Sunday, June 27, 2010

Under Construction

I've written about protecting patient confidentiality before.  Now that I have a new job in a new place, I've decided to take confidentiality one step further and make this blog a little more "anonymous."  A while back I created a personal blog and played around with Blogger on what was and wasn't connected to me.  I've decided to permanently separate those blogs now.  If I was following your blog and you are a social worker or work in end of life care, I've temporarily stopped following your blog under the current settings.  Don't worry!  Once these changes are in effect, I'll start following again under this blog only.  Confused?  I am too.  The long and short of it is that I need to separate my blogs and ensure that my name is not associated with this blog.  I do welcome any and all emails but they will be going to a new account.  I just hope that I can make the proper changes without accidentally deleting this blog!  I do plan to continue blogging my experiences here but I may not be able to share as much as I did while working for hospice.  I plan to discuss this with my supervisor tomorrow and see what other safeguards I can take.  Thanks for all your support as I continue through orientation!  I do have more of a hospice/bereavement backlog so keep your eyes peeled for those posts, hopefully sprinkled in with more of my new experiences.

Thursday, June 24, 2010

Really Starting

Orientation has been good but overwhelming.  I work for a very large organization.  I didn't realize how large it was until this week.  It's amazing how many ways you can get lost.  I've decided to stick with the routes I know and figure out the shortcuts later!  I've been meeting tons of people from my departments, learning about the different clinics I'll be a part of, meeting the other social workers, meeting with my supervisor, and setting up my office.  That's right: I actually get an office!  I share it with another social worker and I am so astounded to have my own space, with a window view no less.  Next week will be filled with more meetings and field trips, as well as computer training and a host of other activities.  After that I hope to do some observation of the social workers who have been covering my department and the nurse practioners and other staff.  And then, I guess I'll have to dive in and hope for the best.  Most people have said it took them a couple of years before they felt like they had a good understanding of all the that makes me feel better.  There are some interesting opportunities for me to develop programs and contribute my strengths to existing programs.  I'm not even going to think about that though until I figure out my new routine.  One step at a time, one day at a time.  Still, every day I pinch myself that I get to work here and that I will get to work with these children!

Sunday, June 20, 2010


Tomorrow is my first day of orientation.  It's been nice to have a month off- I highly recommend it to everyone!  I received my orientation schedule for the next two weeks and it's pretty overwhelming.  Lots and lots of meetings, some at the hospital and some off-site.  I just hope I don't get lost too often!  There are the usual nerves associated with starting anything new.  I hope to feel a little better about things once I'm actually there and start meeting some of my coworkers.  I will certainly keep you all posted as I get a handle on the specifics of what my role will be.  I've talked to or emailed with a few friends or online acquaintances that have experienced pediatric cancer or some other disease to find out if they utilized the social worker and get a sense of what things were helpful or what things were not.  One thing I didn't think to ask anyone that occurred to me yesterday is how to address my previous experience, if it comes up.  If a parent asks me what I was doing before I started working there, I can only imagine how they would respond to the word "hospice."  Especially as pediatric hospice may be an outcome for their child someday.  Does anyone have any suggestions?  I don't want to gloss over my background but I also don't want to unintentionally send out adverse messages either.  Thanks!

Thursday, June 17, 2010

Preventing Elder Abuse

Tuesday I wrote about reporting Elder Abuse; today I'll focus on prevention tips.

