used drugs have had Black Box warnings from the Federal Drug Administration (FDA) for years. Those warnings include things like increased risk of death, stroke, and heart attack. There are numerous other unpleasant side effects from the use of any antipsychotic.

I have addressed this issue here at this blog several times. If you are new to the topic, those links are provided below. 

But first, hear Marilyn's wonderful success story, a story that reflects good nursing, good doctoring, and a good life for all those blessed to live in a place like Perham Living!

Marilyn wrote this just weeks agoabout the decreased use of antipsychotics at Perham Living in Perham, MN. where she served as Director of Nursing and was highly instrumental in initiating and implementing that nursing home's journey to Culture Change.


Marilyn Oellfke:
We at Perham Living saw a significant impact on the use of anti-psych meds with the implementation of the households. If we think about it, the household model meet all or most of the principles of dementia care: quiet setting of home; no distracting noises like overhead paging; normal conversations; and a routine that is based upon the resident's desires - rise at will, eat when and where the resident wants to, bath when the resident chooses and is ready, etc.


I think the fact that the residents are able to sleep better at night helps also. The resistance to care behaviors we used to see all but went away with the household routine. We went from 17% to 3% use of anti-psych meds and have maintained that rate since 2005. (Emphasis mine.)

We also spent time teaching the nurses not to call the physician with the first sign of behavioral symptoms - often the physician's first response (sometimes with the nurses urging) was a med. They look for the cause of the behavior "what are they trying to tell us" and modify the care plan. We also work with a Geriatric Psych NP who is very conservative when it comes to meds.

We find that it takes residents who are admitted with behavior issues a period of time to adjust - sometimes meds are needed initially - but once the resident is responding, we begin looking at how we can reduce and ultimately eliminate them. The few residents that we do have on meds are R/T a psych diagnosis requiring them.

FYI: Perham Living is a 96 bed skilled facility with 6 household of 16 residents each. We do not have designated memory care areas - all households are safe and prepared to meet the needs of residents with dementia. We have never had a separate dementia care unit and wanted to create a place where all residents could age in place without having to move because of change in diagnosis. It works well for us.


http://www.providencewomen.blogspot.com/2013/01/selling-well-being-in-pill.html

http://www.providencewomen.blogspot.com/2012/12/would-you-give-your-mother.html

http://www.providencewomen.blogspot.com/2012/10/information-about-psychoactive-drugs.html

http://www.providencewomen.blogspot.com/2012/10/are-you-advocate-for-someone-living-in.html

http://www.providencewomen.blogspot.com/2012/08/when-are-antipsychotic-medications.html

http://www.providencewomen.blogspot.com/2009/09/drugs-and-dementia-care-unnecessary.html


Thursday, April 11, 2013

Where is Perham Minnesota?

Tuesday’s post noted the meaningful ritual around death and dying at Perham Living, a nursing home that operates with the resident as the center. Not the schedule, not the task, not the staff, the resident. This is the essence of Culture Change. It turns the “normal” ( actually a system that is lethal to staff and residents) way of running things on its head. That’s why a whole new understanding of the role and exercise of leadership is of foremost significance. It too is turned on its head. Really, it’s transformation. Seeing things with new eyes. My goodness, this sounds like Easter! Transformative culture change DOES generate new life for residents and staff! And it is budget neutral!

So where is Perham? It is a small town in western Minnesota. Perham Hospital was originally owned and operated by the Franciscan Sisters of Little Falls, MN. Many years ago the Sisters turned the hospital over to the county who still owns and operates the hospital and the retirement complex.

I visited Perham Living when it was offered as an onsite visit (and 6 CEUs!) opportunity of the 2006 Pioneer Network Conference. The nursing home was five years into it transformation from a mni-hospital model of a nursing home to HOME. An interesting question and even more fascinating answer was part of an interactive discussion period:

“Do you have a short-term rehab program?”

“Yes.”

“How many do you presently have in that program?”

“None presently. However, a very high percentage of individuals who come for short-term rehab choose to continue to live at Perham rather than exercise their option to return home.”

We as a group were pretty amazed. However, it was clear from our tour and conversations that people who live at Perham Living ARE at HOME! That’s the goal!!





Wednesday, April 10, 2013

A comment from yesterday's blog entry

I enjoyed reading about the dignity quilt and walk of honor that has been established in one nursing home to honor those residents who have died. As a former Department of Health surveyor for long term care, I would often ask the Director of Social Work what was done when a resident passed away. One nursing home places a rose on the pillow of the deceased resident’s bed to honor them. They felt this would be comforting to the resident’s family when they came to their room to pick up their loved one’s personal belongings. A very thoughtful gesture in my opinion.


