Tag Archives: dying

More Americans are dying at home, but family caregivers still lack support

holding hands

Image courtesy of Pixabay.

The New York Times published an article this week that touched on a subject close to my heart. The article explores the impact of new data published this week in the New England Journal of Medicine that found more Americans are dying at home than in hospitals.

On the face of it, this sounds like good news. In poll after poll, the majority of people say they would prefer to die at home rather than in a hospital or nursing home. The tide now appears to be turning, and perhaps returning to a culture which embraces providing end-of-life care at home.

But the major challenge, which I’m grateful to reporter Gina Kolata for highlighting in her report, is the following: “Many terminally ill patients wind up in the care of family members who may be wholly unprepared for the task.”

This is something I’ve written about extensively, based upon my own family caregiving experience. My personal essay, Why Dying at Home is Not All It’s Cracked Up to Be, ruffled some feathers at the time. But my point wasn’t to be anti-home hospice. I think home hospice can be a wonderful service. The problem is that there are not enough home hospice service providers, especially in rural areas of this country. As the New York Times article discusses, this leaves family caregivers carrying the heavy burden of providing medical care for a dying loved one, while dealing with the financial cost and emotional toll of that experience. Most family caregivers are woefully unprepared.

“We have put a tremendous burden on families in the type of care they have to provide and the type they have to pay for,” said Dr. Sean Morrison, chair of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York.

With my parents, I experienced the worst of both kinds of deaths. My father died in a skilled nursing facility without any family members with him, and my mother died at home, with myself, the only child, providing her end-of-life care but lacking support from limited home health care services.

The New York Times article also discusses another downside of dying at home: pain management. My mother’s pain was not managed as well as it could’ve been in an institutional setting, and that will haunt me for the rest of my life. No one should have to suffer needlessly at the end of life.

If you want to learn more, I was interviewed recently on the challenges of dying at home by journalist Blake Farmer at WPLN, Nashville Public Radio.

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A towering reminder

tree collage

This week marked the fourth anniversary of my mother’s death. I’ve hit that mark where it’s hard for me to believe that it was only four years ago. It seems like a lifetime ago.

But the towering water oak tree in my front yard serves as a sturdy reminder. It has been four years ago since the last time I had it trimmed. The reason why I remember the date of such a mundane task is because it was the day that I realized Mom was dying and that I needed to be with her. I remember the chaos of that day, with Mom getting admitted to the ER again for uncontrollable pain. I was trying to field phone calls with the roaring machinery going full-throttle outside. There was an issue with a car parked on the street and I was being asked to assist. I remember wanting to scream, “I don’t care about the damn car. My mother is dying!”

I recently had the tree pruned again, and the foreman proposed May 21, the day of my mother’s death. Somehow I thought it was appropriate. The tree may very well outlive me. It grows, it sheds its leaves in the fall, occasionally branches drop, and then it is tended to and left naked with knots. It’s akin to how time alters the grief process. One is left raw with some hardened spots, but life continues to grow.

You may never be the same after the death of a parent, but life does go on.

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“Into the Night: Portraits of Life and Death” a fascinating documentary

Leave it to me to find the heartbreaking, gut-wrenching yet powerful documentaries. While films about dying are always an emotional experience for me, I also find them thought-provoking, which is why I keep watching them and sharing with others.

The latest film I watched is titled, “Into the Night: Portraits of Life and Death.” It aired on PBS earlier this year, but I caught it on Netflix. What I liked most about the film was the diverse range of subjects who were interviewed about their perspectives on death. From people of faith to scientists to a former member of an Islamic extremist group, those interviewed were candid about their thoughts on the meaning of life, death and the afterlife.

I loved the imagery captured in the film, such as a son finding an acorn in the pants pocket of his recently deceased father, or a favorite family photograph of a parent and child on the shore of the beach. There was also an interesting discussion of near-death experiences.

One of my favorite death positive advocates, Caitlin Doughty, is also interviewed for the film. A traumatic brush with death as a young child greatly influenced her life.

The most moving segments were with those who were actively dying. Anyone who has spent time with a dying person knows they often offer an insightful take on their imminent demise. Some people fight death until the very end, but others make their peace with death in order to better appreciate the time they have left.

The overall message I took away from the film is that each of our lives are unique stories, and all stories must come to an end eventually.

