April 13 – An Evening with Viki Kind – Austin, Texas, 6:30 PM Presentation sponsored by the Alzheimer’s Association of Texas and Austin Groups for the Elderly
April 8, 2011 by Viki Kind
Filed under Ethics In Action
April 13 – An Evening with Viki Kind – Austin, Texas, 6:30 PM
Presentation sponsored by the Alzheimer’s Association of Texas and Austin Groups for the Elderly.
The Alzheimer’s Association-Capital of Texas Chapter is a non-profit organization that provides family support, community education, public awareness and supports research for the prevention, cure and treatment of Alzheimer’s disease and related disorders.
Their mission is to provide leadership to enhance care and support services for individuals and their families while supporting the advancement of research to eliminate Alzheimer’s disease. Their vision is a world without Alzheimer’s disease.
Austin Groups for the Elderly is a non-profit organization empowering caregivers, the elderly and their families through education, advocacy, resources and support.
RSVP to 512.241.0420 or email
TXPrograms@txalz.org
Have a kind and respectful day.
Linda Leon will be interviewing Viki on April 7 – 9:30 a.m. PDT – Book That Author on http://www.blogtalkradio.com/book-that-author
April 1, 2011 by Viki Kind
Filed under Uncategorized
April 7 – 9:30 a.m. PDT – Book That Author on http://www.blogtalkradio.com/book-that-author
Media and print producer Linda Leon who hosts Book That Author – a talk show devoted to authors, editors and other book professionals in the writing industry to display their talent, skill, insider information and love for the craft. Linda’s background is in commercial broadcast television. During her 12 years in the industry she hosted and produced several programs which have aired nationally and internationally. She also spent 7 years producing radio broadcasts for an international market. Linda currently owns a video production and author services business. Where she guides independent authors on publishing, publicity and distribution. She also works with them to create infomercials, commercials and trailers to promote their books. She is the author of several books and will be launching her new book Publishing and PR Business For Smart People in 2011. Linda is always busy with her writers group at bookprofessionals.ning.com
Have a kind and respectful day.
Join Viki as she speaks at the South Bay M.A.P.S. meeting at Silverado Senior Living in Redondo Beach, on March 8 from 8:30-10:30AM PST.
February 23, 2011 by Viki Kind
Filed under Uncategorized
Join Viki as she speaks at the South Bay M.A.P.S. meeting at Silverado Senior Living in Redondo Beach, on March 8 from 8:30-10:30AM PST.
Silverado Senior Living -Assisted Living Dementia Care in Redondo Beach
514 N. Prospect Ave.
Redondo Beach 90277
http://www.silveradosenior.com/dementia_care/LA_Ventura_County_CA/zip_90277/silverado_senior_living/2568
Phone 310-421-4867
Silverado Senior Living -Move your loved one into our Redondo Beach Assisted Living Dementia Care Community located on the campus of the Beach Cities Health District, a preventive health and wellness agency. This three-story, state-of-the-art community offers all of the trademark amenities and services that have made Silverado famous for providing exceptional, world-class care in beautiful surroundings. Like all Silverado communities, Beach Cities is a secure environment specializing in caring for those with any type of memory loss.
When you look for a senior care community to take care of your loved one with dementia, it is important to consider if their health needs will be taken care of by qualified staff. At Silverado Senior Living – Beach Cities, we believe in hiring the best! We have registered nurses and licensed nurses at our community in Redondo Beach just like every other Silverado community. All of our caregivers receive extensive training on how to provide special care for those with memory-impairing conditions. Our caregiving and nursing staff will support your loved one to enjoy the best of health every day, while giving our families peace of mind.
Have a kind and respectful day.