For the Older Person:
  • Avoid isolating yourself. Isolation can lead to loneliness, sadness, and depression, leading to the increased possibility of abuse or neglect, including self-neglect.
  • Maintain a strong network of friends and social contacts
  • Keep in touch with old friends and neighbors, even if you move
  • Develop a buddy system with a friend outside of the home, i.e. check in on each other regularly to make sure there are no problems
  • Ask friends and family to visit you at home
  • Participate in activities with friends and within your community
  • Volunteer if you're able
  • Get legal advice regarding your will, Power of Attorney for Health Care, as well as Property, Living Will, etc.
  • Review your wishes with your listed POA periodically to ensure you're on the same page
  • Review your will periodically
  • Assertively express your wishes and how you will or will not be treated by those around you
  • Arrange to have your Social Security and/or pension checks deposited directly into your bank account
  • Add your name and number to the national "Do Not Call Registry"
  • Don't live with someone that has a history of violent behavior or substance abuse
  • Don't sign a document unless someone you trust has reviewed it
For Families:
  • Maintain close ties with aging relative and friends, check in with them regularly
  • Listen to what the older person tells you.  Offer advice but don't dictate.
  • Find sources of help and use them, i.e. geriatric case manager, community resources
  • Consider your family's ability to provide long-term, in-home care.  List the pros and cons.
  • Don't offer to be a personal caregiver or to bring the older person in to your home unless you thoroughly understand the demands of caregiving and can meet the responsibility and costs involved 
  • Seek out caregiving training if you choose to care for the older person in your home
  • Explore alternative sources of care, i.e. long-term care facility, assisted living, adult daycare
  • If a hired caregiver or long-term care facility is caring for the older person, stay involved and observant to ensure quality care. Vary the time and day that you visit.
  • Anticipate that someday your loved one will be incapacitated and figure out now what the best plan of care will be, ask them what their wishes would be
  • Pay attention to your own limitations and set boundaries.  Take regular breaks, line up outside professionals or family/friends to provide respite.
  • Don't expect family problems to disappear if the older person moves in to your home, if anything, they may intensify
  • Consider counseling for yourself and/or the older person if behavior problems become an issue
  • Don't limit the older person's independence or unnecessarily intrude on their privacy
For Communities:
  • Develop new ways to provide direct assistance to caregivers
  • Ask other community groups to become more involved in Senior Service programs
  • Encourage public and private employers to support caregivers, such as through Family Medical Leave programs, flex time, etc.
  • Publicize support services that are available, as well as accessibility to professionals
  • Train public agency employees in initial response and case management
  • Provide training for direct service employees
  • Recognize that many forms of elder abuse are crimes
The National Center on Elder Abuse explores some of the causes and how to prevent them for fully in their booklet: Preventing Elder Abuse by Family Caregivers.  

Do you have any other tips on prevention?

Tuesday, June 15, 2010

World Elder Abuse Awareness Day

Today is the 5th Annual World Elder Abuse Awareness Day, a campaign started by the National Center on Elder Abuse.  You may be wondering what constitutes as elder abuse and what you can do about it.  I'm glad you asked!

Elder abuse is the least recognized form of family violence, according to the 2006 Illinois Elder Abuse Annual Report.  It takes on many forms, ranging from severe physical abuse to neglect to financial exploitation.
  • Physical abuse: intentional infliction of physical harm of an older person.  This could include slapping or excessive forms of physical restraint.
  • Sexual abuse: Any sexual activity for which the older person does not consent or is incapable of giving consent, unable to understand, threatened or physically forced.  This could include touching, fondling, exhibitionism, and oral, anal, or vaginal intercourse.
  • Emotional/psychological abuse: Intentional inflection of mental harm and/or psychological distress upon the older adult.  In addition, any activity used to compel the older person to engage in conduct from which she or he has a right to abstain or to refrain from conduct in which the older person has the right to engage.  This may include verbal assaults, threats or abuse, harassment, or intimidation.
  • Confinement: restraining or isolating the older person for reasons that are not related to medical care.
  • Passive neglect: Caregiver's failure to provide an older person with the necessities of life, including food, clothing, shelter, or medical care, because the caregiver does not understand the older person's needs, lacks awareness of services or resources available to meet needs, or lacks capacity to care for the older person.
  • Active neglect/Willful deprivation: Caregiver intentionally fails to meet the older person's basic needs, such as denying assistance with medication, medical care, shelter, food, therapeutic device, or other physical assistance; the older person is then at risk of harm.
  • Financial exploitation: The misuse, misappropriation, and/or exploitation of the older person's material (i.e. possessions, property) and/or monetary assets.  This is to the disadvantage of the older person and the profit or advantage of another person.
Recognize the physical warning signs (the existence of one or more of these does not necessarily mean abuse is occurring):
  • uncombed or matted hair
  • poor skin condition or hygiene
  • unkempt or dirty
  • patches of hair missing or bleeding scalp
  • any untreated medical condition
  • malnourished or dehydrated
  • foul smelling
  • bed sores
  • torn or bloody clothing or undergarments
  • scratches, blisters, lacerations, or pinch marks
  • unexplained bruises or welts
  • burns caused by scalding water, cigarettes, or ropes
  • injuries that are incompatible with explanations
  • any injuries that reflect an outline of an object, ie handprint
Recognize the behavioral warning signs:
  • withdrawn
  • confused or extremely forgetful
  • depressed
  • helpless or angry
  • hesitant to talk freely
  • frightened
  • secretive
Recognize the financial warning signs:
  • unusual banking activity, such as large withdrawals within a brief time period or ATM activity by a homebound older person.
  • Bank or credit card statements no longer come to the older adult (if the older person has dementia, finances may be managed by their Power of Attorney for Property in which case this may be appropriate.)
  • Documents are drawn up for the older person to sign but they cannot explain or understand the purpose of the papers.
  • Their living situation does not add up, based on the size of their estate, such as unpaid bills or lack of new clothing.
  • Caregiver only expresses concern about the older person's financial status and doesn't ask about or express concern regarding their physical or mental health.
  • Jewelry, art, furs, or other valuables are missing.
  • Signatures on checks and other documents do not match the older person's.
  • Recent acquaintances, such as housekeepers or caregivers, declare undying affection for the older person and isolate them from friends and family.
  • Recent acquaintances promise lifelong care in exchange for deeding all property or assigning all assets over to them.
Possible Causes
  • Caregiver stress
  • Dependency or impairment of the older person
  • External stress
  • Social isolation
  • Intergenerational transmission of violence (aka cycle of domestic/familial violence)
  • Personal problems of the abuser

