Art Therapy and Hospice

Art Therapy
A Parrot

Below is a wonderful article about the value of art therapy and hospice. Esteem Hospice, since its very foundation, has used art as a means of building esteem with our patients. Enjoy this article.

Art Therapy and Hospice

Whether the activity involves putting brush to paper or assembling images into a collage, expression through the visual arts can powerfully improve the quality of life for people with dementia and terminal illness.

Guided art activities can rekindle a sense of self in people with Alzheimer’s disease and other dementias by facilitating a reconnection with long-term memories, said Cordula Dick-Muehlke, Ph.D., executive director of the Alzheimer’s Family Services Center, Huntington Beach, Calif. For hospice patients, art therapy can afford the opportunity to find meaning and closure through the concrete expression of personal accomplishments, important relationships, and cherished experiences, Katy Barrington, Ph.D., professor of art therapy at the Adler School of Professional Psychology, Chicago, said in a separate presentation.

Profound Meaning

Art Therapy

Van Gogh Sisters

Benefits of Art Therapy in Dementia and Hospice Patients

“The process of dying is a unique and vulnerable time for anybody,” Dr. Barrington said, and art therapy can provide an excellent catalyst for the expression of thoughts and feelings as hospice patients near the end of life.

She presented the results of a qualitative study of three elderly female hospice patients in rural Wisconsin. The study was based on existential philosophy, which emphasizes the importance of individual responsibility, choices, actions, and self-examination.

With guidance from Dr. Barrington and a hospice social worker over the course of four visits, patients completed a collage in collaboration with a selected loved one based on a story about their lives. She also asked each selected individual to tell a highlighted story that included the patient. The collages were framed and presented to patients and their loved one in the final session.

The process of creating a piece about one’s life harmonizes with the goals and principles of hospice, which stress connectedness, dignity, respect for the patients’ choices, and giving patients as much control over their lives as possible as they attend to psychological, physical, social, and spiritual concerns, Dr. Barrington said.

Art therapy helps patients cope with anxiety about death and encourages meaningful reminiscence. The latter is particularly valuable because it enables patients to take stock of their contributions and legacies at a time when they might wonder whether they have accomplished anything worthwhile in their lives, she said. Dr. Barrington analyzed the meaning in the finished art pieces using grounded theory, a qualitative research methodology in the social sciences in which data (in this study, patients’ comments) are coded and grouped into similar concepts to generate a theory

She said that she anticipated having to “pull” stories out of the three patients. Instead, “all of them unloaded on me … and I probably had 20 different stories. This tells me that confronting death is huge, and that there is a need to talk or bring it all together–to bring life together.”

Each of the three patients talked about mentors in their lives who had helped them deal with struggles and personal choices. Creativity (skill in embroidery, quilting, and sewing) had also played a prominent role in each woman’s life, providing a means of navigating hardships, developing pride and dignity, saving money, and improving the quality of life for themselves and others. Their skills were parts of their legacies.

Through the creative process, patients “recognized that their experience was valuable, that it constituted knowledge, and that meaning came from that knowledge,” Dr. Barrington said. The project gave patients “choices and decisions to make, which made them whole and made them feel they were contributing to bettering their own lives, even as they confronted death.”

Creativity Despite Dementia

For people with dementia, activities have a different value. While providing an excellent vehicle for emotional release and social connection, art also can enhance cognitive functioning by helping individuals tap into brain functions that remain relatively intact, including long-term memory systems, Dr. Dick-Muehlke said.

“When we talk about art, we always talk about the creative process and the emotional process … but it’s important for us to recognize that art allows people with Alzheimer’s disease to use their preservedcognitive skills,” said Dr. Dick-Muehlke. She noted evidence that cognitive stimulation with medication might be more effective than medication alone (Dement. Geriatr. Cogn. Disord. 2006;22:339-45).

The neurodegenerative process of dementia impairs short-term memory, language, judgment, and visual spatial abilities. “We place a great deal of value on those [abilities] in our society. And we often forget about that other aspect of that person–the aspect of the person that is still so alive,” she said.

By tapping into what a person can still do and feel successful at, art helps individuals express essential features of themselves. Episodic autobiographical memories, such as “the day I got married” or “when I went to college,” as well as the long-term memories of skills and procedures called procedural memories often endure.

“People are very surprised that people with dementia can create such beautiful art,” said Dr. Dick-Muehlke. “Every time you see someone’s mouth drop is a time that you decrease the stigma of what it means to have Alzheimer’s disease.”

