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Hospice

Dr Jerry Old

2011-12-27 14:06:09

Q: What role do volunteers play in hospice? Volunteers do a great service in this country, and those doing volunteer work consistently find the experience extremely rewarding. But why would anyone want to volunteer for Hospice? Wouldn’t that be depressing; working with dying people?

A: Ironically, that is not the case! Individuals who step out of their “comfort-zone” and volunteer for hospice organizations find it personally gratifying, intellectually stimulating and emotionally meaningful. Hospice is not about death—it is about life! Priorities change, but Hospice is about living the best quality of life, for as long as one can live it. There is now global awareness that hospice and palliative medicine must be a reliable part of every health care system. We have left behind the era where hospice was timidly advanced as a ‘choice’ or an ‘alternative’ to standard care. More and more people are choosing the option to stay home, to forego expensive (and often painful) medical therapies that don’t help much, to maintain control of their decisions, and have quality of life at home when reaching the end of their physical lives. Q: What can volunteers bring to hospice? A: Perhaps merely helping with simple administrative duties, such as filing or addressing envelops for thank- you letters in the office. Maybe it’s child care assistance. Volunteers have made invaluable contributions with family pet care. Perhaps it is support or respite for family members. Simple things such as allowing a caregiver an opportunity to run errands, buy groceries, or to get a little time away from the house may be invaluable in preventing burnout. Even assisting with household maintenance or yard work can be a precious gift for those who can’t perform those tasks. For persons brave enough, or comfortable enough, Hospice volunteering may mean actually visiting with patients—reading, talking, helping them reminisce, playing music or supervising visits with pets. All volunteers are trained and will feel comfortable and confident in whatever Hospice setting they choose. All you really need is a desire to help your friends and neighbors while serving the community. The importance of volunteers is reflected in the fact that one of the requirements of a Medicare certified hospice is that at least 5% of the total patient care hours be provided by volunteers. They are valuable members of the multi-disciplinary team that supports the patient and the family, along with the physicians, nurses, aides, social workers, chaplains and others. The hospice philosophy recognizes that dying is not merely a medical event, but a profoundly personal journey. What could be more exciting and fulfilling than to help someone facing that journey? Volunteering for Hospice is something to consider. The most common comment I hear from Hospice volunteers is, “I went there to help someone else, and I received far more than I gave.”

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Hospice

Dr Jerry Old

2011-10-24 11:31:10

Q: Doesn’t going on hospice care mean “giving up”?

A: Not at all. We are reaching a point in modern medicine where the concept of “Aggressive Care” at the end-of-life needs to be re-defined. When we think of aggressive medical care, we often think of all the amazing technology that can be used to prolong “life” in the 21st century. However, Hospice care, while usually seen as opposite of “aggressive care,” is in reality also aggressive care. The modern Hospice movement, while recognizing the futility of life support and ineffective therapies at the end-of-life, is not “No Care.” It is often more care—more aggressive pain management, more aggressive symptom management, insistent wound care and more aggressive “quality of life” care. 30-years ago when I was in Medical School, Hospice was seen as “alternative medicine”. I remember one of my professor’s great concern about the group of renegade hospice nurses going around giving people morphine! Now, with the creation of the newest medical specialty of Hospice and Palliative Medicine in 2006, Hospice has become standard of care—a very fast transition for the medical field. Little wonder its purpose is still frequently misunderstood. Hospice care and aggressive care are not opposites. The goals are just different. The goal in Hospice is neither to cure the disease nor to extend life expectancy beyond all reason. With hospice, the goals become things such as preservation of dignity, allowing the patient to maintain control, to stay at home and recognizing the importance of treating emotional and spiritual suffering. It is helping patients and families through one of the greatest times of change and personal growth they will ever experience on this planet. Sounds like pretty aggressive care doesn’t it! The word “palliative care” literally means “to cloak” or surround the patient with caring. Even the term “comfort care” comes from the Latin “Com Forte” or to “care with strength”. A recent study has shown that people with similar medical conditions enrolled on hospice in a timely manner, actually lived LONGER than their counterparts who continued the traditional aggressive treatments such as chemotherapy or high risk surgeries and procedures. Most of us have heard of the “DNR” (Do Not Resuscitate) order that can be placed on a patient’s chart. The general interpretation of this order is that it means to do “nothing” medically for the patient. I much prefer the newer term “AND” which stands for “Allow Natural Death”. DNR is negative—do not do things! “AND” is much more positive—it implies allowing a natural process, but being active about it by aggressively keeping the patient comfortable in all ways possible. We must recognize that “Aggressive Hospice care” is not an oxymoron! Payment sources will continue to divide aggressive and non-aggressive medical therapies, but medically and realistically, that line is becoming less and less clear. We thank all those dedicated hospice employees and volunteers at Hospice Care of Kansas and the nearly 70 hospices across the state for the “Aggressive Hospice Care” that they are providing to their patients and families.