Aegis of Granada Hills will be hosting the San Fernando Valley MAPS meeting – Viki will be speaking about Culture and Communication
February 21, 2011 by Viki Kind
Filed under Uncategorized
Aegis of Granada Hills will be hosting the San Fernando Valley MAPS meeting – Viki will be speaking about Culture and Communication on March 1st from 8-10AM. Aegis of Granada Hills, 10801 Lindley Ave., Granada Hills
SFV M.A.P.S. is an organization of over 80 professionals working together to give quality and personal care to seniors, their families and caregivers. Since 1996, SFV M.A.P.S. has been dedicated to the raising of the public’s awareness of the quality of senior housing and services in the San Fernando Valley. http://www.sfvmaps.org/index.html
Aegis of Granada Hills – http://www.aegisliving.com/assisted_living/Granada_Hills__CA/zip_91344/aegis_living/1661
Five-star service is what sets Aegis of Granada Hills apart from the competition. Our beautifully designed retirement community was built with the needs of seniors in mind, while still being visually pleasing to everyone. Conveniently located near shopping, recreation, health facilities and freeway access, we have accommodations to suit a variety of needs – from an active senior who simply doesn’t want to cook and clean any longer, to someone who needs total care because of mental or physical decline. Aegis of Granada Hills also provides care for residents with Alzheimer’s Disease and other dementias. And we do it all with dignity, love and attention to the finer details that make life better. Come see Aegis’ apartments and sample a lunch by our fantastic chef. Or call and ask about respite, a short-term option for those who only need a couple of weeks to a month-long stay.
Call today if you would like to schedule a personalized visit at Aegis, including sampling a meal, taking a tour, or participating in our daily activities program. We are available seven days a week, holidays, and evening hours!
Have a kind and respectful day.
Joyce Graff from the Powerful Patient – Advice to Caregivers on BlogTalkRadio – Feb. 17th at 12noon PST
February 14, 2011 by Viki Kind
Filed under Kind Ethics Radio
Joyce Graff host of Powerful Patient – Advice to Caregivers on BlogTalkRadio will be interviewing Viki Kind. http://powerfulpatient.org/
Do you feel helpless in the face of “the system?” This show is to help you learn how to take control and steer your way to health. Hear how others have met these challenges and overcome them. Learn how you can do so too. This program is a forum to share your experiences, ask your questions, and learn how to create and manage your health care team. Make the healthcare system work for you! Powerful Patient won a grant from Chase Community Giving. http://www.tinyurl.com/vhlchase
Have a kind and respectful day.
Dr. Virginia will be doing part 2 of her interview with Viki, Wed. Feb. 16th 2:30PM PST
February 14, 2011 by Viki Kind
Filed under Kind Ethics Radio
Balanced Living with Dr. Virginia on BlogTalkRadio. Dr. Virginia is a licensed Psychologist with special interests in healthy living, how contemporary living affects our mental health, and anti-aging lifestyles. She has consulted with corporations addressing safety factors and employees’ attitudes to the changing workplace, as well as with individuals in her private practice. She takes a personal approach based on solid Cognitive Psychology skills to engender comfort and trust in her clients. Dr. Virginia’s shows are appropriate for everyone. She encourages you to call in with questions and comments, especially with your ideas about living a balanced lifestyle in this complex world.
Listen live or download later. http://www.blogtalkradio.com/search/dr.-virginia/
Have a kind and respectful day.
Right at Home Radio – Listen to the show that helps professionals and families caring for their loved ones as they age. Wed. Feb. 16th, 12:30 EST, 9:30AM PST
February 11, 2011 by Viki Kind
Filed under Kind Ethics Radio
Right at Home on BlogTalkRadio: Right at Home patchogue
http://www.blogtalkradio.com/right-at-home-patchogue
Right at Home will be interviewing Viki on Wed. Feb. 16th at 12:30EST, 9:30 AM PST. Listen live or download later. http://www.blogtalkradio.com/right-at-home-patchogue
Discussing issues relating to seniors, caregivers, geriatric care managers, social workers, eldercare specialists, families, and loved ones as they age. Right at home – in home care & Assistance is an organization of caregivers serving all of Suffolk county on Long Island. They provide in home caregivers for seniors and others who need help to remain living in their own homes.
The radio show airs LIVE weekly, every Wednesday at 12:30 with our target audience comprising of Healthcare advocates, Seniors, and Eldercare specialists. Right at Home is a worldwide organization with offices located in Brazil and in the UK, and Corporate offices located in Omaha, Nebraska. Our radio show intends to educate, enlighten and nurture and promote eldercare resources.
Have a kind and respectful day.
