Erin Diehl is a clinical pastoral counselor, and she offers wise words for those in the middle of grief or preparing for it. Her guidance may be important for looking to place a loved one in hospice care.
Overcoming Loneliness After Loss
1. Reach Out to Friends: "After my husband's death, I had to learn that when my loneliness seemed overwhelming I could not sit around and wait for someone to call me. I needed to initiate the encounter...If you seek support you will find it."
2. Commemorate Your Loss: "If you are grieving the death of a loved one, find a way to express the loss you feel, and also to symbolize the ongoing presence of that loved one in your life...Find a way to celebrate the gift that your loved on has been to you. Perhaps you could plant a tree or write a poem. However you choose to memoralize your loved one, draw comfort from the fact that nothing can take your cherished memories from you or erase the untold ways your loved one has touched your life and remains very much with you."
3. Trust that the Pain Will Pass: "My friend Mary was in a lot of pain after her husband abruptly left her with six children to raise. Even though the marriage had not been an ideal one, Mary felt the agony of loneliness. But her faith carried her through the most difficult times, and she is a wiser and stronger person today.
'We can pass through pain because it will not last forever,' she says. Mary believes that all of life involves gift and loss. If your pain feels overwhelming, take some comfort in knowing it will not always feel as intense as it does today."
4. Cultivate an Appreciation For Solitude: "Find activities you can do alone that bring you satisfaction and peace of mind and heart. At your time of deepest loss, try to find something special to do that brings you joy. You can never replace the person you have lost, but you can find comfort in solitude if you learn to befriend it."
5. Get the Support You Need: "After an experience of great loss, it is natural to feel a variety of emotions. If you would like some ongoing help exploring and working through some of the difficult emotions that may surface, consider getting some private counseling, attending a support group that addresses your needs, or both."
6. Turn to God for Strength: "My faith in God was and is the best coping tool I have. Prayer and meditation can be excellent paths to inner peace and balance. If you are feeling too distressed to pray or sit quietly, don't forget that there are a host of excellent spiritual books and tapes."
"Brother David Steindl-Rast, a Benedictine monk, emphasizes the value of a grateful heart. It is hard to be thankful and sad at the same time. Spend a little time pondering the many things in your life for which you are grateful. With time, you may even feel gratitude for the admittedly painful lessons you are learning as you move through your present loss."
March 31, 2011
March 7, 2011
Hospice News: Good and Bad from Around the World
"Reimbursement Cuts Will Negatively Affect Hospice Care"
A recent study shows that "as a result of two recent cuts to Medicare reimbursement, the first regulatory and the second statutory, the overall median Medicare profit margin for the hospice community could decrease from 2 percent in 2008 to -14 percent by 2019."
The study goes on to demonstrate how, like nearly everything else involving health care in the United States, poor areas--both urban and rural--will face the worst consequences of cuts to hospice care.
Blue Skies Hospice serves many low-income families at no cost. Organizations like Blue Skies play a vital, valuable, and essential role in their communities, because they attempt to fill in the gaps of social dislocation by providing suffering people with services they otherwise could not have. Small organization can only go so far, however. The larger polity of the United States needs to make quality hospice care a larger priority.
"At India's First Hospice, Every Life is Important"
"The pin drop silence gives no indication that there are 60 patients admitted at the moment in Shanti Avedna Sadan-the country's first hospice that is located on the quiet incline leading to the Mount Mary Church in Bandra. "
"There is only one guiding principle here: no life is so worthless that it can be thrown away. 'Life is a gift given by God. We cannot dictate when it should end,' said Sister Aqula Chittatil. Sisters and nurses who take care of the day-to-day running of the hospice have only goal: to ensure that the patient's end of life is as pain-free as possible and full of care."
This beautiful story is a reminder that from Egypt to Ethiopia and from India to Indiana, human beings have the same physical, emotional, and spiritual needs. Hospice care does a wonderful service for suffering people by making a valiant and qualified effort to fill those needs.