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Hospice

Paula Smith

2011-09-29 15:49:36

Q: What should I consider in selecting hospice for a loved one?

A: Providing hospice services can vary as much as hospitals, physicians and other professional services. From hospice to hospice, there are varying levels of expertise… different approaches to supporting patients and families… alternative philosophies of care. The choices can be bewildering for patients and families who are trying to find the hospice that is right for them. Medicare requires that every Medicare-eligible person has the right to choose their hospice. Here are some questions every family or caregiver should consider as they learn more about hospice and how to obtain the kind of service and support their loved one deserves. Ask these questions of hospices you are considering: • How do I obtain hospice services? • How do I qualify? • What services can I expect? • Where are services provided? Home? Assisted living? Nursing home? Inpatient? • Are supplies provided related to the terminal diagnosis? • Can our personal physician continue to be involved in care management? • How frequently are nursing visits made? • How large is the hospice professional’s caseload – eight patients? 30 patients? • How are nights, weekends and holidays handled – answering machine or hospice nurses at the phones? • Is there a pharmacist on staff to focus on pain and symptom management? • Is there a wound care specialist should there be a need? • What role will the family play in providing care? What if there is no family? • How much choice do the patient and family have over care management? • What if the patient needs to go to the hospital? Or needs additional treatments or medications? • What bereavement support is available to the family after the death and for how long? Getting answers to these questions will help you find the hospice that best meets the needs of your family and will enable your loved one to comfort, compassion and dignity at the end of life.

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Hospice

John Chastain

2011-07-01 10:51:00

will arise and there are just no answers. And whether we want to accept it or not, we will all face this experience sometime in our life, either with ourselves or with someone we really love. That is when you should involve your doctor, family and hospice. Why involve hospice? Contrary to what many people think, hospice is not a death sentence. I prefer to call it “Hope Renewed”. A team of professionals comes in to help you physically, emotionally and spiritually. We believe that people should live life to the fullest as long as they possibly can. I have found that many times the family is having a harder time than the patient and they need the help, love and support of the entire hospice team. That is what we are here for. The hospice team has been trained professionally to fulfill their individual calling. But it is more than professional training. It is a wonderful privilege we are given to share some “sacred” moments with both the patient and the family in perhaps one of the most difficult times in their lives. We consider this a high and sacred calling. Some of the greatest experienc

Answer: Years ago, I became involved in hospice work. My first experience in hospice was unforgettable. A man who was angry because he was dying was determined to make life miserable for everyone, especially his family. However, not long afterward I visited another lady on hospice service who inspired me and all who were around her. She was determined to not let this disease destroy her. She was going to live life to its fullest, however long that might be. Every day was a celebration of life for her and she taught us all so many valuable lessons. She lived seven months longer than the doctor expected, with her pain controlled and her family at her side. Some things in life are not our fault. You didn’t plan to get sick. You may say, “Why is this happening to me? It’s not fair.” At first there may be some denial, and maybe even a little bargaining. Mix in with that some fear and anger. You may even blame yourself for not taking better care of your health. Questions will arise and there are just no answers. And whether we want to accept it or not, we will all face this experience sometime in our life, either with ourselves or with someone we really love. That is when you should involve your doctor, family and hospice. Why involve hospice? Contrary to what many people think, hospice is not a death sentence. I prefer to call it “Hope Renewed”. A team of professionals comes in to help you physically, emotionally and spiritually. We believe that people should live life to the fullest as long as they possibly can. I have found that many times the family is having a harder time than the patient and they need the help, love and support of the entire hospice team. That is what we are here for. The hospice team has been trained professionally to fulfill their individual calling. But it is more than professional training. It is a wonderful privilege we are given to share some “sacred” moments with both the patient and the family in perhaps one of the most difficult times in their lives. We consider this a high and sacred calling. Some of the greatest experiences of my life have been in hospice. A person who is facing end-of-life issues has nothing to hide. To the contrary, they are eager to bring closure to areas of their life they have long ago “swept under the carpet”. It is now time to be transparent and open about everything. Years ago, I served as a hospice chaplain and I often became a sounding board or a listening ear for my patients. Some of what patients have confided has been shocking, and yet this time of confession became a “freeing” time for many of them. I have seen families come together and resolve family issues that had been destroying their family for years. These types of resolutions are as important as our nursing/clinical treatment of the patient. They can now face either life or death with a clear conscience. What a blessing this is for all concerned! Next month we will talk about where hospice care takes place.