Cynthia H. Adamowsky, LMSW
Sisters of St. Francis of the Neumann Communities
Director of Aging Services

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Thank you, Cynthia, for sharing your experience. I know how comforting it is for family members and friends of the deceased who come after a death and see that the room is still being honored as a dwelling place, as still holding a special meaning and sacredness.

I have seen other meaningful practices in nursing homes which include – especially in Sisters’ retirement settings – a Scriptural verse or some other signification quotation printed and formatted appropriately and then posted on the door of the recently deceased.

It is so much more sensitive doing things this way rather than the task-oriented approach in which a CNA is assigned the task of clearing the room as soon as the body of the deceased is removed. I have heard of the shock of family members who walk in and find the bed and the room already stripped bare.

Even writing of such a thought-less practice evokes very negative and sad feelings for me. Let’s focus on and implement the actions and practices that reflect thought and sensitivity as well as respect and honor for the deceased, the staff and friends and family members.

Tuesday, April 9, 2013

Wonderful Things Happening!

Yes, there are wonderful things happening in some nursing homes! The following post is taken from a Web-based group-by-invitation that I belong to. It is a forum open to individuals who have participated in Action Pact’s week-long workshop, “Choreography of Culture Change.”

In this post, Marilyn describes the evolution from awareness to action around the issue of honoring death and dying in a nursing home and supporting those who have lost someone through that death: family members, other residents and staff.

The rituals which which became a tradition at Perham Living reflect staff sensitivity to the reality around them. It reflects a response to “the signs of the times.”

There is no one-size-fits-all in any such significant ritual. What is common in all meaningful practices is the intentional response and value-based philosphy undergirding them. There may be ideas that Marilyn’s article stirs in you. If you have any connection with e! nursing home, you may have experiences of a similar approach. You would enrich us all by sharing them in the comments section or by e-mailing your comments to me so that I can post them. (ilmcdp@yahoo.com)

To the article!
By Marilyn Oelfke former Drector of Nursing at Perham Living, Perham Minnesota

Perham Living began their culture change journey in 2001. As the households evolved, it became apparent to everyone that we needed to find a way to help family members, the other residents in the households and the staff cope with death. We wanted to treat residents with dignity and respect from the time they entered the home until they left. As relationships grew stronger, the loss of a resident was more difficult for everyone to manage. We had tried to find new ways of addressing the need and nothing seemed to be really effective. Until one day when a household lost two long-time residents within 5 minutes of each other. The families, other residents and staff were deeply affected - something needed to be done....It happened that the first resident to pass away had been lovingly called the "jungle nurse" by her family as she had served in the Korean War. We had a quilt in the living room that had a vine quilted around the edge. Someone took the quilt to the room and placed it over the gray zipper bag that the funeral home typically used. Her body, draped in the quilt, was brought to the living room in the household where a brief prayer was said and everyone had an opportunity to share. When we were ready, everyone escorted her out through the town center to the front door to the waiting hearse. Our new tradition was born - each house now has a dignity quilt for use when a resident dies. The "Walk of Honor" is done on all shifts.

The practice was well received in the community of Perham - we heard many positive comments. The hospital adopted the practice as well. They too use a Dignity Quilt and the Walk of Honor when a patient dies. The Funeral Home staff have been very supportive of the practice and give residents, family and staff as much time as they need to say their "goodbyes".

This may not work in all facilities - it happened so naturally out of a need at the moment and everyone was involved in making it happen. It has made a significant difference for those at Perham Living and certainly worth consideration for other households.

We also have Memorial services for residents if the family wishes. One difference is that the service is prepared and done by the residents and staff in the household.



Wednesday, March 13, 2013

Hand in Hand

This information was provided in an earlier post, but what I alluded to is SO important, I believe, that I want to share it again -- with a special focus on our many convent retirement settings which, because they are not licensed, do not have the same easy access to information from CMS.

I want to share some information with Sisters and lay person who serve our Sistsers  about a marvelous resource, the "Hand in Hand Toolkit". My copy of this resource arrived a couple of weeks ago. After reviewing it, I highly recommend it for use in your retirement setting. Added to this good news is that the resource is FREE to all, available upon request!

The Center for Medicare and Medicaid Services (CMS) has created this training tool that emphasizes person-centered care in the care of persons with dementia. There are six modules, each one hour in length, four of which relate to dementia and caring for residents living with dementia. The two remaining modules deal with the recognition and prevention of abuse.

