Hospice Care Insights

How To Help Ourselves During the Holidays

Tue, 06 Dec 2011 09:46:20 GMT

When a loved one or friend is in hospice or has recently passed away, the holidays can be difficult days. The emphasis on family and the special memories associated with the season can create a huge number of powerful emotions: grief, denial, nostalgia, anger, fear and happiness are just a few. With all these sometimes-conflicting emotions, how can a person cope? Here are some effective strategies I have seen and recommended over the years.

1. Make honesty a priority. Share your apprehensions, feelings and fears with someone you trust, like a relative or friend. Admit that this is a tough time for you and ask for their support. You’ll benefit from their care.

2. Banish the word “should” from your vocabulary. This year is going to look different than you expect because you’ve never been in this situation before. Let things unfold in their own time and way and accept that even painful situations have beauty and grace.

3. Talk to your family about how you will commemorate the day(s). Sit down together and set realistic goals for yourself as a whole and yourselves individually. Talk about your feelings and try not to have high expectations—family members may not be able to handle their usual responsibilities and may want to do things differently this year.

4. There are no rights or wrongs as you navigate this season. You may want to cling to traditions or you may want to change things up. But try to keep things as joyous as possible for children, family members and yourself. Yes, you’re saying goodbye and there is real grief there, but the process of death is also a celebration of life.

5. Ask for help. This is a tough time and it’s OK to ask for assistance with shopping, decorating, baking, cleaning, chores, packing, planning, writing cards, etc.

6. You’re going to need extra sleep. This is draining emotionally, physically and psychologically and without that enough rest, you’ll have a much tougher time.

7. Donate a gift or money in your loved one’s name to a charity he or she liked.

8. Set healthy limitations. You may not be able to do every thing on your to-do list and the Christmas card list may need to be shortened. This is OK. Focus on doing things that are meaningful and important to you and your family.

9. Volunteer to help the less fortunate and get outside yourself for a few hours. This can often help you feel gratitude for the blessings you do have in your life.

10. Last, but perhaps most important, be gentle with yourself. Let yourself cry. Laugh as much as possible. And know that you’re doing the very best with the tools you have during this difficult time.

AseraCare Palliative Care Offers Team Approach to Serious Illness

Wed, 09 Nov 2011 17:06:02 GMT

As a nurse for over 30 years, I have often seen patients and families struggle in understanding the complexity of medical care prescribed to them. They often are afraid, confused and misinformed about their diseases and treatment sets. In my patients with serious illness, I often wished for a better way to coordinate all the professionals working for their health.

It has been my pleasure and privilege to play an active role in the development of a different holistic program over the last ten years, something we call palliative care. As part of the next step in this growth, we’re introducing AseraCare Palliative Care across the United States this year and in 2012.

Our palliative care team approach coordinates all the players in a patient’s well being: physicians, nurses, nutritionists, pharmacists, physical therapists, occupational therapists, speech therapists, social workers, chaplains and volunteers. They have the time to spend with you to discuss treatments, goals and concerns. They will offer information about home health, hospice or community resources for care needed as goals and treatment plans are established. They in effect “bridge” treatment plans between service providers.

AseraCare Palliative Care is available for any person facing a serious or life-limiting illness and the family when requested by the primary physician. We work in conjunction with a current medical care plan to give patients the greatest quality of life possible. When a medical plan has many moving parts, superb communication is a must so that patients and families may make informed decisions regarding their health care.

Palliative care doesn’t replace your current physicians; you receive palliative care in addition to working with them. It’s the medical care every seriously ill patient needs, wants and deserves.

We do all of this because we believe that quality of life matters every day.

Spreading the News of Hospice and Palliative Care

Fri, 07 Oct 2011 10:14:15 GMT

As the Director of Psychosocial Services for AseraCare Hospice, I have a passion for spreading the news of hospice and palliative care. These services relieve suffering, improve quality of life, bring families closer together and help seriously ill people cope with their illnesses, and, in many cases, help patients prepare for the end of life.

Tomorrow is the perfect day to shine the light of awareness because it’s World Hospice and Palliative Care Day, when thousands of people in about 80 countries worldwide will come together at more than 1,000 events to celebrate, support and speak up about these important medical services.

The theme for this year is, "Many diseases, many lives, many voices—palliative care for non-communicable conditions." These include illnesses such as cardiovascular diseases, cancers, chronic respiratory conditions and diabetes, diseases that cause about 60% of death worldwide.

There is a difference between these two services. Hospice is non-curative medical care for terminally ill people who generally have less than six months to live. The focus is on pain and symptom management. With palliative care, the patient does not have to be terminal, but has a serious, life-threatening illness, and treatment can be curative or not.

Both hospice and palliative care call for a team approach to care by a primary care doctor, specialists, social workers, nutritionists, nurses, pharmacists, occupational therapists, speech therapists, spiritual leader and volunteers. The goal is to improve quality of life for both the patient and the family.

