beyond death and dying
Post on 17-May-2015
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- 1. Beyond "DEATH and DYING" - Managing Grief to Improve Occupancy
- Graduated Med School from Univ. of Zurich 1957
- Psych Resident NY & CO
- Asst. Prof U. of Chicago
- Clinical Prof - UVA
Elisabeth Kubler-Ross, M.D. In 1969, wrote the groundbreaking treatise on how we treat terminal patients in this country! "On Deathand Dying" 3. Why You Should Study these Concepts
- Need to be a Grief Counselor for Residents
- Understanding your own fears of dying will help you deal with residents and their fears.
- Much of theory applies to other losses and concerns besides just death.
- Gain better understanding of how to support resident in their last days w/o move-out!
- Learn how prospects go thru these same steps before making a move-in decision.
- 1.Increasing speed of move-ins
- Learn how the stages of death & dying also apply to other losses ; AND
- Learn how to use this psychology inbuilding relationships with prospective residents.
Improve Occupancy by: Grief Management =Learning to Accept Loss 5.
- Understanding more of the underlyingneeds & motivationsof existing residents,Including:
- Whysome residents complain all the time ; AND
- AVOIDING MOVE-OUTSby better handling of these residents complaints!
Improve Occupancy by: 6. Improve Occupancy by:
- Avoiding move-outs in a hospice situation
- Understandwhyresidents may move out;
- Learn why that may be the wrong decision;AND
- Provide insights as to how you can help them make theBESTdecision.
7. Kubler-Ross Theory
- All people go through 5 separate and distinct stages when faced with tragic news.
- Psychologically, these stages are different defense mechanisms enabling an individual tocopewith an extremely difficult situation.
- The length of each stage will vary by person, but theymustexperience each stage.
- Had she written her book after computers became more prevalent, she might have portrayed this as a FLOW CHART, such as:
8. Denial anger Bargaining depression ACCEPTANCE HOPE HOPE HOPE HOPE 9. Kubler-Ross
- 5 Stages of Acceptance
- [Applies to all losses not
- only our own mortality]
- Death of spouse or other long-term companion
- Loss of physical capability (e.g. failing eyesight, suffered a fall with on-going limited mobility)
- Not permitted to drive anymore
- Suffered some diminished mental capacity and / or family expresses concern about forgetfulness
- Child / grandchild caregiver moved away
- Spouse /friend experiences declining health and unable to provide previous level of support
- NO, Not me!
- There must be some mistake, the tests were mixed up somehow.
- That (e.g. heart attack) was no big deal, Ill be okay as soon as I get out of the hospital and back home!
- I dont need any help, Ive always done
- I just left the stove on that one time, normally Im very safe.
- Normalhuman emotion / reaction.
- Temporary state of shock .
- Serves as abuffergives time to continue with life and avoid becoming totally consumed with bad news.
- Often followed by ISOLATION.
- Easier to fool yourself if dont also have to try to fool other people!
- Can lead to living in a fantasy world.
- Resident that moves out because doesnt want to face all their friends in the building!
- Patient (resident) can be quite selective in using this trait:
- Can be honest and discuss their situation quite openly with one person; while
- Pretending to be fine with others.
- May be more open with outsiders than own family members!
- Resident behaviors evidencing Denial of disease
- Diabetic refusing to eat diabetic desserts.
- Resident w COPD on O 2& still smoking
- Resident ignoring MD orders to exercise
15. STAGE 2:ANGER
- Feelings of anger, rage, envy & resentment.
- Why me and not _________
- It was your fault that I left the stove on because you interrupted me by
- Youre just saying that because you want to put me away.
- My daughter (son) doesnt care, she/he just doesnt want to be bothered
- Everybody here treats me like dirt.
16. STAGE 2:ANGER
- Very difficult to deal with for both staffandfamily members.
- Anger is often displaced in all directions
- Projected onto the environment
- Appears to be directedat random
17. STAGE 2:ANGER
- Often becomes cyclical in nature
- Visits from family & friends become painful
- Staff avoids the resident because always complaining
- Resident becomes more isolated andmore angryabout being ignored!
- Leads to further acting out, raising voice, making demands, complaining, etc.
18. How to AVOID MOVE-OUT
- Dont take the anger personally (be defensive) understand that it generally has nothing to do with you!
- Try to place yourself in residents shoes and understand what loss or fear of loss is precipitating the behavior.
- Unresolved grief from loss of loved one
- Anger at medical diagnosis / prognosis
- Loss of physical or mental capabilities
- Loss of control other people making decisions for them
19. How to AVOID MOVE-OUT
- Dont get into unnecessary arguments
- No need to defend your stand
- Issue is most likely irrelevant
- Only feeds into hostile behavior
- Understand that expressing anger (even if irrational) will help resident move thru the steps towards acceptance of their loss.
- Show compassion, let the resident know that they are still alive, not forgottenand important to you.
20. How to AVOID MOVE-OUT
- Give assurances that they dont have to raise their voice to get your attention.
- Encourage family members and staff to approach resident with cheerfulness andpatience instead ofAVOIDANCE.
- Train staff to understand that, at times, anger will simply be because they still have physical and mental abilities that residents no longer possess.ENVY .
21. How to AVOID MOVE-OUT
- Encourage resident to retain independent control of their decision making.
- Dont ignore residents wishes and deal only with the children.
- Respect the residents feelings, wishes, and opinions especially regarding his/her own care needs.
- Remember that each resident wants to be unique but still loved and accepted.
- Make sure you and your staff treat the resident as an individual and not a thing!
22. Denial anger Bargaining HOPE The Next Stage is BARGAINING 23. BARGAINING
- Looking for some type of agreement topostpone the inevitable!
- Not unlike a child:If I am very good all week and do all my chores, then will you let me go?( after being previously told NO )
- I just want to stay here long enough to attend
- Ill only drive to my doctors, church and the grocery store.
24. Marketing Opportunity
- When building relationships, identify loss(es) that prospective residents have suffered:
- Loss of a Loved One
- Loss or diminishment of physical ability
- Declining mental capabilities
- Determine which STAGE the senior is in dealing with their GRIEF over that loss.
- In STAGE 3, Bargaining, offer them positive alternatives vs focus on disabilities.
- Anger and rage replaced with a sense of aGREAT LOSS .
- Effects bothCurrentandFuture Residents
- Realization thatLIFE is GOING to CHANGE
- Loss of Independence
- Give up their ho