All posts by Ann Catlin

Hospice professionals: He’s an Invalid Now. Really?

Words have power - handwriting on a napkin with cup of coffee
Words have power – handwriting on a napkin with cup of coffee

“He’s an invalid now.” These words were uttered by a hospice caregiver. I can’t recall  I heard this comment, but it wasn’t all that long ago.  Now, I haven’t used the word invalid to describe a person probably since I was a kid who didn’t know better.  The culture change movement has generated a lot of discussion about words we use to describe people over a “certain age”.  (That’s me- yikes!)

Language matters:

Elder versus elderly. Community instead of nursing home. Care partner instead of caregiver.  Person rather than patient. Older adults versus senior citizens.  I’m especially sensitive to what eldercare or hospice professionals call people.  I know plenty of these folks and I’m here to tell you they are not invalids.

Think about that word. Invalid. In (without) valid (validity).  Really? That’s like saying “you’re sick, you’re old, you don’t matter anymore.” Curious, I looked online to see if this word is still being used much. Webster’s online dictionary tells us that the first recorded use of invalid to describe a “sickly” person was in the early 1700′s. Then I saw something interesting. Webster’s asks people to comment on what prompted them to look up the word. One man commented, “I recently (for the first time) was described as an “invalid” because of my chronic arthritis.” Another said,” They told my wife she was an invalid. She is going for lung transplant.”  New Zealand’s financial assistance program called Work and Income has a benefit called the Invalid Benefit.  So it looks like this term is hanging around.

I can hear some of you saying, oh good grief, Ann, it’s just a word- get over it!. But there is power and energy in words.  When someone is already dealing with major health and life challenges, the last thing he needs is to be “invalidated”.

The person labeled as invalid is still of value; still has relationships; passions; and a life to live. And he can teach the rest of us a little about the grace and grit of our humanity. How’s that for validity?

Senior care: Don’t touch! But why not?

hand-prints

Elders in senior care have something to teach us about the importance of touch. Have you ever comforted a crying baby?  How did you sooth her?  Chances are you held her close, stroking her back while gently rocking her.  We feel naturally drawn to comfort infants with caring touch.  It is through touch that we convey warmth, safety, love and acceptance.

But what about a very old person in senior care? Or someone with advanced Alzheimer’s disease? Are we as willing to comfort with the same touch we offered the baby?   Most likely not.  It seems that in our society, we distance ourselves from elders and our willingness to touch them diminishes.

Fears Keep us From Reaching Out

We live in a culture that deems aging and ill people as “untouchable” in many ways.  An image of a very old body or a person with a disability is not exactly what our culture identifies as desirable and, therefore, touchable.  Many are fearful of touching an old person, saying things like “I’m afraid I might hurt her.”; “I’m afraid if I touch, it will be considered inappropriate.”; “I don’t know how to touch safely.”

Ashely Montegu, author of Touching: the Human Significance of the Skin tells us that “tactile needs do not seem to change with aging– if anything, they seem to increase.”

There is another cultural fear at work here, too– the fear of aging itself.  To touch a frail elder can be like looking in the mirror, while bringing up in us our personal attitudes and beliefs about our own mortality.  This experience can show us things about ourselves as we witness close-up the very raw human condition of aging. In these moments, we have a choice.  We can turn away from our discomfort or we can embrace the opportunity to learn something about our shared journey of growing older.

Touch is one of our most fundamental human needs. It is a need that remains constant for a lifetime.  Although our situation, age and condition may change the need for human contact does not. The need for human touch increases in the search for reassurance, comfort and connection.

Elders in senior care are often deprived of nurturing touch and meaningful physical closeness. Social withdrawal, depression, and emotional distress are the result.  In senior care, touch is certainly a part of necessary care activities– medical treatments, personal care such as bathing and dressing, or mobility.  However the intention of this touch is to complete the task, the doing.  The attention is on the condition or the disease rather than the person being cared for.  Imagine if the caregiver stopped doing for a moment to simply be present with the individual? This is the gift we can offer.

While serving another in this profound way, we serve ourselves as well.  Our fears may soften and we no longer see ourselves as separate from those we care for, but rather a part of a shared experience of giving and receiving.

Senior Care Professionals- Four Tips to Develop Cultural Sensitivity

Senior Care cultural sensitivity

As the world becomes increasingly ethnically blended senior care professionals are called upon to care for people from diverse cultures. This is true in hospitals, clinics, long term care, hospice and home care.  To create person centered senior care it’s important to develop multicultural sensitivity while respecting cultural differences of individuals, families and groups.

