“How do doctors break the news to a patient or their families that the patient is dying without seeming like they’re simply giving up hope?” 

Though everyone is going to die, most of us have not considered what that will look like or when it will be. This is the case even for many patients receiving care for serious conditions.

In most instances, for patients or their families, the realistic possibility of dying of a particular injury or disease is not a conversation they’re eager to initiate with a medical professional. This means that most medical professionals are forced to bring up the subject as carefully as possible. Broaching the subject without seeming like one is throwing in the towel is one of the most difficult conversations a doctor can initiate. It can be a balancing act in which not only is a dialogue about death is brought up, but from figuring out how to do so from a place of practical planning and care. 

Unfortunately, because most medical professionals are highly specialized in their field and not end of life care specifically, this means often means they need to call in the help of a hospice or palliative care professional. In the meantime, bringing up preparations for death with a patient or their families occurs in a few different ways using careful language.

When Dying Needs to Be Discussed Quickly

A conversation about dying usually comes about following or during a major health episode. These episodes can range from someone being admitted to a hospital with severe symptoms, their condition has suddenly deteriorated, or their condition has not improved and efforts to treat their disease have not had positive results. In these quicker instances, discussing the likelihood of not surviving can come as more of a shock to patients or their families because dying sooner rather than later simply wasn’t part of their plan. 

When death may be more imminent than originally thought, doctors must move fast if any care is to be administered that, though may not extend their life, will improve the quality of however much time they have left. Failure to initiate a conversation about death and the possibility of receiving hospice care or other palliative efforts can result in continued treatment that will only worsen the quality of the patient’s last days. When this is the case, discussing hospice care as soon as possible helps to preserve the patient’s quality of life for as long as possible.

When Dying is Brought Up Long Before It Occurs

There are other medical situations in which broaching the subject of the possibility of hospice care months or even years in advance is helpful for a patient with a terminal condition. While this initially seems like a gloomy forecast of their condition, it can actually be very helpful and reassuring for patients and their families to know that, no matter what happens, there is always a plan to preserve their patient’s quality of life as long as possible. 

Though it can seem scary or a sign of defeat for a medical professional to bring up the possibility of dying or hospice care, families should understand that doing so is simply a medical professional’s way of making sure their patient receives the absolute best care available—no matter what. 

Professional Hospice Care in Tulsa, Oklahoma

Speaking of receiving the absolute best care, if you or a loved one will need or are in need of professional hospice care, look no further than Cura HPC Hospice & Palliative Care.

We get it—it’s awkward for everyone. 

Whether you’re the caretaker of an elderly parent, an ill loved one, or an individual with dementia, bath time is likely one of the most challenging rituals of your care. But it doesn’t have to be. The following are a few tips to help make bathing less of an uphill battle and maybe even a treat. 

Tip 1. Check in with yourself before getting started. 

Even if the individual you’re helping bathe is visually-impaired or has advanced dementia, they will still be receptive to your attitude or demeanor going into any caretaking experience. If your facial expression, tone of voice, or body language is expressing uncertainty, squeamishness, nervousness, or annoyance, they will very likely mirror these feelings. 

Instead:

Approach bath time with optimism, confidence, and a calming influence. You may be quite surprised how receptive the individual becomes to what was ordinarily a time fraught with tension and discomfort. 

Tip 2. Prep the bathing space before getting started. 

Why would anyone want to take a shower or bath in a cold, wet, echo-filled place with potentially weird smells—also just to have you leaving to get more supplies periodically? 

Instead: 

1. Older and disabled individuals with circulation problems are more sensitive to the cold, so you will want to warm up the bathroom before bathtime. 
2. Consider lighting pleasantly scented candles or using nice-smelling soaps to make the space more inviting. 
3. Have all of your supplies within reach before starting bathtime. Having to leave the bathroom to fetch anything will make the person feel alone and may cause them to attempt to leave the bathroom—which is not only a mess waiting to happen but is also potentially dangerous. 

Tip 3. Strive to make the process less awkward and more private. 

Put yourself in their bath chair—having to be assisted with bathing is awkward. But you can make it seem less weird. 

Instead: 

Instead of just taking over the entire process and treating them like another chore, give them both privacy as well as a role. 

