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Elderly father and adult child sitting and having a serious discussion

End-of-Life Conversations

People often shy away from talking about end-of-life wishes. In fact, the Conversation Project found that although 92% of people feel it’s important to discuss end-of-life wishes, only 32% actually do. But it doesn’t have to be a scary topic that you avoid. In fact, it’s incredibly important to have the discussion.

Dear Caregiver,

As your loved one grows older, they may be hesitant to talk about their end-of-life wishes. And you may not want to bring it up because it forces you to face the fact that they won’t be here forever. Trust us, we get it. However, it is incredibly important to talk about it. Here’s why.

Gives Them the Chance to Die Well

End-of-life conversations give us the chance to die well. What does that mean? It means our wishes are known and followed, and we have the opportunity to live our life – right up to the end – the way we choose to.

By discussing their end-of-life wishes, you will have a better understanding of how they want things to happen. This will prevent you from needing to try to guess or figure it out on your own.

Makes it Easier on Family and Caregivers

That brings us to our next point. Knowing what a person wants makes it easier on those caring for them. If you discuss it with your loved one, you don’t have to worry about making the right decisions on their behalf because you already know what they want. If you don’t discuss it, you may worry if you are doing right by them. Talking about what they want and having a clear plan eliminates this pressure.

It’s also not uncommon – in situations where the patient becomes unresponsive, such as in a medical emergency – for the family to argue over what the right decision is. This just creates added and unnecessary stress and trauma for everyone. All of which can be avoided by knowing and understanding your loved one’s wishes ahead of time.

Starting the Conversation

Your loved one may already know what their end-of-life wishes are. They might just be unsure of how to bring it up. Maybe they just need you to start the conversation. But how do you?

This Conversation Starter Guide is a wonderful tool to help us get the conversation started. It includes prompts to answer to help cover all the bases. Encourage your loved one to fill it out, with you or on their own. Then, you can sit down together and talk about their answers. If you have this guide printed out, you can take your own notes and save it so you are prepared.

Keep the Conversation Going

It’s important to keep the conversation going. Our wishes can change over time so it’s important to keep one another updated.

End-of-life planning isn’t about dying – it’s about living. Understanding your loved one’s end-of-life wishes allows you to understand how they want to live their last months, weeks, and days. So, start the conversation and keep it going.

Pretty, young Asian woman with her arms around an older Asian woman outdoors during sunset

Caregiving During COVID-19

By: Laura Mantine, MD

During periods of crisis, like the COVID-19 pandemic, family members and close friends continue to provide daily care for their loved ones. These caregivers provide the initial response and defense for individuals who are often battling chronic medical illnesses. Like many first responders, caregivers often experience stress due to heavy workloads, fatigue, and anxiety. There are important steps that caregivers can take to help manage and cope with this ongoing pressure.

Important Steps for Caregivers to Take

Caregivers should develop habits and strategies to maintain their own physical health and emotional well-being. A caregiver can reduce transmission of a virus by diligent personal and patient hygiene. Washing hands with soap and water for at least 20 seconds frequently throughout the day has been shown to reduce viral spread. It is also important to wash your hands during food preparation, toileting, and blowing your nose, coughing, or sneezing. To be at your best, be sure to eat healthy, balanced meals, maintain a regular sleep routine, and find chances to exercise whenever possible. There is also a constant barrage of pandemic-focused news that can be overwhelming, so try to limit your intake to a certain time or times each day, and do not mistake social media opinion for fact. Remember to take care of yourself, as your loved one’s well-being relies on your ability to maintain your own.

Caregiver Burnout

Over any amount of time, caregiving can be physically, mentally, and emotionally exhausting. Caregiver burnout can happen in any caregiver-patient relationship, but the risk is heightened in times of increased stress like the COVID-19 pandemic. When suffering from burnout, a caregiver may experience hopelessness, overwhelming anxiety, sleep problems, or difficulty coping with everyday tasks. Although caregiving is a major responsibility, it shouldn’t completely overtake an individual’s life. Make time for yourself and take breaks when possible. Use these spare moments to listen to your favorite music, read, or work on a hobby. Also, stay connected to friends and family. Social distancing doesn’t mean total isolation so reach out to friends and family regularly for casual chats and wellness checks. Consider spending time together virtually, whether by watching a movie over a video chat session or playing games together online. If you live with loved ones, find ways to help and support each other.

