Facing the “Work of Aging” with ResoLute

Video By: Malori Weigel, Communication Specialist
Written By: Sarah Brown, Executive Director

Empira, a consortium of 25 nursing homes in metro and rural Minnesota are helping residents and their loved ones bravely face the “Work of Aging” with ResoLute.

What is the “Work of Aging”?
Empira has coined the phrase “Work of Aging” to describe conversations or actions that support finding hope and peace while facing mortality.

The Work of Aging begins when people start to reflect on the following questions.  This reflection is often prompted because of advanced age or terminal illness… (however wisdom may lead some do this “work” sooner and more frequently…)

  • Did my life have meaning?
  • How long will I live?
  • What matters most to me now?
  • How do I want to live the rest of my life?
  • Will my loved one be okay when I am gone?
  • How will I be remembered?

We know this work is not easy, and that is why have created the ResoLute program which stands for “Resident Empowered Solutions on Living Until the End”. In this program, we are facilitating conversations that support the resident and their loved ones explore these questions to discover fears, hopes, and priorities. Thus creating the opportunity for living with integrity centered around what matters most all the way to end.

Are you ready to support the “Work of Aging” for yourself or your loved ones? I urge you to listen to the cues of your loved ones who may need your support as they bravely face these questions.  Death on this earth is guaranteed for all of us. Instead following your gut reaction to provide false comfort, offer some time to those who want to talk about the “work of aging”.

 

Hats & Halos – My Grandmothers Purpose

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By: Heather Johnson RN,

Clinical Educator and Program Specialist

Watching someone you love; someone who holds such a piece of your heart, go through the trials and depths of dementia can often is difficult and sometimes just darn right unfair. Growing up I spent a great deal of my time with my grandparents. Both of whom shared their love with me, my siblings, and my cousins. Our extended family is large, yet somehow my grandparents ensured that we each had individual opportunities to have some special time with them. They took us, two-by-two, on road trips across the United States. My Grandfather was at the wheel of their Lincoln Town Car and my beautiful Grandmother sat as his co-pilot with and her trusty highlighted Rand McNally Road Atlas on her lap. Packed and ready, with one last trip to the bathroom, we set out on trips ear-marked by great stories, laughter, history lessons, singing from a wine-list, and learning how to tip when given great service. All experiences are forever engrained in my memory and in my heart.

My grandparents taught us to have a “Servant’s Heart” and to take an active part in your community. My grandfather served as the mayor of his small hometown of Clarks Grove up until the time of his death. He was on the local volunteer fire department, served on councils in the area, and was also active in the Benevolent Order of the Elks, working his way up to the Minnesota State President.

My grandmother served as a 4-H leader, scout leader, church leader, and a founding force of the Clarks Grove Heritage Society. As she aged, she shifted her talents to knitting and, one of her legacy gifts to her community in Albert Lea was knitting thousands of baby caps for the local hospital which were then presented to each newborn baby. Later, when she made the move north to Maple Plain, MN to an Assisted Living she continued to knit. She knit beautiful pastel baby hats and added what became her signature golden thread halo to the crown. Beautiful. Grandma assigned me a new role and duty and that was to assist her in counting those hats and then deliver them to the Allina Buffalo Hospital where her gifting tradition continued. Grandma had a little notebook that she kept near her knitting chair and basket, and in the notebook we would write the date and number of caps that I was delivering. She would point out specifics with each little hat and asked me to critique her work. Each hat, each stitch, was completed with amazing precision and done with love, and I would praise her for her talent and her contribution. When I would visit her following the deliveries of the hats, I would relay the “thank you” from the hospital staff and she would smile and in her eyes I could see she was pleased.

