A what?

Thanatology
The study of death and dying, especially in their psychological and social aspects.

I have never heard of this profession until I received an email from a woman who does this for a living. And I am amazed.

From Donalyn’s web site:

Dr. Donalyn Gross, PhD., LCSW, CMP, Thanatologist
D. Gross, PhD., LCSW, CMP, Thanatologist, has worked with the terminally ill and their loved ones for over thirty years. She has worked in hospitals, correctional systems, been a hospice volunteer director, has taught college courses in death and dying, and gives workshops on death and dying issues.

Donalyn created a program called Good Endings.

At her web site, Donalyn offers training materials for nursing home staff who work with people who are dying- so this encompasses all nurses and CNA’s of course:

GOOD ENDINGS-Caring for the Dying Resident-A Guide Twelve page booklet dealing with the end of life issues for those in the nursing home and health care agency field. Provides strategies and insights for caregivers. It includes Five Stages of dying, Problems Associated With a Terminal Diagnosis, How We Can Help The Dying, Physical Signs of Active Dying, and After A Death. $2.00 each booklet plus s/h.

We have written here many times how CNA’s are not prepared to deal with the emotional aspects of the death process. We even lack good training when it comes to Hospice practices in all honesty. I think any education on this matter is worthy of having on hand. Donalyn sells booklets which can be shared with staff and perhaps an in service can be developed based on her program. She offers on site training for nursing homes located in the North East region of the US.

Additionally she offers CD’s with her own music, which she uses harps as a means to relax people who are in the process of dying. She authored an article on this topic at Long Term Care Living recently.

Be sure to check this out. The booklets alone would make an excellent addition to Staff Develop book resources.

Frances Shani Parker used to be a school principal. Then she became a hospice volunteer and has written about her experiences in nursing homes. I received a copy of her book and it is excellent. I recommend it to anyone who works in a hospice setting, and for all CNA’s as well. I will venture to ask that DON’s and Administrators have a look too. Sometimes people in higher places at nursing homes forget some of Frances’ important lessons.

You can purchase her book HERE.

Also, Frances has a blog HERE.

Provider Magazine, a long term care trade publication, has an excellent article up about how CNA documenting can be streamlined and made much more efficient and, productive. In less time.

Read on (PDF File)

A new pressure ulcer reduction program—known as On-Time Quality Improvement for Long Term Care(On-Time)—was developed by the Agency for Health Care Research and Quality (AHRQ) with support from the California Health Care Foundation in an effort to close the gap between staff knowledge and staff practice.
[...]
Since certified nurse assistants (CNAs) spend the most time with residents, they are frequently the first to notice subtle health status changes; however, their observations often never reach the team members who are formulating care plans. In addition, nurses are sometimes reluctant to use CNA
documentation because it may not accurately reflect resident health status and is often incomplete.

More:

There are three key components of the On-Time program:
*Assessing current CNA documentation, streamlining CNA documentation, incorporating best practice elements into daily charting, and consolidating CNA documentation into one form;

*Establishing audit and feedback processes to confirm CNA information completeness and accuracy;

*Integrating weekly reports that identify at-risk residents into care planning processes and structures.

Sometimes I wonder about ALL the documenting we do- is it helpful, is it really necessary and, who reads it? Where does it all go? AND how much of the paperwork is geared towards making someone’s else’s job easier? Hmm.

Implementing The Program
Successful implementation of the On- Time model entails the following three steps.
Step One: Streamline and standardize CNA documentation to capture relevant information. The heart of the On-Time program lies in the daily care documentation conducted by CNAs. Prototypes of the CNA documentation form and the On-Time reports are the starting point for implementing the program.
During the first stage of the initiative, documentation forms currently used by CNAs are reviewed; cross-referenced against regulatory requirements, facility care protocols, and best practice elements; and compared to the On-Time CNA form prototype.
[...]
The result of this process is the development of a new CNA form designed to include best practice elements and to eliminate both redundancy and documentation of unessential items.

READ the entire article HERE; this is a PDF file and it’s very worth printing and saving. Any efforts to reduce the amounts of paperwork is worth looking into. CNA’s and nurses spend astronomical amounts of time writing, checking, noting and reading many forms, sheets, records, logs..much of it is inefficient and wasteful.

The National Association of Health Care Assistants- NAHCA- used to have a magazine for CNA’s called “CNA TODAY”- it ceased publication a couple years ago. NOW, they introduce a new magazine for ALL direct care workers in the nursing field, titled, “MY CAREGIVER”.

From the MY CAREGIVER web site:

My Caregiver is a quarterly magazine published by the Academy of Certified Health Professionals (ACHP) for and about health care assistants and their role in long term care. It is a special magazine, a publication virtually every person in the long term care industry will want to read.

With a circulation of 10,000, we reach nursing assistants, Directors of Nursing, facility Administrators, nursing home residents, and their families, product manufacturers, policy makers, and other health care associations.

The first issue of My Caregiver debuted March 2008. It evolved from the original CNA Today magazine to focus on health care assistants from diverse settings in long term care. The original magazine, CNA Today, launched June 2001 and was unveiled at the NAGNA National Convention.

Now My Caregiver will prove to be a remarkable resource for information on long term care for all who perform the role or duties of a nursing assistant, regardless of title.

The magazine is published quarterly and costs $15.00/year for non NAHCA members; $10.00/year for members.

NAHCA’s main web site is HERE.

A nursing home in New York City cut off health benefits to it’s staff over last summer, and they have been on strike since February.

After three wearying months of walking the picket line, 220 nursing home workers at the Kingsbridge Heights Rehabilitation and Care Center in the west Bronx have had plenty of time to sharpen their message.