Join Marion Smith on KFOK – Aging Successfully radio show for a special Valentine show with Viki Kind. 9AM PST
February 11, 2011 by Viki Kind
Filed under Kind Ethics Radio
Radio Interview with Marion Smith, KFOK- Aging Successfully radio show. They stream our live broadcast onto the internet 24 hours a day. KFOK features nearly 70 hours of live broadcasting per week, brought to you by dozens of broadcasters, plus computer-automated music for your late-night and early-morning listening pleasure.To listen online go to www.kfok.org and click on the green play button. Most listeners will need to go through a configuration process to get the station to play and most XP computers will give you instructions in pop-up windows on how to proceed with the installation of the Live365 internet radio player. If you have trouble go directly to www.live365.com for help in setting up your system to listen to our broadcast.
Have a kind and respectful day.
Resident’s Rights Week – October 3-9
September 30, 2010 by Viki Kind
Filed under Ethics In Action
Defining Dining…It’s About Me
2010 National Residents’ Rights Week: October 3-9, 2010
For more information and resources: http://www.theconsumervoice.org/resident/nursinghome/residents-rights
By Sarah Wells, Executive Director
The National Consumer Voice for Quality Long-Term Care (formerly NCCNHR)
Dining is such an integral, systemic function of our lives that, oftentimes, we may forget how lucky we are to enjoy or share a delicious meal. Many of us are accustomed to eating at any time of the day we desire, with the flexibility of choosing to drive to a five-star restaurant or simply to the grocery store to cook our own meals at home. Often we take these simple everyday pleasures for granted. American culture is based largely on socializing with others during meals, and we expect these meals to look and taste good! For me, dining with family and friends is a favorite activity. While I am not a great cook myself, I am the beneficiary of my husband’s and mother’s kitchen magic!
Residents’ Rights Week 2010 reminds us that long-term care residents deserve the same high-quality dining experience to which the rest of us have access. Individual residents in nursing homes, assisted living, and board and care facilities should have the ability to voice their opinions and be heard when choosing what they eat, when they eat, and the atmosphere in which they dine. The dining experience should be a fun celebration of food, friends, culture and life without invoking a sense of dining in an unfriendly, detached institution.
Residents should be given choices about the kinds of food they eat. This can include having a variety of nutritious and culturally diverse meals prepared throughout the week, as well as meals catered towards vegetarians. It is important to prepare food that residents actually want to eat. Not only should food be tasty and well prepared, but it should be visually appealing as well. Tasty and nutritious foods that appeal to a resident’s sense of sight as well as taste take into account the full dining needs of our long-term care residents.
If residents are forced to eat only at certain times of the day, they may consume food even when they are not hungry – or worse, they will skip meals and not have food available when hunger does set in. Flexible meal times – including an expanded time frame for each meal – are necessary to allow residents to eat when they want. It is imperative that food is available to residents throughout the day, and an option to do this is to offer a canteen within the facility. Another option is to offer room service to residents. Long-term care residents, especially those who sleep during the day and are awake in the evenings and at night, can enjoy the convenience of requesting food to be sent to their room when they feel hungry.
Another area that can benefit from improvement is the way in which food is being served. While many facilities utilize buffet-style and restaurant-style dining for their main meals, more facilities can introduce open access to food in addition to these more established serving styles. Residents may crave snacks when meals are not being served, and this option should be made available to them.
Allowing residents to eat together in a common dining room also enhances the dining experience, and fosters a home-like, friendly atmosphere. This environment should ideally be a well-lit, open area where residents are encouraged to interact with each other. Facilities should also aim to create self-contained living areas for their residents, with each area equipped with a kitchen and dining room. The goal is to permit residents to feel welcome, invited, and safe while enjoying good food and company.
This year’s Residents’ Rights Week theme Defining Dining…It’s About Me challenges us to think of creative ways to implement an exceptional dining experience for our long-term care residents during the week of October 3 – 9, 2010 and throughout the year. If mealtimes are the only event during the day that residents look forward to, which is often the case, then we should strive to give them the best dining experience possible.
As we enter Residents’ Rights Week in October and start thinking about the holiday season – of which an entire day is dedicated to eating deliciously prepared Thanksgiving foods with our loved ones – let’s work together to make 2010 the year to provide our long-term care residents with the tastiest food, comfortable dining environments, and flexible options for mealtimes.
Have a kind and respectful day.
