Thursday, June 26, 2014

Near Death Awareness

Near death awareness is a special communication of the dying. It usually occurs when individuals are approaching or are in the dying process. Most patients who have signs of near death awareness are more peaceful after the experience.

Signs of Near Death Awareness

People who are experiencing signs of near death awareness may:
  • Appear confused or disoriented
  • State that they have spoken to those who have already died
  • Speak to people and see places not visible to you
  • Describe spiritual beings and bright lights
  • Talk aloud to people who have died before them, such as their mother, father or a close friend
  • Make "out of character" statements, gestures or requests
  • Describe another world of peace and beauty
  • Tell you exactly when they will die
  • Make hand gestures, reach for or hold unseen objects or wave to unseen beings
These behaviors do not mean that they are confused, hallucinating or having a reaction to their medications. It is believed that the person is beginning to transition from this life. The person may be trying to describe the dying experience or something they need to do before they die.

These messages of the dying may be symbolic communication to ask for permission to die or address a need. Some things they may need include resolving previous conflicts, receiving a visit from a friend, or knowing that you will be okay without them. What they say often has meaning to them and is linked between this life and death. For example, if they traveled a lot, they may say, "I need to pack my bags" or "I need to get on the plane." A patient who was a boater may talk about the tides. A rancher may describe his horse waiting to take him for a ride.

What You Can Do:
  • Do not contradict, explain away, belittle or argue. These experiences can be very comforting to the individual.
  • Be present with the person. Simply sit at their bedside and be open to their attempts to communicate.
  • Listen attentively and sensitively and acknowledge the experiences.
  • Ask gentle questions about what your loved one is saying or doing. Questions such as "who do you see?" "what are you seeing?" and "how does that make you feel?"
  • Allow the person to share this experience with you.
When individuals experience near death awareness and describe death as peaceful, they are providing others with a better understanding of the death experience. This may be their final gift to you.

Tuesday, June 24, 2014


Journaling is one way to express your thoughts, feelings and experiences through writing or audio taping. It is a safe, personal and private activity that may help individuals with serious illness or their caregivers release stress and clear their mind.

How to Journal

You do not have to be a writer to journal, and there are no right or wrong ways to journal. Journaling

is for you alone, so it is whatever you want it to be. Some suggestions for keeping a journal include:

  • Keep paper and pen nearby. You can write in your journal everyday or whenever you feel the need to express yourself. Don't pressure yourself to write. The words will come to you when you are ready to release your feelings and clear your mind.
  • Let your thoughts flow. Do not worry about grammar or punctuation. Remember, you are the only one reading your journal and it only needs to make sense to you.
  • You can write on any paper, in a notebook, a diary, a journal and even on a napkin or the back of cards.
  • You can draw pictures if writing is not your favorite activity. You don't have to be an artist.
  • Remember that your journal is yours alone, a private expression of your thoughts and feelings. No one should read your journal without your invitation or permission.
  • If you are unable to write or writing is not comfortable for you, you can record your thoughts and feelings on audiotape.
What You Can Journal

You can write about anything that is important to you. Some suggestions of things to include in your journal are:

  • Feelings and emotions
  • Fears
  • Accomplishments
  • Major events in your life
  • Your life story
  • Favorite memories
  • Favorite pictures
  • Your hopes
  • Your dreams
  • Daily experiences
  • Relationships and what they mean to you
  • Conflicts
  • Poetry or favority quotes and what they mean to you
  • Anything that is causing you physical, emotional and/or spiritual comfort or discomfort

Thursday, June 19, 2014

Emotional and Spiritual Preparation for the End-of-Life

Dying is an emotional and spiritual journey. Each person involved may feel a wide range of emotions. You and the person facing the end of life may experience emotional and spiritual reactions as you prepare for death. The following feelings are normal reaction and part of that preparation process.
  • Asking "why me?"
  • Fear of being alone, dying or going to sleep
  • Increased desire for physical affection or touch
  • Increased desire to have loved ones close by followed by withdrawing from relationships
  • Loss of interest in usual activities
  • Feelings of embarrassment about being dependent on others and being a burden
  • Feelings of denial, guilt or anger about changes, relationships or life
  • Wanting to talk about the past
  • Returning to religious practices or losing faith in religious beliefs
  • Seeing or talking with dead loved ones
  • Experiencing spiritual being or phenomenon such as angels, bright lights or visions
There are also many practical considerations which individuals and their families may face and feel a need to discuss including:
  • Fear of not having enough financial resources, both by the dying person and family members
  • Completing wills and estate planning
  • Planning for cremation, burial and/or memorial service
  • Planning for future care of children, pets or dependents
It is important to allow each person to talk openly and honestly about these feelings and issues. Talking about these issues may be important to finding comfort and peace. The Arbor Hospice care team is specially trained in these discussions and are available to help patients and families.

Tuesday, June 17, 2014

What is Reflexology?

Reflexology is the practice of applying pressure to the feet and hands utilizing specific thumb, finger and hand techniques without the use of oil, cream or lotion. It is based on a system of zones and reflect areas that reflect an image of the body on the feet and hands with a premise that such work effects a physical change in the body. This is one of many techniques massage therapists use on clients, including individuals nearing the end of life.

The concept of reflexology began to emerge in the 19th century with European and Russian research into the nervous system. Reflex therapies were created as medical practices but soon eclipsed by the use of surgery and drugs. The ideas of reflex use for health improvement were carried on sporadically and brought to America in 1909 by Dr. William Fitzgerald, an eye-ear and nose specialist from Connecticut. Physiotherapist, Eunice Ingham is credited with developing a system of reflect areas sometime in 1938.

Research has shown the specific techniques of reflexology to be effective and beneficial in many ways. A survey of 170 reflexology studies from 21 countries showed that reflexology is effective, impacting a variety of physical and psychological concerns.

There are many benefits to a reflexology session:
  • Creates relaxation: From the moment the reflexologist's hands start their work, the relaxation begins as shown in research using EEG brain activity. All together, 24 studies demonstrate reflexology's relaxation effects.
  • Reduces pain: Pain reduction following reflexology work is documented in 27 studies, including research showing impact on individuals of all ages and health states.
  • Enhances medical care: Reflexology helps when nothing else can for many phantom limb pain sufferers, neuropathy patients and hemodialysis patients, to name a few.
  • Benefits mental health: Research demonstrates that reflexology can reduce depression and anxiety.
  • Complements cancer care: Pain, nausea, vomiting and/or anxiety eased for chemotherapy patients following reflexology work as shown by 16 studies from seven countries.
In general terms, the benefits of reflexology have to do with the reduction of stress. Because the feet and hands set the tension level for the rest of the body, they are an easy way to interrupt the stress signal and reset homeostasis, the body's equilibrium.

Reflexology sessions last from 30 minutes to an hour. The client sits in a reclining chair placing the feet conveniently for the reflexologist to work. The reflexologist uses pressure and stretch movement to work through the foot methodically. Technique is applied to the whole foot or hand.

This blog post was written by Michelle Chaves-Torres, Arbor Hospice Massage Therapist. You may contact Michelle by commenting below or emailing her at

Wednesday, June 11, 2014

The Dying Process

It is common for patients, families and caregivers to have questions about the dying process. The Arbor Hospice care team does their best to help families understand what is happening. Yet, the dying process is different for each and every individual and the duration may vary from hours to days.

Some of the first changes caregivers notice include decreased appetite, increased weakness, withdrawal from family and friends and increased sleepiness. As death approaches, body functions continue to change.

When death is imminent, caregivers may begin noticing some physical and mental changes, including:

  • There may be changes in responsiveness. Your loved one may be more difficult to arouse. Even if your loved one is not responding, please remember hearing may be very acute. Continue to communicate and comfort the patient by talking to them and gently touching them.
  •  Usually, it is difficult to swallow near the end of life, and your loved one may refuse liquids and/or medications.
  • There may be changes in urinary function, such as incontinence (loss of bladder control) or decrease in the amount of urine.
  • A temperature elevation is not unusual at this time.
  • Breathing may become more irregular, labored and noisy. This does not mean that your loved one is uncomfortable or in distress.
  • Arms, hands, legs and feet may become cool to touch and may take on a bluish color. This is due to slowing of circulation.
Should any of these signs occur, contact your Arbor Hospice team. Arbor Hospice is available to patients and families 24 hours a day, seven days a week.

Monday, June 9, 2014

Remembering The Legacies of Great Generation Dads

In a recent post by Arbor Hospice volunteer, Dennis Sparks, he outlined how we can fashion legacies through life choices and actions. Dennis also noted the importance of preserving the stories of a family's heritage. He has applied his talents in patient care settings, making audio and video recordings that will stand as remarkable keepsakes.

We are in a time of exodus for a great generation. But men and women born in the first third of the 20th century did not spend much time contemplating their legacies. They worked hard--often with their hands and backs, and often under the duress of worldwide upheaval: the Great Depression, World War II, Booms and Busts and yes, Bubbles.

As the Condolence Note Coach, I encourage everyone to observe, remember, and share. The result--when stories are retold, provides tremendous comfort and insight to persons who grieve. Father's Day nears, and I decided to gather legacy stories of "great generation" Dads. Listening for legacies will be helpful when the time comes to write a condolence note.

Some legacies hold admiration for a character quality
“The memory of my dad’s love for my mother, is a legacy I cherish,” Lyn shared. Though that love was evidenced throughout her life, Lyn remembers her father, Ellis, during his home hospice care: Even when he was sick and in bed, he wanted to be sitting up, out of the bed, ready to greet his wife when she came home.” The memory is bittersweet for Lyn, long-divorced, but she believes in the "gold standard" for all marriages.

“Daddy was a giving person,” Libby shared, and described how he was never too busy to be helpful, playful or community involved. “Chores were set aside to play a board game or croquet; to ferry me to piano lessons and recitals,” she continued. “I admired him greatly; he’d think nothing of hosting a crab feast in our yard for a big crowd of the Penn Daw Fire Dept. Auxiliary.”
Some legacies are rooted in wonderful experiences
Larry shared, “The legacies my father, Joseph, passed on to me and my seven siblings were not tangible things—like a pocket watch or money—but much more valuable: an all-encompassing value system. I grew up during the Depression, and my dad was busy keeping bread on the table, but found time to nurture our imaginations, our skills, our characters, and our spirits. To me, these legacies never tarnish, never depreciate, never decay throughout life.”

“When I was a boy, I was my dad’s “tag-along” buddy,” remembered Ray. “We’d go to places like the VFW Post, the Knights of Columbus Hall, the barbershop, and bricklaying side jobs at the homes of his friends. I enjoyed being a part of "Alfie’s" world, listening to conversations while having some pop and chips. Dad’s legacy was showing me how to be a good buddy.” Friendship and helping go together, in Ray’s view: “When I help a friend cut down a dead tree or fix a plumbing problem, I know my dad is smiling down on me.”
Old-fashioned, practical advice is a common legacy
My dad was one to share a few pearls of wisdom,” Christine chuckled. “My favorites are:
1. Honesty is the best policy.
2. Don't leave for tomorrow what you can do today.
3. If you don't have to stand---sit. If you don't have to sit---lie down.”

Bev grew up in a family business where everyone was involved. “My parents gave me so many life tips, like:
  • Take pride in your work and, finish what you start.
  • If you can't pay for it with one week’s pay you can't afford it (except for a house and a car.)
  • Try to accept others for who they are and remember, we are all different.

And there are legacies that read like an eHow page
“My dad, who was raised on a sugar beet farm, told us that the WHOLE apple is good, and sure enough he would eat the whole thing. And now, I do too.” Christine recently learned that the apple seeds are very nutritious. “People give me surprised looks, and I explain,’that’s what my dad taught me.’”
Beverly, just shy of 60, has never been in an accident, thanks to her dad’s bald instruction: “Drive like everyone is out to kill you.”

