Tag Archives: compassionate touch

Aging Services Future Focus

The rails may seem long and never-ending, but there are stops along the way. Aging Services providers keep looking to the future.

On the brink of a new decade, I contemplate what the next ten years will look like for the aging services industry. Reflecting on the past provides me some hope for the future. In some respects, we have come a long way.  By the same token, we should maintain a future focus and continue to develop more strategies that support the quality of living of frail elders.

One future focus could be to equip our caregivers with best practice strategies to respond to resident behaviors utilizing therapeutic approaches. 

We realized years ago that physical and chemical restraints weren’t the answer. The emergence of Compassionate Touch, Music & Memory, and Joy for All Companion Pets are best practice possibilities. All of these interventions provide a non-pharmacological approach to improving quality of life.  Expressive touch, music, and pets to love address basic human needs of connection, inclusion, and purpose, to name a few.

A second future focus could be to educate our employees about the process of aging and dementia to demystify, normalize, and create an environment of understanding and acceptance.

Can we say that our caregivers understand the process of aging? In addition, do they comprehend and empathize with the struggle of living with memory loss and sensory changes?  To that end, employee education creates empathetic caregivers, and that leads to better care. In the same way,  this is also true for family members.  More understanding leads to better care partners.

As one example, the educational program Dementia Live provides caregivers with an inside-out understanding of what it is like to live with dementia. It is a powerful experience for employees and family members.

Workforce

A third future focus could be to cultivate a revitalized workforce.

The workforce challenges that face the aging services industry seems overwhelming and hopeless.  But keep this in mind, nurses did not take care of post-heart transplant patients twenty years ago in skilled nursing.  We rose to the challenge. Nothing is impossible.  Providers alone cannot entirely solve this problem. However, there are things to do that can get the ball rolling.

In conclusion, while the future may look daunting, consider how far we have come over the previous 10-20 years. Celebrate the evolution of an industry that was once “warehousing,” and face the future with boldness and ample self-care, we will need it.

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 for family and professional caregivers.  In addition, 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.

How to Prevent People in Nursing Homes from Becoming Invisible?

People in care can often feel invisible.

People living in nursing homes become “invisible” when they are regarded as feeble-minded and lacking in the ability to contribute to society in a meaningful way.

I once met a man named Frank, who lived in a skilled nursing facility, and his memory still haunts me. I noticed him because he wasn’t particularly old, and he was tall and muscular. He was sitting in a corner in the hallway near the nurses’ station. By his appearance, it seemed he had suffered a stroke.   The following day I noticed Frank sitting in the same spot– for hours, just sitting there.  He had no real interaction with anyone and pushed restlessly on the wheelchair footrests. He couldn’t propel the wheelchair himself. Lots of people passed by, but no one paid him much mind. To me, he seemed lonely, frustrated, and, yes, invisible.

I felt drawn to offer him a Compassionate Touch. I pulled up a chair introducing myself. He immediately looked me in the eye. He had trouble with language, but he could, with effort, carry on a conversation. A Vietnam veteran, Frank grew up in Illinois. He believed his age to be 37, moreover, other signs of confusion were there, too.  I held his stroke-affected hand. He was receptive to the touch. I gently rubbed his shoulders and back, and he told me it felt good.

At the end of our time together I asked him if he would like to sit somewhere else. He pointed to a spot about six feet away that was near a table, so, I maneuvered his wheelchair around so he could reach the table with his hands. He reached out took hold of a newspaper, and proceeded to read it. He engaged in something purposeful.  The restlessness stopped.   As I left, he said, “thank you for stopping.”

Frank still haunts me. He likely sat in that same corner spot the next day, invisible again. So, how do we prevent people like Frank from becoming “invisible”? In closing, Alisoun Milne, a gerontology academic in the UK, tells us, “There is evidence that well-trained staff can build up relationships with residents that help to reduce reliance on medication and the need for acute medical care. Because the more you know about the person in that chair, the more likely you are to see them as rounded human beings, and the less risk there is of neglect.”

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.

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.

Infection Control and Expressive Touch: We Can Have Both

The healing benefit of expressive touch is lacking in the lives of older adults.

The topic of infection control almost always enters the conversation when I deliver Compassionate Touch training.  This training teaches caregivers the skill of expressive touch.

Hand, back, and foot rubs used to be a part of the care process.  Seasoned nurses consistently confirm this fact.  In contrast,  newer nurses and nursing assistants report that expressive touch was not a part of their training.

This lays the foundation to discuss the reasons why older, frail adults lack expressive touch in their lives.

Glove Culture and Expressive Touch

Infection control is consistently cited by skilled nursing employees as a reason for the lack of expressive touch in the lives of older adults.    Furthermore, employees fear citations from surveyors for not using gloves.

Megan J. DiGiorgio, MSN, RN, CIC, FAPIC  coins the phrase “glove culture”.  In addition to the wasteful use of resources, the over-use of gloves increases disconnection and a lack of trust in caregivers, among other negative outcomes.

Burdsall, Deborah Patterson, MSN, Ph.D.,  identified situations that require the use of gloves.  Touching intact, non-infectious skin of older adults in healthcare settings does not require gloves.

Skilled nursing caregivers do expressively touch their residents.  Indeed, holding a hand or giving a hug communicates how much we care and provides comfort.  We can incorporate more of this excellent medicine of expressive touch in our caregiving practices and still uphold infection prevention standards.

Gloves are not used with Compassionate Touch techniques. I urge those I am teaching to resist the temptation. The benefits of touch would be lost for both the resident and care provider.

Consider evaluating the extent to which gloves are used in your community and understand the unintended consequences.  Even more, it seems like this would be a worthwhile QAPI project.

 

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,  she 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.