During these uncertain times, caregivers remain a valuable constant for their loved ones. Please stay physically and mentally healthy as you perform your crucial role.

References

“Family Caregiving During the COVID-19 Pandemic.” Scott R BeachRichard SchulzHeidi DonovanAnn-Marie Rosland. Gerontologist. 2021 Jul 13;61(5):650-660.

“Ensuring Adequate Palliative and Hospice Care During COVID-19 Surges.” Jean Abbott, MD, MHDaniel Johnson, MDMatthew Wynia, MD, MPH. JAMA. 2020;324(14):1393-1394.

COVID-19 and Guilt

By: Michael Larrimore, Director of Bereavement and Chaplain Services

“Guilt is perhaps the most painful companion of death.”

-Coco Chanel

Feelings of Anger and Guilt

Anger can be a common emotion we experience when we have lost someone close to us. We seek someone to blame or someone to hold responsible, someone who could have altered fate to erase what happened, and sometimes our target is the person looking back at us in the mirror. Guilt is a form of anger turned inward, and it can be one of the most challenging emotions to overcome. We look back on the time proceeding our loss, searching for something we missed, what we could have done differently, or ways we could have convinced our loved one to seek out a different course of action. Sometimes we look back and wish we had said something that we kept inside or kept something inside we regret saying.

The Impact of COVID-19 on Guilt

Guilt is complex, and since the beginning of the COVD-19 pandemic it is more pervasive than ever. We might feel guilty because we were unable to visit a loved one during their final days, even if this was a result of precautions or restrictions outside the realm of our control. We might feel guilty for not taking the threat as seriously as we should have, ignoring or forgetting to take the appropriate precautions. Maybe we feel guilty we survived the virus when so many others, including people we knew or loved, succumbed to this terrible disease. This last form is often referred to as “survivor’s guilt,” and it can be very common among people who live through difficult or traumatic events. We are often ill-equipped to deal with any loss, but no one was prepared for something as widespread as COVID-19.

Managing Feelings of Guilt

If you, like so many others, are struggling with guilt related to the pandemic, it can be difficult to find a way to shake how you are feeling. Here are a few things to keep in mind when you are trying to deal with your guilt feelings: The above suggestions are just a few ways to start down the path to forgiving yourself and getting past your feelings of guilt. If you or someone you know is struggling with issues related to COVD-19 or any other difficult life event, there is help and support available in your community. You can call our agency anytime and our family support staff will help get you to the help you need. You can also reach out to the National Alliance on Mental Illness at 800-950-6264 or if you or someone you know is struggling with thoughts of self-harm please contact the National Suicide Prevention Lifeline at 800-273-8255.

Free Rides to Vaccination Sites

In an effort to encourage Americans to get the COVID-19 vaccine, President Biden announced a new partnership with Uber and Lyft. The ride-sharing companies will provide free rides to vaccination sites for anyone in the United States from May 24 through July 4. This agreement was made to help work toward meeting the President’s target of 70% of American adults getting at least one vaccine dose by July 4.

“We’re going to be able to take a serious step toward return to normalcy by Independence Day…And there’s a lot of work to do though to get there. But I believe we can get there.”

– President Biden

How to Redeem Your Ride

A new feature is set to launch in the Uber and Lyft apps within the next two weeks. It will allow you to simply select a vaccination site near you, follow the directions to redeem your ride, and then get a ride to and from a nearby vaccination site free of charge.

While Uber has not yet provided specific details on how the rides will work in the app, Lyft has said a ‘ride code’ will be available through the app and their website.

So be sure to check back in the Uber and Lyft apps to redeem your free ride to a vaccination site!

Happy National Assisted Living Week! As the COVID-19 pandemic continues to change our daily lives, assisted living facilities continue to take the necessary precautions to ensure the safety of their residents and employees. While keeping your loved ones safe might mean you cannot connect in person, here are some ways to support facility residents and employees from a safe distance. Whether it’s a photo of your playful dog, writing a letter sharing an uplifting story, or sending a bouquet of flowers for the front desk to display, it may be just the boost of happiness someone in an assisted living facility needs during this time. As we celebrate National Assisted Living Week, we encourage you to reach out to both residents and staff members with acts of kindness, reminding them of your support and love during these times.By: Portia Wofford Physicians, scientists, and researchers are still learning about COVID-19 and its effects on the body. As they study the impact coronavirus has on different illnesses and disease processes, diabetes is getting attention. The CDC notes that having Type 1 or Type 2 Diabetes increases your risk of severe illness from COVID-19. Because people with diabetes are at an increased risk for developing infections, they should take precautions to protect themselves against COVID-19.

