A New York Times article published today discusses a topic near and dear to my heart: the challenges of dying at home.
I have written about this topic extensively, including in my book, The Reluctant Caregiver. I also published an article, “Why dying at home is not all that it’s cracked up to be,” on The Caregiver Space that generated a passionate discussion. Some people thought I was anti-hospice, and that definitely isn’t the case. I think home hospice care, when it’s available in a well-funded and well-staffed form, is a wonderful concept that can support a good death.
But as Paula Span points out in her NYT article, there are challenges and limitations in real-world home hospice care. One issue that I can personally relate to is pain management. My mother suffered because I could not adequately manage her cancer pain at home with the drugs available to me. There was also the battle with her doctor just to get her enrolled in home hospice, which came much too late to be effective.
Caring for the dying at home can be physically strenuous. I struggled to move my mother in bed to change sheets and prevent bedsores. Before she was bedridden, helping her to and from the bathroom was also a challenge. I was a 40-year-old woman in decent shape. But for elder spouses of the dying who may have health issues of their own, it can be overwhelming and untenable.
Palliative care specialists at Harvard Medical School recently published an article in the New England Journal of Medicine suggesting improvements to hospice care, and I agree with their recommendations. For those determined to die at home, it’s essential to have have sufficient home health care services so that families are not overwhelmed. This includes nursing care and personal aide services but also equipment like medical beds. The authors also suggest alternatives that are underutilized, such as inpatient hospice care. This was a suggestion that was made in my father’s case, but there was no bed available at the time of his hospital discharge, so he was sent to a skilled nursing facility instead. We met with the inpatient hospice representative and I appreciated the personal aspect of the care, wanting to get to know him, asking what kind of music he liked, etc. I so wish he could have died in that setting. It’s what I would want for myself.
Hospice units within hospitals is another alternative. This offers access to end-of-life care such as pain management but rooms can be configured to be more home-like by removing unnecessary monitoring machines and having hospice-trained staff provide palliative care. It can be a good alternative in areas without freestanding inpatient hospice facilities.
It’s important to think about these options for yourself and your loved ones now so that you are better prepared to make the best choice for your situation when the time comes.
I recently had the privilege of writing a blog post for The Conversation Project. My father died 10 years ago and in May, I will be marking seven years since my mother’s death. I’ve had a lot of time to think about end of life issues in the years since their passing and I’ve shared my perspectives here on The Memories Project blog and in my book, The Reluctant Caregiver.
In my post for The Conversation Project, A Good Death Is More about the Journey than the Destination, I discuss my family’s reluctance to talk about death and end of life issues, and how that impacted their end of life journeys, albeit in very different ways. My father’s death impacted how I cared for my mother, when just several months later, she was diagnosed with cancer.
Neither of my parents experienced the kind of death that I would want for myself, and that is why it has become such an important advocacy issue to me. Please talk to your loved ones, discuss your end-of-life wishes and document it all so that you can have some peace of mind when that phase of life is reached. What I wish for everyone is that you can find the time to simply be with your loved ones who are nearing the end of life, and not overly preoccupied with medical care duties. Just like at the beginning of life, it’s important we have those bonding moments at the end of life as well.
I’m a big fan of the Netflix show “After Life” created by and starring Ricky Gervais. While the subject matter and profuse profanity make it a show that not everyone will enjoy, I find its take on death and the grieving process refreshing and poignant.
The third and final season debuted this month and I was blown away by one scene in particular, which felt like my mother was speaking to me from beyond the grave.
As I’ve written about extensively on this blog and in my book, The Reluctant Caregiver, my mother was reluctant to discuss any end-of-life issues, but she did give me a poem she had copied by hand and said she would like that read after she died. She didn’t want any service and she chose cremation over burial so it was left to me, her only child, how to honor her wishes.
The poem she chose is the poem that is read during a very moving scene in the final season of “After Life.” When the actress began reciting the poem, I almost jumped out of my seat and my breath caught in my throat. The poem is fairly well-known but still, what are the chances that the poem my mother chose was the one that was recited on a TV show?
I chose to honor my mother’s wishes by not only reciting the poem after her death, but having it imprinted on her urn. You can read the poem below.
I had to say goodbye to my beloved Rosalie two days before Christmas. She went into respiratory distress and a large mass was found on her trachea, which was almost entirely blocking her airway and ability to breathe. Because of its location, her age, and her condition, there were no realistic treatment options. I decided to let her go while she was still under anesthesia from the diagnostic procedure so she could slip out of this world as peacefully as possible.
Rosalie came into my life at the worst of times (my mother dying) and departed during another tough period of my life. I was fortunate to get six years with her delightful spirit. She was by far the easiest cat I’ve ever cared for and very affectionate. While I’ve loved the timid cats that I’ve adopted over the years, Rosalie was not shy at all. Nothing much seemed to spook her. She lived every day soaking up the simple pleasures of life (sitting on the heat vent or napping on the heated blanket during the winter, enjoying food, being petted, knocking her favorite crinkle ball toys under the couch) and I would marvel at how content and relaxed she was no matter what strife I and/or the world was facing.
I may have jinxed her by thinking she could be my “20 year old cat,” because she had the calm and happy-go-lucky demeanor that centenarians often have. Alas, cancer claimed her just a month after her 15th birthday.
The day I adopted Rosalie I put aside my normal common sense and went with my gut instinct. It was just days after another one of my beloved cats had died and many people would have felt it was too soon to adopt another. The weather that day was dreadful and for any other event or task, I would have opted out. Navigating through violent thunderstorms, I arrived at the shelter and met with Rosalie just minutes before another adopter arrived asking about her. From that fateful beginning, Rosalie and I forged a special bond.