The goals of World Hospice and Palliative Care Day:
* To share the vision to increase the availability of hospice and palliative care throughout the world by creating opportunities to speak out about the issues
* To raise awareness and understanding of the needs – medical, social, practical, spiritual – of people living with a life limiting illness and their families
* To raise funds to support and develop hospice and palliative care services around the world

As David Praill, co-chair of the Worldwide Palliative Care Alliance, explains, “more than 100 million patients and family caregivers worldwide need palliative care every year, less than 8 percent actually receive it. Palliative care is a human right, yet there are millions of people, especially in the developing world, dying in pain and distress every year.

"Much more needs to be done to increase prevention and treatment of non-communicable diseases and we need to make sure palliative care is a fundamental part of the global response."

Activities around the world include: the premiere of a film screening in Nairobi, Kenya; a walk for palliative care in Pune, India; the launch of a cancer patients network in Mexico City; a Quilt Show in New Zealand; a symposium in Recife, Brazil and press conference in Rivne, Ukraine.

To find out more about World Hospice and Palliative Care Day 2011, visit www.worldday.org.

The Role of a Hospice Nurse

Tue, 06 Sep 2011 12:39:25 GMT

Caring is the essence of nursing and that is particularly true in hospice, where nurses are present to help patients and families navigate the end-of-life journey.

This is a time when patients have stopped life-prolonging medical treatments and have begun pain management and other comfort measures and have started the process of closure. A hospice nurse is frequently asked to fill several vital roles, from medication supervision to emotional support. It can be difficult to care for patients with terminal illnesses, but more often, I see it become a meaningful journey for patients, families and those who work with them.

I have tremendous respect for the men and women who choose hospice nursing as their calling — and I believe it is a calling to be present with others as they prepare to die. As a culture, we often avoid thinking about or talking about death, but in hospice the philosophy is different. Because the end of life is imminent — usually a patient is admitted to hospice within the last six months of life — the patient and family can prepare themselves, say what needs to be said, and perhaps have long-wanted experiences.

A hospice nurse serves as a case manager and advocate for their patients. Their job is to monitor vital signs; manage medications, particularly for pain; and generally take care of the needs of the patient. Sometimes, this means helping a family learn to take care of their loved one at home; sometimes it means arranging for a a late-night run to the store for a food craving. For patients living at home, the nurse may help alleviate the burden of household tasks to allow the family to focus on their loved one. The hours are those of the patient, so late nights and weekends are on the schedule.

I’ve often heard hospice nurses called “angels” in the lives of those affected because of the comfort and ease they provide to patients in their final stages of life and to their families and friends. It certainly takes a special person with the right personality and temperament who can adjust to the powerful emotions that come with grief and loss. This should tell you just how important this job is and what a meaningful impact this work can have on others. In fact, most hospice nurses that I have spoken to feel that it was not they that found hospice to be their calling, but that hospice found them.

Grieving: 12 Tips for Getting Through

Tue, 09 Aug 2011 16:11:50 GMT

Grieving is not an easy process, and everyone grieves differently. Some people are open and expressive about their feelings; others are reserved and private. And depending on the day, you could be a combination of both.

The important thing is to heal, to be able to get up every day and carry on. Here are a few tips to help you along this journey.

1. Keep decision making to a minimum. Your judgment will likely be cloudy for a while. Try not to jump into new things too quickly.
2. Stick to schedules. Plan your days and activities. This will give you a sense of order.
3. Accept support from others. In fact, seek support from others. It is human and courageous.
4. Let the tears free. Crying is cleansing and a wonderful release. It is okay to feel depressed.
5. Feel the anger. Everyone acts angry at the loss of a loved one, it is normal. Channel it wisely and it will go away as you heal. Hit the pillow, kick a bed, yell and scream when you are alone.
6. Maintain a healthy diet get plenty of rest. Good eating and sleeping habits help the healing process.
7. Keep a journal. Putting your thoughts and feelings on paper can be quite therapeutic.
8. Heal at your own pace. There will always be certain things that trigger sadness again; expect relapses. This is normal.
9. Spend some quality time in solitude. Alone does not mean lonely. Solitude can be creative, restful, even fun. You can learn to enjoy it.
10. Surround yourself with living things. A plant, pet or even a bowl of fresh fruit can help ease the blues.
11. Reaffirm your beliefs. Use your faith right now. Explore it. Lean on it.
12. Be gentle with yourself. Treat yourself with care.

13 Months: Personal Grief and Volunteering for Hospice

Thu, 14 Jul 2011 14:29:33 GMT

Family members that have gone through hospice with loved ones are often so appreciative of the compassionate attention they received from volunteers that they want to immediately help others in the same way. However, out of respect for the grieving process, AseraCare Hospice asks that grieving family members wait at least 13 months prior to beginning hospice volunteering.

After losing someone, bereaved family and friends often feel numb. They need time to feel the pain of the loss in order to heal, and healing is not a smooth upward journey. It has progressions and regressions. It is full of ups and downs—dramatic leaps and depressing backslides.