A recent study shows that "as a result of two recent cuts to Medicare reimbursement, the first regulatory and the second statutory, the overall median Medicare profit margin for the hospice community could decrease from 2 percent in 2008 to -14 percent by 2019."
The study goes on to demonstrate how, like nearly everything else involving health care in the United States, poor areas--both urban and rural--will face the worst consequences of cuts to hospice care.
Blue Skies Hospice serves many low-income families at no cost. Organizations like Blue Skies play a vital, valuable, and essential role in their communities, because they attempt to fill in the gaps of social dislocation by providing suffering people with services they otherwise could not have. Small organization can only go so far, however. The larger polity of the United States needs to make quality hospice care a larger priority.
"At India's First Hospice, Every Life is Important"
"The pin drop silence gives no indication that there are 60 patients admitted at the moment in Shanti Avedna Sadan-the country's first hospice that is located on the quiet incline leading to the Mount Mary Church in Bandra. "
"There is only one guiding principle here: no life is so worthless that it can be thrown away. 'Life is a gift given by God. We cannot dictate when it should end,' said Sister Aqula Chittatil. Sisters and nurses who take care of the day-to-day running of the hospice have only goal: to ensure that the patient's end of life is as pain-free as possible and full of care."
This beautiful story is a reminder that from Egypt to Ethiopia and from India to Indiana, human beings have the same physical, emotional, and spiritual needs. Hospice care does a wonderful service for suffering people by making a valiant and qualified effort to fill those needs.
February 15, 2011
Governor Mitch Daniels Advocates New Approach to End-of-Life Care
Indiana Governor Mitch Daniels (Republican) recently made headlines and provoked heated discussion when he discussed the fiscal, medical, and moral need to reevaluate end-of-life care. Daniels supports a stronger emphasis on palliative care for the terminally ill. He is also taking the lead within his party to engender a serious, mature, and balanced conversation on very difficult, painful, and uncomfotable issues relating to death, grief, and medical treatment. Politico reports:
Regardless of whether or not one agress Daniels' position on end-of-life-care, he deserves recognition and respect for attempting create public space for an often muted, but always important conversation.
February 3, 2011
New Report Confirms Earlier Suspicions and Findings Regarding For-Profit Hospice
A new study adds to the already convincing evidence that for-profit business motivations and hospice are incompatible. Financial incentives defeat compassionate care under such an arrangement:
CHICAGO (AP) — For-profit hospices may be cherry-picking the least costly, most lucrative patients, potentially putting the nonprofit industry at a financial disadvantage, a study suggests.Read the rest of the report at Google News.
The researchers found hospice care provided by for-profit agencies averaged 20 days versus 16 days for nonprofit agencies. Care lasting more than one year was most common among for-profit hospice patients.
Also, compared with nonprofits, for-profits had about twice as many patients with dementia and fewer cancer patients. End-of-life cancer care is typically much more intensive and costly than dementia care.
Patients with more days under hospice care and lower skilled needs may be more profitable under the Medicare reimbursement system for hospices, said lead author Dr. Melissa Wachterman, a palliative care physician at the Harvard-affiliated Beth Israel Deaconess Medical Center in Boston.
January 26, 2011
Hospice News from New York and Canada
In Canada right now hospice is a major topic of discussion. A small number of Chinese protestors are opposing the construction of a hospice sight in a Chinese neighborhood out of cultural fears and folkloric beliefs about ghosts and hauntings. The majority of the Chinese, however, are in favor of the project. David Choi, national executive director of the National Congress of Chinese Canadians, said that "Compassion and respect – especially for the elderly – are entrenched Chinese cultural values and a hospice is compatible with those values."
The applicable aspect of this story is that just as in Northwest Indiana, around the world there are far too many people without adequate hospice care. According to the Worldwide Palliative Care Alliance, more than 100 million people a year need palliative care but fewer than eight million receive it. In Canada, only 16 to 30 per cent of residents have access to or receive hospice palliative care, depending on where they live. Read more at the Globe and Mail.
