I am excited to let you know about a new book I have just finished which has uniquely designed visual tools to help with difficult conversations, lots of articles you can share with others, and a step-by-step conversation guide to help with issues such as denial, guilt and evaluating danger. – To order use the contact page or email Viki at firstname.lastname@example.org
New — Resource Workbook, Conversation Guide and Visual Toolkit
100 pages (8½ x 11) Full sized, photocopiable worksheets
Usually $40 – Book launch SPECIAL: $32.95 plus sales tax and shipping
(You can order it by emailing me at email@example.com)
Here are a few of the resources included the workbook:
- Section 1: Medical Decision Making Tools
Crisis Planning Article and Worksheet
Drawing an Option Roadmap Article and Diagram
Weighing the Options – Risks, Benefits and Burdens Exercise
Evaluating Treatment Options Article and Algorithm
Two-Hand Test for Making Medical Decisions Diagram
5-Step Process to Help the Person Get Out of Denial
- Section 2: Evaluating Danger and Risk Tools
Protecting vs. Respecting – Managing the Danger Article
Evaluating Risk for Those Without Capacity Diagram
Evaluating the Dangers Worksheet
- Section 3: Caregiver Conversation and Support Tools
The Ladder Diagram – The Caregiver’s Needs Count Too!
How is Your Relationship Now That Illness Has Come Into Your Lives?
Viki Kind’s 4-Step Process for Asking For and Accepting Help
How to Say “No” Handout
- Section 4: End-of-Life Conversation Tools
Quality of Life Statement Template
Guidance for My Decision(s) Maker Worksheet
What I Want My Doctor to Know About My Faith and/or Culture
Two CPR vs. DNR Articles
While it’s very important to create advance directives, its equally important to make sure they’re available when they’re needed. You wouldn’t believe how many times doctors are told, “I know my mom has a healthcare directive but I don’t know where she keeps it.” Without access to your documents, how will the healthcare team know what you want?
DocuBank is a service that makes sure a person’s advance directives and emergency information are immediately available 24 hours a day, worldwide by fax or the Internet. Each member receives a plastic wallet card, and then they, their family, or hospitals can use that card to obtain their important documents. http://www.docubank.com/
Have a kind and respectful day.
End-of-Life Conversation Kit
A Bioethical Perspective and Toolkit
- Includes: 80-Minute DVD, the Go Wish Cards, and my Award Winning Book
Holiday Special for entire kit: $55 plus sales tax/shipping (Usually $70)
Items can be ordered separately. Email/call to order: firstname.lastname@example.org or 805-807-4474
1. 80-minute DVD presentation and 13 articles and worksheets:
“Why the Healthcare Directive You Wrote Might Not Work In the Hospital”
A Bioethical Perspective and Toolkit to Protect Patients
A practical, in-depth presentation for you and those you work with:
•Specific ways healthcare directives fail in the healthcare setting.
•How to create a document that will be personal, meaningful and will work in the hospital setting.
•Discussion of CPR, feeding tubes and other life saving medical treatments from a medical point of view.
•Conversation tools to facilitate these difficult end-of-life discussions.
•Insights regarding the unexpected financial costs at the end of life.
•An algorithm to help your client’s decision maker make better medical decisions when the time comes.
•How to increase the chance that the doctor will honor the directive.
DVD also includes the following documents:
•A Template to Use to Create a Quality-of-Life Statement
•Viki’s Quality-of-Life Statement
•Guidance for My Decision Maker(s) Worksheet
•A List of Questions to Ask When Making Medical Decisions
•Crisis Planning Worksheet for Urgent Decision Making
•An Algorithm for Evaluating Treatment Options When You Know the Patient’s Long Term Goals
•Three Easy to Understand CPR Articles
•What Do I Want The Doctors To Know About Honoring My Faith and Culture Worksheet
•Steps to Follow When Having My Doctor Review My Advance Directive Worksheet.
•Insider’s Guide to Filling Out Your Advance Directive
•Quick Tips $45 if purchased individually.
2. Go Wish Cards: An easy way to talk about your client’s end-of-life wishes by sorting the cards into piles: What do you want? What don’t you want? Do you want to be free from pain? Do you want your family with you? Do you want to meet with clergy?