Avoiding the Pitfalls in CPR/DNR Decision Making
September 6, 2010 by Viki Kind
Filed under Ask Viki, Newsletter
Avoiding the Pitfalls in CPR/DNR Decision Making
Educational Objectives:
Examine the obstacles to good DNR decision making.
Discuss what is CPR and the perceived vs. actual chance for success.
Demonstrate best practices for communicating about CPR.
Consider how the signing of the DNR is just one component of
end-of-life care.
Background:
Older adults and their loved ones are being asked to make difficult end-of-life choices about CPR (cardiopulmonary resuscitation) and its refusal, DNR (do not resuscitate). These decisions are fraught with emotional angst and misinformation. In the past, we only used CPR on patients who were having a heart attack and who might benefit from receiving CPR. Now we use it for everyone, including those in a terminal state, whether it will work or not.
One of the complicating factors is that CPR used to be very simple to understand. Now, the general public doesn’t realize that when the doctor says CPR, she is including medications, intubation and ventilator support. A common misunderstanding occurs when people are given the misleading choice of a “chemical code only.” As nurses and doctors will tell you, if the doctor gives the medicine but doesn’t do the chest compressions to move the blood around, the medicine will not circulate in the body. Without circulation, the medicine can not do its job.
Another factor is that the decision about CPR has inappropriately become an indicator of a person’s complete end-of-life wishes—but the decision about CPR should be only one part of the treatment plan. A patient may want chemotherapy, surgery, radiation therapy or other kinds of aggressive treatments and still may want to be a DNR. Or the person may not want other medical treatments but still want to receive CPR. These are all separate decisions and any combination is possible.
One positive change is that the language of DNR has been modified to “do not attempt resuscitation” (DNAR) or “allow natural death” (AND). Both of these help to clarify the confusion. Do not attempt resuscitation truthfully explains that just because CPR is attempted, doesn’t mean it will work. If you ask healthcare professionals, “How many of you would like to die by CPR?” No one ever, ever raises a hand. What they know, but don’t always share with their patients, is that the chance of CPR working is minimal, sometimes even 0 percent. On television shows like ER, CPR brings the patient back to life about 75 percent of the time (Diem, Lantos and Tulsky 1996), when in real life it only works, at best, 17 percent of the time on healthy patients (Peberdy, et al. 2003). In many real-life situations, the chance of success is zero.
William J. Ehlenbach, MD, lead author of a study of CPR in the elderly, published in the New England Journal of Medicine in 2009, explains, “CPR has the highest likelihood of success when the heart is the reason, as in an ongoing heart attack or a heart rhythm disturbance. If you’re doing well otherwise, CPR will often be successful. But, if you’re in the ICU [intensive care unit] with a serious infection and multiple organ failure, it’s unlikely that CPR will save you” (quote from Gordon 2009; study published by Ehlenbach et al. 2009).
The newest term, allow natural death or AND, is a more gentle way of saying do not resuscitate. Instead of stating what won’t be done for the patient, the doctor is offering to allow the patient a peaceful, natural death and will not attempt resuscitation. Because the CPR/DNR decision is about more than medicine, it frames the dying experience for the patient and the loved ones. For those who are making the CPR/DNR decision, it is important to balance the chances of CPR working and bringing the person back in a good condition with the desire for a good, peaceful and dignified death. This is why healthcare professionals wouldn’t want to die by CPR; there is nothing peaceful or dignified about this type of death.
Case study 1:
Mr. Jackson is a 67 year old gentleman who has end-stage Alzheimer’s, is unable to eat and recently had a feeding tube placed. The patient does not have an advance directive and never told his kids what he would want done and unfortunately, his doctor didn’t ask about his CPR wishes when he was in the early stages of the disease. The physician is now asking, “Would he want CPR?” His adult children have been through a lot over the past years and are overwhelmed by the question. The thoughts running their minds are, “Is it time? Are we giving up? I don’t want to make this choice but I can’t stand watching him suffer any longer. If I make this decision, does that mean I have lost my faith?”
How can the healthcare team help guide the adult children through this decision making process? What are the underlying issues that will make the decision more difficult to make? What statistical information might make the decision easier? What grief support can the healthcare team provide to ease the process?