Watching such a film made me reflect upon my own views of death, as well as those of my parents. My father, a staunch Catholic, had an intense fear of death. Did his dementia offset that fear, or intensify it? There is no way for me to know. My mother, on the other hand, had a more positive end of life view. She thought we “go to a good place, and a right place,” based upon whatever our views are of the afterlife.

For me, I’m more afraid of terminal disease and the dying process than death itself. I dread the idea of pain, misery and loss of self-control. I also dread the loss of mental faculties, but know that is a distinct possibility, as Alzheimer’s is all over my family tree. I admire those that make peace with death, as I think it is the best way to go. At some point, the fight to live is over, but I don’t see that as giving up. I see that as focusing remaining energy on the life you have left.

If you’ve seen the documentary, I’d love to hear your thoughts.

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‘Driving Miss Norma’ teaches valuable lessons on aging, caregiving, dying

I haven’t been shy about my professed loved and admiration for “Miss Norma” Bauerschmidt, who at 90, became an internet sensation when, instead of undergoing grueling treatment for uterine cancer while dealing with the recent death of her husband, she told her doctor, “I’m hitting the road.”

Driving Miss Norma: One Family’s Journey Saying “Yes” to Living, a book about the final, amazing year of Norma’s life, is now available, and I highly recommend it.

Norma joined her son and daughter-in-law in a motor home for an epic trip around the U.S., where she was welcomed like a celebrity everywhere she stopped. While Norma’s symptoms were managed quite well on the road, her cancer progressed and she died on September 30, 2016.

Her story has touched millions around the world, and I couldn’t be happier about that.

Norma’s story touches upon many topics that are near and dear to my heart. First, the “treatment without question” mentality that pervades the American health care system got turned on its head here. The doctor was taken aback by Norma’s reaction at first, but admitted that his own treatment recommendation would have set up Norma on a long road of recovery that she may not have survived. Instead of spending months in a skilled nursing facility recovering from major surgery and being sick from chemotherapy, Norma chose quality over quantity for the remainder of her life.

The highs and lows of caregiving are poignantly and honestly discussed in this book. Norma’s son and daughter-in-law don’t shy away from the challenges that family caregiving poses, which are only complicated when mixed with an unpredictable life on the road. Norma’s son and daughter-in-law weren’t experienced caregivers before taking on Norma, and their “nomadic by choice” lifestyle had to be adapted to Norma’s abilities and health challenges. Ultimately it was an experience that they wouldn’t trade for all the world, but I appreciate their openness in discussing their caregiving experience.

What was most surprising to me was how, according to her son, Norma was not known as the “wild gal” that we saw on Facebook who would make funny faces for the camera or who took delight in quirky tourist spots. Norma, a quiet, stable presence in the family, had been content to live in her husband’s shadow. But once on the road, a new side of Norma emerged. This may be the most important lesson of all in the book. It is never too late to find oneself.

By late summer, it became apparent that Norma’s trip through this life would be coming to a close soon. Being on the road presented some unique challenges, but Norma passed on as comfortably as is possible, surrounded by love and fulfilled in a year’s worth of joyous sights and experiences. For everyone seeking that elusive “good death,” I think after reading this book you will conclude that Norma had a good one.

Obviously, not all of us have adult children who could accommodate such an epic life’s end journey. What we can take from the book is that when faced with what could have been an overwhelmingly depressing moment in her life, coping with the death of her husband and a cancer diagnosis, Norma chose to embrace optimism. Norma chose adventure, to let go of any old grievances and open her heart to new people and experiences. One of the catchphrases for Norma’s journey is, “Say yes to living.”

That’s a lesson we could all take to heart.

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Getting creative with dying

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John Evans/Freeimages

Thanks to those who participated in my caregiver survey. The OpenIDEO end of life challenge is going through its final review, and top ideas will be announced in the coming week. Regardless of the outcome, the experience has been educational and inspirational.

I spend quite a bit of time on this blog sharing my frustrations with the health care system, but the good news is there are a lot of compassionate, smart people out there who are working on solutions. They want to improve the experience of those nearing the end of life, the death process itself and the caregiver’s well-being.