Thirteen months encompass many of the special times that hold significant memories—Mother’s Day, Father’s Day, Thanksgiving, birthdays and sports seasons to name a few. And yes, after 13 months, you will have survived the anniversary of your loved one’s passing.

And so, take your time. AseraCare offers grief counseling and support groups during the13 months after your loved one has passed away. Take part in these services if you feel the need. And after a year or more, if you are still interested in volunteering, come back and see us. We’ll be glad to have you.

Volunteering with Hospice: A Few Things You Should Know

Tue, 24 May 2011 11:20:34 GMT

Volunteers are crucial to hospice patients and their families. They provide support that helps enhance the patient's quality of life and reduces the family's caregiving burden. Every hospice volunteer has something special and significant to contribute, and we welcome new ideas.

Here are the basic requirements for volunteering. You must be able to:

Move around, talk, sit, stand, read and write
Communicate effectively
Provide current ID card or driver’s license and liability insurance if you will be driving to your volunteer assignment
Relate and work cooperatively with other associates
Meet local health regulations, such as a tuberculosis screen
Submit to criminal background check and drug testing
Perform tasks as arranged with volunteer coordinator
Provide parental consent and adult supervision if under the age of 18
Undergo fingerprinting (required only in some states)

In addition to the basic requirements, direct volunteers (as opposed to administrative volunteers), are trained on the psychosocial, spiritual and medical aspects of end of life. Out of respect for the grieving process, we also ask that grieving family members wait at least 13 months prior to beginning hospice volunteering.

Direct volunteers, particularly those interested in companioning, spend about eight hours in training. Specialist volunteers, such as those that provide pet therapy and music, spend about four hours in training.

We go over a number of topics in training—what to expect, what to do and what not to do. For example, it’s okay to hold patients’ hands or give them hugs, but patient care such as giving medicine should only be done by designated individuals.

There’s no set amount of hours per week that you must commit to volunteering with AseraCare Hospice. We simply ask that volunteers visit with patients at least once a week. The time, frequency and length of visits are up to the volunteer.

Training is individualized by each AseraCare agency, so please check with the local volunteer coordinator for specific information.

To learn more about the types of hospice volunteers, read “Volunteering with Hospice: There’s a Role for You.”

Volunteering with Hospice: There’s a Role for You

Mon, 02 May 2011 15:21:37 GMT

I started out with AseraCare as a companion volunteer, my first patient being a home patient with chronic obstructive pulmonary disease. She loved crossword puzzles and we spent many hours doing them. She also loved lemon bars. I would make them and take them to her on most of my visits. She and I gained weight and we laughed.

It was so rewarding to see her smile and know she enjoyed our visits and the support I offered her. Companioning did more for me than it did for the patients I served. It feels good to brighten someone’s day a little bit.

At AseraCare Hospice, volunteers are a huge part of our mission to provide compassionate care to patients and families. Our volunteers bring an array of gifts, talents, interests and experiences that enrich our program.

Our volunteers fall into two main categories: administrative and direct.

The administrative volunteer performs administrative tasks essential to operating the local hospice including assisting with mailings, filing, answering phones and putting together packets for patients, families and referral sources. Administrative volunteers may also create newsletters and perform data entry and other computer-based tasks.

A direct volunteer interacts with patients and caregivers in the home or patient care facility. A direct volunteer may be cross-trained to perform several roles or may choose to serve in a single capacity.

Our direct volunteers offer a number of specialties:

Patient companion volunteers visit on a regular basis for social support
Respite volunteers provide 1-5 hours of respite support for caregivers
On-call/vigil volunteers are available for hospice program staff to call when there is an acute and immediate need for a volunteer to sit with a patient
Reflections/life-review volunteers record memories and reflections of patients and document them for the family
Bereavement volunteers specialize in supporting the bereavement program
Pet companion volunteers take their licensed animal to the patient for regular visits
Birthday bakers bake cupcakes or cakes for patients with birthdays or anniversaries and deliver them to the patient
Veteran certificate volunteers take appreciation certificates to honor patients who are veterans
Music outreach volunteers sing at patients’ bedside
Companion artist volunteers take art supplies and facilitate creative expression with their patients
Specialist volunteers offer their unique and specialized skills for the benefit of our patients and/or their families. These volunteers include clowns, magicians, photographers, massage/Reiki/healing touch practitioners, energy practitioners, musicians, beauticians and translators.

In addition, we also benefit greatly from the creative gifts of generous souls. Some of our volunteers make cards, grow and arrange flowers, create crafts and sew lap blankets or other items for the enjoyment of patients and their families.

Volunteering with AseraCare Hospice is a rewarding experience and we are always looking for compassionate people to join us as we guide patients and families through a difficult time.

The Life of a Hospice Social Worker

Wed, 13 Apr 2011 12:59:13 GMT

Social workers are familiar with the usual 8 to 5 work schedule, but matters of life and death do not always follow that schedule. Patients’ conditions can change suddenly or families may be in need of counsel. One hour I may be holding hands with a patient and in the next hour, I could be helping a family facing electric service disconnection.