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Hospice

Dr Jerry Old

2011-07-01 08:32:00

Question: Is hospice care about death and dying?

Answer: There is now scientific evidence in the medical literature that people on hospice care live, on average, longer than their counterparts who choose aggressive care! In one recent study, patients averaged living 29 days longer and rated their quality of life as “superior” to those on aggressive therapies. For example, people with end-stage heart disease lived an average of 81 days longer; for lung cancer it was 39 days longer; and for pancreatic cancer it was 21 days longer. As a medical director with Hospice Care of Kansas/Hospice Care of the Midwest for the past 10 years, I have seen both physician and public views of hospice change. There is now global awareness that hospice and palliative medicine must be a reliable part of every health care system. We have left behind the era where hospice was timidly advanced as a ‘choice’ or an ‘alternative’ to standard care. More and more people are choosing the option to stay home, to forego expensive (and often painful) medical therapies that don’t help much, to maintain control of their decisions, and have quality of life at home when reaching the end of their physical lives. So hospice is really about Life—not death! It is about living the best quality of life for as long as one can live it. It’s about the “bucket list” and doing the things that one enjoys. Priorities change and some things seem a lot less important, while other duties and relationships take on a more immediate concern. The biggest problem is knowing, or admitting, when one is “ready for hospice!” Some people still equate calling hospice with “giving up”. In reality, the hospice philosophy recognizes that approaching end-of-life is not merely a medical event, but a profoundly personal journey. One of the most frequent statements from patients and families is “I wish I had called hospice earlier!” We now have 21st century technology to keep people alive indefinitely, and many great medical miracles abound. We should embrace those medical miracles that enhance life. But what comes after the miracles—mortality rate is still 100 %. We must not forget the 19th century principles of palliation--putting emphasis on quality of life and treating symptoms, rather than sacrificing everything for a cure. Not realizing these principles is one of the factors that is bringing our country’s health system to a state of economic crisis. Perhaps our mission should not be as much about adding years to our life, but about adding life to our years. It appears that the gentle, natural philosophy of hospice may help us to do both. As people travel to visit family members during this summer and fall vacation time, it can also be a time to reflect on “quality of life,” and to discuss individual wishes with loved ones and friends.

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Hospice

Dr Jerry Old

2011-06-01 11:08:00

Question: What can you tell me about pain management?

