Hospice & Palliative Care…My Next Step

Hospice Pallative Care Detroit MichiganToday’s blog will be a little different. This time it is about me. I rarely do this. I have been practicing nursing for more than 20 years and am taking a significant step toward fulfilling one of my professional goals.

New Skills:

I will be embracing the role of a hospice and palliative care nurse. Just part time, Gentle Readers- I know there are those who need help navigating their next course here on earth! And that is still a calling I need to fill.

Helps ElderCompass:

This is such a meaningful step for me and for ElderCompass. For years, I have worked alongside hospice professionals who give of themselves and share one of the most intimate experiences we have here on earth. Now I get to share too and anticipate doing what comes completely naturally to me.

Some may cringe, some may say “yes!”, I myself say- finally. I will learn what I am made of and will be blessed by shepherding loving dads, moms, sisters, aunts, best friends and neighbors to their next experience as only they will know it. Hospice care gives people the a chance to have those last conversations, to be comfortable, and surrounded by loved ones as they transition.

Please see this definition for hospice and palliative care:

“…compassionate care for people facing a life-limiting illness or injury, hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’s loved ones as well.  At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so.”

Click here to learn more

Guest Post: How to take care of aging feet

Aging feetIt’s been a really cold and really long winter.  Everyone wants to get out and enjoy some of that sunshine! However, it is very important, especially in the senior population to make sure those feet are ready to spring into action.  Here are some simple tips to help keep your feet healthy, avoid falls, and to improve your quality of life.

It’s very important to practice good foot care.  Check feet regularly.  If you see or feel a problem see your podiatrist right away.  Most foot problems can be fixed or alleviated.

Senior Foot Care Tips:

  • Make sure to keep the blood circulating to feet as much as possible.  Put your feet up when sitting or lying.  Stretch your feet and ankles if you have been sitting for a long time. Try walking, gently massage your feet, or soaking feet in a warm foot bath to get the blood flowing to avoid cramps, sores, and blood clots.
  • Make sure shoes are comfortable and the right style based on activity.  Walkers should wear good walking shoes.  Avoid shoes that don’t fit right and put pressure on feet in all the wrong places.
  • Avoid exposing feet to extreme temperatures.  Feet can get a very bad sunburn on the tops depending on the shoe.  And sorry to say, flip flops are a no no at any age!
  • Before going out and doing any type of exercise make sure to be well rested, take medications, and be sure to have any type of necessary devices like a walker or a cane available.

Put your best foot forward and don’t  try to over do it.  We have many summer months ahead to enjoy this beautiful weather!

Author Information:

Karen Swisher, Hone Podiatric Care LLC

When Should Do Not Resuscitate Orders Be Written?

The topic is more important than you may think. It’s not a pleasant one, but it is worth discussing as we live longer and more medically-complex lives. Medical technology can keep us and those we love, alive longer. But what does this life look like to you? How does it affect yours and your family’s lifestyle? Your spirituality?  Your finances and financial legacy? We actually have the potential to influence and choose how we want to live the last weeks or days of our lives!

Do Not Resuscitate Law

In Michigan, we have the Do-Not-Resuscitate Procedure Act. This act informs health care professionals NOT to revive individuals who have signed a do-not-resuscitate order document.  It is for those individuals who do not want any special efforts made to prolong their life if their breathing or heart stops.  The document can be customized to include or exclude certain measures like chest compressions, use of certain drugs to help re-start the heart etc. and whether to include the use of breathing devices.  A competent adult can obtain and complete this order after discussing with his or her physician. The physician must also sign the order. People whose religion opposes medical treatment do not need a doctor’s signature.

The Do Not Resuscitate Form

The form/order should be placed in a prominent and visible place where one resides. Have discussions with family, friends, and caregivers and inform them about the signed do-not-resuscitate order; tell them where to find it. All advocates should carry a signed copy with them. Bracelets indicating specific wishes are also suggested.

Frequently Asked Questions:

Where do I get the form? The forms are available at most hospices and online. Click here to see an example of one.

Can I be forced to sign a Do-Not-Resuscitate order? Absolutely not. No one may require it as a condition for care or treatment.

Can I change my mind after I sign it? Yes, it may be cancelled at any time by any means of communication possible.

Will my insurance coverage be affected if I  sign such an order? No, the law says that your insurance provider cannot change, stop, refuse to renew, or invoke a suicide exemption or exclusion.

Keep up to date!

Do-Not-Resuscitate orders have changed and may continue to change as our health care technology evolves. Such orders used to, or may still apply  in your state, only in health care facilities such as hospitals and rehabilitation/nursing homes. People were not covered outside of such facilities, such as those at home with terminal illness. Licensed health professionals were required to try and revive anyone who had no heart beat or sign of breathing. In our state, when an order is present or a bracelet is worn, emergency responders cannot start resuscitation.

Make your wishes known today. Have that challenging conversation with your loved ones. Live the way you want to live while you are here on earth. You and your Elder will have peace of mind that the last season of life will be as they wished.