There are days when the whirlwind of activity, admissions, meetings and paperwork can leave me with scarcely a moment to catch my breath before running off to complete another task. And then there are the still, soft moments when I can sit with a dying patient and talk quietly as we entertain what Heaven will be like.

That’s why I’m a hospice social worker. We have a unique, wonderful and privileged role in the lives of the patients and families we serve. We provide assistance with everything from the practical to the existential. For me, it is a ministry.

The Five Wishes

Mon, 07 Feb 2011 15:05:10 GMT

As I read this excerpt, I am reminded of how no life or death exists in a vacuum. We are all connected with others, whether they are family, friends, caregivers, community members or even pets.

The loss of those we are connected to can be painful and profound, but the bond we share allows us to support our loved ones over the final steps of their journey with grace and dignity. We all hope that someone will do the same for us when our time comes. Therein lies the circle of life.

(This excerpt comes from part four of Hospice: The Loving Circle of Care. It deals with bereavement—healing, grief, and support. Bereavement begins with the acceptance of the imminent passing away of a person we love.)

The Five Wishes

With no family contact for years, the 90-year-old patient relied heavily on her two best friends on whom she had conveyed power of attorney for all legal, health and financial matters. Her friends were in denial. They refused to allow “hospice” to be mentioned in the patient’s presence. The staff at AseraCare Hospice in Bloomington, Minnesota was deeply alarmed. The two friends desperately needed help.

They were asked to meet with a group that included the facility social worker, dietitian and registered nurse, along with the AseraCare team’s spiritual care coordinator, social services coordinator, and registered nurse case manager. The purpose of the meeting was to gently prepare and guide the friends through the dying process. Writes clinical liaison Kathryn Conery, “We believed the patient would not and could not die peacefully until the friends were able to understand and let go.”

“We spent half the day with her friends, gently discussing all aspects of the patient’s condition. As a team, we discussed the physical, spiritual and emotional aspects of dying. The five wishes: saying I love you, I forgive you and know you forgive me, I’ll be OK, thank you and goodbye were carefully explained,” Conery recalls. “Clearly moved, there were a lot of emotions and tears but the anger had dissipated. There was only the spirit of calm acceptance.

“Following this meeting, the friends went to the patient’s bedside together that evening, and for the first time they were able to honestly and openly give the patient permission to die surrounded by love. A service of ‘commendation of the dying’ was requested and performed, after which, the friends spent several hours following our team’s guidance and were able to give the patient the five wishes. They left late that evening, emotionally spent but at peace. The patient died peacefully shortly afterward with members of the AseraCare team present.”

Getting to Know Mirna

Tue, 01 Feb 2011 11:07:14 GMT

It’s understandable why many people want to avoid starting the hospice journey. Like any painful event, the natural human tendency is to avoid or withdraw from the source of pain.

For patients who’ve spent a lifetime caring for others, it is a time when the tables have turned and they are now on the receiving end of the gift of compassionate care. It can be foreign, frightening and difficult to accept, as in Mirna's case.

However, as described in Mirna's story, getting to know the hospice team turned out to be a huge blessing. As hospice providers, we have the privilege of building relationships with families who have opened up to let us in during a vulnerable and painful time. Much of the emotional and spiritual healing occurs within the context of this strong and trusting relationship.

When families begin hospice early, they describe an immeasurable sense of being supported and nurtured emotionally and spiritually. There is a saying that goes, "Many of life's greatest gifts come wrapped in pain.” And that is what hospice can become for families--a gift that arises from pain and grieving.

(This excerpt comes from part one of Hospice: The Loving Circle of Care. It deals with the decision of when to call hospice.)

Getting to Know Mirna

Choosing hospice early can actually add wonderful memories and change the lives of survivors. Lisa’s 89-year-old mother, Mirna, was diagnosed with cancer. What makes this story exceptional is the care given by and relationship developed between Mirna’s family and the AseraCare Hospice team led by Lori, a certified hospice and palliative care registered nurse, and Mary, a home health aide and certified nursing assistant, who supported Mirna in her last 51 weeks of life.

Lisa knew about hospice care after a close friend experienced the benefits of hospice during the end-of-life stage of her mother. Lisa remembered the impact that the hospice philosophy had on her friend and knew it was time to consider hospice care for her own mother when Mirna chose to stop taking treatments. Lisa then went to their physician, who confirmed that Mirna was eligible for hospice care.

Lori came to Mirna’s home to determine her needs. At that point, Mirna was reluctant to accept hospice care as she felt she could “get along all right.” And, Lisa said, “She probably could have,” but it was important to Lisa, and to the AseraCare team, that they get to know who Mirna was before the disease progressed further.