$10 if purchased individually.
3. The Caregiver’s Path to Compassionate Decsion Making: Making Choices For Those Who Can’t. The unique, award-winning book on how to make the life, health and end-of-life decisions for those who have lost capacity. Ethically based, it alleviates a lot of caregiver angst.
$15 if purchased individually.
About Viki Kind:
Viki Kind is a clinical bioethicist, medical educator and hospice volunteer. Her award winning book, “The Caregiver’s Path to Compassionate Decision Making: Making Choices For Those Who Can’t,” guides families and professionals through the difficult process of making decisions for those who have lost capacity. She has lectured across the United States teaching healthcare professionals to have integrity, compassion and to improve end-of-life care through better communication. Patients, families and healthcare professionals rely on Viki’s practical approach to dealing with challenging healthcare dilemmas. Viki provides bioethics consultation and support for many hospitals in the Los Angeles area. She holds a master’s degree in bioethics from the Medical College of Wisconsin. Viki is an honorary board member of the Well Spouse Association. She has also been a caregiver for many years for five members of her family.
Have a kind and respectful day.
How to Say “No” Handout – author unknown but very much appreciated.
When you need additional time to think about your own needs:
1. I don’t have an answer on that so I’ll have to get back to you.
2. I’m not sure what I’m in the mood for. Let me check in with myself for a moment.
3. Let me check my calendar and get back to you.
4. I’ll have to see about that. How about I give you a call in a week of so?
5. I may have something else planned that day. I’ll let you know.
6. I feel overwhelmed this month. Can we talk about it again in a few weeks?
7. Let me do some thinking about it first. When do you need an answer?
8. That merits serious consideration. I’ll make a few calls and let you know.
9. That sounds good, but I’ll have to see what ___________ has planned for us first.
10. You’ll have my answer by five o’clock tomorrow.
When its time to say “No”:
1. I’m just not available next week.
2. I think I’ll have to take a rain check on that.
3. I won’t be in town. Can I help you come up with some alternatives?
4. I’ve decided I need a rest from that sort of thing, but thank you for asking.
5. I’m afraid I just can’t afford to right now.
6. I promised my family to spend more time with them. I am sure you understand.
7. Have you asked ___________ or ___________? Either one seem perfect for that job.
8. I’m flattered you asked for my help, but I am a bit overcommitted right now.
9. It’s been a rough week and I’m just not feeling up to it.
10. I’m taking myself on vacation. I’m sure you’ll find good volunteers for that.
11. Tomorrow? Oh, that’s short notice. I’m afraid I can’t make it.
Keep in mind that:
1. No excuses are necessary.
2. No apology is necessary.
3. It is quite possible to say, “No,” while being both courteous and polite.
4. Saying it like you mean it tends to prevent the other person from trying to talk you into it.
I am delighted that Comfort Keepers is hosting a book signing for me at the Westside Pavillion on September 29th, 2013 from 1pm-3pm.
Come by and see their new location and discover the services that they offer.
10800 W Pico Blvd #280
Los Angeles, CA 90064
(2nd floor, next to Nordstrom)
The Caregiver’s Path to Compassionate Decision Making:
Making Choices for Those Who Can’t by Viki Kind offers practical tools, techniques and support for making informed, respectful decisions for those affected by Alzheimer’s, strokes, brain injuries, developmental delays, mental illness and other mental limitations. Caregivers will find peace of mind knowing they are doing right by the person in their care. . . Come get your copy signed by the one and only. See you then!
Hope to see you there,
Have a kind and respectful day.
Wednesday – September 4th at 11AM PDT/2PM EDT on http://www.blogtalkradio.com/kindethics/2013/09/04/groundbreaking-dementia-hospital-wristband-program
Listen live or download later.
Join me as I interview Gary Joseph LeBlanc and Margaret Doerr about the groundbreaking dementia hospital wristbands which are designed to help healthcare professionals to know that the patient has a cognitive impairment and that special care and patience needs to be given. This new program is launching in Florida. Find out how you can bring this program to your hospital and community.
