A Reflection: The Comfort of Touch for Family at End of Life

 

Touch is is a comforting gesture for both the dying and their loved ones.

My friend Andrew shared with me his reflections on the care his family received while his mother was in the hospital dying. He poured out his heart on paper to discuss how frequent expressive touch was a comfort to his mother, and himself.

He writes, “We would kiss her forehead, touch her shoulder or hold her hand with varied responses. Holding her hand was the clearest communication and the best way to tell if she was with us or not. Most days she would squeeze our hands or lift them to her face for a kiss. At times, these actions were silent, and other times accompanied by grunts or whispers or even an attempt to speak.”

“The staff were lovely and compassionate people who understood her needs, but also our needs as family members. I saw many nurses and aides greet Mom on a good day with a hug or try to wake her gently with a hand on her shoulder, but there were also hugs for us.”

“We craved something to do, some way to comfort her and let her know she wasn’t alone. These small gestures of touch were all we had in her final days and the only way we could communicate with her.”

Touch:  A Final Connection

“In the end, she no longer responded to touch because hospice was doing their job correctly. We will never know what she understood and felt in those precious moments, so we continued to touch her. That small amount of physical contact was as much a comfort to us as we hoped for her.”

“Holding her hand, the hand that comforted me as a child, was again comforting me as an adult.”

Andrew’s words flew off the page at me because it gets to the heart of the work we do at the AGE-u-cate Training Institute with Compassionate Touch training. Touch is the first sense that develops in the womb and is a fundamental human need throughout our life course.  Through touch, care-giving professionals who work with families of dying persons can positively impact end-of-life care for both patient and family.

Thank you, Andrew, for reminding us of the impact that touch can have on the living, and the dying.

 

Shared by permission from Andrew Azzarello, a person with a personal and professional passion for eldercare.  Andrew continues caregiving responsibilities for his father and is the former Director of Human Resources for two aging services organizations.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving to private and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Importance of Aging Courses in Higher Education

Students at Northern Illinois University experience Dementia Live

Higher education should not overlook the benefit of educating students on issues related to aging.  In addition, tremendous career opportunities exist in Aging Services.  The field is a legitimate career choice.  However, students are largely unaware.

I didn’t give much thought to growing old when I was 20.  But, while attending college at Northern Illinois University many moons ago, I elected to take two courses about aging, and that was the beginning of my career path into aging services.

The subject was interesting, and the focus of the two courses was very different.  The first had more of a negative perspective- how growing old usually means depression, disability, and disease.   In comparison, the second course painted a more optimistic view.  Growing older can be a time for renewal, a life encore so to speak.

Fast forward 35 years, and I now teach aging courses at Northern Illinois University.  With the wisdom that is acquired with age, I have a keen understanding of why it is important for young people to learn about issues of aging.

Young Minds Learning about Aging

First, the more we understand about the process of aging when we are young, the more influence we can exercise over our aging experience.  I ask students who they want to be when they are 80, and what they will want out of life.   It is not surprising that most students are unable to answer this question.

Second,  we need to nurture more professionals into the Aging Services industry.  To that end, my second course discusses Leadership in Aging Services.  I introduce students to the possibility of a career in Aging Services.  It is wonderful to witness their “aha” moment!

Many students find the topic of aging fascinating, especially when coupled with experiential learning.  One student shared, “The book put the process of aging an interesting light. I also thought the Dementia Live experience is something that all students should continue to participate in.  This was an experience that I will remember moving into my career, and even as a human being.”

“I am actually shocked at how much I learned in this course and how interesting it really is” shared another student.  Many students discuss their own family members and gain a heightened appreciation for their challenges and how to support their personhood.

Teaching the young about the process of aging surely will produce positive benefits all the way around.

 

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving to private and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

 

 

 

 

 

 

 

Get Ready for Trauma-Informed Care

Beginning November 28, 2019, the Centers for Medicare & Medicaid Services will require nursing homes to provide trauma-informed care. Consequently, they must  “ensure that residents who are trauma survivors receive culturally competent, hence minimizing triggers that may cause retraumatization.”

What is Trauma?

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) describes the “Three E’s of Trauma.” First of all, the person is exposed to an event such as loss, violence, a natural disaster, or abuse. Next, he experiences the situation as physically or emotionally harmful or life-threatening. Finally, she has lasting adverse effects on well-being.

People express trauma differently, and some are more resilient than others. Furthermore, the impact of trauma is often confused with other conditions, such as depression or even dementia. Symptoms may have a delayed onset and include:

  • Physical: Aches and pains, poor sleep
  • Psychological: Anxiety, poor emotional control, flashbacks
  • Cognitive: Difficulty with memory and attention
  • Social: Poor trust in others, isolation
  • Spiritual: Lacks meaning in life

What is Trauma-Informed Care?

According to SAMHSA, trauma-informed care rests on a set of critical concepts referred to as “The Four R’s. These assume that all people within an organization:

  1. Realize that trauma exists and understand the impact and consequences of traumatic experiences.
  2. Recognize signs of trauma.
  3. Respond consistently using the principles of a trauma-informed approach.
  4. Resist the re-traumatization of people with traumatic histories.

Therefore new regulations for trauma-informed care expect facilities to:

  • Assess each resident’s exposure to traumatic events in their life.
  • Train staff in the impact of traumatic experiences.
  • Incorporate trauma-informed approaches into care plans.
  • Use strength-based interventions that maximize trauma survivors’ resilience to avoid retraumatization.

Acknowledging traumatic experiences and providing care that is sensitive to each individual is essential. However, I question how realistic this new regulation is for many nursing homes faced with high staff turnover. As a result, limited resources go to basic care and training in practical approaches.

In conclusion, how do you perceive the future trauma-informed requirements?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.

Employee Education = Engagement = Quality Care

Employees at Emerald Health and Rehab in North Carolina are immersed in education about the positive effects of expressive touch.

We understand the negative impact on quality care as a result of high employee turnover.  However, more elusive is an understanding of how lackluster engagement of employees with longevity impacts quality.

Much of the focus is on recruiting new employees, and rightly so. Estimates show employee turnover nationally at 45%-66%.

At the same time, it is important that we also maintain the spirit and engagement of current employees. However, scare resources have forced employers in Aging Services to make tough decisions.

Cuts into the marrow of the employee education budget in light of the current staffing challenges could be devastating.  In doing so, we inadvertently create a more disengaged workforce and impair quality.

Defense Against Declining Quality Care

The vital connection in health care is that employee engagement drives quality of care. To that end, one of the best ways to engage employees is through ongoing hands-on education and training.

Guard against what could become turn-over induced decline in quality with a robust and engaging employee education program for your experienced and dedicated employees.

Employees with longevity have also felt the devastation of workforce challenges.  Fatigue with over-time and the constant flow of new employees in and out impacts the spirit of our dedicated workers.  All the more reason to dedicate resources and efforts towards their ongoing growth and engagement.

The absence of training appears on this list of reasons for poor employee engagement. Employees with longevity also need to continue to learn and adopt best practices. In doing so, we ensure the evolution of our quality of care and service.

In conclusion,  a corporate culture that supports growth and education for long-term employees will promote engaged workers and defend against declining quality care and service.

 

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving to private and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

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