Mirna’s brief reluctance quickly turned into a desire to see her many hospice friends, including Mary and Lori. In no time, Lisa said, “Mother was asking, ‘When is Mary coming?’ or ‘Where is Lori?’ They became a part of the family.” “I encourage families to consider hospice care for their loved one as soon as they learn that they are incurable,” said Lisa. “That way, everyone — the loved one and the family — has the opportunity to become friends with the hospice team members. Mother would tell the hospice team things that she wouldn’t tell me such as ‘I’m afraid it’s getting close.’ ’’

The Decision to Call Hospice: A Personal Story

Mon, 17 Jan 2011 14:40:07 GMT

It is natural human tendency to avoid painful things, and I’ve seen many people struggle to accept the painful reality of facing their own death or the impending loss of a loved one. These are the times when families feel conflicted about giving up hope for a cure and accepting that the loved one is going to die. As mentioned in the story below, when families begin with hospice early, there’s a better chance that they can have those conversations within the safe and caring circle of care that hospice provides.

My approach (and that of many others in hospice) is to work with the living that happen to be nearing the end of their journey on earth. Hospice is not an extended funeral. When we can help our families "live intentionally," they are able to consciously make choices about how to live in this season of their lives. Yes, this includes grieving, but it also includes encouraging families to say those things yet unsaid. It includes empowering patients and their families to make intentional choices related to how they want to spend their time and plan for the funeral, or think about the legacy they wish to leave behind. Sometimes they just need permission to talk. And when those connections are made and all is said and done--very rarely do I see regrets.

(The following excerpt comes from Hospice: The Loving Circle of Care.)

Elizabeth’s Early Call

Elizabeth never regretted calling hospice early. Her husband had renal failure. He didn’t want to go on dialysis because there was no guarantee that it would be effective and he didn’t want to spend his days hooked up to a machine. He told Elizabeth that he wanted to stay at home without any drastic medical measures. He wanted to go peacefully and in his own time.

Elizabeth contacted hospice, and she and her husband met with the social worker, the chaplain and the nurse. “They answered all our questions,” said Elizabeth. “They told us my husband had about three months, but he lived for six months.”

Although her husband initially decided against taking drugs for his pain because he didn’t want to feel “foggy,” he eventually decided that morphine was necessary. “But before I take it,” he told Elizabeth, “we need to sit down and talk.”

And they did. “We were together 20 years and we sat and talked for hours about our lives,” said Elizabeth. “Then he said, ‘Now I’m ready.’ I told him I was so grateful that we had the time to do this. I couldn’t have asked for any better.”

Because hospice had been involved early, the staff was able to advise Elizabeth and her husband on everything that needed to be done before he passed away. “He decided about his own funeral arrangements — and he could make those choices because we didn’t wait too long,” said Elizabeth. “The decisions are made and you have time to grieve. Everything was done, right down to the flowers, and he had been a part of it. All I had to do was make a phone call.” At the end you feel comforted because your family member had a say in their own end. It doesn’t make losing them easier, but it helps you to deal with it.

So often life is filled with regrets — “I should have done this” or “I could have done that.” Elizabeth had no such regrets. “I knew I’d done everything in my power to help my husband,” she said. “It’s wonderful to be able to keep your family member at home. Hospice sends a great team backing you up. If you think your loved one would be more comfortable at home, keep them at home. The burden of medical and personal care doesn’t fall on you. Everyone is there, and everything you need is at your disposal. You’re never without a support system.”

Hospice: The Loving Circle of Care is available for free download here.

A Story of Forgiveness

Fri, 07 Jan 2011 16:10:04 GMT

I’d like to share a story with you that changed my life.

In my earlier years, I was a pulmonologist, doing hospice. I was visiting a patient who had end-stage lung disease. He had been having a difficult time. He was calling out in the middle of the night, waking up his wife. It was terrible. And nothing I did seemed to help.

So I went to visit him and his wife, and as we were sitting there, I said, “Well, is there something bothering you?” And he paused for a long time and he asked his wife to leave the room.

Then he told me this story. “Doc, 50 years ago during World War II, I was on an island in the South Pacific. There was hand-to-hand combat, my buddies had died and we won over this island. And I was making patrol, I was coming around in my Jeep, and over the hill came about 30 Japanese, white flags, guns up high.” And he said, “I was by myself, and I took my machine gun and I mowed them all down.”

He’d never told a soul until that moment.

Suddenly I realized what hospice is all about. Hospice is about forgiveness. Hospice is about the fact that each one of us does things we shouldn’t do. Each one of us has said things we wish we didn’t say. Or we should’ve said something and we didn’t.

The good news of this case is that forgiveness is possible – even for patients and residents that only have a few hours or a few days remaining in their life. We ended up calling the chaplain and minister. Feeling forgiven, he eventually told his wife.

He also wanted to tell his two older sons what happened. So I sat in the living room and he told them the same story. And it was very interesting – he added an important part. He said that when his sons were born, he had to go to the bathroom at the hospital and weep because of all the Japanese children that would never be born because of what he did. The kids got up, they hugged him. There were tears, there was crying, and he died fairly peacefully just a few weeks later on minimal medicines.