Gary Joseph LeBlanc, is the author of “Staying Afloat in a Sea of Forgetfulness,” “Managing Alzheimer’s and Dementia Behaviors” and co- author of “While I Still Can”. Also, a weekly columnist of “Common Sense Caregiving” published in the Tampa Tribune and Hernando Today and many other health publications.
He also founded the Alzheimer’s/Dementia Hospital Wristband Project
His writings and speaking events utilize his 3,000 plus days and nights of personal caregiving experience to help other Alzheimer’s and dementia caregivers cope with the everyday challenges and emotional struggles of caring for the memory-impaired.
Margaret Doerr is the Chief Nursing Executive for Brooksville Regional Hospital (Health Management Associates) and brings 21 years of nursing experience to the Hernando community. Brooksville Regional is located in Brooksville, Florida (less than an hour north of Tampa).
Margaret received her Master’s Degree in Nursing from Grand Canyon University in Phoenix Arizona. She is a patient advocate and sits on the Patient Advisory Council, which consists of residents in her community.
As a hospital administrator Margaret’s vision is to assist with the implementation of processes that provide quality care and a safe environment for the patients in her community.
The dementia initiative is important because “As health care workers we must provide safe quality care. Through the identification process and staff education our health care team will be able to provide optimal care for our patients with dementia.”
Have a kind and respectful day.
An article from Hayes Rowan about improving the nursing homes.
Reclaiming Our Heritage
In his quixotic campaign to save Cleveland’s John Marshall High School from demolition, a dedicated soul (forgive me please for mentioning him) declaimed “The right of the community to hold onto its heritage is a basic one.”
Landmark buildings are good. Our greatest legacy though is in the nursing homes (or hopefully in their own homes) – our elders, who taught us to tie our shoes, cheered us when we sang the blues, made us breakfast lunch and dinner years through and through; who know us often better than we know ourselves, and that’s true.
There are many ways of turning the nursing homes, our living heritage, into centers of civic activity – meeting places for block clubs, scout troops, library reading circles, leagues of women voters.
For that heritage, and our right to hold onto it, is imperiled.
A few years ago, Clevelander Steve Piskor had to put a video camera in his mother’s room at our county’s nursing home to uncover the abuses she was enduring.() Raised her son right, and lucky she did.
A study in an Atlanta GA nursing home, cited in the June ’06 Ladies Home Journal, found nearly half the residents had been punched, kicked, or choked.
We can and really must build new bridges between nursing homes and neighborhoods – bring movies in to enjoy with the residents; hold sewing bees with them, helping them mend their favorite clothes. Create indoor gardens, and outdoor. Those of you with affectionate dogs – a great opportunity for truly meaningful engagement with your community.
Attention: families who protest abuses often find themselves barred from even visiting their loved ones. Patricia McGinnis, California Advocates for Nursing Home Reform: “We’re seeing more retaliation like this than ever before against families who try to protect their parents.”
For some long-term residents – especially those without strong family ties – it can be a form of imprisonment, as Mike Bright told a Texas jury recently. Walk some halls and you will see the truth of his words.
MacArthur Fellow Marie Connolly says abused elders receive little or no protection from any system or agency. It may be one reason she resigned from justice department, DOJ.
Many of you know the poster in the 2nd Police District lobby, circulated years ago by our county’s Adult Protective Services. It portrays the photograph of an elderly woman in a picture frame; the glass is shattered.
The caption proclaims: “THE ABUSE NO ONE TALKS ABOUT”.
What to do? Jesus told us, “Visit the sick.”
Your mission … should you choose to accept.
Improving Our Nursing Homes
Published in Acorn Press, Ridgefield, CT.
“The Cards I’ve Been Dealt” Resource Helps to Manage the Transitions That a Senior Faces in a Positive Way
The Cards I’ve Been Dealt is a wonderful new resource available for facilitating conversations about the important transitions in a senior’s life or for creating your own amazing second half of life. If you like the Go Wish Cards (www.gowish.org) for end-of-life decision making, then you are going to love The Cards I’ve Been Dealt (http://thecardsivebeendealt.com). There are three different decks of cards to help you facilitate important conversations with your clients. The first deck is called The Daily Activities cards which can be used as a need’s assessment tool to help you discover and discuss what the senior can still do and what he or she needs help with. I will be using The Daily Activities cards in my work because my clients include families who are caring for cognitively impaired seniors and people with disabilities. I really like that the cards use a positive approach to talking about this difficult subject matter. The family caregiver will understand the changes that need to be made and can begin to develop an action plan for the senior’s needs.