Reporting Elder Abuse
If you suspect elder abuse is occurring, you should report it.  When in doubt, lean towards reporting.  I will never forget the case of this Geneva woman who was gravely neglected by her two daughters.  Paramedics found her weighing 80 pounds, lying on dirty sheets with ants crawling on her. She was suffering from severe dehydration. She also had bedsores on her back, one so deep that hospital workers said they could see her vertebrae. These same hospital workers reported the daughters to their county's Elder Abuse department.  It made me wonder where the rest of the family was when this was occurring or what the neighbors thought.  Did no one else in this poor woman's life suspect something was not quite right?

Abuse can continue and escalate if left unchecked.  Intervention can save the health, dignity, assets, and even life of the older person.  If the older person is in immediate danger, call 911.  If you suspect abuse is occurring and the person lives at a long-term care facility, the report should be made to the local Long-Term Care Ombudsman, local law enforcement agency, or county Elder Abuse department.  If abuse has occurred in a home or assisted living setting, reports should be made to the local county Adult Protective Services (aka Elder Abuse) or to the local law enforcement agency.  If you report a case, you are protected from both criminal and civil liability.  Reports are confidential.

Certain professions are mandatory reporters, including the following fields: social services, adult care, law enforcement, education, medicine, state service to seniors, and social workers.  Mandatory reporting requirements are in effect only when the reporter believes the older person is incapable of reporting the abuse themselves.

Making a report
Be prepared to give the following information:
  • alleged victim's name, address, phone number, sex, age, and general condition
  • alleged abuser's name, sex, age, relationship to victim and condition
  • circumstances that led the reporter to believe the older person is being abused, neglected, or financially exploited; be as specific as possible
  • whether the alleged victim is in immediate danger, the best time to contact the person, if he or she knows abuse is being reported, and if there is any possible danger to the worker going out to investigate
  • whether you believe the older person could make the report themselves
  • your name, telephone number, and profession
  • names of others with information about the situation
  • if you're willing to be contacted again
  • any other relevant information
 When a call is received
A trained elder abuse case worker will respond within a specified time period depending on the severity of the case.  This could be within 24 hours for the most dangerous or serious situations, within 72 hours for less serious ones, and up to 7 days for all others.  The caseworker will contact the victim and help determine what services are most appropriate to stop the abuse.  This could include in-home care, homemaker services, nutrition services, adult day care, respite care, housing assistance, financial or legal assistance and protections, counselling referral for the victim and abuser, guardianship proceedings, nursing home placement, and emergency responses for housing, food, etc.  A competent older person may refuse an assessment and may refuse all services and interventions.  Every effort is made to keep the person in his or her home.  When the older person has dementia or other cognitive impairment, the caseworker will assess and provide services as needed.  Guardianship and nursing home placement is always the last resort.