My grandmother had a form of dementia that affected her speech, ultimately taking her ability to verbally communicate. Her difficulty in talking did not slow down her knitting or detract from the number of babies who felt Grandma’s love.  Sometimes we wondered if she could make those hats with her eyes closed! Months and months would go by and we had our same “game plan.” She would knit hats, I would stop by and she would share them with me, we would count them and, of course tally them. I would deliver them and later tell her of how they were received. As time progressed, I noticed a difference in her work. The stitches were not as tight and uniform. The hat sizes were different from one another and her signature halos had become a little crooked. It occurred to me as her disease was progressing, the hats were telling her story. There came a time that the hats were no longer ones that someone else might identify as beautiful, and I didn’t deliver them to the hospital as I had promised my grandmother. I saved them, shared them with my siblings and cousins who had been such a meaningful part of Grandma’s life, and kept a number of those prized hats for myself; tucked carefully away in my cedar chest.

“Maintaining a sense of purpose through meaningful activities has a direct effect on dignity and selfhood for people living with a diagnosis of dementia” (Roach & Drummond, 2014). My grandmother lived the age of 90, outliving my grandfather, the love of her life, for 18 years. For my grandmother, her ability to contribute, to have a purpose and be of value came in the form of knitting those hats.  I can’t help thinking about what is my purpose today, and what will my purpose and value bring?

 

 

 

Reference:
Roach, P., & Drummond, N. (2014). It’s nice to have something to do; early-onset dementia and maintaining purposeful activity. Journal of Psychiatric & Mental Health Nursing. 21 (10). Pp889-895. doi:10.1111/jpm.12154

ResoLute Resolutions

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Written by:  Cathleen Lindgren, RN ~ Clinical Educator & Program Specialist

          Several years before Grandma Jean died, she and her husband, Grandpa Gene, prepaid for their funeral expenses.  As they aged, they talked about selling their house at some point and when Grandma became more forgetful, they talked about it with a bit more urgency.  Grandpa had worked well past the age of normal retirement but a few years back stopped working outside of their home so that he could spend his days with Grandma and ultimately, Grandpa became her caregiver.  In the last years of her life, their children and grandchildren became more involved in her care.  Their family included the knowledge of a Geriatric Nurse Practitioner, a few Registered Nurses, and a couple with general healthcare experience.  While this provided much comfort, the last years of her life remained an incredibly stressful time filled with concerns, “what if’s”, and unforeseen moments.

In the months that have passed since her death, I have reflected on our families experience during her last few years of life.  I have great confidence in where our hearts and intentions were as Grandma aged, but many regrets regarding the quality of life she had during those same moments.  I had my own “Ah-ha!” moment like many have had before me and realized there was a sizable gap existing throughout the last few years of life.  There was a lack of resources, education, and focus on this span of time – the period upstream from hospice.  And, without a doubt, a vast need of admirable, purposeful, determined, and unwavering support for the millions of nursing home residents who continue to live throughout these golden years.  Thus, due to the work of Empira, ResoLute was born.

This upcoming new year has inspired our team at Empira as we begin working within our new program, ResoLute (Resident Empowered Solutions on Living Until The End).  ResoLute is a MN Department of Human Services Performance Improvement Grant (PIPP Grant) with a goal of helping residents and their loved ones bravely face the work of aging.  2018 will be filled with improvements as we focus on the cornerstones of the ResoLute program.  These cornerstones are quality resolutions for us all to uphold:

Resolute Resolution #1:   Each residents care team will create a foundation upon which the work of aging can be built.  This is done biologically, psychologically, and socially.

ResoLute Resolution #2:  We will provide information to a resident about their prognosis in a timely and truthful manner.

ResoLute Resolution #3: With the help of our ResoLute teams, our resident’s priorities, fears, life reflections, and wishes regarding their legacy will be explored.

ResoLute Resolution #4: We will truly know our residents, not just know of them.  This means we will care for them holistically.  They are not just a body/diagnosis.  They are a person with unique spirituality, a social history, great achievements, and so much more and they happen to be experiencing symptoms of one or more disease processes.

ResoLute Resolution #5:  We will work together as a team.  Communication between everyone on the residents care team is important when developing a whole-person/holistic care plan.

ResoLute Resolution #6:  We will continue to know better and do better ourselves as we encourage others to do the same!

Wishing you the happiest of New Years!