Decades ago I worked as an occupational therapist at an Iowa hospital.  One day my supervisor called a meeting about a new patient—not something that typically triggered a meeting.  But this was not a typical patient. He was the elder of a gypsy family. The hospital was making preparations to accommodate what tradition dictated in gypsy culture. The entire extended family would stay on the premises during the elder’s hospitalization.   I admire the way the hospital handled the situation. For days this family lived in campers in the parking lot in addition to several people staying in the hospital room night and day. I was fascinated by all this even though I didn’t understand it.  I’m glad the hospital set such a good example and honored the needs of this patient while demonstrating cultural sensitivity.

Cultural competence is the ability to relate to and provide services for people from cultures and traditions other than one’s own.  Lots of things make up a person’s culture and world view.  Ethnicity, family heritage, spiritual tradition, beliefs about illness and well being, views of death and dying, food beliefs, family structure, language and non-verbal communication are a few such influences.

Four Tips to Develop Cultural Sensitivity

  1. Experts in the field of transcultural nursing as well as professional chaplains suggest we first identify your personal cultural identity. Recognize your social roles, spiritual self-knowledge, cultural heritage, personal habits and attitudes. Your own influences determine how you think and behave socially and in the workplace.
  2. Identify the cultural mix in your own community. The cultural tapestry of Miami is different than in San Francisco or Des Moines or the Appalachian mountains. What shapes the tapestry where you live?
  3. Generalize, rather than stereotype. To stereotype is to apply a belief or attitude to everyone in a cultural group, for example “all Hispanics do this” or “all Chinese think that”. To generalize is to have a basic understanding about a culture and use that knowledge as a starting point to then learn more about a person, family or group. You don’t have to be an expert about cultures to become more sensitive and competent.  Accurate basic information is a good start.
  4. Practice authentic listening. Listen with your ears, eyes, heart and mind. Authentic listening is paying attention in the moment. Information gathered in the moment guides right action.

Person centered senior care fosters a holistic approach.  Factoring in the needs of people from a range of cultures seems logical. Do service providers encourage cultural competence and sensitivity? Share your experience!

Hospice Care: Can Compassion be Taught?

hospice-care compassionSome think compassion is an attribute reserved for people like Mother Teresa. But compassion isn’t just reserved for those who travel a moral high ground.  Hospice care professionals cultivate compassion for when they are called to the bedside.

Compassion is Good Medicine
Compassion has many qualities, most noteworthy loving-kindness and heart-centered. Therefore, compassion is a heartfelt concern for suffering coupled with wanting to ease the suffering. Scientists show interest in the impact of compassion. As a result they’re finding that it’s good medicine. The Center for Compassion and Altruism Research and Education conducts scientific studies of compassion and altruistic behavior. Scientists look beyond Western “hard science” to learn about human behavior and emotions.  Neuroscientists conduct brain studies to discover how compassion affects us biologically.

A study published in the Journal of Clinical Oncology showed that 40 seconds of compassionate communication from a physician reduced anxiety and increased confidence among breast cancer patients.  In hospice care compassionate communication may enhance the experience for the patient. But it may also help hospice care professionals find greater satisfaction in their work.

How to Cultivate Compassion
Compassion is a human quality. With intentional practice it arises spontaneously.  Many heart-centered practices exist. Anyone serving people in hospice care can integrate such practices. Especially  relevant is the following example.

Sit comfortably. Be in your body and focus your attention upon your breath. If you wish, place one or both hands over your heart.

First, direct loving kindness to yourself.

Picture two or three people who care about you. Imagine them looking lovingly at you. These might be people in your life now or in the past or even spiritual figures. What would they wish for you? Repeat these simple phrases imagining they were saying them to you.

May you be filled with kindness and compassion.

May you be safe in every way.

May you be well in body and mind.

May you be happy.

May you live with ease.

How do you feel? Notice what arises trying not to judge thoughts, but simply let them pass through your mind.

Next picture someone you would like to send compassion to. It could family or a friend; a co-worker; a stranger; or even  someone you find challenging. Repeat the same phrases except this time direct them to this person. Again, sit for a few minutes simply noticing anything that arises in your mind.

To end, take in a deep, cleansing breath and bring your awareness back into your body. In conclusion, offer thanks for the experience in whatever way you wish. Perhaps a simple “thank you” will do!