Answer: When it comes to treating persistent pain, the medical profession often feels that we are “doomed if we do and doomed if we don’t!” On the one hand, almost all studies done since the 1950’s show that medical practitioners tend to under treat pain, especially in the elderly and in end-of-life situations. There is good evidence that 40% of cancer patients are undertreated, and that 45-80% of all nursing home patients reports some pain every day. Yet, on the other hand, diversion of pain medications to those that use them for recreational purposes is on the rise. The question is “how do we treat pain in those patients that have legitimate pain, but avoid narcotic medications from being abused and adding to the drug problem in this country?” Just like most things in life, balance seems to be the key. Dispelling myths about pain medications is the first step. First, we have to define pain. One national guideline states that “Any pain that has an impact on physical function, psychosocial function, or other aspects of quality of life should be recognized as a significant problem.” Pain is divided into basically two types. Acute pain and chronic pain. Acute pain is what we are all familiar with like a sprained ankle or accidently hitting your thumb with a hammer. The cause is known and the duration is limited. It will eventually get better, with or without treatment. Chronic pain is different. The cause may not always be clear and it persists without improvement for months or years. Treatment of chronic pain is of greatest concern because it is going to require long-term treatment. The World Health Organization has devised a very practical approach to treating pain, called the “pain ladder.” Essentially, the ladder starts with mild pain medications such as acetaminophen (Tylenol) and then goes up the ladder to opioids such as morphine. The lowest dose of medication is used that will adequately control the level of pain. The greatest myths in pain control come from treatment requiring opioid pain medications, such as morphine and its other derivatives. Morphine was available without a prescription in this country in the 1800’s, and was used extensively during the American Civil War for pain treatment. Modern examples of morphine compounds include hydrocodone (Lortab, Vicodin Norco), oxycodone (Oxycotin, OxyFast, Percocet, Tylox, Roxicet) and hydromorphone (Dilaudid), to name a few. Since these medications are sometimes abused, their legitimate use for pain has become stigmatized. Patients and physicians both have bought into several myths about narcotic pain medications. Patients often feel that reporting pain to their physician is a sign of weakness—after all, John Wayne would have never shown pain, even after being shot several times! Sometimes pain is seen as a punishment for previous transgressions—perhaps a punishment from God that is to be endured. In my geriatrics practice, older adults often withhold telling the doctor about their pain because of fear of unwanted medical testing or loss of independence (“If you are having that much pain we may need to think about nursing home placement”). Another myth that patients have, shared by many physicians, is that adequate pain control is just not possible. Physicians are worried about legal ramifications of prescribing narcotic pain medications and share the patients concerns about addiction and side effects. In truth, addiction and serious side effects (i.e. stopping breathing) are extremely rare in treating pain. Likewise, a physician getting into legal problems for treating pain is extremely rare (but highly publicized) and generally involves inappropriate prescribing. Many of the myths about pain management evaporate when we understand the difference between tolerance, dependence, and addiction. Tolerance means that one has to increase the dose of a substance to keep getting the same effect. This is common if medications are used to get a “high.” Even alcohol is in this category. Each time you drink to get a “buzz” you have to drink a little more to get the same “buzz!” But this is uncommon in medications used for pain control. If we find the correct dosage of pain medication, the patient may stay on that dose for months or years. Dependence simply means that withdrawal can happen if the medication is stopped suddenly. Again, this is not addiction. A number of medications produce dependence. There are a number of blood pressure medications that should not be stopped suddenly. Steroids such as prednisone are giving in a tapering dose. Dependence is also rare when pain medications are being used for legitimate pain control. In hospice, I have seen patients stop large amounts of narcotics when the pain goes away, and not experience withdrawal. Think of it this way: Pain acts as an antidote to the narcotics. When pain is present, it soaks up the opioid and addiction, tolerance and withdrawal are rare. If pain is not present and the medication is used for that euphoric buzz then all three will become a problem, addiction, tolerance and dependenceny. Psychological addiction is simply anything that is ruining your life and you keep doing it, drugs, porn, food, etc. If the pain medication is making your life better, particularly in function, then it does not fit this definition. Opioids are physiologically very safe medications. The American Geriatric Society has determined that opioids are safer for the elderly that ibuprofen! Opioids do not seem to damage the body and have no warnings for liver, kidney or lung disease. What about side effects? Everyone knows that morphine can stop respirations—right? Actually that is another myth. With increasingly large doses of opioids, people go through predictable stages of sedation. They do not go from awake and talking, to dead with one appropriate dose of medication. Significant stages of coma are noted before respirations are affected. In summary, there are several myths about medications used for severe pain control. However, chronic pain can be treated safely and adequately. The risks of addiction and respiratory depression are rare in proper pain management. The myths discussed here should not be barriers to patients receiving proper pain control.

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Hospice

Dale Williams

2011-05-01 13:04:00

Question: Is hospice care available for veterans?