Discussion – Mr. Jackson:
How can we as aging professionals help those we serve as they struggle with these difficult decisions? One of my roles as a bioethicist is to assist families, like Mr. Jackson’s, who are making the difficult decisions. I am not there to tell the family or healthcare team what to do, but to help those involved to think through the issues so they can make a more informed decision. It is important during these conversations that we keep the patient’s wishes and needs at the forefront.
When working with Mr. Jackson’s son and daughter, I would make sure they are educated about CPR. Hopefully, Mr. Jackson’s doctors will not have eroded the trust and created a confrontational relationship by pushing for the DNR. I would need to be patient as these end-of-life conversations are a process, not a one-time event.
I would make sure Mr. Jackson’s children understand the possible outcomes of CPR. He may survive CPR but never be able to leave the hospital or he may be hooked up to ventilators for the rest of his life. Research has found if CPR is able to bring a patient back to life, the chance of the person going home with good brain function is about 7 percent (Kaldjian, et al. 2009). And in Mr. Jackson’s compromised condition, his chances are even lower. The typical success rate of CPR will depend on the health of the patient, the patient’s age, how quickly the CPR was begun and other medical factors.
Next, I would make sure that the family understood what can happen during CPR. Mr. Jackson may be brought back to life but in a worse condition than before, both mentally and physically. There is a chance of broken ribs, a collapsed lung, damage to the windpipe, and the longer he isn’t able to breathe, the greater the chance for brain damage.
Once the family understands the likely chance of CPR working and what kind of outcomes might be expected, I would then point out that by discussing that by choosing CPR, Mr. Jackson may not have the opportunity for a peaceful and meaningful death experience. I would ask his children, “When your father pictured the last minutes of his life, did he see strangers straddling him on a bed, pushing on his chest, with his family waiting outside his door? Or would your father want his family and friends gathered around his bedside, with words of love being expressed, music being played or prayers being said?” By asking these important questions, I am helping to contextualize the medical choices by explaining what it will be like for their father to experience CPR versus a more peaceful death.
Another common issue I may have to address is to relieve the guilt and angst of those making these difficult decisions. One gift I may be able to give Mr. Jackson’s children is to help them understand that it not really their decision. It is the patient’s decision. I would explain that as the decision makers, they are supposed to consider all that they know about their dad, what he has told them in the past, what his values are, and what would be important to him. Using this information, they should do their best to make the decision they think their father would make.
I would gently ask, “What would your dad be telling us if he were able to understand what has happened? What would your dad say about wanting CPR?” And then I would be quiet and let them sit with the question. In most situations, the family will know the answer but it will be painful for them to verbalize the choice. I would then acknowledge how loving and courageous they are to honor their father’s wishes. No matter what decisions are made, it will be important that this family receive emotional and spiritual support as they struggle with these issues.
Case Study 2:
Mrs. Garcia is an 83 year old woman who has multiple sclerosis. Her advance directive states that she does not want CPR. Her multiple sclerosis has developed to the stage where she has lost the capacity to speak for herself. Her husband is her decision maker and caregiver and he knows her wishes. Last week, Mrs. Garcia suffered a heart attack and is now in the ICU. This morning she coded and was brought back to life by CPR. Her husband has just been called to come to the hospital and was told that his wife survived CPR but her condition is deteriorating. What went wrong? Why wasn’t her DNR honored? What is Mrs. Garcia’s expected outcome after receiving CPR?
Discussion – Mrs. Garcia
What went wrong?
Unfortunately, this scenario happens more often than it should. When Mr. Garcia got the call about his wife, he was shocked and angered. How could this happen?
There are a few possibilities. Some doctors won’t agree to a DNR because of moral opposition and therefore won’t write or respect a DNR. While doctors are allowed to live by their morals and to refuse to participate in acts that go against their values, they are still obligated to let patients know about valid medical options and then let the patient or decision-maker decide. If the doctor is unwilling to do this, then the doctor should help the patient to find another doctor who is willing to talk about the DNR option. If the patient, family or someone from the healthcare team is worried about the patient’s rights being violated, he or she should call for a bioethics consult from the hospital’s bioethics committee.