But that’s what hospice is about; it’s not just about pain management. It’s about forgiveness and the peace of letting go.

Visit our YouTube channel to watch James Avery, MD and Martha Twaddle, MD talk more about hospice.

Give the Gift of Memories

Mon, 20 Dec 2010 13:10:47 GMT

Who was Mom’s favorite band in high school? What did Grandpa say to Grandma when they first met? What was Dad most proud of?

When a loved one passes on, the unanswered questions can be daunting. However, if you have the opportunity to do so, helping a friend or family member who is receiving hospice care to tell his or her own story can be a gratifying experience for everyone involved.

This very valuable collection of books and resources compiled by Golden Living staff lists a wide variety of reading material that may be helpful on your journey through grief to healing.

1. Grandmother Remembers Holidays: An Album of Memories and Photos for My Grandchild by Judith Levy. This album gives Grandma the opportunity to record memories of holidays, birthdays, vacations and other family celebrations.
2. Book of Us: A Journal of Your Love Story in 150 Questions by David and Kate Marshall. Write your love story with your significant other by responding to prompts such as “Before I met you, my love life was…” and “If this had not happened, we never would have met…”
3. The Girlfriends Keepsake Book: The Story of Our Friendship by Carmen Renee Berry and Tamara Traeder. Part quotation book, part collected stories, part journal, The Girlfriends Keepsake Book is a beautiful way for friends to remember each other throughout the years.
4. The Book of Myself: A Do-It-Yourself Autobiography In 201 Questions by Carl Marshall and David Marshall. Broken into three segments-early years, middle years and later years—this book allows you or your loved one to reflect on family, friends, education, work/responsibilities and the world.
5. To Our Children’s Children: Preserving Family Histories for Generations to Come by Bob Greene. This hardcover book begins with the basics in a chapter called “Facts.” What is your name? Are you right-handed or left-handed? What is your height, your weight, your eye color? Subsequent chapters go on to ask about entertainment, food, politics and community.
6. For My Mother: A Keepsake of Thanks & Memories of Growing Up by Jessie Chapman. A book from child to parent, For My Mother offers a different perspective than most memory journals. It allows adult children to express their thoughts and memories of their parents.
7. Your Story: A Guided Interview Through Your Personal & Family History compiled by Inc. Seattle Aero. This debossed hardcover clothbound keepsake has room for photos and asks over 150 questions designed to capture precious memories.
8. Touching Tomorrow: How to Interview Your Loved Ones to Capture a Lifetime of Memories on Video or Audio by Mary LoVerde. This thoughtful book provides tips on preparing both yourself and your interviewee for the process of video or audio recording his or her life story.
9. The Story of a Lifetime: A Keepsake of Personal Memoirs by Stephen and Pamela Pavuk. This hardcover keepsake offers nearly 500 questions to spur memories that may be passed on for generations to come.
10. Legacy: A Step-by-Step Guide to Writing Personal History by Linda Spence. Available in hardcover and paperback, Legacy is divided into nearly 20 chapters, including “Love and Marriage,” “Ethnic Heritage,” Regrets, Mistakes, Milestones, and Turning Points,” and “Beliefs, Values, Lessons and Advice.”

Five Tips for Getting Through the Holidays While Grieving

Wed, 08 Dec 2010 10:02:32 GMT

For many, the holiday season is a time centered on family and friends. But if you’ve recently lost a loved one, the grief of that loss can cause this time of year to be unbearable. If you’re able to find some merriment, don’t feel guilty about it. And if joy escapes you, that’s okay too. The most important thing is to get through the season while still paying attention to your own health and wellbeing.

If you are experiencing the holidays alone for the first time, or are having trouble coping with grief during the season, here are five suggestions that may help:

1. Break away from past holiday traditions. Go to a movie or out of town. Help at a soup kitchen. Don’t feel pressured to reenact the usual holiday activities without your loved one.
2. Create a gratitude list. Jot down at least three things or people you are most thankful for each day between now and New Year’s Day. Try not to repeat them. This exercise will help you to think positively.
3. Be a force for good. Vow to do one good deed every day of the holiday season (and don’t make gift buying part of the deal). Send a heartwarming e-card, take someone to lunch, pay the toll for the car behind you, call a friend or relative you haven’t spoken to in a while. Each night, reflect on that good deed.
4. Take care of yourself. The holidays can be plain old exhausting…physically, emotionally, and financially. Get plenty of rest and exercise, and be sure to stick to your budget.
5. Acknowledge your feelings. Allow yourself to cry and to laugh. Seek guidance and comfort with your spiritual leader, a counselor, friends or family, and journal your thoughts about your loved one. You may also want to reach out to hospice for support.

National Hospice Month

Tue, 09 Nov 2010 12:18:56 GMT

Every November, the National Hospice and Palliative Care Organization (NHPCO) celebrates National Hospice/Palliative Care Month. This is a perfect time to recognize all of the hospice caregivers across the national who provide compassionate care to patients and their families every day.