The Wishes and Values cards, which contain 50 open-ended question cards, focuses on uncovering what matters most and what brings that individual joy and satisfaction. I can see these cards being used by professionals such as therapists, probate and elder law attorneys, financial planners, etc. who are talking with seniors about building good life plans. The Life Practices cards include 50 positive aging skills and practice cards which can enhance senior’s lives. (I need to begin to use the Life Practices Cards since I turned 49 this year and want to get a head start on aging positively.) Also included on the website are worksheets and downloadable tools to use as you navigate these important conversations with your clients or for yourself to use.
Have a kind and respectful day.
The goal of writing a quality-of-life statement is to have it express your personal preferences and to have it sound like you. One of the problems with many of the legal/medical forms is that they all sound alike and they don’t allow your voice to be heard. I encourage you to use the categories I have listed below to express what you would want people to know about you if you were too sick to speak for yourself. You can use some of my language from my document at http://kindethics.com/2012/01/my-new-quality-of-life-statement-to-attach-to-my-advance-directive/ if you would like but my goal is for you to make it personal and meaningful to you. You will know you have gotten it right if people say to you, “Yes, this is sounds like what he/she would say.” By making it feel personal, you will help your family/friends feel more confident that they are truly honoring your wishes.
Sections of QOL Statement to Consider Including in Your Directive:
? Types of illnesses where this advance directive would apply.
? What is important to me?
? What conditions would I find reprehensible to live with long term?
? CPR, ventilator and feeding tube preferences.
? Reassurances for the decision maker.
? What is a good death in my opinion?
? What I want the doctors know about honoring my religious/cultural beliefs both while I am sick and/or dying?
If you have questions, feel free to contact me at email@example.com. If you would like to share your new document with me, I would love to see it so I can see how the structure is working.
Have a kind and respectful day.
If you would like this in a Word Doc, email me at firstname.lastname@example.org
Caregiver Crisis Planning Worksheet
Ideally, before the next crisis, you should read this worksheet from the front to the back. Then you should fill in your personal information and strategies for handling the next caregiver crisis. If you are in a crisis right now, you should go to the last few pages immediately and read the rest later, but as soon as possible.
This worksheet is divided into three sections:
1. An overview of things that go wrong in how we cope during a crisis.
2. An overview of how we can improve how we cope and prepare for a crisis.
3. A worksheet to plan how you are going to handle the next crisis.
Evaluating your crisis management style
Everyone who has been in a crisis has looked back and said, “I wish I had said or done something differently.” This is an opportunity for you to think about how you have managed a crisis in the past and to discover what you did well and what you need to improve. Then you can be better prepared and more confident when the next caregiver crisis occurs.
Let me tell you about Monica – a true story. Monica had been home from work for a few hours and was enjoying her third glass of wine. The phone rang and it was the hospital calling to tell her that her father had fallen, had hit his head, and was unconscious. (Sounds like a typical caregiver day – right?) She jumped in the car, forgetting to grab her purse, and drove to the hospital. About a mile from the hospital, she sees a police car behind her signaling for her to pull over. The police officer begins by asking for her license, which she forgot to bring with her. Next, the officer smells alcohol on her breath and proceeds to have her take a breathalyzer test, which she fails. She is arrested for drunk driving. Of course, Monica doesn’t make it to the hospital to be there for her dad.
I don’t need to tell you what she did wrong. It is obvious. She now knows that she should have been more prepared. She could have had a crisis plan that could have slowed her down for just a few minutes so she could have thought more clearly and made better decisions.
How are you in a crisis?
Think about a time when you handled a difficult situation really well. What did you do that made it easier, better, more manageable, etc?
Now think about a time when you panicked, mishandled a situation, or when you didn’t make the right decision. What got in the way of you thinking clearly enough to cope with what was happening?