Another possibility is that the DNR request from her Advance Directive was not transferred onto her hospital chart. If the DNR is not on the chart, it doesn’t exist. Whether you are the patient, the loved one or someone working with the family, make sure you go over the patient’s Advance Directive and other healthcare wishes with the doctor and make sure they are documented.
A final possibility is that medical miscommunication occurred. Perhaps the advance directive wasn’t sent up from the emergency room, the team couldn’t find the DNR, no one took the time to look for it, the on-call physician wasn’t familiar with the patient or numerous other mishaps. As much as the public would like medicine to be perfect, healthcare is significantly flawed and human.
What should happen next?
The first step will be to make sure the DNR order is written immediately. I would hope that apologies would come next. Administration, risk management and other hospital staff will be involved in resolving this situation. This event will be evaluated to determine what caused this medical error and to take steps to make sure it doesn’t happen again. (But it will happen again, but usually not to the same patient.)
Ultimately, the doctor will need to sit down and to talk about where to go from here. Since the CPR was performed, what condition is the patient in? What options are available which would be respectful of Mrs. Garcia’s wishes? Is it time for a hospice referral? The doctor who performed the CPR may not be the best person to handle the situation at this point because of the broken trust. It may be necessary to bring in a different consultant to help bring peace to this situation. It will also be important to address Mr. Garcia’s anger and frustration with the hospital and the healthcare team. He will probably be devastated that his wife’s wishes were not honored and that she is still suffering. Appropriate social services should be brought in to help him with his grief.
Upon evaluation of the event, it appears that it wasn’t that Mrs. Garcia’s wishes weren’t respected, but her wishes were not known (because no one read her advance directive) and the CPR/DNR conversation never occurred. This is also a common problem in healthcare. Many physicians are uncomfortable talking about end-of-life issues. I would hope that healthcare professionals don’t just talk about the medical choice of CPR but would also talk about what kind of life one would want after CPR and what kind of death is desired. The following questions are just as important as, “Do you want CPR?”
Where would the person want to die?
Whom would the person want to be with as he or she dies?
What would bring peace and comfort during the dying process?
For many people, CPR just prolongs the dying process, is this okay?
Conclusion:
The conversation about CPR and other end-of-life decisions is a journey of informing, understanding and helping to support the person who has the difficult choice to make. As professionals, we have to find the courage to walk with our patients as they move through their illness and toward death. As patients and family members, it is important to have these conversations early on and I would encourage everyone to ask for the answers and support you need. If the doctor won’t talk to you, find a doctor who will. And if after talking with the doctor, you realize he won’t respect or support the patient’s wishes, find a doctor who will. Once you have made the decision, write it down and tell others what you would want. Don’t make them guess.
A final thought: I am not saying that people shouldn’t choose to attempt CPR; I just want to make sure patients and their loved ones have the facts about what is CPR, the chance of it working, the kind of condition the person might be in after CPR and the kind of death that is being chosen. Make wise and informed decisions for yourself and for those in your care. Have a kind and respectful day.
Study Questions:
What are the common misunderstandings about CPR?
When talking about DNR, what other issues should be discussed?
What do you think would get in the way of you making a good decision for your loved one?
What decision would you make regarding CPR/DNR and how does that affect how you interact with those you serve?
References
Diem, S. J., J. D. Lantos, and J. A. Tulsky. 1996. Cardiopulmonary resuscitation on television: Miracles and misinformation. New England Journal of Medicine 334 (24): 1578–82.
Ehlenbach, W.J., A.E. Barnato, J.R. Curtis, et al. 2009. Epidemiologic
study of hospital cardiopulmonary resuscitation in the elderly.
New England Journal of Medicine 361 (1): 22–31.
Gordon, S. 2009. CPR Survival Rates for Older People Unchanged.
HealthDay: News for Healthier Living, July 1, 2009.
Kaldjian, L.C., Z.D. Erekson, T.H. Haberle, et al. 2009. Code status discussion and goals of care among hospitalized adults. Journal of
Medical Ethics 35 (6): 338–42.
Peberdy, M.A., W. Kaye, J.P. Ornato, et al. 2003. Cardiopulmonary
resuscitation of adults in the hospital: A report of 14,720 cardiac
arrests from the National Registry of Cardiopulmonary Resuscitation.
Resuscitation 58
Have a kind and respectful day.