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"Beets and Beans: Living and Dying with Hospice" is a new documentary on hospice care. It will have its first screening in Ithaca, NY. Read more about it at the Ithaca Journal.
The applicable aspect of this story is that just as in Northwest Indiana, around the world there are far too many people without adequate hospice care. According to the Worldwide Palliative Care Alliance, more than 100 million people a year need palliative care but fewer than eight million receive it. In Canada, only 16 to 30 per cent of residents have access to or receive hospice palliative care, depending on where they live. Read more at the Globe and Mail.
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"Beets and Beans: Living and Dying with Hospice" is a new documentary on hospice care. It will have its first screening in Ithaca, NY. Read more about it at the Ithaca Journal.
January 18, 2011
The Ten Biggest Myths About Grief
Kay Talbot, a certified grief therapist and noted author on grief and mourning, writes that there are ten persistent myths about grief.
1) When a loved one dies, our relationship with that person ends: When the person isn't there anymore, a new relationship begins. The bereaved takes on the role of biographer, and must work through the pain and suffering to establish a new relationship that acknowledged the reality of death, but maintains the bond of love.
2) People who experience the same loss have the same grief: Individuals grieve in individually unique ways.
3) There is one right way to grieve: Empty platitudes and cliches do not acknowledge the individually unique quality of grief. Grief is not a problem to be solved or disorder to be cured. It is a process to be lived.
4) Time heals all wounds: It is what the bereaved do with the time that counts. Healing begins as people acknowledge true feelings and share stories with empathetic listeners.
5) All losses are the same: Experiencing loss does not mean that you completely understand another individual's loss.
6) Feeling and expressing intense grief emotions is a sign of weakness and lack of control: It takes great strength to fully live and express grief. Therefore, individuals should take the time and energy necessary to resolve their grief, most especially emotional time and energy.
7) Once grief is resolved it never comes up again: Most people who find peace after grief will still experience occasional, temporary upsurges of grief.
8) Everything about grief is negative and devastating: Love and humor can result from grief. As Father Edward R. Ward points out, "Death makes love urgent." Grief can often help individuals gather insights into their lives and prioritize their relationships more meaningfully and beneficially.
9) Religion always brings comfort during times of loss: Many people find solace in their faith. Other, immediately after a loss, find it too difficult and painful to pray or attend church. People must be allowed to grieve, in all ways, even spiritually, according to their own inner-schedule.
10) We "get over" grief: No one ever "gets over" a devastating loss. It is not that simple. People absorb it, and leanr from it. Their lives are changed forever.
For those of you looking for assistance, comfort, and "empathetic listeners" during your time of grief, contact the Blue Skies Hospice office. Blue Skies sponsors a bereavment group that meets once a month.
1) When a loved one dies, our relationship with that person ends: When the person isn't there anymore, a new relationship begins. The bereaved takes on the role of biographer, and must work through the pain and suffering to establish a new relationship that acknowledged the reality of death, but maintains the bond of love.
2) People who experience the same loss have the same grief: Individuals grieve in individually unique ways.
3) There is one right way to grieve: Empty platitudes and cliches do not acknowledge the individually unique quality of grief. Grief is not a problem to be solved or disorder to be cured. It is a process to be lived.
4) Time heals all wounds: It is what the bereaved do with the time that counts. Healing begins as people acknowledge true feelings and share stories with empathetic listeners.
5) All losses are the same: Experiencing loss does not mean that you completely understand another individual's loss.
6) Feeling and expressing intense grief emotions is a sign of weakness and lack of control: It takes great strength to fully live and express grief. Therefore, individuals should take the time and energy necessary to resolve their grief, most especially emotional time and energy.
7) Once grief is resolved it never comes up again: Most people who find peace after grief will still experience occasional, temporary upsurges of grief.