Don’t worry that you struggle. We all do. We are all incredibly human. This is why I want you to create a plan that can help you get calm, to ask for help, and then think more clearly.
Everyone is different when it comes to what will help them calm down. For me, it is picking up the phone and calling a friend. For my brother, it is taking a walk and getting some air. For others, it might be taking a couple of deep breaths, having a quick cry, praying, counting to ten, or doing research on the Internet. You will need to think about what has worked for you in the past that has helped you get your emotions under control. Go to page 5 and write down what will help you stay calm.
Why getting calm matters
The problem with decision making in a crisis is that our emotions have taken over our brains and this leaves little space for us to think rationally. The initial surge of emotion and adrenalin lasts approximately 90 seconds. Then, every time we think additional panicky or scary thoughts, we fire off 90 more seconds of emotional chaos. The goal of slowing down for a few minutes is to give your emotional brain a chance to calm down which will then allow your rational brain time to get activated.
(This is why Monica shouldn’t have rushed out the door. If she had sat still for a few minutes, she could have thought about getting someone to drive her to hospital. If she had calmed down even a little bit, she might have remembered her purse or called for someone to come and help her.)
You have more strength than you realize
You have more control and strength in a crisis than you realize. You can take control of your brain if you don’t keep telling yourself things that get you more upset. Instead of telling yourself, “Oh my goodness…I am so afraid…I can’t believe this is happening…Oh no this is the worst thing that could happen, etcetera.” Tell yourself, “I don’t have time to be upset right now…I have to focus on figuring out what is the right thing to do.” Tell yourself that you can cry, scream, or be afraid later on, but right now, you have to think. Say to yourself, “I am calm and focused. I can listen and understand what is happening and make a good decision.”
Here are ideas for what you might need to do before you run out the door:
• Ask someone to watch my kids.
• Arrange for someone to stay with the other person I am caring for.
• Tell my boss I have to leave.
• Have someone come over to drive me since I am still hysterical.
• Pack a bag because I may need to stay over night at the hospital. (I had a bag that I kept in my trunk filled with what I would need when I had to meet one of my relatives in the emergency room. I made sure I had a sweatshirt, bottled water, snacks, change for the vending machine, a book to read, and a change of clothing.)
• Pack my phone and/or computer charger. (I wish I had remembered this when I went to visit my mom in the hospital and ended up staying there for four days straight.)
• Pack my list of phone numbers.
• Grab this crisis action worksheet.
• Bring a list of person’s medications and medical history.
• Bring my own personal medications that I will need later on today.
• Pack a book to read or something to do while I am waiting.
Trust me. You will be so glad that you stopped and went through this list before you rushed out the door. Not only will you be more prepared, but by reviewing this worksheet, it will help your brain calm down. Before you read the next section, go to page 5 and fill in what you need to pack. Make sure you think about what you might need and what your loved one might need, etc. I am sure you will keep adding things to this list.
If you have to make an important decision in a hurry:
Ask how much time you really have. Oftentimes, the doctor says you need to decide right now, but really you could have a few minutes, a few hours, or even a day. Sometimes the doctor will want you to rush because it convenient for his/her schedule to take care of the crisis right now or the doctor may be worried about his/her legal liability if you wait too long. Ask the doctor how long you really have to make this decision.
Even if you only have a few minutes before you need to make the decision, take a couple of deep breaths or take a quick walk outside. Do whatever you need to so you can get past the initial 90 second surge of emotions that is getting in the way of thinking clearly.
What do you need to find out so you make the decision?
1. Find out the facts. I would encourage you to ask another person to help you listen and to have someone write down what is being discussed or record it. When in a crisis, your mind is not working as well as it usually does, so it helps to have someone there to be a second or third set of ears. If you don’t have anyone there with you in person, do a conference call with a friend or family member who can listen and ask questions. If you don’t know how to do this, ask someone there to help you or to use their phone.
2. Ask the healthcare professional to talk about the all the possible options/solutions that are available. There is rarely just one option or choice. You will feel better later on if you feel like you had a real choice in the situation.
3. Ask about how each of these solutions would play out over time. Too often, people forget to ask what will happen in the long-term. Yes, right now is really important, but make sure you ask about how your decision will play out in the future. How will the patient’s quality of life be changed by this decision?