You can give them privacy by covering sensitive areas with washcloths. You can also give them washcloths to use to clean themselves while you’re cleaning other hard-to-reach areas. If they’re more responsible and less likely to make a mess, you could even give them the handheld showerhead to rinse themselves. 

Even if you have to go back over certain areas they didn’t quite clean, not only will this role make them feel more independent, but it will distract them from any perceived awkwardness related to being bathed. 

Tip 4. Luxuriate the experience. 

“C’mon—it’s bath time,” isn’t the most appealing sentence you could say to someone in need of a good washing.

Instead: 

When a loved one is in need of a bath, make the experience seem more luxurious for them. Don’t call it “bath time” or highlight the utility of the experience (“you stink and you need a bath”—possibly the worst thing you can say), instead call it “spa day” or offer them a nice “soak” or a “sauna experience.” 

Tip 5. Simplify the experience with the right tools.

Without the right tools, any job can become unpleasurable and stressful. Bathing is no exception. Even if you’re capable of hoisting this person into position and manually reaching all of the hard-to-reach areas, doing it the “hard way” can make the experience more intense and less enjoyable for them.

Instead: 

Invest in a handful of items that will make the washing experience not only easier for you but also more enjoyable for them. 

• A handheld showerhead is a must for washing a sitting individual—as well as letting them help out in the process.
• A shower chair and a larger shower opening can remove the challenge of getting in and out of a tub. 
• A transfer bench can help less-capable individuals enter the bathing space. 
• A variety of handles can help the person achieve stability in the bathroom—not only functionally useful but also helpful in increasing confidence.

Tip 6. End the experience with something they’ll look forward to. 

Even when bath time is over, many of those people cared for may still not have a positive association with the experience. And you may think you’ve done all you can. There are still ways to make their perception of bath time a more favorable one. 

Instead: 

At the end of every bath-time experience, provide the individual with a positive association—a treat or an expression of personal dignity. Perhaps a woman may enjoy an application of a favorite perfume. Maybe a fella appreciates a little aftershave or cologne. There may even be a favorite treat—such as tea, cocoa, or ice cream—that they enjoy and can begin to associate with the bath-time experience. 

Hospice & Palliative Care Services in Tulsa, Oklahoma

If you or a loved one is looking for professional and compassionate hospice and palliative care in the Greater Tulsa, Oklahoma area, look no further than your friends at Cura HPC Hospice & Palliative Care.

“I totally forgot to ask the doctor about…” 

Whether you’re going to the doctor for your own needs or as the caretaker for someone else, making the most of the appointment can be tricky. Why? Stressors related to conditions, a feeling like you’re wasting the doctor’s time, or even the feeling to need to make the most of this limited time with a medical professional can feel like you’re quickly throwing the entire appointment off target. 

The following are a few tips to lower the tension and make the most of doctor’s appointments for you or a loved one. 

Tip 1. Plan ahead before you plan ahead. 

A very simple way to make the most of appointments with doctors is to jot down all of the questions you wish to ask the doctor before you head out of the door for said appointment. For some, this works just fine. For others, attempting to rack their brain for all of the questions they want to ask just before an appointment is too much. 

What is the solution? 

Keep a running list a week in or more in advance. 

Whether you keep a journal or are familiar with a note-taking application on your phone, jot down your questions for you or your loved one’s doctor as soon as they arise. Then, the night before the appointment with the doctor, transfer these questions to a single sheet of paper or digital note to bring along to the appointment. 

Pro tip: If you’re jotting these questions down to bring with you, leave space on the paper to fill in the doctor’s reply. 

Tip 2. Get help guarding your attention. 

If you’re escorting a loved one to an appointment with their doctor, your first job is to be your loved one’s caretaker and secondly to be their advocate with the doctor. Unfortunately, being there for your loved one—especially a loved one with dementia—can overshadow your role as their patient advocate.

What is the solution? 

Get a friend to help. 

1. If you’re heading into a doctor’s appointment for a loved one where you have a lot of questions or you simply need to focus heavily on what the doctor is saying, recruit a friend or family member to assist in the caretaking duties.
2. If you don’t feel that additional caretaking abilities will be fully necessary, you can still opt to record the appointment using a voice recorder or specialized phone application. There is actually a medical appointment recorder and transcription application called Abridge that we have written about before. 