Answer: Hospice care is a covered service for all enrolled veterans of any age, authorized in the VA’s Medical Benefits Package, on an equal priority with any other medical services. VA Medical Centers must provide, or purchase hospice care from a community hospice, when the VA determines that an enrolled veteran needs it. An estimated 1,600 veterans die every day in this country, most of them members of the Greatest Generation who won World War II. Veteran deaths make up 25% of all U.S. deaths. The median age of today’s 26 million living veterans is 58.9 years. It is estimated that the veteran population in Crawford County is 3,144. For some veterans, the effect of combat experience may remain buried for years, emerging only when the veteran is very sick and dying. Doug Weadick, chaplain for the hospice unit at the Orlando, Florida VA Health Center says, “When you are dying, you look back on significant events. Combat is a form of intimacy – very traumatic, life changing. It defined who they were and became. What I see is that they want to process these events at the end of their lives.” The Department of Veterans Affairs (VA) hospice units have learned a critical lesson in caring for dying veterans: a patient’s military service history is highly relevant to providing the most appropriate, personalized end-of-life care. Recognizing the unique needs of our nation’s veterans who are facing a life-limiting illness is important in guiding veterans and their families toward a more peaceful ending. According to Don Schumacher, CEO of the National Hospice and Palliative Care Organization (NHPCO), all hospices are serving veterans but often aren’t aware of that person’s service in the armed forces. With support from VA headquarters, NHPCO and other end-of-life advocates, Hospice-Veteran partnerships are now forming at state and regional levels to honor veterans’ preferences for care at end of life. This We Honor Veterans campaign is a giant step in helping hospice providers understand and serve veterans and work more effectively with VA medical facilities. VA’s and hospices share a common goal of providing the best care specifically tailored for veterans. “America’s veterans have done everything asked of them in their mission to serve our country,” said Don Schumacher of NHCPO. “Now it is time that we step up ....and fulfill our mission to serve these men and women with the dignity they deserve.” Volunteers are an essential part of all hospice care – in fact, Medicare requires that volunteers provide 5% of all patient care hours. Terminally ill veterans will talk with another veteran more easily than to a non-veteran. As hospices increase their efforts to respond to veterans, the demand for volunteers will grow. Volunteering may be a way that current veterans can lend support to those who are nearing the end of life’s journey. Not all hospices are the same. Knowing that your hospice team is trained in specific issues surrounding your service to your country is a valuable piece of this difficult decision.

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Hospice

Dr Jerry Old

2011-04-01 13:55:00

Question: What role do volunteers play in hospice?

Answer: Volunteers do a great service in this country, and those doing volunteer work consistently find the experience extremely rewarding. But why would anyone want to volunteer for Hospice? Wouldn’t that be depressing; working with dying people? Ironically, that is not the case! Individuals who step out of their “comfort-zone” and volunteer for hospice organizations, find it personally gratifying, intellectually stimulating and emotionally meaningful. Hospice is not about death—it is about life! Priorities change, but Hospice is about living the best quality of life, for as long as one can live it. There is now global awareness that hospice and palliative medicine must be a reliable part of every health care system. We have left behind the era where hospice was timidly advanced as a ‘choice’ or an ‘alternative’ to standard care. More and more people are choosing the option to stay home, to forego expensive (and often painful) medical therapies that don’t help much, to maintain control of their decisions, and have quality of life at home when reaching the end of their physical lives. What can volunteers bring to hospice? Perhaps merely helping with simple administrative duties, such as filing or addressing envelops for thank you letters in the office. Maybe it’s child care assistance. Volunteers have made invaluable contributions with family pet care. Perhaps it is support or respite for family members. Simple things such as allowing a caregiver an opportunity to run errands, buy groceries, or to get a little time away from the house may be invaluable in preventing burnout. Even assisting with household maintenance or yard work can be a precious gift for those who can’t perform those tasks. For persons brave enough, or comfortable enough, Hospice volunteering may mean actually visiting with patients—reading, talking, helping them reminisce, playing music or supervising visits with pets. All volunteers are trained and will feel comfortable and confident in whatever Hospice setting they choose. All you really need is a desire to help your friends and neighbors while serving the community. The importance of volunteers is reflected in the fact that one of the requirements of a Medicare certified hospice is that at least 5% of the total patient care hours be provided by volunteers. They are a valuable members of the multi-disciplinary team that supports the patient and the family, along with the physicians, nurses, aides, social workers, chaplains and others. The hospice philosophy recognizes that dying is not merely a medical event, but a profoundly personal journey. What could be more exciting and fulfilling than to help someone facing that journey? National Volunteer Week is April 10-16. Volunteering for Hospice is something to consider. The most common comment I hear from Hospice volunteers is, “I went there to help someone else, and I received far more than I gave.” Call the hospice in your area to get involved.

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Hospice

Rita Weibert

2011-03-01 14:39:00

Question: How does a child’s grief differ from an adult’s?