The Patient Protection and Affordable Care Act (commonly called Obamacare or the federal healthcare law) mandates that licensed nursing homes provide CNAs regular training annually on caring for residents with dementia and on preventing abuse. Licensed or unlicensed, the information contained in this resource is vital information for caregivers and for those who act as family members to our Sisters in the retirement setting.

The two-inch thick manual provides step-by-step guidance (like a teacher’s manual!) for effective presentation of each of the six modules. Suggested teaching materials are also included and can be duplicated for each participant trainee.

There is a very helpful glossary and a rich resource section in the Toolkit.

Karen Schoeneman, a major player in the development of resident-centered regulations at CMS and Dr. Al Power, author of the outstanding book, DEMENTIA BEYOND DRUGS, each give a short audio-visual introduction, and overview on the first of the DVDs included.

This is how you request this FREE, EXCELLENT resource: go to this link:

http://www.cms-handinhandtoolkit.info/Downloads.aspx

(Enter the name of your convent or the name of your retirement center for “facility”.)

I encourage you to forward this letter to any appropriate parties, to request a copy of this valuable resource, and encourage your team in the retirement center to engage in the use of this excellent training. Our elder members as well as our devoted staff will be the beneficiaries.




Wednesday, February 20, 2013

I got a letter the other day from the government that I want to share with you.

Now I know that perhaps the cynical among you will think that I’m sending this with a smirk. Actually I’m not. Actually I’m sharing it with the same sense of enthusiasm that I experienced when I read it. The letter came with a resource offered by CMS entitled “Hand in Hand” which is available FREE OF CHARGE to anyone who requests a copy. Information about how to request this excellent resource is included in the letter.
The letter that follows will be of great interest to anyone who works in a retirement setting, licensed or unlicensed, or for anyone who knows someone living in a retirement center, licensed or unlicensed. This is because in reading the letter one sees that the government agency that sets the minimum standards of care in nursing homes, in this letter, makes clear that it is the individual elder who comes first, not the task, not the paperwork, not staff convenience or efficiency. CMS refers to this aspect of standards of care as person – centered care. Note the entire paragraph in which person – centered care is described and defined.

CMS also makes clear that if person – centered care is adopted as a philosophy in a nursing home, organizational changes will be called for. We can’t keep doing the same things the same way and just say we have person – centered care. We can’t keep using the same words and say that we have person – centered care. One word that comes to mind is “compliant.”

The letter is from the Department of Health and Human Services, within the Center for Medicare and Medicaid services (CMS) and I quote it here in its entirety.



Dear Nursing Home Administrator:


Section 6121 of the Affordable Care Act requires the Centers for Medicare and Medicaid Services (CMS) to ensure that nurse aides receive regular training on caring for residents with dementia and on preventing abuse. CMS created Hand in Hand, the training you are receiving today, to address the annual requirement for nurse aide training on these important topics.

Our mission is to provide nursing homes with one option for a high – quality program that emphasizes person – centered care in the care of persons with dementia and the prevention of abuse. The Hand in Hand training materials consist of an orientation guide in six one – hour video – based modules, each of which has a DVD and an accompanying instructor guide.

Person – centered care is an approach to care that focuses on residents as individuals while also emphasizing the role of the caregivers working most closely with them. It involves a continual process of listening, trying new approaches, seeing how they work, and changing routines and organizational approaches in an effort to individualize and de – institutionalize the care environment. Person – centered care is at the heart of the Hand in Hand training.

Consistent staffing, empowering nurse aides, making person – centered care a team commitment, and building relationships, you and your staff will be able to better understand and respond to residents’ needs. These practices may also play a role in preventing abuse by helping caregivers put themselves in the shoes of residents, understand residents’ actions, look at their own actions, and know themselves and their limits.

Implementation

Though Hand in Hand is targeted to nurse aides, it has real value for all nursing home caregivers, administrative staff, and others. For this training to be most effective, it is important to choose a team approach to training. Hand in Hand asks nursing home administrators to educate, empower, and create an environment of person – centered care with an emphasis on a team approach and building relationships.

Person – centered care is about seeing the person first, not as a task to be accomplished or a condition to be managed. It is the fulfillment of the Nursing Home Reform Law (1987) to consider each resident’s individual preferences, needs, strengths, and lifestyle in order to provide the optimum quality of care and quality of life for each person.

While annual training for nurse aides on dementia care and abuse prevention is required in current nursing home regulations, we do not require nursing homes to choose Hand in Hand specifically as a training tool. Many other excellent tools and resources are also available.

Thank you for your commitment to utilizing available materials such as Hand in Hand for the required annual training for nurse aides. We anticipate that these enhanced training programs will enable you to continuously improve dementia care and abuse prevention, as well as resident and caregiver satisfaction in your community.