Senior Driving Tips: Time to relinquish the Keys

taking away seniors keysOnce conversations have occurred about decreasing or stopping driving, pull out all the stops! [So to speak]

Get Evaluated

Suggest or even insist on a professional or state evaluation—sometimes this suggestion can get a more realistic response and spur an honest self-evaluation of the driving senior. Or encourage your senior to enroll in a course for refresher skills. Many driver evaluation tools are available and listed below. Assessment tools from The Hartford Services Group, Carfit, Alzheimer’s Association, and others are included.

Financial Cost

Another approach involves taking the conversation to the bottom-line financial cost of driving and maintaining a vehicle. Discuss the breakdown of owning, insuring, licensing, parking and general automobile care. Appeal to the pocketbook. Minimize transportation–related issues by utilizing delivery services of groceries, prescription medication, even prepared meals, and shopping by catalog or online with assistance from an advocate.

Safety Steps

Safety of your Elder and the safety of others must be considered first. Because the result of unsafe driving can mean serious injury and even death of the senior and others, there may come a time that keys must be relinquished or the vehicle disabled. If no amount of rational discussion has convinced your older driver to stop driving, even the use of driver evaluation assessments, professional and personal recommendations, there are some steps you can take to get impaired drivers off the road.

  • Organize an intervention-invite family, close friends clergy, a social worker or nurse, and anyone else your senior might view as an impartial authority. AND be respectful during the meeting no matter what. If more than one person is present, it will not seem like nagging. Give specific examples like: “You cannot turn your head as easily anymore, or you have had three parking lot accidents this year,” etc. During this meeting, all those who can volunteer to drive should make their offering known.
  • Make an anonymous report to the local Department of Motor Vehicles and explain your concerns. You will be asked to provide the driver’s vehicle license and/or name. A driving test may be initiated or even a warning letter issued. Both of these may convince the impaired driver to discontinue driving and hand over the keys.
  • If medications are impairing your driver, request a ‘No Driving” prescription from the treating physician.
  • Alter the vehicle to impede function/make it impossible to start, lose the keys, or remove all together.

These last measures may seem so extreme, but remember that this approach saves lives. Understand that the change of no longer driving is an extremely difficult transition. Make sure to be present and willing to assist during such an emotional time. Hopefully your senior will understand and respect what it takes to offer this tough-love solution to aging.

Senior Driving Assessment Resources:

Senior Driving – AAA

NSC – Driver Safety

As You Age – Senior Driving Resources


Pre-Paid Funeral Planning Tips

Is your loved one in the last season of their life?

End of Life Decisions

Some call it, “end of life”. So much happens at the end of a person’s life. Decisions that must be made and the information that must be gathered can seem overwhelming. Someone you love dying can be very emotional and stressful.  It is helpful to plan today. Please take an important first in step and consider a pre-planned funeral. When the planning and effort is put forth early, you have the peace of mind that wishes are fulfilled to the best of your ability. This will allow you to grieve and spend time with loved ones as well, and not worry over all the details.  In addition, it can prevent your family from being taken advantage of in your time of grief.

Do your best to ascertain what your elder wants or would have chosen for his/her particular funeral or burial arrangements if they are no longer able to make decisions. Oftentimes people can be uncomfortable or confused with pre-planning funeral or burial arrangements.

Pre-Paid Funeral Planning Items to be Considered:

  • Traditional burial, cremation, or mausoleum interment
  • Specifics regarding a casket or urn
  • Memorial Service  & details, if desired
  • Funeral home choice
  • Memorial Funds/donation suggestions

Discuss the details of what may be in place presently and then meet with other advocates and a funeral director when you are ready. Funeral directors are trained to provide services with integrity and the compassion one needs during such an emotional time. There are variably-priced funeral and cremation facilities: make the choice that fits with your elder’s wishes and budget. Select a funeral home close to your family and support system. Have the funeral director provide written detailed costs.

Funeral Home Services Include:

  • Preparation of the body for cremation or burial
  • Details regarding the facility and equipment- visitation room, chapel, slide show etc
  • Assistance with preparation of obituary
  • Completion of necessary paperwork required for death certificate
  • Coordination with cemetery for plot purchase or placement

Note: It is crucial to understand financial and beneficiary listings: seek counsel from an elder law attorney to make sure plans fit together with the resources available.

If your loved one was a veteran, you or your family member may be entitled to burial benefits. They must have completed the required period of duty honorably. Please check with your local or regional Veteran’s Administration Office for current benefits or procedures as they are sometimes changed by the Administration or Congress.  You can call the Department of Veteran Affairs in Washington. D.C.  (800) 827-1000. As with Social Security, you must apply for Veteran’s Benefits.


Required Military Funeral Documentation:

  • Veteran’s Death Certificate
  • Veteran’s Marriage Certificate (copy)
  • Birth Certificate of Veteran’s Minor Children
  • Veteran’s Discharge Papers
  • Receipt of Itemized Veteran’s Funeral Bill

Three Advantages to Pre-Planning a Funeral:

  1.  Your loved one’s wishes can be preserved and carried out.
  2. Having the details already identified, family and advocates can focus on the work of grieving and receiving the support they need during this challenging time.
  3. The person for whom you are planning the funeral also knows their advocates will have less stress and that their affairs are in order.

More Information & Resources: