Tuesday, September 30, 2014

The Role of a Massage Therapist in End of Life Care

The end of life can be an extremely scary and stressful time. Massage therapy is one of the ways Arbor Hospice provides care for the whole person, relieving physical, emotional and spiritual distress, and offering comfort. The role of the massage therapist includes:

  • Be a healing presence. Massage therapists bring forth something that comes from deep within--their ability to be present. Rather than revert to prescribed techniques, therapists must trust the simplicity of human compassion and their capacity to offer it to another. A therapist’s best resources when serving the dying person doesn't come from the techniques they’ve studied but from within their own hearts. They become the space-holder, allowing the dying person his/her own process and experience, and sometimes serve as an anchor for family members and other caregivers.
  • Enhance the quality of life. Doing what is called for to ease any form of discomfort is the best approach to take. One minute a therapist might be offering a gentle foot massage or holding a hand and the next, moisten dry lips or help turn someone on their side to make breathing easier. Mother Teresa once said, "Let us touch the dying, the poor, the lonely and the unwanted according to the graces we have received and let us not be ashamed or slow to do the humble work." Hospice service is about doing the humble work each moment as it unfolds.

Moving a part of the body for positional change and to ease pressure is a good technique to implement. Change the adjustment of the bed or add supportive pillows under the arms or legs. Mindfully adjust the pillows under the head. Lifting a part of the body and holding it up for a moment relieves pressure.

Therapists must be willing to let go of their idea of what a “regular” session looks like. A session with a dying person may include gentle massage, focused touch or no touch at all. The length of a session varies according to what is called for at the time. The key is sound clinical judgment but also letting the rules go to truly serve the person. Confidence in skills is what allows the therapist to listen to inner guidance and respond accordingly. The patient may simply need someone to compassionately hold a hand or the feet while focusing attention on the inner wholeness of the person. Sometimes massage therapists have to stop doing and simply BE.

Thursday, September 25, 2014

Anticipatory Grief

It is common for loved ones to begin feeling the effects of loss and grief before a death actually occurs. These are normal reactions to current and future losses. Losses can include those associated with caring for someone with an illness, changes in relationships, and the anticipated loss of a loved one. This anticipatory grief may actually help you prepare for the losses and decrease the intensity of grief after the death occurs.

Causes of Anticipatory Grief
Some of the causes of anticipatory grief are related to fears and actual or possible losses, such as:
  • Loss of social life
  • Loss of companionship
  • Loss of usual eating, sleep, work, and recreational habits
  • Loss of independence
  • Loss of control, such as, being able to care for yourself or a loved one
  • Fears related to life without your loved one
  • Fear of losing present family structure, such as head of household, the family matriarch, or frequency of visits from family members
  • Fear of starting over 
  • Fear of the unknown
Signs and Symptoms of Anticipatory Grief
It is normal to experience recurring or combinations of signs and symptoms of anticipatory grief. Some of the signs and symptoms of anticipatory grief may include the following:
  • Feelings of guilt
  • Tearfulness 
  • Constant changes in emotions 
  • Anger 
  • Depression 
  • Feelings of emotional numbness 
  • Anxiety or feelings of fear 
  • Changes in sleeping and eating habits 
  • Poor concentration 
  • Forgetfulness or poor memory 
  • Loneliness 
  • Denial 
  • Acceptance 
  • Fatigue
What You Can Do
There are things you can do which may be helpful for working through the anticipatory grief process. Some suggestions may include:
  • Go for short walks when possible
  • Write in a journal
  • Plan for the future
  • Seek spiritual assistance if needed
  • Talk to someone such as friends, family, or clergy. 
  • Make changes only as needed but put off major decisions when possible
  • Do the things you want to do now. Forget the chores that you can do later. 
  • Spend time with your loved one, friends, support group and family
  • Seek help from your family, friends, and/or a hospice volunteer to arrange some time to spend doing things you enjoy
  • Call your Arbor Hospice team if anticipatory grief feels overwhelming or you want to talk about your feelings
  • Attend a caregiver support group
Sometimes it may feel that the grief process will not end as you experience loss. Please feel free to call Arbor Hospice's grief support services with any questions or concerns. You are not alone.

Tuesday, September 16, 2014

The Importance of Musical Preference in Music Therapy

Why is music preference so important in music therapy?
Research shows that people benefit most from the music they prefer. If a patient loves country music, a music therapist will prepare that genre of music for various interventions depending on that patient’s goals. If the same patient can’t stand jazz, but the music therapist brings a few jazz standards to share in the music therapy session, the patient will not receive the benefit. The patient may think about how much he or she dislikes the music being shared the entire time. When preferred music is being shared, however, patients reminisce more readily, are more social, interact with a brighter affect, and they might even be more active in the session – dancing, singing or playing instruments.

Where does musical preference come from?
Throughout our lives, we are exposed to music in many different environments – in school, on the radio, movies and television, from our children’s and family members’ recitals, or from our own music making experiences. Each exposure to music has the potential to create a permanent impression on us through our emotional memory banks. Research shows that these musical memories can even stick with us when other memories fade away. A patient who has a background of playing the piano may very much enjoy listening to classical piano music, or on the other hand, they might prefer not to think about the weekly piano lessons that they dreaded as a child!

Music therapy research has shown that the most meaningful music typically is that of a person’s young adulthood. For a typical 80 to 90 year-old patient, this means the music therapist will be pulling out 1940’s classics like “Don’t Sit Under the Apple Tree,” or “Let Me Call You Sweetheart.”

However this is a generalization, and is only meant to be a starting point for determining musical preference. Many patients may also be quite familiar with, and have fond memories of, music of their parents’ generation, for example.
Musical Memories
Reminiscing with patients about their musical memories is interesting. One patient recently remembered going dancing with her sister every Saturday night. Another patient always remembers his mother singing around the house. Another patient remembered a song she sang to comfort herself as a girl, when a boyfriend broke up with her. Some patients feel connected to their spirituality through music, and some people just enjoy listening to music in general!

Visit the Arbor Hospice website for videos from some of our music therapy sessions.

Wednesday, September 10, 2014

Addressing Chewing and Swallowing Difficulties

It is common for aging adults and those with illness to have trouble chewing or swallowing their food. Arbor Hospice recommends individuals who have trouble chewing and/or swallowing may benefit from changing the consistency of their food and trying either a mechanical soft or puree diet.

A mechanical soft diet requires some chewing ability. Food should be moist and cooked to a fork-mashable texture. Meat should be ground or minced. Covering the meat with gravy may help. Bread products, crackers and other dry foods may be difficult to swallow and a good substitution can be pasta with sauce.

A puree diet requires minimal chewing. Food should be processed in a food processor until smooth and pudding-like. It should contain no small particles or chunks, which could make swallowing much more difficult. Adding small amounts of water, milk, broth or other fluids to the food being pureed can make the process quicker and help yield a smoother product. Peanut butter should always be mixed with other items when pureed and should never be eaten alone as it is a choking hazard for those with swallowing difficulties. Some items puree better than others. For example, cooked sweet potatoes puree better than regular potatoes, and cooked carrots puree well but corn does not.

Here are some meal suggestions:

  • Regular cooked cream of wheat or grits: no need to puree
  • Fruit: some fruits become wet when pureed and require the addition of a stabilizer. Unflavored gelatin works well for this. Add a bit of lemon juice and sugar to pureed bananas to reduce discoloration. 
  • Coffee cake, danish or donut: add one tablespoon milk or more to reach desired consistency.
  • Hardboiled eggs and toast: puree one egg with two tablespoons milk, one slice of toast and one teaspoon of butter until completely smooth. 
Lunch and Dinner: 
  • Casseroles: puree freshly cooked casserole and add gravy or broth to achieve desired consistency
  • Meat: add a stabilizer like bread, mashed potato flakes or fat to help produce a smoother product
  • Vegetables: cook raw and frozen vegetables first. Puree and add butter or a stabilizer as needed. 
  • Fruit: Some fruits become wet when pureed and require the addition of a stabilizer. Unflavored gelatin works well for this. 
  • Peanut butter and jelly sandwich: puree two slices of bread, three tablespoons creamy peanut butter, two tablespoons seedless jelly and three tablespoons milk or more to obtain desired consistency.
  • Smooth cream soups
Snack Ideas: 
  • Pureed cottage cheese
  • Pudding
  • Apple sauce
  • Yogurt
  • Dutch Apple Pie: puree one slice of pie with three tablespoons milk until desired consistency. 
  • Cupcake: puree cupcake with two tablespoons milk
  • Frosted brownie: puree browning square with 1.5 tablespoons milk or more to reach desired consistency

Wednesday, September 3, 2014

Spiritual Care Offers Education and Encouragement

When most people think of spiritual care, they think of religion. In healthcare and at the end of life, spiritual care means so much more.

"Spiritual care becomes what the patient or family needs it to be," said Tim Brokaw, Arbor Hospice Spiritual Care Coordinator. "Sometimes patients want to talk about religion and heaven, but more often than not, they need affirmation and encouragement."

Spiritual needs and concerns sometimes relate to the "big" questions in life - what is happening, what does it mean, how do I make sense of this, what is important in my life, will my family be okay when I'm gone? Other times, patients and families need someone to talk to.

"It's my job to listen, educate and encourage," Brokaw said. "I don't go in with an agenda. I go with experience and training, wanting to offer whatever the family says they need."

Brokaw often hears patients and families describe their life as a rollercoaster with many ups and downs.

"People are so used to controlling everything, organizing and planning," he said. "You can't control the end of life, so I encourage patients and families to be flexible and embrace the time they have with each other."

Arbor Hospice Spiritual Care Coordinators acknowledge and explain that what a patient or family is going through is normal, and they do not have to endure alone. Patients need to know their loved ones understand and are going to be okay. Tim and his counterparts encourage spouses to tell their loved one that he or she will be okay - "the kids will take care of me," or "don't worry about me."

Brokaw says you can never assume you know what someone needs. He always asks and encourages others to do the same.

"When I asked one man what he wanted when he was dying, he told me he didn't want people whispering around his bed. He wanted to hear his family chatting loudly, enjoying life. His family was happy to know he wasn't afraid and how they should act. That's what spiritual care is all about - bringing patients and families comfort."