I would like to personally thank the AseraCare Hospice staff for all that they do. The teams of medical directors, nurses, social workers, chaplains, bereavement counselors and volunteers all make it possible for AseraCare to provide such an important service to our communities.

This year’s theme for National Hospice Month is “Seasons of Caring.” Hospice and palliative care professionals and volunteers work with people to help them recall, retell, reflect, remember and celebrate all of the seasons of their lives. Each and every person we care for has a lifetime of unique experiences and relationships to share. AseraCare Hospice and the hospice community at large take care to honor patients and families during their end-of-life journey and recognize their individual needs.

To help patients, families and caregivers better understand hospice, AseraCare Hospice’s National Medical Advisor explains some of the most common hospice questions in these videos.

Also, to read inspiring patient stories and caregiver insights, download AseraCare Hospice’s new book: Hospice: The Loving Circle of Care.

Additional information can also be found at NHPCO’s website: www.nhpco.org.

Honoring Patients’ End-of-Life Care Preferences

Wed, 13 Oct 2010 15:54:10 GMT

AseraCare Hospice and other Golden Living companies are introducing a new process to help physicians and nurse practitioners improve the quality of care our patients and residents receive at the end of life. It’s a practice that treats our patients, families, and residents with dignity and is intended to honor their end-of-life goals and wishes.

The Physician Orders for Life-Sustaining Treatment (POLST) process is designed to elicit a patient’s care preferences and translate them into a set of medical orders addressing several end of life interventions — such as CPR or tube feeding — relevant to the patient’s current condition. These orders are documented on a brightly colored, standardized form that becomes part of an individual’s chart and is portable across care settings, thereby maximizing the chances that a patient’s preferences are honored.

The POLST process is meant for patients and residents with progressive chronic illness or frailty. A conversation with a patient or legal healthcare decision maker is required when the POLST form is initially filled out and the same parties as well as the physician must sign the form to be valid. To be sure that the patient’s wishes are carried out, the POLST cannot be changed in any way unless there is another conversation.

The POLST includes what is found in an advanced directive and DNR (do not resuscitate) order and puts it into a single, simple easy to use form. The voluntary process is in use or under development in more than 30 states and increasingly is being adopted in and AseraCare Hospice agencies, AseraCare Home Health agencies and Golden LivingCenters across the nation.

March is National Professional Social Work Month

Fri, 06 Aug 2010 11:51:58 GMT

Every March is National Professional Social Work Month. The White House officially recognized this month in 1984 as a way to call attention to a different social issue each year. Beginning in 2005, the month promoted a specific area of practice, along with general promotion of the profession, to educate the public about the role of social workers.

This year’s theme for National Professional Social Work Month is “Social Workers Inspire Community Action.” With hundreds of social workers in national, state and locally elected offices, including two U.S. Senators and six U.S. Representatives, this theme certainly holds some truth. In hospice alone, we aim to inspire the community to volunteer and consider hospice as an option for comfort and quality during the end of life.

Ironically, during my first year working in hospice, the theme for National Professional Social Work Month was “The Business of Social Work: Helping People Help Themselves.” This theme continues to be my mantra for why I do what I do.

I grew up wanting to help people. Always a skilled problem solver, I believed that with the right resources, people could help themselves through all sorts of situations. Becoming a social worker was a natural path for me, and even after nearly 20 years as a social worker, 11 of which have been as a hospice social worker, my passion for the profession remains strong.

During my undergraduate studies, I took an elective course on death and dying. This ended up being a life-changing decision because during that class I realized I wanted to work in hospice. At the time my friends thought I was crazy. After all, wouldn’t working with terminally ill patients be difficult? I knew it could be, but I’d always had the desire to help people when others were unsure of what to do. Helping hospice patients and their families address concerns – whether emotional, financial, or ethical – was what I knew I wanted to do.

Having been a hospice social worker since 1999, I’ve seen the profession grow and change, along with the public’s perception of what we do. Social workers started out simply as friendly visitors. While there’s still the misperception that that’s all we are, the truth is that we help people help themselves. We reach out, touch lives and empower others to do work that’s necessary and help people cope with difficult times in their lives.

In honor of this month, I encourage you to be an advocate for hospice, read more about social workers at the National Association of Social Workers’ Web site and learn more about social work offered by the caring professionals at AseraCare Hospice.

The Many Roles of the Hospice Social Worker

Fri, 06 Aug 2010 11:52:35 GMT

The social worker is an integral member of the AseraCare hospice team. As trained professionals, our first responsibility is to evaluate the needs of the patient and their family upon entering the hospice program. Going forward we represent the individual/family’s wishes at every hospice team meeting.

At the initial evaluation our goal is to identify where each of our patients and their families are emotionally. Using this as a starting point, we then join them on their journey and continue along at their pace. This is an amazing privilege that none of us take lightly. It is not our job as hospice social workers to impose any particular agenda. We are there to support the patient and their family’s wishes, and address their concerns be it financial, emotional or ethical. I like to describe it as being in the passenger seat, and holding up the map for them.