She taught me that sometimes rules and traditions are meant to be broken and she could have taught a master class in self-care. I will be forever grateful that the universe brought her into my life.
It has been 10 years since my father’s death. So much has happened in the past decade, but I’ll never forget where I was when my mother called with the worst news of my life, in the middle of the newsroom at the Atlanta Journal-Constitution. I had been waiting for that awful call for quite some time, and some part of me wished for it, because it pained me so much to see my father suffering in the late stages of dementia. But of course there was no immediate sense of relief upon my father’s passing, just sadness and regret.
I do still carry feelings of regret and guilt to this very day, and probably always will. I discuss this at length in The Reluctant Caregiver, and urge others not to judge themselves too harshly. In that spirit, I am taking a look back on what my father inspired me to do over the last decade.
I began this blog, The Memories Project. What began as a way to document memories of my father and process my grief has become the foundation of my dementia and caregiver advocacy platform. I have also met so many fellow caregivers through the blog and am grateful for their wisdom and their support.
I wrote a book, which was a life goal of mine. My collection of personal essays on family caregiving, The Reluctant Caregiver, won a gold medal at the IPPY Awards. An essay from that collection won the Rick Bragg Prize for Nonfiction from the Atlanta Writers Club. A story I wrote about my father, “French Toast,” was included in the Chicken Soup for the Soul: Living with Alzheimer’s and Other Dementias collection. I know my dad, a lifelong lover of books, would be proud.
I finally made it to Ireland and visited my father’s hometown of Belfast, Northern Ireland. This was at the top of my bucket list and has been one of the best experiences of my life.
The privilege of sharing my father’s story through a variety of outlets, including NPR, AlzAuthors, Caring Across Generations and the Aging in America conference.
The decade since my father’s death has been the most difficult of my life, but also the most rewarding. I hope that you can take time this holiday season to recognize and reflect upon the highs amidst the lows of your own caregiving journey. Give yourself the grace that you deserve.
The 20th anniversary of 9/11 is coming up and there will be many powerful reports, essays, and accounts written to mark the somber occasion. Remarkable pieces have been published over the years about 9/11, such as The Falling Man. An essay published in The Atlantic recently is one of the most well-written and moving accounts I’ve ever read. On the surface it’s about a family’s struggle with losing a loved one on 9/11, but peeling back the layers with both compassion and clarity, Jennifer Senior reveals much more than meets the eye.
One of the more interesting aspects of the essay to me is the impact that trauma and grief have on our memories. It’s a lesson that may serve dementia caregivers well. Getting the details just right may not be as important as how we are able to process past traumatic events in the here and now. Sometimes remembering a specific word is less important than conveying the meaning and emotion of the message.
Another important lesson learned from this family’s heartbreaking experience is that grieving can cause us to act in ways we don’t intend. Communication can become difficult. It’s important to give those who are grieving space to process what they are feeling. Be a compassionate listener. This essay captures in vivid detail just how different the grief process can be for members of the same family.
The 9/11 anniversary is coming at a time when our nation is reeling from the deadly coronavirus pandemic. There are many of us grieving right now. I would encourage all of us to remember that as we go through our daily interactions. A moment of kindness can make a big difference.
What a fantastic exercise in developing empathy and understanding of the challenges facing those going through the end of life phase. I believe this training could also be adapted for those caring for those with dementia to better understand how one might feel like they are losing pieces of their identity to the disease.
From a fellow blogger training to be a hospice volunteer:
Yesterday, in a training for upcoming hospice volunteering, I was asked the following: Who are the 4 most important people in your life? What are your 4 most important possessions? What are your 4 top beliefs and/or aspirations in life? What are your favorite 4 activities to do? What are your 4 greatest comforts? I […]
The COVID-19 pandemic has left thousands of Americans motherless this year. One model shared in a study published in JAMA Pediatrics suggested the number of children who lost a parent due to the pandemic could be as high as 40,000, a staggering amount in just a year’s time span. On the other end of the spectrum, adult children grieve their elder mothers who died during the pandemic, some who must grapple with the extra pain of not being able to properly say goodbye.
Having lost both of my parents, I do find that Mother’s Day is harder for me emotionally than Father’s Day. I believe this is because my mother died in the month of May, just a couple of weeks after the holiday. My last memories of her before she became bedridden was reading her Mother’s Day card and admiring the fresh flowers I bought for her. Even though this year will mark six years since her passing, those bittersweet memories are still the first to surface when I’m reminded of Mother’s Day via the endless online ads and TV commercials.
For those whose mothers are still alive and perhaps will be seeing in-person for the first time in months due to the pandemic restrictions, I am so thrilled for you and I hope you have a wonderful reunion. We know now more than ever that each moment with loved ones is precious.
If you have a friend who may be grieving the loss of their mother, reach out and offer support in whatever way is meaningful to them. It can be a lonely holiday for those whose mothers are no longer alive, and acknowledgment from caring souls can mean so much.
Today would have been Dad’s 89th birthday. This year will mark 10 years since his passing. It’s hard to believe that much time has gone by, and how much the world has changed in just a decade.
I’ve always loved this series of photo booth shots. I wasn’t an entirely cooperative model but Dad’s beaming smile makes up for it. Dad rarely smiled in photos as he was self-conscious about his teeth, so the wide smiles in these shots are extra precious. He was definitely a proud papa.