Resources for professionals.

Coming soon, tips for preventing elder abuse.

Saturday, June 12, 2010

Air Ambulance Network

Air Ambulance Network's website is a treasure trove of flight options for those who are critically ill and medically stable.  Sure, you can arrange a commercial flight on your own but there is a host of paperwork that you must have in order, especially if the patient needs any portable equipment.  This is where Air Ambulance Network comes in.  They will arrange for the required medical clearance from the airline, book tickets for the patient and family member(s), coordinate with attending and received facilities, set up ground transportation, arrange for necessary portable equipment, and arrange for aeromedically trained personnel. They require 7 to 10 days notice so they will have time to make the necessary arrangements.  The Medical Escort Service is for patients that are medically stable but require basic monitoring, oxygen, assistance in the bathroom or with hygiene, administration of medications, and assistance with boarding and departing the plane.  Air Ambulances are available for the most basic patient to the critically ill or injured patient.  Click here to request a quote.

Science Care

I'm back on the blogging wagon, ready to start writing all the posts I meant to write this past year.  First up is Science Care, a whole body donation program.  Science Care facilitates both whole body and organ donation.  Science Care is accredited by the American Association of Tissue Banks (AATB) and accredited as a provider by the Accreditation Council for Continuing Medical Education (ACCME); learn more here. If you don't care to learn more about body donation, I suggest you stop reading now. Body donation is used for medical research and training for physicians and surgeons, thus improving quality of life for future generations.  If you sign up with Science Care, you can be both an organ donor for transplant and a whole body donor.  Acceptance of the organ or body donation is contingent on medical and suitability criteria at the time of death.  A donated gift could be used in several settings, such as medical school, a laboratory, or for medical research.  To be blunt, your body may be embalmed and then dissected; if so, your body would not be publicly displayed.  Obviously, you'll have no control over how your body is used if you choose to donate, although they will try to meet your wish to donate to specific research.  Donating your body is not for everyone but it is an incredible gift.  Once donation is complete, the cremated remains are returned to the next of kin, usually in 3-5 weeks.

Almost everyone can donate regardless of age, location or health. Most illnesses are accepted, including cancer, heart disease, lupus, ALS, arthritis, stroke, H1N1 and diabetes. Donors are screened to ensure safety and suitability of the donation for medical research and training. If you have HIV/AIDS, hepatitis B & C, active tuberculosis or syphilis, you will not be able to donate. Other considerations include severe obesity, decomposition, trauma or extensive orthopedic surgeries.

Science Care can accept donations from every state in the U.S. except Minnesota and New Jersey. Donations from outside the United States are currently unable to be accepted.  If you're over 18, you can click here to pre-register with Science Care.  You'll need to authorize the Donation Form and then the Cremation Form. If you're thinking you would like to donate your body to science, it's important to plan in advance.  This will allow you to discuss your wishes with loved ones and eliminate any confusion at the time of death.  Science Care has also compiled a handout on religious viewpoints regarding organ and tissue donation.  However, registration can also occur at the time of death by the next of kin.  There are no costs associated with donation and Science Care will provide transportation from the place of death so there is no need to call a funeral home.  This also means that it will not be possible to have an open casket funeral; the funeral may be delayed if family decides to wait for the cremated remains to be returned before holding the service.   Science Care will also file the death certificate, provide cremation, and return the remains to the next of kin, if requested. 

At the time of death, simply call Science Care.  If the person was pre-registered, you can follow the directions on their personalized ID card.  A staff member will need to speak with the next of kin to complete a medical and social history questionnaire to determine acceptance, sign any necessary authorization forms, and verify information for the death certificate.  Science Care is available 24 hours a day.

Are there any good organ or body donation organizations of whom you are aware or with whom you have worked?

Wednesday, June 02, 2010

Palliative Care Grand Rounds 2.6

The latest edition of Palliative Care Grand Rounds is up at Bedside Manner.  There's lots of good stuff- I especially enjoyed the New York Times articles. GeriPal is slated to host next month and be on the lookout for me to host in September.