Answer: The loss of a loved one for a child can be complicated and confusing, but if adults in the child’s life understand a child’s grieving process they can better nurture the little one through their loss. Adults must understand that the loss of a loved one for a child can change the outcome of this child’s adult life as well as the initial time after their loss. Children very much follow a grief process but it differs from that of an adult. Adults commonly experience their grief process through denial, guilt, anger, depression, upward turn, reconstruction, and acceptance. Children often have stages such as disorganization, transition followed by reorganization. Disorganization is an expression of grief for children that can vary from regression, throwing out-of-characteristic fits and exaggerated fears in elementary-aged children, to physical symptoms such as no longer concentrating and mood swings in older children. Adults can assist children through this stage with patience and understanding. With the transition stage, a child will show feelings of despair, helplessness and hopelessness leaving them feeling different and very alone. This follows the stress and chaotic behaviors of the initial disorganization stage of the process. Several little ones will show actual depression symptoms. More commonly seen among children in this stage are symptoms of withdrawal, aggression and giving up not only in school, but also extracurricular activities; this can affect their well-being and school performance. Finally, with the reorganization stage, feelings may be expressed with emotional energy ups and downs and detachment is a concern. During reorganization, children have more energy and motivation for reaching toward a positive outcome to their grief. It is key to note here that when an adult sees a child playing and happy during this stage, understand the grief process may not be over, but is on track to emotional well-being. The last thought in helping young ones live through grief is the developmental stage of the particular child involved. It is necessary to take into consideration that a grieving child’s developmental stage may fall behind his or her chronological age. Regression is expected and developmental accomplishments take longer to obtain. Though children’s grief moves along this cycle most commonly, it is difficult due to the circular nature of grief (many people can understand this if they have experienced grief on a personal level). About the time one has moved ahead in their resolution of grief, a reminder of their loss can bring back waves of emotions that take them right back to the feelings of loss and great sorrow. Adults in the child’s life can see these signs and understand what is happening, but more than likely the child is unable to grasp this understanding of their emotions. Adults can then recognize the continual nature of grieving to help a child through this trying time during their development.

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Hospice

Jeffrey L Owen

2011-03-01 11:31:00

Question: Do children grieve differently than adults?

Answer: That is a most astute question. I think many of us are guilty of thinking we all grieve the same. We do not. Let me demonstrate by giving you a true story. Krista was just five years old when she saw her Popo lying in a hospital bed, gasping for every breath, fighting desperately to stay alive. The look of concern on her face as she would shift her eyes from her Popo to me, her daddy, is one I will never forget. At five years of age, Krista knew her Popo was dying. I had explained to her that her Popo was very ill and that he would probably die soon. Krista felt as helpless as I did, knowing there was nothing she could do to prevent her Popo from leaving her. Being his first grandchild, Krista and Popo had a very special relationship. Popo tried not to show favoritism, but just couldn’t help himself where Krista was concerned. To this day, Krista has a picture of her Popo holding her, proudly displayed on her refrigerator. On that day, the hospital room was filled with family members. We were waiting, knowing that it wouldn’t be long and then he took his last breath. When he died, many of the adults lost control of themselves, one even pounding on Popo’s chest. Krista had a look of horror on her face as she viewed the spectacle and heard all the wailing. This true story happens every day and every day some little child experiences death for the first time. Their grandpa, grandma, mom, dad, or perhaps their brother or sister, stops breathing and death occurs. Often, the child is left alone while the adults busy themselves with all the details surrounding the death. Calling other family members is often seen as the most important duty, and the child is left to watch television or to otherwise occupy themselves. A friend told me that he attended a death, and found one little girl sitting in front of the television, while the adults all sat around the deceased, telling stories. Some of them were laughing, others were crying, as they were recalling the life of their now dead loved one. My friend was immediately drawn to the little girl and began to work with her, helping the child to understand what had happened. He then began helping her work through her own grief. Children will display grief differently than adults. A preschool age child does not yet understand that death is a permanent event. My daughter was five, and because death was explained to her, she was able to process the death of her Popo. As difficult as it may be for we adults to explain death to a child, I believe it is imperative that we do so. Dr. Leighko Yap, a clinical psychologist and co-founder of Oakland-based Kids Connect states: “At around seven or eight years old, children start to understand the irreversibility of death. Until then, they still engage in “magical thinking,” and it’s hard for them to differentiate between reality and fantasy. Yap states, “For example, a child might think that the dead person is just sleeping which means they might come back one day.” I’m not disputing Dr. Yap’s opinion, but I personally believe that children can begin to understand death at an earlier age, based on my daughter’s ability to process her Popo’s death. How can we adults help our children understand death and those events surrounding the death? Perhaps we should share with them what death means to us, such as our beliefs of what happens after death. We can share that Popo will always be with us, in our hearts and our memories. It would be helpful if we could take the time to find some helpful literature, and then utilize what we learn as we speak with our child about death. When a death has occurred, we should be prepared to help our children understand that it’s okay for them to express how they feel, openly and freely. We need to help them explore their loss. Failing to do so could result in some significant negative behaviors. If a child does not learn to grieve appropriately, they could experience depression, a lack of interest in daily and routine activities, and even withdraw from other family members. They’ve lost their Popo and it hurts. They don’t ever want that to happen again. Unless we help them work through their grief appropriately, they could suffer much longer than they need to, and have lasting trauma that could have been avoided. The next time a death occurs in your family, make sure your child is not left alone in front of the television, or off somewhere by themselves. Reassure them that they’re not alone and that they are loved. It will take some effort on your part to educate yourself so that you can help your child process the death of a loved one, but it will be well worth your time. Contact your local hospice for information about grief groups available for children and adults. Other resources are available to assist you in helping your child understand death, and may be found by contacting the Mental Health Services departments in your county. The Internet is a great source for finding published resources which may be helpful in beginning a conversation with your child.