Birk, Susan. “Art therapy benefits hospice, dementia patients.(GERIATRIC PSYCHIATRY).” Clinical Psychiatry News. International Medical News Group. 2010. HighBeam Research. 21 Feb. 2011 <http://www.highbeam.com>.


7 Benefits of Hospice Care

Learn the advantages of hospice care for your ailing loved ones and your family.

Jennifer Geisman, Contributor
Articles> 7 Benefits of Hospice Care
nurse holding hand of a patient

When the doctor mentioned hospice as an option for Elaine Bleiden’s mother, Bleiden was surprised. “I was totally blown away, as I realized this is what end of life is like,” remembers Bleiden, who lives in Northridge, CA. I discovered the 7 benefits of hospice care. Esteem Hospice provides the 7 benefits of hospice care to all its patients and their families and caregivers.

For many, hospice is a frightening word because it is associated with end of life. But really the confusion is due to not understanding what hospice is and how it can help people who are sick and their families.

Often, the biggest myth surrounding hospice care is that the family has given up and hospice is a final surrender. But hospice is a way for people to prioritize the wishes of the patient and the family and is in no way “giving up.” It is a specialized care and support that works to create ease and comfort for the patient and the family.

Below are some of the benefits of choosing Esteem Hospice care for your loved ones.

  1. It Offers a Familiar Environment
    While hospice is sometimes provided in nursing homes and hospitals, it can also be provided in the comfort of the patient’s home or in a hospice facility. The focus is on finding a place that is calm, quiet and very different from the typical stressful buzzing of a hospital. Hospice care is a collaborative effort between the patient, the family, the hospice team and the doctor to impart a care regimen that benefits everyone.”Research has shown that people would prefer to die in comfortable or familiar surroundings rather than in an institutional setting,” says Spencer Levine, vice president of programs at the Hospice Foundation of America. “Hospice will come to the patient wherever he or she calls home.”
  2. It Provides a Comprehensive Plan, Competent Professionals
    The key to providing comfortable final days is a comprehensive plan that involves a team of medical and health care professionals, who address all aspects of a patient’s illness with importance on controlling and reducing pain and discomfort.You may be working with doctors, nurses, therapists, health care aides, clergy, social workers, etc.”Hospice workers have been there before — many times,” says Lauren Sommer, LCSW, a bereavement specialist at Seasons Hospice & Palliative Care. “Families find the experience they bring to the table invaluable as they navigate end-of-life care.”
  3. It Offers Personalized Care and Support
    Hospice care eases family anxiety, as hospice professionals are on-call 24-hours, allowing the family to rest in between visits. They can offer patients what they need, from companionship to a listening ear to a favorite food.”There were nurses and CNAs that would come and check on my mom,” relays Bleiden. “During the last four weeks of her life, hospice helped me make sure she was covered.”
  4. It Gives Patients a Sense of Dignity
    Hospice offers a chance to die with dignity. Hospice patients aren’t hooked up to loud machines, aren’t poked or prodded hourly by medical personnel and won’t undergo invasive procedures to prolong life.
  5. It Respects a Patient’s Wishes
    This is an essential element of hospice care. By placing a loved one in hospice, families can focus on spending time with the patient and not dealing with the red tape and extensive procedures of a hospital environment.”With physical, emotional and spiritual pain addressed, patients and loved ones can spend the precious time remaining concentrating on things that are important to them,” Levine adds.
  6. It Lessens Financial Burdens
    For many families, hospital bills can be overwhelming. Under hospice supervision, out-of-pocket costs are significantly reduced and Medicare, Medicaid and private insurances help cover hospice care. Check with your individual insurance to see what elements of hospice care are covered.
  7. It Provides Family Counseling
    Guidance and support are a necessary piece of the puzzle. Hospice helps families deal with the range of emotions that surround this difficult time, offering guidance from social workers and chaplains. In addition, hospice will also offer the family bereavement and grief counseling after their loved one has passed and help with some of the after-death tasks that need to be completed.”We asked the chaplain from hospice to officiate at my mom’s funeral, as she was the one that was with us for those last few weeks,” notes Bleiden. “She really did so amazingly,”

For Bleiden and her family, choosing hospice care for her mother was a calming and successful experience during a heartbreaking time. Bleiden was pleased with the 7 benefits of hospice care and the program and knows she made the right decision for her mother.

Jennifer Geisman is a freelance writer living in Los Angeles.