            Empira

            Sarah, Kelly, Heather, Malori, & Cathy

Elf-Care

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Providing self-care for the caregivers this holiday season

Written by:  Cathleen Lindgren, RN

Clinical Educator & Program Director at Empira

            As a nurse and mother to five, I know collapsing into bed after a long day of work is the only self-care I will have time for this month of December.  I also know there are literally over 1.5 million resources on the concept of self-care for healthcare providers and realize just how important it is.  Due to multiple factors, providing proper self-care in the coming days isn’t an option for many of us.  So this year, I decided to do what I (and likely you) do best:  administer care to others.  Only this time, it’s to other caregivers.

During the holiday season, the lack of time is more notable for all caregivers.  In addition to that 8, 12, or 16 hour shift, we return home where our giving spirits continue our work through shopping, gift wrapping, holiday baking, and decorating.  While these tasks are accomplished by many, the reality of this season is described well in the book “Nurse Burnout: Overcoming Stress in Nursing”: “To be a dedicated artist requires commitment, sacrifice, talent, and a desire to create something beautiful, often out of something that others will never see the beauty in. They make many sacrifices. Nurses work odd hours, off shifts, and holidays. They frequently miss family gatherings and milestones in their children’s lives. They sleep through a concert because they have been up for 36 hours. Christmas is often moved to another day on the calendar because it is their holiday to work. Nurses often leave their shift hungry, exhausted, and barely able to think about what has to be done at home or in other aspects of their lives.”  (Waddill-Goad & Sigma Theta Tau International, 2016, p. 56)

Inspired to make a huge difference with a small gesture, I put together a list of several ways any of us could literally make a caregivers day brighter throughout the 12 Days of Christmas (and beyond)!  I hope these ideas create a call-to-action for you and that you find joy in giving to others!

  1. Send an inspirational text message.
    1. Here are a number of inspirational meme’s you can share:  https://www.google.com/search?q=inspirational+memes+for+nurses&client=firefox-b&tbm=isch&tbo=u&source=univ&sa=X&ved=0ahUKEwi7pJnBr_PXAhUo9YMKHbLpCawQsAQIKA&biw=1440&bih=723
    2. Guided Imagery.   All these last between 5-10 minutes and would promote several minutes of de-stressing time!   They focus on restoring energy, stress relief, and rejuvination.  Just copy and send to a caregiver in need via text message.
      1.    5-10 min long:
        1. https://www.youtube.com/watch?v=moBLrox7bwk
        2. https://www.youtube.com/watch?v=CcqZ47d398k
        3. https://www.youtube.com/watch?v=ozdznXeTnG0
        4. https://www.youtube.com/watch?v=_kQ1lh2tC2w
        5. https://www.youtube.com/watch?v=RZQ9GfmzR14
        6. https://www.youtube.com/watch?v=bRch_4IeuXQ
        7. https://www.youtube.com/watch?v=Y1zN6eJLudY
  2. Provide for a serene break room this holiday season.
    1. Stagger breaks to offer a peaceful environment
    2. Aromatherapy
    3. Dim lighting or even consider a Happy Light for those in dreary/cold climates.
    4. Leave a devotional geared towards caregivers in the break room.
    5. Place a tupperware container of moistened rolled wash clothes in the break room refrigerator.  Instant bliss!  Add some cucumber slices and you’ve got a spa-like break!
  3. Food with a purpose!  Bring in enough for your care team as a holiday surprise or an energy pick-me-up.
    1. Chili with lentils – http://www.eatthis.com/foods-for-energy
    2. Whole wheat cereal + gallon of milk + disposable bowls = enough energy to get through a couple more hours of your shift.
    3. Green tea:  bring in a canister of tea bags to brew either hot or cold green tea.  This provides energy without the jitters.
    4. Greek yogurt + granola
    5. Trail mix
    6. Bag of oranges or apples
    7. Coffee + all the extras (creamers, whipped cream, sugar).  Who wouldn’t want this fun treat as part of their breaktime???
  4.   Give the gift of answering that call light.   If your sleigh isn’t overfilled already, and you find yourself with the time to help someone else, offer your assistance in an unexpected way.  I’ve been a recipient of this, and it truly makes my day each and every time!
  5. Play some music.  There are multiple studies showing how the simple act of listening to music can reduce stress, and this works incredibly well for caregivers too!  An article discussing the well-being of caregivers reported that “music can be a cost-effective resource in developing interventions to reduce stress and improve well-being” (Ploukou & Panagopoulou, 2018, p. 77). 