The ideas generated in this challenge were truly awe-inspiring. Some of my favorite ideas included musicians writing and playing songs for those in hospice inspired by the dying person’s life. I loved this idea because not only would it offer comfort to the dying, but also would be a memento the family could keep forever.

I also was inspired by the “Leave a Wish” idea, which would allow you to leave any message you want for family members after you have died. It could be something like hiking to a favorite spot to mark a holiday, or making sure your loved ones fulfill their own goals, like writing a book or running a marathon. I loved the way this idea could allow you to connect with your loved ones even after you are gone.

Other ideas included green burial options, documenting a loved one’s life stories and encouraging greater discussion of end-of-life wishes.

There were so many wonderful, innovative ideas that I can’t go into them all here but you can check out the full list on OpenIDEO.

It’s reassuring to know that there are good people out there who want to make dying not something painful and miserable, but a final phase of life in this world that can be meaningful and inspirational.

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My essay about dying at home posted on The Caregiver Space

I’ve been reading posts on The Caregiver Space for quite some time, but never had time to submit my own writing.

Now that I find myself in a post-caregiving phase of my life, I’m really trying to focus on writing a series of essays that have been stewing in my brain for awhile.

hospital bed

Last week, The Caregiver Space published my essay, “Why dying at home is not all it’s cracked up to be” and the reception has been quite positive. The post was published on The Caregiver Space Facebook page where it generated several hundred likes and many heartfelt comments.

The essay is not an attack on hospice care workers; I admire most of them and think they do a phenomenal job. Hospice care is truly a calling in my opinion, and one can see the benefit of the loving, compassionate care they provide.

My essay is a look at dying at home vs. dying in a facility from the family caregiver’s perspective. After my dad died in a skilled nursing facility, I was all for my mother dying at home. But the reality was a bit different. It was an emotionally brutal experience that I wouldn’t wish on my worst enemy. That’s not to say that her death would have necessarily been better in a hospital, it would have been difficult in a different way.

My main point of the essay is to bring awareness to family caregivers in rural areas. They may find that the local home hospice agency is understaffed and overworked, and cannot provide the around-the-clock care that is often touted by die-at-home advocates. People should be aware and prepare themselves for taking on more of the nursing duties of caregiving. If they feel they cannot do it themselves, they should seek out help from family, friends or professional caregivers.

If you have the time, please read the essay and let me know what you think. Also, please share with anyone who you think could benefit from the information.

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Grief, relief and regret

As anyone knows who has lost a loved one, your grief doesn’t always progress through the designated stages like it’s described in books. Many of these self-help manuals make it clear that there is no one correct path, but it’s still something you have to experience for yourself to understand.

To all of you who left lovely comments, thank you so much. It does help to know you are not alone.

The first few days after my mother’s death were fueled by an adrenaline rush, to power through and focus on completing the necessary tasks. My goal was to get home as soon as possible.

Mom was a jokester, and would want to be remembered with smiles and laughter, not tears.

Mom was a jokester, and would want to be remembered with smiles and laughter, not tears.

I returned home and took a few days off from work to get settled in and recharge my batteries. I spent a lot of time receiving “purr therapy” from the cats. I went on walks. I got a massage.

Then I returned to work and the fast pace of my daily duties left me little time for reflection.

So here I am, 10 days after my mom’s death, and more than grief or sadness, I’ve experienced moments of relief and regret.

There is a sense of relief at how quiet my phone is now. Over the last year or so, I had talked to Mom daily on the phone, and over the last few months, she was calling me multiple times per day sometimes, usually to remark about her pain or lack of effective medication. I began to dread seeing her face when it would pop up on my phone, signaling a call from her.

Mom was about the only person to call me on the phone. (I prefer written communication whenever possible.) My battery has dipped low a couple of times, but I wasn’t frantic about making sure I was available by phone because at this moment, for the first time in several years, I am not managing the care of an ailing parent. There is relief in not feeling like I’m on call 24/7.

The regrets pop up in scenes played out from the last month, when I was taking care of Mom. I think what I can take away from these flashbacks is to not get so lost in the necessary caregiving tasks that you forget the simple things, like trying to make it possible for a loved one to enjoy a moment basking in the sunlight, or having a spoon of ice cream. There may be risks involved in trying to make a dying person happy, but looking back, they are risks I wish I had taken.

What lessons have you learned from grieving for a loved one?

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