These most-prized legacies are weightless yet fill the heart. In writing a condolence note when a friend has lost a father (in this example,) recognize something you perceive to be a legacy. It may be an first-hand observation of the man, or a quality of character adopted by the child. Here are some suggestions:

“I could sit for hours listening to your Dad's stories about ____. He will be greatly missed.”
“Your father’s carpentry tools will never grow rusty. Like him, you’re ready to help …”
"Your dad greeted everyone at the church door with a cheery ‘_______’’”
“I remember watching you work on that Camaro, with your Pop …"
"Your father inspired me to volunteer at _____ by his work with ______, "
This blog post was written by Deborah R. Chappa, the Condolence Note Coach. She works in a Livonia, Michigan funeral home and is an author, blogger and instructor on writing condolence notes.

Thursday, June 5, 2014

The Desire To Be Known

"As one gets older one's fear subsides. What becomes more and more important just to be known, known for all that you were during this brief stay. How sad it seems to me to leave this earth without those you love the most ever really knowing who you truly were." -The Bridges of Madison County

In the past three years, I have supported dozens of Arbor Hospice patients and their families in preserving patients' life stories on video and DVDs.

I have learned through those experiences that most of us have one fundamental thing in common as our lives near their end - we want to share what we have experienced and learned and to be known for who we uniquely are.

During the hour or two that it typically takes to record patient and family memories, patients share:
  • Life events and memories that no one else in history has had or will ever duplicate;
  • The simple but always profound wisdom that they have acquired over their lifetimes, no matter how long or brief life has been (the oldest patient was on the cusp of 101 and the youngest was 17); and
  • Special messages of encouragement and support to children, grandchildren and other loved ones that will resonate across generations.
It is not necessary to wait until the end of life to reveal to others who we are. Use every opportunity that presents itself to reveal to your loved ones what you have experienced and what your life has taught you?

This blog post was written by Dennis Sparks, Arbor Hospice Volunteer. You may contact Dennis by commenting below or emailing him at

Tuesday, June 3, 2014

Songwriting With Patients

Songwriting is an intervention used by music therapists in many different settings. In hospice, songwriting can be a beneficial tool to address a vareity of patient needs. This intervention can be shaped and changed to be successful for many patients, regardless of their cognitive abilities or their willingness to be open and expressive.

For patients whose cognition is compromised, a music therapist may use songwriting as a success-oriented intervention to increase interaction and reminiscence. For example:

"This train is bound for (location), this train.
This train is bound for (location), this train.
This train is bound for (location), and (patient's name) is going to bring (item).
This train is bound for (location), this train."

In this example, the music therapist would encourage the patient to choose a location to which they would like to travel, or have enjoyed traveling in the past. The patient would then identify some items (favorite book, favorite drink, favorite snack) or even a special person to bring on the make-believe trip. This intervention can continue as long as the patient can still come up with ideas for a trip and things to bring along.

When working with a patient who is higher functioning, but has difficulty expressing themselves, a fill-in-the-blank songwriting experience can be very useful for eliciting expression, reminiscence and interaction. A music therapist may omit words from an existing song, such as "lean on me" or "sometimes in our lives."

"We _______________________________________
We ________________________________________
But if we ____________________________________
We know that _________________________________"

In this example, a patient can benefit from the structure of a pre-existing song to develop their own thoughts and feelings. This, like the previous example, is very success-oriented to help the patient have a sense of accomplishment and enjoyment.

Finally, occasionally, a patient may enjoy talking about a certain subject during every visit. Discussing this topic may bring this patient a sense of joy, pride or contentment. In this case, the patient demonstrates facility with self-expression and may benefit from a less structured form of songwriting. In this case, the music therapist would work with the patient to devise original song lyrics, and possibly even a chord structure, rhythm and overall style of song. This song would be a unique product of the patient, and a great source of pride and accomplishment.

Songwriting can be a useful intervention with hospice patients. For patients who wish to leave a legacy or a gift for their families, a unique and original song may be a treasured item after the passing of the patient. Additionally, music is a powerful tool to elicit socialization and reminiscence, increasing the quality of life of the patient with whom the music therapist is working.