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Why Planning for End-of-Life is Important

Planning for End-of-Life

planning for end-of-life

Planning

Care Decisions

Because of advances in medicine, each of us, as well as our families and friends, may face many decisions about the dying process. As hard as it might be to face the idea of your own death, planning for end-of-life, you might take time to consider how your individual values relate to your idea of a good death. By deciding what end-of-life care best suits your needs when you are healthy, you can help those close to you make the right choices when the time comes. This not only respects your values, but also allows those closest to you the comfort of feeling as though they can be helpful.

There are several ways to make sure others know the kind of care you want when dying.

TALKING ABOUT END-OF-LIFE WISHES

The simplest, but not always the easiest, way is to talk about end-of-life care before an illness. Discussing your thoughts, values, and desires will help people who are close to you to know what end-of-life care you want. For example, you could discuss how you feel about using life-prolonging measures or where you would like to be cared for. For some people, it makes sense to bring this up at a small family gathering. Others may find that telling their family they have made a will (or updated an existing one) provides an opportunity to bring up this subject with other family members. Doctors should be told about these wishes as well. As hard as it might be to talk about your end-of-life wishes, knowing your preferences ahead of time can make decision making easier for your family. You may also have some comfort knowing that your family can choose what you want.

On the other hand, if your parents are aging and you are concerned about what they want, you might introduce the subject. You can try to explain that having this conversation will help you care for them and do what they want. You might start by talking about what you think their values are, instead of talking about specific treatments. Try saying something like, “when Uncle Walt had a stroke and died, I thought you seemed upset that his kids wanted to put him on a respirator.” Or, “I’ve always wondered why Grandpa didn’t die at home. Do you know?” Encourage your parents to share the type of care they would choose to have at the end of life, rather than what they don’t want. There is no right or wrong plan, only what they would like. If they are reluctant to have this conversation, don’t force it, but try to bring it up again at a later time.

ADVANCE DIRECTIVES AND OTHER DOCUMENTS

Written instructions letting others know the type of care you want if you are seriously ill or dying are called advance directives. These include a living will and health care power of attorney. A living will records your end-of-life care wishes in case you are no longer able to speak for yourself. You might want to talk with your doctor or other health care provider before preparing a living will. That way you will have a better understanding of what types of decisions might need to be made. Make sure your doctor and family have seen your living will and understand your instructions.

Because a living will cannot give guidance for every possible situation, you probably want to name someone to make care decisions for you if you are unable to do so for yourself. You might choose a family member, friend, lawyer, or someone in your religious community. You can do this either in the advance directives or through a durable power of attorney for health care that names a health care proxy, who is also called a representative, surrogate, agent, or attorney-in-fact. “Durable” means it remains in effect even if you are unable to make decisions. A durable power of attorney for health care is useful if you don’t want to be specific—if you would rather let the health care proxy evaluate each situation or treatment option independently. A durable power of attorney for health care is also important if your health care proxy, the person you want to make choices for you, is not a legal member of your family. Of course, you should make sure the person and alternate(s) you have named understand your views about end-of-life care. If you don’t name someone, the state you live in probably has an order of priority based on family relationships to determine who decides for you. A few states let people name a health care proxy by telling their doctor, without paperwork.

Don’t confuse a durable power of attorney for health care with a durable power of attorney. The first is limited to decisions related to health care, while the latter covers decisions regarding property or financial matters.

A lawyer can prepare these papers, or you can do them yourself. Forms are available from your local or State government, from private groups, or on the Internet. (See To Learn More below.) Often these forms need to be witnessed. That means that people who are not related to you watch as you sign and date the paperwork and then sign and date it themselves as proof that the signature is indeed yours. Make sure you give copies to your primary doctor and your health care proxy. Have copies in your files as well. Hospitals might ask for a copy when you are admitted, even if you are not seriously ill.

Sometimes people change their mind as they get older or after they become ill. Review the decisions in your advance directives from time to time and make changes if your views or your health needs have changed. Be sure to discuss these changes with your health care proxy and your doctor. Replace all copies of the older version with the updated ones, witnessed and signed if appropriate.

You should also give permission to your doctors and insurance companies to share your personal information with your health care proxy. This lets that person discuss your case with your doctor and handle insurance issues that may come up.

Do you live in one state, but spend a lot of time in another? Maybe you live in the north and spend winter months in a southern state. Or possibly your children and grandchildren live in a different state and you visit them often. Because states’ rules and regulations may differ, make sure your forms are legal in both your home state and the state you travel to often. If not, make an advance directive with copies for that state also. And make sure your family there has a copy.

To Learn More

ww.aafp.org/about/policies/all/planning-care.html

About Advance Directives and Living Wills:

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