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Hospice

Dr Jerry Old

2010-11-01 13:31:00

Question: What is good medical care at the end-of-life?

Answer: With the discussion on health care reform, emotional terms such as “death panels” and “healthcare rationing” are making the news. While no one is advocating sending grandma off on an ice floe, perhaps this discussion is forcing us to seriously think about “what is good medical care at the end of life?” Is there a time when we do need to pull back on costly, high tech, aggressive therapies? Do we sometimes make the treatment worse than the disease? The daughter of a patient I was recently caring for on Hospice put it this way, “I watched my father die a slow, painful death from Alzheimer’s disease for eight years, in a nursing home, because his former physician thought he needed a feeding tube and pacemaker!” Studies have repeatedly shown that Americans consume staggering amounts of medical resources (as well as human resources) near the end of life, often on treatments that realistically do not extend quality of life very much. November is national Hospice month. Simply stated, the hospice philosophy is about “quality of life” rather than “quantity” of life. Hospice is now involved with 40% of all deaths in this country and recognizes that each individual has his or her own goals in life that give meaning and purpose. We cannot be very thoughtful individuals if we don’t ask ourselves the sobering question of what gives meaning to our own lives. What is it that, without those things or abilities, ceases to give life meaning or purpose for us? It is necessary that we extend this question beyond ourselves, to our close friends, parents, and other loved ones. Admittedly, it is a hard discussion to have. However, starting the conversation may be as easy as asking your aging mother for that special recipe that you have never bothered to write down—and then moving into: “You know, there are a lot of things I would like to know about you.” Eventually the conversation, if directed, can move into end-of-life wishes. Ironically, older people are much more comfortable with this type of discussion than their children are. The Holidays are approaching where families will be together. It is my plea that we approach some of these “goal oriented” discussions. I guarantee that you will be glad you did.

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Hospice

Sharon Wyatt

2010-11-01 13:31:00

Question: What are some meaningful ways I can interact with persons with Alzheimer’s ?

Answer: November is National Alzheimer’s Awareness Month. Alzheimer’s disease is the most common form of dementia. With its memory loss and personality changes, it robs families of the loved ones they used to know. As the illness progresses, it becomes more difficult for family and friends to know how to relate to the person. As a nurse, I have worked with dementia patients for 18 years and have seen families who struggle with knowing what to say or do. So I developed a list of activities to help friends and loved ones stay involved with someone who has Alzheimer’s, especially as comprehension, memory and behavior deteriorate. These were activities I found to work or that families had shared. People tend to stay away from visiting a friend or relative with Alzheimer’s because they do not know what to do or say. It is important to remember that being with someone with dementia is a new opportunity to that person. Say who you are – if the person with Alzheimer’s thinks you are someone else, don’t try to correct them. Be where they are arguing will only cause upset. Families often want to do something special when visiting such as taking them out to dinner or to a public function. Depending what stage the person is in the illness, the experience can be confusing, distressing and even frightening. Instead, keep numbers of visitors small and stimulation to a minimum – it’s all about that person. It’s about the doing, about being present for someone. Being flexible is so important. Sometimes it’s just your presence. Every activity will not work for everyone. Find what interaction activities work for you. •Listen to music •Toss a ball •Color pictures •Make homemade lemonade •Count trading cards •Sort tokens or trading chips •Read out loud •Rake leaves •String beads •Bake cookies or bread •Decorate a cake •Make a collage •Wash the windows •Feed the ducks •Brush or comb each other’s hair •Plant seeds •Look at family photographs •Wipe off the kitchen table •Dust the furniture •Fold clothes •Have a friend visit with a well behaved pet •Cut pictures out of magazines or greeting cards •Play dominoes •Look at favorite childhood books •Sort objects by color or shape •Sing!! •Dance!! •Wash dishes •Sweep the floor •Wash the car •Make ice cream or popcorn •Make a pie •Take a walk around the yard •Reminisce about sports, school, family, job •Have a picnic •Water house plants •Name the presidents •Play an instrument •Share a hug or hold their hand Just be present and follow their lead!