“Health care workers like us should have health care coverage,” said Jacqueline Simono, who has worked for 10 years at the six-story, 400-bed nursing home.

In August, the nursing home stopped paying the workers’ health insurance premiums, and as a result, their coverage was cut off. That, the workers say, was the main reason they went on strike on Feb. 20.

The workers, members of 1199 S.E.I.U. United Healthcare Workers East, say they are expecting the National Labor Relations Board to give them some good news soon to help end the strike.

Sadly, those on strike are not earning any income and I cannot imagine how they are making ends meet right now. The costs of health care benefits is skyrocketing for everyone- not just health care workers. We’re seeing more and more businesses from every sector dropping coverages or increasing premiums.

Reading the rest of this article, it isn’t clear what’s really going on here. One thing: If these staff belong to a union, it is the unions’ job to make sure benefits are part of any bargaining plan. Somehow, somewhere, someone let the ball drop here.

I did a little digging into this situation and found a couple articles worth mention.

From a May 7th article:

NEW YORK–About 5,000 members of 1199SEIU from across the Northeast rallied May 3 to support 220 strikers at the Kingsbridge Heights Nursing Home, whose owner, Helen Sieger, has refused for six years to sign a contract with SEIU or pay into the 1199 health benefits fund.

The overwhelmingly immigrant strikers entered the rally at Fort Independence Park in a boisterous show of force, calling on a broad spectrum of militant national labor traditions.
[...]
Bartosz and Tomas, two strikers from Poland, described Helen Sieger’s anti-labor practices: “We have no sick days. We have no health benefits. We are required to arrive at 10:30, but are only paid from 11:00 on. Though we should finish at 7:00, we often have to work later, also without pay.”
[...]
A number of federal, state and city politicians and union officials spoke at the rally, including SEIU President Andy Stern and Sen. Charles Schumer. Barack Obama spoke through a recorded message. SEIU members from Albany and Rochester, N.Y., turned out, along with others from Massachusetts, New Jersey and the Washington-Baltimore area.

The rally highlighted the role that immigrants play in organized labor. A win for the Kingsbridge workers will be a victory for both the immigrant rights and labor movements.

There were not 5000 people at any rally for this. That is a gross exaggeration. Using militant strike methods wins few friends in these causes; however, asking politicians to speak on the behalf of those on strike is admirable.

The fact that many of those on strike are immigrants leads me to ask the tough question: Are they legally entitled to work in the US? Are these people just doing another job Americans won’t do? I wonder how many American CNA’s worked for this facility?

Finally, I ask this: If there is a strong union here, HOW do we explain such bad working “conditions” that include no sick days, not being paid for actual times worked, and so on? In many places of employment, meal breaks are not paid time. So, employees are expected to be on premises for 8 1/2 hours- eight of which are paid and the other that is not. And exactly how much longer were they made to stay over 7:00? A few minutes or hours? If minutes, then this issue is moot. If hours, then there is a serious problem. The devil is in the details, and we’re not getting those.

I also found the latest survey information for this facility. As usual, it doesn’t provide a clear picture of the facility, but all in all it isn’t THAT BAD. I have no doubt this place is a dungeon to work in; I also have little reason to believe the management gives one hoot about the workers. But my instincts tell me we’re not being given ALL the facts.

I ask people to be skeptical on these articles because the lack of detail can make a huge difference. A unionized nursing home should NOT have these issues. A union that has failed it’s members, however, might encourage a strike just to blow smoke in the air around it’s own failings and obscure the truth.

Two resources for CNA’s and other direct care workers for learning.

Self study articles from the state of Oregon’s Community Nursing Tools site; these are all in PDF:
Aspiration
Challenging behaviors - Part 1
Challenging behaviors - Part 2
Constipation
Dehydration
Documentation guidelines
Fall prevention
Infection control
Influenza
Medical terminology - Part 1
Medical terminology - Part 2
Medication safety
Pain management
Pneumonia
Quality care - without restraints
Your body - changes through the years

And this, ABUSE PREVENTION TRAININGS, again, in PDF. Facilitators Guides for each module are available as well.
Module 1: Person-Centered Care
Module 2: Identifying Potential Signs of Abuse & Neglect
Module 3: Abuse and Neglect – Defining & Reporting
Module 4: Stress Triggers and Trigger Busters – Life Influences
Module 5: Stress Triggers and Trigger Busters – Job Challenges
Module 6: Stress Triggers and Trigger Busters – Client Behaviors
Module 7: Stress Trigger Signals
Module 8: Active Listening
Module 9: De-escalation – Conflict Resolution
Module 10: De-escalation – Client Behaviors
Module 11: When Abuse Happens
Module 12: Active Communication – Learning Circle

An article about the difficulties many have with finding placement for their loved ones who have dementia. And behaviors.

“After going from crisis to crisis, Joan is finally in a place where they have the time and training to really help,” said her husband, Terry, 76, a retired math teacher and businessman from Shoreview. “How many places can you get kicked out of? Let’s see, for us it was four in one year.”

The combination of dementia and behavioral problems can overwhelm families.

The combination can even overwhelm care facilities, said Annette Peterson, an Alzheimer’s Association counselor in Bloomington who talks every day with weary and sometimes frantic family caregivers.

To meet the needs of people with dementia, and who tend to be “violent”- facilities must have enhanced staffing ratios and dementia-specific activity based programming/care. The facility needs to be designed to allow for freedom of movement while ensuring the safety of wandering residents. Meals should be served buffet style and not at specific times. Routine is good for some with dementia but not all. Ware-housing these people with the non-memory impaired will not result in good outcomes. In the future, facilities will need to copy the model written about in this article.