Tip 3. Set the agenda for the appointment from the outset. 

Doctors have a limited window of time to talk with their patients or advocates, so time is of the essence. It can be easy to feel slightly steamrolled by new information and forget that you have questions to ask. 

What is the solution? 

Let them know you have questions prepared before they even tell you any new updates. But then save them till the end.

As the doctor enters the room, after the initial greetings are dispensed, let them know that you have a number of questions for them. While they may then ask you to ask your questions, you may ask for the questions to be saved for after they dispense the information they have in case this new information answers any of the questions you have.

Once the doctor has finished with their news or questions for you, you can then ask your questions. Don’t feel odd about showing them your list of questions. It may also be helpful to include why you’re asking the questions you are—as the motivation for the questions can help doctors provide the most helpful answer. 

Tip 4. Repeat the doctor’s answer for confirmation or comprehension. 

Even when a doctor does answer your question, comprehending this answer for the average layman can be tricky. Even using a transcription app like Abridge can leave you later running to Google to make head-or-tails of what they said—and those answers can be terrifying when left to the internet to wrangle.

What is the solution? 

Repeat their answers in your own words back to them for confirmation. 

Once the doctor has given you an answer, repeating their answer back to them in your own words not only helps ensure that you understand what they are saying, but that they believe you understand what they said.

You may choose to reply by saying, “So, in other words…” before you repeat their answer in your own words. This will allow them to confirm or correct your understanding of the information. 

Tip 5. Write up your own summary of the appointment. 

So, you asked all of the questions you wanted to ask and received all kinds of new helpful information. Will this appointment seem just as helpful a week from now? Likely not. 

What is the solution? 

Jot down your own appointment summary. 

As soon as the doctor leaves the room, they will likely head back to their office to write up a summary of the appointment. You should do the same. As soon as you get back home and your loved one allows you the time to do so, handwrite a summary of the appointment. It doesn’t have to be word-for-word, but it should include the highlights of the appointment. Not only will this summary be helpful later for reference, but the act of writing it down will help you remember precisely what information was discussed. 

Hospice & Palliative Care Services in Tulsa, Oklahoma

If you or a loved one is looking for professional and compassionate hospice and palliative care in the Greater Tulsa, Oklahoma area, look no further than your friends at Cura HPC Hospice & Palliative Care.

“I didn’t realize it was an option!” - actual green burial proponent

For most people making their final arrangements, there seem to be only three options for their earthly remains: 

• Traditional Burial

This is the process by which a body is embalmed with chemicals, prepared for viewing, placed in a hardwood or metal casket, and buried within a concrete vault or liner in a landscaped cemetery with an ornately engraved headstone.

• Cremation

This is the process by which the body is placed in a cremation retort which is raised to over 1,400 degrees Fahrenheit. What is left of the body is ash and bone fragments, which are pulverized in a blender-like device called a “cremulator.” These cremated remains are then returned to the family. 

• Donation to Science

This is the process by which the body is given to a medical institution where it is dissected and examined by medical students before it is ultimately buried or cremated. 

For most, these options are suitable as they feel that there are few other options. 

For others, these options can seem unsettling, unnecessary, overly expensive, or unnatural. Fortunately for these individuals, a “new” third choice for body disposition is gaining popularity—green burial. 

What is Green Burial? 

Green burial—also known as “natural burial” or “eco burial”—is the process by which a body is laid to rest as naturally as possible. The bodies are typically not embalmed—usually only washed and dressed in very simple, biodegradable clothing. They are then placed in either a biodegradable casket (usually made of untreated wood or woven wicker) or even a sewn shroud, and placed directly in a shallow grave—often only three or four feet deep without any vault or grave liner. These graves are dug in special “green cemeteries”—areas left unlandscaped, containing wild grasses, trees, and wildlife. 

In many ways, green burial is seen as a return to the way most burials were conducted before the rise of the modern mortuary industry. Graveside funeral services often resemble that of earlier pioneers—allowing friends and family members to be as hands-on as they choose.

What is the Appeal of Green Burial? 

Environmentally Friendly

The earliest proponents of green burial were environmentalists looking for a more ecologically responsible way to return to the earth after death. 

Modern traditional burial not only requires the extensive clearing of natural lands to make way for heavily manicured cemeteries but also requires vast resources that are ultimately buried. Over an Olympic-sized swimming pool’s worth of toxic embalming fluid is buried every year as well enough metal (in the form of caskets) to build the Golden Gate Bridge, and cement (in the form of burial vaults) to build another highway between New York and Michigan. 

While cremation seems like the more environmentally friendly option, the process requires substantial energy and emits tons of carbon dioxide as well as other hazardous fumes such as mercury from dental work. 

Green burial, on the other hand, has been used as a method of wildlife preservation. The bodies of the buried feed the earth—nourishing plant life and soil conditions in the area. 

Respectful and Nondestructive

The practice of green burial appeals to many who find other options disrespectful of the remains of the deceased. 

Modern burial typically involves embalming a body—the process of replacing the blood with embalming fluid—sometimes using sharpened spear-like instruments to puncture the internal organs to remove excess fluid. 

Cremation is considered forbidden by observant Jewish and Islamic cultures, as it as seen as disrespectful of the body. 

Green burial seeks to respectfully return the body to the earth as naturally and directly as possible. 

Affordable

Short of direct cremation, green burial is among the most economic option for laying a body to rest. Modern sealed caskets can range from the thousands to tens of thousands of dollars—along with the cost of embalming, concrete burial vaults, cemetery maintenance fees, and elaborate grave markers—leaving the final price tag anywhere from $7,000 to $12,000 or even higher. 

Due to the lack of most of those elements, the cost of green burial can be a fraction of the cost. Plots in green cemeteries range from $1,000-$2,000. Burial shrouds can cost as little as $200. Funeral service costs may even be reduced as many family members and friends may elect to take on some of the responsibilities of a cemetery and funeral director themselves. Such tasks range from the care of the body to the digging of the shallow grave. Many funeral services have cropped up that aim to assist families in any duties they may not feel comfortable or capable performing. 

Is Green Burial Even Legal? 

Green burial is completely legal in all 50 states in the USA. Cemeteries may have regulations that require a burial vault and other items for burial on their sites, but such requirements are merely required cemetery policies and not law. The requirement for vaults or grave liners in modern cemeteries has more to do with preserving the landscaping than anything else.

What is the Downside of Green Burial? 

As it stands right now, the only apparent downside to green burial is the limited availability of green cemeteries and funeral directors with experience in assisting with green burial arrangements. Green cemeteries are typically areas of untouched land or adjoining sections of existing cemeteries that have been set aside for green burial. Still, as the popularity of green burial continues to grow, more funeral services and cemeteries have arisen to meet the growing demand.

How Can I Find a Green Burial Funeral Service or Green Cemetery?

To provide consumers with additional burial options and quality control measures, the Green Burial Council was formed. On their website, they provide a full listing of approved green burial funeral services and cemeteries.

Experience of a Green Funeral

“My wife’s great-grandmother and grandmother—mother and daughter—passed away in hospice care on the same day. They had lived together for over 30 years. They were lively, dignified ladies who lived vibrant lives, but wanted modest final sendoffs. Our family decided to honor them with a double green funeral and green burial. They were washed, clothed in simple gowns, and placed in white burial shrouds. We had a graveside funeral service in the forest with massive trees providing shade. We laid them side-by-side in a single, widened grave as family members and friends showered with them flower pedals. We passed shovels around with dozens of loved ones each delicately covering them with earth. More than feeling like we had them buried, we felt like we buried them ourselves—returning them to the earth, the bosom of their ancestors, and the embrace of their Creator.”

 - Green burial participant

Hospice & Palliative Care Services in Tulsa, Oklahoma

If you or a loved one is looking for professional and compassionate hospice and palliative care in the Greater Tulsa, Oklahoma area, look no further than your friends at Cura HPC Hospice & Palliative Care.

The decision to bring a loved one with dementia should not be rushed. 

As the holidays approach, we have the tendency to want to include all of our family for gatherings. Not wanting to exclude anyone, you may also want to include a loved one with dementia who is currently housed in a care facility—either for their dementia or possibly a hospice care facility. However, this can raise many questions—both logistical and emotional. 

• Will they be comfortable in such a setting? 
• Will the rest of the family members be comfortable with their presence? 
• Will this mean that I completely miss out on the gathering to meet their needs? 
• What happens when it’s time to return them to the facility and they refuse?
• Will they even remember the family gathering?