Complications from diabetes related to COVID-19

Currently, there isn’t enough research or evidence to prove that diabetics are at an increased risk for COVID-19. However, if your diabetes isn’t well-controlled, you could have worse complications if you contract coronavirus. According to the American Diabetes Association (ADA), when diabetics don’t manage their diabetes and blood sugars, they are at risk for diabetes- related complications. Additionally, other conditions —such as heart or lung disease — and diabetes worsens the chance of you getting sick from COVID-19 because your body’s immune system is compromised. A recent study showed patients with COVID-19 and diabetes who had high blood sugars were more likely to have longer hospital stays. If you do get COVID-19, the virus could put you at higher risk for sepsis  and diabetic ketoacidosis (DKA). Sepsis is a complication of COVID-19, which causes widespread inflammation throughout your body and can shut down organs. DKA happens when high levels of acid (ketones) are in your blood. In addition to diabetes-related complications, diabetics also have a risk of developing other complications of COVID-19, such as pneumonia, organ failure, and kidney injury.

Type 1 and Type 2 diabetes and Coronavirus

According to the CDC, people at any age with Type 2 diabetes have an increased risk of severe illness from COVID-19. Based on the CDC, the ADA warns that people with Type 1 or gestational diabetes might also be at an increased risk. The ADA states it’s important for any person with either type of diabetes to manage their diabetes. Those who already have diabetes-related health problems are likely to have worse outcomes if they contract COVID-19 than diabetics who are otherwise healthy.

Tips to avoid infection

  1. Stay home as much as possible
  2. Monitor your blood sugar regularly. Maintaining optimal blood glucose, as determined by your healthcare team, is important in preventing severe complications to COVID-19.
  3. Wash your hands
  4. Avoid sick people
  5. Wear a mask
  6. Check-in with your doctors, via telehealth. Most providers schedule telehealth visits—rather than in-person visits. Ask your provider if he or she offers this service.
  7. Exercise. Try exercising at home. Walk around your neighborhood, but be sure to social distance. Right now, there are exercises and workout plans online where you can follow along.
  8. Wash your hands. Wash your hand with soap and warm water for at least 20 seconds. Keep alcohol-based hand sanitizer with you as well.
  9. Wear a mask and social distance. CDC recommends at least 6 feet apart.
  10. Eat a healthy diet:
If your glucose readings change because of changes in your diet and activity level, speak with your healthcare team before making any adjustments to your insulin or other medications.

Your COVID-19 diabetes plan

Because of social distancing and shelter-in-place rules, it may be harder for you to get your supplies. Stock up on enough supplies to last you for a couple of weeks, in case you get quarantined: Keep your home health team updated on your plans, and if you notice any COVID-19 symptoms be sure to alert your home health nurse.