For information to download the training modules or inquire about replacement copies of the Hand in Hand Toolkit please visit http://www.cms-handinhandtoolkit.info/Index.aspx

Sincerely,

Patrick Conway, M.D., MSc
CMS chief medical officer
Director, CCSQ































































http://www.cms-handinhandtoolkit.info/Order.aspx

Thursday, January 31, 2013

Selling well-being in a pill

The title here is not original. I wish it were! The phrase comes from Al Power, M.D., author of DEMENTIA BEYOND DRUGS. This morning the St. Louis Post-Dispatch carried an article about research being done at St. Louis University (SLU) to study the effects of Ritalin on persons living with Alzheimer’s. I read the article amidst several mental alarms going off.

Source of one alarm: persons living with Alzheimer’s,  according to their family members, often display apathy, social withdrawal, loss of enthusiasm and indifference. Alarm: what might be some underlying causes of an apparent emotional change? Other medications? Bcoming depersonalized via an institutional task-oriented nursing home environment? Boredom? Lonliness?The sense of losing one's self in the institution?

Never fear, help is on the way! No need to reflect or investigate external stressors. A pharmaceutical company paid this SLU MD/professor $ 183,540 to see if their product might be just the right intervention, “well-being in a pill.” Oh, another thing, this same company, according to the article paid the professor $28,000 in 2010 to speak to other physicians about its products. Hmmmm.

In his book, Powers points out that all of the research done on the use of antipsychotics for persons living with dementia were funded by --- guess who --- yep, pharmaceutical companies.

Second alarm. This logic is presented by the SLU physician-researcher in this morning’s article: if a person is depressed, s/he is less focused on the environment and therefore at greater risk for falls. So if individuals have “greater energy” they will be more focused on their environment and less likely to fall. Pass the pills!

I wrote to Dr. Power about this article and asked his opinion. He wrote back saying that there has been some benefit in the use of Ritalin for depression, “but it's not well-studied, and it begs the question of whether we just continue to try and sell well-being in a pill.”

Dr. Power has a blog which can be found at www.changinganging.org. In a recent post, Power states succinctly the misplaced role of drugs for persons living with dementia in typical nursing homes. He says this: “The bigger issue is the inability to realize that much distress comes from our institutionalized, dehumanized approach to care for people with dementia. The real problem lies not so much with one particular class of drugs, but rather the idea that ANY pill is the solution to unmet needs or environmental stressors." (Emphasis mine.)

If you have not read DEMENTIA BEYOND DRUGS, you're missing a whole new world of understanding of dementia and a world of hope beyond its too-often-prescribed drugs.











Tuesday, January 15, 2013

“If You Change Your Words You Can Change the World” or “Never Say ‘Pet Therapy’”

Imagine you are returning home from a day’s work, from a trip, or from the grocery story. You have a pet at home – a dog we’ll call Lucy. You know what to expect when Lucy sees you: Lucy’s tail begins to wag energetically. She may bound up to you and wants to lick your face. You automatically reach down to pet her, to receive her unconditional love, her pure doggie affection. You automatically smile and even chuckle a little over this creature in your life, this creature who affords such delight by her very being, such company and comfort.

Now step back mentally from this image. Would you use the word “pet therapy” to describe the effect on you of Lucy’s warm greeting and presence? Would you describe Lucy to others as your therapy dog?

What do we mean when we use the word ‘therapy’? A quick Internet search surfaced these definitions.

--“Therapy” the treatment of disease or disorders, as by some remedial, rehabilitating, or curative process: speech therapy.

-- Therapy is the action taken to begin a healing process.

-- Therapy is a session where (sic) a health professional aims to provide remedial or compensatory strategies and treatment to improve a participant’s function or well-being. It may first involve assessment of needs, then planning of goals, treatment and finally, review of progress / success of treatment.

What all the definitions have in common, and what we also instinctively conclude when we hear or use the word ‘therapy’, is that it is an approach to addressing a deficit, a treatment to cure an illness, to bring health in place of a lack of it. It is a medical term.

Many nursing homes and assisted living communities have pets who live in ‘the community, and/or pets that are brought in on occasion. That’s a good thing! What is not so good in the vast majority of these circumstances is that the pets are labeled “therapy dogs” or “therapy cats”.

In these circumstances the ‘therapy dogs’ “help combat loneliness, helplessness and boredom among seniors at nursing care centers by offering sensory stimuli and a way to give and receive affection.” (Source is at link below. Accessed January 15, 2013.)