8) Everything about grief is negative and devastating: Love and humor can result from grief. As Father Edward R. Ward points out, "Death makes love urgent." Grief can often help individuals gather insights into their lives and prioritize their relationships more meaningfully and beneficially.
9) Religion always brings comfort during times of loss: Many people find solace in their faith. Other, immediately after a loss, find it too difficult and painful to pray or attend church. People must be allowed to grieve, in all ways, even spiritually, according to their own inner-schedule.
10) We "get over" grief: No one ever "gets over" a devastating loss. It is not that simple. People absorb it, and leanr from it. Their lives are changed forever.
For those of you looking for assistance, comfort, and "empathetic listeners" during your time of grief, contact the Blue Skies Hospice office. Blue Skies sponsors a bereavment group that meets once a month.
January 9, 2011
Medicare, Hospice, and Health Care Reform
The major health care reform bill passed by Congress and signed into law by President Obama in 2010 originally contained a provision that would use Medicare funds to reimburse physicians for discussing end-of-life care options with patients during an "annual wellness visit."
Last week, the White House eliminated that provision from the reform in a move that received very little comment or attention. One hospice director, however, in Gainesville, Florida is concerned about not only this elimination, but the lack of priority given to end-of-life hospice and palliative care within the reform and in the larger context of American medicine.
He told the Gainesville Sun, "Health care reform is going to mean more regulation and less reimbursement."
The Obama administration's inexplicable decision to remove the provision is particularly disappointing because the pre-existing system that exists to give patients knowledge and options for end-of-life hospice care is failing. Medicare requires doctors and health care providers to give patients a list of available hospice providers in their area. It is a good law, but one that is rarely practiced and even more rarely enforced. Many hospice directors develop less-than-ethical relationships with health care providers, and these relationships influence the providers to direct patients to them, rather than inform them on all available options.
Similar problems arise in the relationships between hospices and nursing homes. Medicaid pays 95 percent of room and board fees to qualified residents in nursing homes. The involved hospice organization bills medicaid for the services it provides and then reimburses the nursing home. Hospices often pay the entire remaining 5 percent in turn for possible referrals.
While the health care reform provision would not have addressed the possibility of fraudulent practices in the complicated relationships that exist between health care providers and hospice providers, along with those shared between nursing homes and hospice providers, it would have given doctors and patients an opportunity to have important discussions outside those systems. It would have enhanced the intimacy of the doctor-patient relationship, and encouraged people to have painful, but important conversations.
Future discourse on medical policy and health care reform must prioritize end-of-life care and hospice.
Last week, the White House eliminated that provision from the reform in a move that received very little comment or attention. One hospice director, however, in Gainesville, Florida is concerned about not only this elimination, but the lack of priority given to end-of-life hospice and palliative care within the reform and in the larger context of American medicine.
He told the Gainesville Sun, "Health care reform is going to mean more regulation and less reimbursement."
The Obama administration's inexplicable decision to remove the provision is particularly disappointing because the pre-existing system that exists to give patients knowledge and options for end-of-life hospice care is failing. Medicare requires doctors and health care providers to give patients a list of available hospice providers in their area. It is a good law, but one that is rarely practiced and even more rarely enforced. Many hospice directors develop less-than-ethical relationships with health care providers, and these relationships influence the providers to direct patients to them, rather than inform them on all available options.
Similar problems arise in the relationships between hospices and nursing homes. Medicaid pays 95 percent of room and board fees to qualified residents in nursing homes. The involved hospice organization bills medicaid for the services it provides and then reimburses the nursing home. Hospices often pay the entire remaining 5 percent in turn for possible referrals.
While the health care reform provision would not have addressed the possibility of fraudulent practices in the complicated relationships that exist between health care providers and hospice providers, along with those shared between nursing homes and hospice providers, it would have given doctors and patients an opportunity to have important discussions outside those systems. It would have enhanced the intimacy of the doctor-patient relationship, and encouraged people to have painful, but important conversations.
Future discourse on medical policy and health care reform must prioritize end-of-life care and hospice.
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