What to do if you get sick

Be sure you know the signs and symptoms of COVID-19: Notify your Hospice of North Alabama nurse , with your most recent blood glucose readings, if you have any of these symptoms. Symptoms can range from mild to severe illness, and appear 2-14 days after exposure to COVID-19. Portia Wofford is an award-winning nurse, writer, and digital marketer. After dedicating her nursing career to creating content and solutions for employers that affected patient outcomes, these days Portia empowers health related businesses to grow their communities through engaging content that connects and converts. Follow her on Instagram and Twitter for her latest.To the Abode Healthcare Community, I hope this note finds you and your loved ones safe and healthy. The COVID-19 pandemic is affecting each of us in different ways. As we navigate the current situation together, I want to provide an update on the steps we have taken to be there for our community, our employees, and our patients. All of us at Abode Healthcare are focused on providing the highest quality of care to our patients. I provided an update at the end of March outlining the changes we implemented to prioritize safe patient care in this new environment. Every decision we have made, and continue to make, has been based on the priority of the health and wellbeing of our patients and employees. I am deeply grateful for our employees who display incredible dedication by continuing to fulfill their commitment to our patients during this especially challenging time. These individuals, and everyone working on the frontlines of care, deserve to feel protected, confident, and taken care of. In recent weeks we have made informed decisions and taken actions that ultimately support and benefit our entire community: I am extremely proud of how everyone at Abode has reacted and handled the unique situation that the COVID-19 pandemic has presented. It’s difficult to adequately express my appreciation for our community—patients, employees, and partners. I have been reminded, once again, what an incredible organization we have—one that is driven by a common purpose of caring for, and serving, vulnerable patients. Every member of our team has come together to do what’s right, and I thank you. We look forward to continuing to work together and supporting each other through this challenging time. Stay safe and healthy, MikePandemic Relief via legislation, CMS waivers, and enforcement discretion Telehealth and Telephonic Visits In an effort to protect patients, some SNF, LTC, hospice, and other facilities are limiting the number of visits that Abode Healthcare staff may make to patients in their care. Some patients are even requesting fewer in-person visits to reduce their exposure to the outside world. Abode Healthcare understands and joins in these protection measures by offering telehealth visits. In some cases where access has been limited or is desired, Abode staff are utilizing telehealth on a weekly or bi-weekly basis in order to maintain contact with high-risk patients. In all cases, telehealth visits are meant to be supplementary to in-person patient visits. Telehealth visits should not replace in-person visits altogether. Telehealth Tools Our commitment, as always, is to serve our patients as best we can. Our clinical team has been trained in effective ways to utilize telehealth systems to streamline patient care through our own remote access system using the following tools: Though telehealth is never our first choice, it is the right choice during this time. Abode Healthcare continues to partner with providers to preserve the health and wellbeing of all of our patients.Times of uncertainty often bring about reflection on our individual mission and purpose – our “why” in life.  We all have a different “why” that has been formed through our passions and life experiences.  Maybe your mission and purpose in life is teaching and mentoring the youth in your community, or maybe it is working in law enforcement to keep your community safe.  Across the company, we are fortunate to have some of the healthcare industry’s most talented professionals whose “why” also aligns with our mission to provide first-class care to our patients and their families. While we all adjust to changes in our daily lives, our employees are continuing to fulfill their commitment to our patients.  From conducting music therapy in outdoor nursing home courtyards to providing meals for hospital staff and first responders, the current pandemic has even given us the opportunity to be creative in carrying out our mission. As stated by Rosie Avila, Community Liaison at our Nurses in Touch location, “our purpose here is not for ourselves; it’s for others and in turn their purpose was for us.”  This rings true throughout the company, and our employees are living out their mission and purpose every day. What is your mission and purpose – your “why” in life?  Perhaps it will be uncovered during these times.  Perhaps it will align with ours.  Perhaps it will provide an opportunity for us to partner in carrying out our missions to support our communities.  We are all in this together!Due to COVID-19, more and more Americans are practicing social distancing. While working at home, schooling from home, and sheltering in place, it’s understandable to wish for a simpler time when you could leave the house or interact with others outside of your household without worry. With new recommendations from the White House to continue social distancing through at least April 30, it’s more important than ever add a variety of entertainment to your life to keep yourself from feeling stir crazy. Here is a list of activities to help pass the time at a socially responsible distance:
  1. Utilize social media and video apps to stay connected to friends and family. Skype, FaceTime, Google Hangouts and Zoom are all video options you can use to connect with your long-distance friends.
  2. Walk, jog, hike or bike outdoors (while practicing social distancing from others).
  3. Read your neighborhood forums to see what types of social-distancing activities they have in place. For example, many neighborhoods are participating in bear hunts, where community members place teddy bears in windows so that kids can look for and count bears during their walks.
  4. Take a virtual tour of the Yellowstone National Park: https://www.nps.gov/yell/learn/photosmultimedia/virtualtours.htm. Many parks, aquariums, and zoos are offering free online tours or virtual experiences at this time.
  5. Write letters to your friends, family, nursing homes, and first responders.
  6. Do some spring cleaning.
  7. Play cards, board games or do a puzzle with your immediate family.
  8. Cook dinner – make a pizza from scratch or try a recipe that you’ve never made before because it was time-consuming.
  9. Join an online book club or meet with your friends virtually to discuss a book.
  10. Take a nap.
  11. Watch a movie or your favorite TV series on Netflix.
  12. Dig out your old coloring books. Coloring isn’t just for kids!
  13. Call the elderly people in your life and check on them. This would be a great time to interview your grandparents to learn more about their lives.
  14. Make a photobook online by uploading your favorite pictures from this past year.
  15. Buy gift cards from your favorite local businesses to use after social-distancing ends.
Let’s make the best out of this current situation by staying positive and being responsible. Spread the love, not COVID-19!

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