Is this how you or I view the impact our pets have on us? You get it, don’t you. In such labeling, we are medicalizing a human experience. We are medicalizing the normal human activities of interacting with another creature, a pet. We are also revealing the fact that our view of our residents is not holistic but medical.

In the movement of transformational culture change in which the nursing home moves from INSTITUTION to HOME, pets are seen, experienced and described for the wonderful creatures they are, for the gift they give to all of us. You know, just like you and I experience our pets at HOME.

We make changes in our practices and in our concepts by changing our words. Let’s use words that express what we really intend. The delight, the company, the gift of domesticated animal creatures living in or visiting our home is “pet”. Period.

Read about therapy dogs at
http://wcfcourier.com/lifestyles/resident-therapy-dog-brightens-seniors-days/article_ef0657bf-2ef1-5839-913c-7995251a3f7a.html

Monday, December 24, 2012

A Christmas Message


LeadingAge offers a daily news clipping service as one of its membership benefits. So each day I get an e-mail with links to a half dozen or so current news articles that relate to aging and aging services. This morning one of the articles is from an article originally in The Boston Globe, but quoted from the San Francisco Chronicle. The article is about lack of enforcement for inappropriate use of antipsychotics on nursing home residents in Massachusetts, particularly those living with dementia. It's not a happy Christmas Eve message, but one that too often is found in newspaper and journal articles -- reflecting a tragic reality for too many elders in our country.

I quote just one sentence here, but include the link to the article also:

“A few reports detailed cases when residents were so overmedicated
they were unable to open their mouths to eat or do much but sleep.”

I venture to say that in too many “typical” traditional nursing homes it would not be unusual for a visitor to observe one or more residents at the dining room table so sedated that it was difficult for staff to assist him/her with the meal. Do we just smile such scenes away with some misguided, “sweet” myth that elders just sleep more?

Federal and State regulations forbid use of antipsychotics for the “treatment” of “behaviors” for good reason. Such use does not address the issues at hand, does damage to the resident physically and psychologically and is a cruel imposition of “treatment” – fierce and deadly chemical restraints – on helpless individuals. It is abuse clear and simple and must be stopped.

Not a pleasant message to post on Christmas Eve. However I am reminded of Howard Thurman’s message, “The Work of Christmas.” I offer it here. We must do what we can to “heal those broken in spirit” and to “radiate the Light of Christ . . . in all that we do

When the song of the angels is stilled,
when the star in the sky is gone,
when the kings and princes are home,
when the shepherds are back with the flocks,
then the work of Christmas begins:
to find the lost,
to heal those broken in spirit,
to feed the hungry,
to release the oppressed,
to rebuild the nations,
to bring peace among all peoples,
to make a little music with the heart…
And to radiate the Light of Christ,
every day, in every way, in all that we do and in all that we say.
Then the work of Christmas begins.


Newspaper article quoted can be accessed at:

http://www.sfgate.com/news/article/Report-Mass-rarely-nixes-nursing-home-sedatives-4141901.php




Tuesday, December 4, 2012

“Would you give your mother . . . ”

Later today the Missouri Quality Improvement Organization is providing a webinar for those involved in long-term care. The topic is antipsychotic medication use in the elderly. The phrase that I have used as the title of this post heads one of the slides for this presentation and goes on to list the serious negative side effects of all categories of antipsychotics. It’s scary, really to read all the side effects in one place at one sitting.

A few thoughts come to mind about this. When antipsychotics are used to “treat” “behavioral issues” as a result of dementia, the drugs don’t work! The drugs don’t address the “cause” of the “behavior.” So in addition to not working, the resident living with dementia suffers a myriad of negative side effects, not the least of which includes strokes and as much as a 1.7 fold increased mortality.

My second thought: no, I would not give that to my mother. Who would, really, if one is informed about these issues. This surfaces the importance of being fully informed. Within birth families, when a parent begins to show signs of increased frailty or cognitive disabilities, the adult children are often bewildered. It’s all a new experience; they have little or no knowledge of the aging process or of the avenues of appropriate services that can and should be provided. Often times, there is an admission that when the second parent needed more services, the adult children were more knowledgeable and comfortable in providing them or seeing that they were provided. The adult children have through their previous experiences become informed about appropriate issues: aging process, medications or other treatments, and how to make a decision of informed consent in keeping with the wishes of the parent.

And thirdly, for those of us who live in communities of Religious Institutes, we shouldn’t feel so flustered. Seeing our mentors, our congregational giants, and our friends move along this path, it is not so new to us. With our experience, with our growing knowledge of the intricacies of aging, normal or with more chronic disorders, we should be able – in a very informed way – to companion our Sisters wisely, gently, compassionately and competently.