4. Ask about the risks of choosing the solution the person has recommended. One of the biggest dangers in picking a solution too quickly is that we don’t ask about the downside or possible negative outcomes. We are so anxious to have things work out okay, that we forget that there is no perfect solution or solution without risks.
5. If you are a person who needs to write things down, then do so. If you are a person who needs to talk things out, then talk. Use whatever strengths you have when you usually problem solving. For me, I have to do some research on the Internet and then talk to someone I trust. After that, I can make my own decision. Stop for a minute and think about what you usually do when you have made good decisions in the past.
6. Make the decision. I know you wish you had more time. I know you wish you had more information. And I know you wish you knew for sure that this is the right thing to do. We can never know for sure. All we can do is the best we can based on what we know at the time and what kind of pressures are on us in that moment.
7. Now that the crisis is over, see if you need to modify or improve the plan. You can’t go back in time and change what has already happened, but you can see if you need to put an even better plan in place. This is life. We can only go forward from where we are.
8. Get some support for you. Now that the crisis is over, you need to get some comfort and support. Reach out to the people who make you feel better or stop and do the things that make you feel better. Caregiving is never about just one crisis. It is a long journey with many crises and decisions. This is why you need to begin building a support system around you so you can survive the long caregiver’s path.
It is time for you to create your own action plan.
Make copies of all of this paperwork and put copies in your car with your caregiver bag, in your briefcase, a drawer at work, in your purse, near your front door with the bag you have packed, and/or in the drawer where the person you care for lives. You can also email yourself a copy or to friends/relatives who could fax it to you at the hospital. You will also want to add a copy of the person’s Advance Directive for Healthcare, Living Will, Durable Power of Attorney, and other documents you will need.
This crisis action plan worksheet will only work if you have it with you.
My Crisis Action Plan
Here is what works for me when I need to calm down my emotional reactions:
What will I need to do or to pack before I run out the door?
Who will I need to call and what are their numbers?
Doctor, paramedics, hospital or nurse helpline, insurance company, family, friends, hospice nurse, palliative care team, suicide hotline, etc. Once you have gotten to the emergency room and the person is being cared for, your first job is to call the insurance company and let them know what is happening so you don’t end up owing more money than you should.
Who could come over and be with me right away?
Who can give me emotional support on the phone?
Who do I need to call to let them know what is happening?
Who can I call to help me figure out what is the right thing to do?
Who can I call to help me do some research on the internet?
While I am waiting for the ambulance, the doctor, or for help; I can decide what questions I will need to ask and what I will need to tell the professionals about what has happened?
What is important for me to tell them about my loved one’s condition and healthcare preferences?
Information to have ready (Use the back of this sheet for your notes)
1. Attach copies of the person’s advance healthcare directive, living will, durable power of attorney for healthcare, POLST/MOST/MOLST/POST form, and/or other legal documents.
2. Bring “List of Questions to Ask When Making the Medical Decisions”
Download from Viki’s resource page on her website: www.TheCaregiversPath.com.
3. Attach information about the person’s medical history
Ask the primary care doctor for a copy of the person’s history and physical. Staple this information to this worksheet.
4. Bring “List of Medications,” including any vitamins and herbs. Bring the actual bottles with you.
You will need to update this each time there are changes in the medications. Staple this information to this worksheet
10 Quick Tips for Crisis Decision Making
Do something to help yourself calm down. Breathe.
1. Ask how long you really have to make the decision.
2. Get the facts. Have someone do some research for you if you aren’t near a computer.
3. Ask about other options.
4. Ask what would happen if you chose these other options.
5. Ask about the positive and negative consequences of each of the possible choices.
6. Ask about the short-term and long-term consequences of each choice.
7. Have someone else help you listen to what is being said and to take notes and/or record it.
If nobody can be there with you, have the person call in and listen to the conversation over
8. Make the decision realizing that you are doing the best you can in this crisis situation.
9. After the crisis is over, think about whether you will need to modify or improve the plan.
10. Now that the crisis is over, get yourself some support. You just went through a lot.
Have a kind and respectful day.