“For it is in giving that we receive” (Francis of Assissi) is one of my most favorite quotes simply because of the vast truth it holds.  This holiday season, one simple gesture can create a butterfly effect, causing a small gift to multiply in the blessings it brings.  I hope these words provide a foundation for all your creative minds to find a hundred other ways to share a little elf-care with those on your team.

May your holiday season be a little more stress-free, merry & filled with joy!

 

 

References

Eat This Not That. (2016, March 28). 23 Best Foods for Energy | Eat This Not That. Retrieved from http://www.eatthis.com/foods-for-energy

Ploukou, S., & Panagopoulou, E. (2018). Playing music improves well-being of oncology nurses. Applied Nursing Research, 39, 77-80. doi:10.1016/j.apnr.2017.11.007

Waddill-Goad, S., & Sigma Theta Tau International. (2016). Nursing: Art vs science. Nurse burnout: Combating stress in nursing (p. 56).

 

 

Shoot It To Me Straight Doc…

Written by:  Kelly Klund, Clinical Educator & Program Specialist

My Uncle Harry is more than an uncle to me. As I grew up fatherless and lived with my grandparents, Harry has been an uncle, a brother, a father figure, and most importantly, my friend.

Early this fall, as Harry planned an upcoming fishing trip, he wasn’t feeling quite up to par. Believing he was in fairly good health, he was admitted into the hospital for what was supposed to be a routine gall bladder removal. Unfortunately, the surgery did not end up being routine as expected. During the surgery, the doctor saw the need to biopsy his liver. The result was a diagnosis of end stage liver cancer. Harry was given a prognosis of two months to live without treatment and “maybe double that” if he chose palliative chemotherapy. Receiving this shockingly straight forward prognosis felt like a semi-truck had smashed straight into the heart of our family.

Coincidently, I was preparing for Empira’s next grant: ResoLute (Resident empowered solutions on Living until the end). One of the cornerstones of ResoLute is truthful prognostication. As my professional and personal lives collided, I summoned the courage to ask my Uncle Harry if I could interview him, asking some tough questions about how he felt knowing he was facing the end of his life.

During our interview, Harry said it was most important he knew the truth about his prognosis. He told me he looked at the doctor and said “Shoot it to me straight doc”. The prognosis was devastating, but the physician’s honesty gave him a sense of urgency around the work that was left to do, the relationships he had to heal, the affairs he had to get in order, and the things he had left to say.

Karen Hancock did a review on discussing prognosis in advanced life-limiting illnesses and stated “many health professionals express discomfort at having to broach the topic of prognosis, including limited life expectancy, and may withhold information or not disclose prognosis. Reasons include perceived lack of training, stress, no time to attend to the patient’s emotional needs, fear of a negative impact on the patient, uncertainty about prognostication, requests from family members to withhold information and a feeling of inadequacy or hopelessness regarding the unavailability of further curative treatment”, (Karen Hancock et al., 2007).

Another supporting journal publication by Fallowfield, Jenkins, and Beveridge discuss how deceit hurts even more than a painful truth could hurt. They state, “Ambiguous or deliberately misleading information may afford short-term benefits while things continue to go well, but denies individuals and their families opportunities to reorganize and adapt their lives towards the attainment of more achievable goals, realistic hopes and aspirations” (Fallowfield, Jenkins, & Beveridge, 2002).

In his book “Being Mortal” Atul Gawande says, “The chance to shape one’s story is essential to sustaining meaning in life” (Gawande, 2014). For our family, truthful prognostication has given Harry the opportunity to shape to his story. We are thankful for the time to do the undone, and for knowing the time to plan the next fishing trip is NOW.