One of the many roles of the social worker is to “paint the landscape” of the patient and their family for the other hospice team members. I begin this process by asking each of the family members “Who is your Mom?” or “Who is your Dad?” This really helps open up the family members because everyone has a story, whether it’s an example of their loved one overcoming adversity or a wonderful personality trait. Additionally, it’s our responsibility to be aware of and sensitive to any social, cultural or religious ideals regarding the end of life process that is specific to each patient.

During the hospice process families often struggle with self care. They feel guilty taking time away from their loved one. We help them realize that they need to first take care of themselves so that they can be healthy, strong and able to then care for their loved one.

Creating a safe place for the patient and their family to talk about death is vital to the hospice journey. It is the social worker’s job to create a “safe container” for this discussion. Foremost, we are there to help support the patient and family in the areas of emotional care. For those patients or family members experiencing tremendous emotional grief, we may act as a grief counselor or hospice therapist. In some cases where there is a need for additional psychological counseling, we will put the patient or family member in touch with a licensed therapist specializing in this area.

Understanding the family dynamics surrounding the patient is an important role of the social worker. Oftentimes family members may disagree on the end of life decisions of their loved one. In these cases, we can help educate family members regarding any misconceptions or dilemmas they may be facing during this stressful time.

Many times it is just the presence of the social worker that offers a sense of support to the patient and family, because they know we are there to help.

Handling Grief Through the Holidays

Mon, 09 Aug 2010 11:03:45 GMT

"My husband died in April, leaving me with four children. This will be our first Christmas without him. The children and I are just starting to adjust to these new circumstances and now I am doing worse again. Not only do I dread the holidays but I am getting depressed and anxious because I don’t know how to approach this day with my kids, the in-laws, my folks, and even friends—it is all just too much."

Holidays—whether religious or secular—are especially painful for those who have lost a loved one. Holidays emphasize the absence of the loved one, they require energy while grief saps energy, the gaiety of public places increases a person’s sense of isolation and alienation, and the very nature of the holidays (for instance, “giving thanks” at Thanksgiving) seems impossible for a grieving person to embrace. There is the empty chair, the missing voice, the missing laugh, and the presents that aren’t given or received. For these reasons and more, the holidays—especially the first year—are often difficult times for those who have recently lost a loved one.

Therefore, I would like to offer you ten suggestions that might help you cope with the approaching holidays this year:

1. Don’t try to avoid the holidays: We can mentally try to ignore the holidays by pretending that they don’t exist but it takes tremendous energy to deny all of the input we see around us. Because the holidays are so ubiquitous, this is a recipe for disaster and a poor coping plan.

2. Plan ahead: Although your may experience some emotional pain during the process, planning ahead is a very good idea. Studies show that those who experience the most difficulty are those who have given little thought to the challenges they will encounter.

3. Leave the word “ought” out of the holidays: Consider scheduling a family meeting in which everyone can express his or her feeling and expectations. Make joint decisions. Be flexible with holiday traditions. Keep the traditions and rituals you want and eliminate the ones you don’t. Reduce the pressure by knowing that whatever you decide to do this year, you won’t have to do next year.

4. Let your family and friends know what you can handle: Share your feelings and your needs with your friends and families. Tell them what things will bring you comfort this year. Learn to be comfortable saying, “Sorry, not this year.”

5. Take care of yourself physically: Get plenty of rest—take naps if you like. Try to incorporate an exercise program into your day. Don’t overdo on the eggnog and sweets—you’ll simply feel worse later.

6. Allow tears and allow laughter: Accept ahead of time that there will be times when you are going to feel sad—carry extra tissues. Someone very wise once called tears the “gift of healing.” But also give yourself permission to feel good, to laugh, and even to have fun. Don’t feel guilty if your find yourself enjoying an activity.

7. Reach out spiritually: Keep in mind that painful losses can shake up religious beliefs. The questioning of faith is a normal expression of loss and consistent with later spiritual growth. Tell God about your anger and your questions—I’m sure God can handle it. Many people find consolation in meaningful spiritual rituals, religious services, and in the reading of Holy Scriptures—especially the Psalms.

8. Be kind to yourself: Decide what you really want to do and what can be avoided. Lower demands and expectations on yourself. However, if you find yourself declining all invitations, push yourself a bit to select some. Consider gift certificates if shopping is too much. Feel free to shorten or even omit your greeting cards this year.

9. Be kind to others: Consider doing something special or unexpected for someone who is in need.

10. Remember the true meaning of the holidays: Thanksgiving, Chanukah, and Christmas all celebrate hope, faith, and love and none of these is diminished with death.

The opening quote in this paper was not a fictional character or even one of my patients. It was my mother about thirty years ago. My father had died in a tragic car accident and I was the oldest of the four children. Yes, Christmas was not easy that year, but we survived and we eventually flourished again. With faith, so will you. AseraCare Hospice offers bereavement and help to those who are hurting—please don’t hesitate to give us a call.