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Hospice

Nadine Friesen

2010-10-01 11:45:00

What does it mean to remember?

Answer: Re-mem-ber - to retain in the memory; keep in mind; remain aware of. It seems we are always trying to remember something; the items on the grocery list we left at home, the appointment we missed last week or location of the cell phone. There are also people we don’t want to forget, particularly those who are no longer physically present with us because of death. Remembering is one of the best ways to continue to love. It is also true that remembering can wear many different faces and those faces sometime peek out at us when we least expect them. There is the face of sadness as we reflect on all that we miss since that person is gone. While we may want to avoid the sadness, facing and embracing it generally lessens rather than increases it. The face of regret may cause us to think of all the coulda/woulda/shoulda’s that can be part of any relationship. They may stem from our own lack of response or from what we felt we missed from the one who died. Remembering includes acknowledging the regrets when they exist but also recognizing the face of gratitude. Bringing to mind all the good things we loved and enjoyed about the one who has died; giving thanks for the positive and ongoing ways that their life has impacted our own. Remembering someone after a death often requires time for sorting through the memories. Time doesn’t heal all wounds but it does allow for clarification and new perspective. When sorted and processed, the most painful memories can fade and the best and most treasured can rise to the surface as the face of new perspective begins to show up more frequently. The face of hope is closely related. Hope that maybe life can have purpose and joy again. Hope that one has opportunity to encourage and live out the qualities of the one who died, and in so doing, keep their memory alive and their influence active. The word “remember” also means to know by heart. Those who have been a significant part of our lives are part of us forever. We remember, know and love them by heart and they continue to give us courage to face the future.

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Hospice

Nadine Friesen

2010-07-01 12:50:00

What does it mean to remember?

e-mem-ber - to retain in the memory; keep in mind; remain aware of.

It seems we are always trying to remember something; the items on the grocery list we left at home, the appointment we missed last week or location of the cell phone. There are also people we don’t want to forget, particularly those who are no longer physically present with us because of death. Remembering is one of the best ways to continue to love. It is also true that remembering can wear many different faces and those faces sometime peek out at us when we least expect them.

There is the face of sadness as we reflect on all that we miss since that person is gone. While we may want to avoid the sadness, facing and embracing it generally lessens rather than increases it.

The face of regret may cause us to think of all the coulda/woulda/shoulda’s that can be part of any relationship. They may stem from our own lack of response or from what we felt we missed from the one who died.

Remembering includes acknowledging the regrets when they exist but also recognizing the face of gratitude. Bringing to mind all the good things we loved and enjoyed about the one who has died; giving thanks for the positive and ongoing ways that their life has impacted our own.

Remembering someone after a death often requires time for sorting through the memories. Time doesn’t heal all wounds but it does allow for clarification and new perspective. When sorted and processed, the most painful memories can fade and the best and most treasured can rise to the surface as the face of new perspective begins to show up more frequently.

The face of hope is closely related. Hope that maybe life can have purpose and joy again. Hope that one has opportunity to encourage and live out the qualities of the one who died, and in so doing, keep their memory alive and their influence active.

The word "remember" also means to know by heart. Those who have been a significant part of our lives are part of us forever. We remember, know and love them by heart and they continue to give us courage to face the future.

Nadine Friesen is a bereavement coordinator with Hospice Care of Kansas. She received a bachelors degree from Tabor College and a masters degree from Sioux Falls Seminary. Nadine has 27 years of pastoral care experience and is a facilitator of a number of grief and encouragement groups. She played a key role in developing a children’s bereavement camp and is a presenter at caregiver conferences around Kansas. For more information about Hospice Care of Kansas grief support groups, call 559-2049.