If you or a loved one had a life limiting illness would you value truthful prognostication or in the words of Scarlett O’Hara subscribe to the belief that “I can’t think about that right now. If I do, I’ll go crazy. I’ll think about that tomorrow.”?

 

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References

Fallowfield, L. J., Jenkins, V. A., & Beveridge, H. A. (2002). Truth may hurt but deceit hurts more: communication in palliative care. Palliative Medicine, 16(4), 297-303. doi:10.1191/0269216302pm575oa

Gawande, A. (2017). Being mortal: Medicine and what matters in the end. New York, NY: Metropolitan Books, Henry Holt and Company.

Hancock, K., Clayton, J. M., Parker, S. M., Wal der, S., Butow, P. N., Carrick, S., … Tattersall, M. H. (2007). Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review. Palliative Medicine, 21(6), 507-517. doi:10.1177/0269216307080823

 

Falling From Grace

Author:  Heather Johnson, RN Clinical Educator & Program Specialist

Without a doubt, I can say almost 100% of our population has fallen at some point in their lifetime.  When I pose this as a question to participants in educational sessions I often find a handful of individuals that honestly report they have never fallen.  Unless you are some type of super-human and are as agile as a mountain goat or monkey, you have fallen at some point in your lifetime and the odds are you will fall again.

My older sister was nicknamed “Grace” in our childhood years as she mastered the uncanny ability to fall even while going UP the stairs in our home.  We often referred to this ability as her “talent” and would laugh if we were present to witness her mishap.  As we grew older and more experienced I came to understand how the consequences of her missteps could carry horrific injuries.

While a fall for any age can have serious results, the impact of a fall for an older adult can be grave.

Are you aware one in four Americans aged 65 and older falls each year?  Every 11 seconds, an older adult is seen and treated in a hospital emergency room due to injuries sustained from a fall?  Hip fractures, broken bones, hematomas and traumatic brain injuries are often the result of a fall for those over the age of 80.  One in five hip-fracture patients will die within one year of their injury.  Yes, they will die.  The trajectory is not in their favor.

I spent this past week at the 4th Annual National Falls Prevention Conference in Philadelphia and took part in a learning experience that left me feeling both extremely positive and proud about the work we are doing in falls prevention.   Simultaneously I was overcome with a desire to continue to push harder and work for better outcomes for our seniors.  While in Philadelphia, I had the opportunity to see the very steps Sylvester Stallone made internationally recognizable in the movie Rocky, the ever-famous steps of the Institute of Art Museum. In the movie, Rocky not only climbs these steps in different weather elements, but he runs.  He runs, he trains, makes himself stronger, and he becomes more agile each day.  Rocky was relentless in his training with his desire to ultimately become the Heavy Weight Boxing Champion. While you may not be training to become the next world famous boxer, we certainly can be left inspired by his grit and undying desire to improve himself.  At the age of 71, Sylvester Stallone makes it well known that he takes his physical health and exercise seriously.

What can we do?  Evidence-based best practices support assisting individuals with maintaining (or even improving) mobility, balance and core muscle strengthening through regular exercise.  These are proven ways to greatly reduce the chances of falling at all ages.  This alone is the number one way to prevent falls!  The National Council on Aging offers a wide range of exercise and for all abilities.

https://www.ncoa.org/healthy-aging/falls-prevention/   

By encouraging and promoting activity, you are not only reducing the risk of falling for an older adult, you are also encouraging their opportunities for socialization which, in turn, has been proven to decrease episodes of both depression and anxiety.

 Falling is not a normal part of aging and there are numerous ways that are proven to reduce the chances of having a fall.

I encourage you as a care provider, a son or daughter of aging parents, as a grandchild or as a friend to a senior, to not only consider the physical environment, footwear, and eye glasses when striving for preventing a fall, but to also consider what you can do to help promote movement, core strengthening and social opportunities for the aging.   By doing so, maybe we can all extend each other a bit more “Grace.”

Written by:  Heather Johnson RN, Clinical Educator and Program Specialist

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