While these are good items to consider, it is also important to look for indications that this loved one may not be up for such a gathering. 

Red Flags for Attendance

Red Flag 1: If your loved one has a previous habit of voicing their displeasure with their facility. 

If your loved one with dementia has a habit of speaking extensively about how much they dislike their facility, these are not to be considered one-off comments. They are expressing a feeling they have that they may wish to express at a family gathering in the form of active resistance.

Red Flag 2: You already have trouble returning your loved one with dementia to their facility after visiting your home or other locations.

If your loved one has shown extreme hesitancy, frustration, or even resistance to returning to their care center after visiting your house or another location, that means that these feelings or behaviors may be intensified upon leaving a family gathering—even while still at the said family gathering. 

Red Flag 3: They have stated that they simply do not want to attend this family gathering or do not understand the concept. 

While you may feel that seeing some family members and getting out of the care facility may be in their best interest, fight the “you’ll thank me later” urge—thinking that they’ll come to enjoy the experience. They may, but they’ve also expressed that they do not wish to go and you should respect that wish by not pressuring them to attend. 

Logistics to Consider

If your loved one with dementia has not voiced displeasure with their care facility or resistance to returning to it, you may feel that it would be appropriate to take them to a family gathering for the holidays. While this is a valid decision that may end up being wonderful, it is important to plan ahead in case their mood sours—especially when it is time for them to return to the care facility. 

How will you make leaving enticing? 

Let’s say that your father has dementia, has expressed no ill feelings toward his care facility, and you wish to take him along to a family gathering. That’s wonderful! However, when it comes time to return and you say, “Ok, dad—it’s time to go back home,” he refuses. What should you do now? 

This is when it is important to make the prospect of leaving the family gathering enticing with something he likes. 

Perhaps instead of saying it is time to go home: 

• Have a family member say they want to show your father their new car
• Tell him that you wanted to take him to pick up some ice cream
• Tell him that you want to show him the pretty changing leaves
• Tell him that you’re all loading up in the car to see the neighborhood holiday lights

The important thing is to find something that will appeal to your loved one—something enticing enough to get him to willingly leave the situation. While it is important to not lie to him, simply create the journey home into a series of agreeable steps until he has reached his destination instead of one abrupt trip back to a place he may not want to go. 

Realizing the Why of Their AttendanceThough it may almost seem harsh to consider out of context, but before you decide that your loved one should attend this holiday family gathering, you will need a firm and simple reasoning why. This reason or lack of reason is not meant to more easily disqualify their attendance, but rather to ensure that this reason is being fulfilled. 

Not often enough good reasons: 

• “Well, it’s the holidays.”
• “Well, they’re family members.” 
• “I’d feel terrible if I didn’t bring them.”

All of these reasons are forgetting the most important contributing factor to this decision: your loved one. Instead of considering the benefits to them, such reasons are usually your reason why they should attend. In many instances, such events outside of the typical routine of someone with dementia can leave them confused and frustrated—not just immediately following the event, but also days or even weeks later.

However, if you feel that this experience may actually benefit their overall state, a family event may very well be a great idea. 

But how can you know? 

How to Consider if a Family Gathering is Good For Them 

When trying to determine if a holiday family gathering will be a good experience for them, it is important to consider the past, present, and future of their state. 

• How have they responded to going out and needing to return to their care center in the past?
• Will you be able to provide adequate care for them for the entire duration of the experience?
• Will this family gathering be positive for them or will it likely only cause confusion? 
• How likely are they to be receptive to returning? 
• How do you plan to entice them back to the care facility if they become confused, hesitant, or resistant? 
• How is this family gathering as well as their return to care expected to leave them feeling in the days following it? Happy? Confused? Agitated?
• Why do you think they should attend—for you, your family, or for their own wellbeing? 

There are several different aspects to consider when making the decision to bring a family member with dementia to a family gathering this season. Hopefully, this piece gives you a few more items and scenarios to consider for the health and happiness of your loved one. 

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Hospice & Palliative Care Services in Tulsa, Oklahoma

If you or a loved one is looking for professional and compassionate hospice and palliative care in the Greater Tulsa, Oklahoma area, look no further than your friends at Cura HPC Hospice & Palliative Care.