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Post-Traumatic Stress at End of Life

December 18, 2014

By Edgardo Padin-Rivera, Ph.D.

Dr. Padin-Rivera Head Shot

Editor’s Note: Dr. Padin-Rivera is Chief, Psychological Services, and Chairman of the Mental Health Council for the Louis Stokes Cleveland VA Medical Center.

 The symptoms of post-traumatic stress disorder (PTSD) have been found among soldiers in every war. The syndrome begins when a traumatic event or events that a person has experienced leaves such a strong psychic impression that the person later suffers from recurrent, painful, and intrusive recollections. These may take the form of unwanted thoughts, images, or even hallucinations, called flashbacks, during which components of the event are actually relived.

Many traumatized persons, to avoid re-experiencing the anxiety and pain of a trauma, will avoid activities that activate emotions or thoughts about the events. Consequently, emotional numbing and psychological amnesia to parts or all of an experience may occur. Other symptoms that may develop include nightmares, sleep disturbance, hyper-alertness, survivor guilt, exaggerated startle and unresolved mourning.

Late-onset PTSD

There is evidence that late-onset PTSD in formerly well-functioning individuals now facing end- of-life issues is an increasing phenomenon.As nurses and other providers care for veterans encountering medical intervention or end-of-life issues, they are in an important position to identify this often overlooked disorder and provide appropriate care and referral for mental health treatment.

Often, veterans facing the prospect of death may experience an onset of PTSD symptoms in response to changes in environment, medical interventions or loss of family members. It is also reasonable to expect that the veteran who suffered war traumas may be faced in late life with re-activation of symptoms in reaction to the developmental imperative to reflect upon and integrate his life history.

 Potential triggers

In unfamiliar and new environments, a veteran may suffer great anxiety when exposed to sudden loud noises, confinement and even movies or songs reminiscent of the period when the trauma occurred. In response, the veteran may purposely avoid discussions that are reminders or try to emotionally “tune out” things that might cause a resurfacing of feelings or thoughts associated with the trauma.  Also, staff should be aware that any noxious stimuli such as surgery or an unknown medical procedure may trigger PTSD symptoms.

The aging process itself can cause symptoms to surface as serious health issues force limits on driving, working and walking. Subsequent feelings of vulnerability and powerlessness can mimic emotions similar to those experienced during combat. All people have common experiences as death approaches. Among these is a life review that allows the person to reassess significant experiences in their lives. This life review may be more complex for combat veterans who have faced the chaos, destruction and death that are signature components of war.

 Helpful interventions

Clinicians at residential facilities can assist veterans with some short and immediate interventions. These include initiating conversations about their military service, without going into traumatic experiences. Intensive trauma processing may worsen depression and anxiety. Pushing for details of traumatic events is best left for an expert in PTSD.

Showing respect and gratefulness for their service goes a long way. Discuss with family members how the veteran has coped with symptoms over the years; this will give the clinician a better picture of how to approach symptoms and what to expect. Doing PTSD symptom education with the veteran can help normalize the fearful imagery and emotions associated with memories. Thought distracting can also help manage intrusive thoughts and reorienting the veteran to present day can help contain overwhelming imagery or sensory illusions.

Sudden anxiety and depression might be clues to an activation of symptoms. Intense anger may also be a sign. It is worth noting that soldiers learned during war that allowing intense feelings of vulnerability, loneliness and helplessness were a threat to survival while expressing anger or aggression was more apt to help in survival. Often, this lesson has been carried and ingrained in behaviors for decades after the war.

 Special considerations for combat veterans

Combat veterans are less disposed to ask for psychological help, are reluctant to discuss the emotional effects of combat and often deny or downplay symptoms when first approached. Be aware that somatic complaints and depression often mask PTSD. Note extremes in emotions. Sudden anxiety and depression might be clues to an activation of symptoms. Intense anger may also be a sign.  It is worth noting that soldiers learned during war that allowing intense feelings of vulnerability, loneliness and helplessness were a threat to survival while expressing anger or aggression was more apt to help in survival. Often, this lesson has been carried and ingrained in behaviors for decades after the war.

 

Job Opening: Procurement Assistant

December 18, 2014

 

PROCUREMENT ASSISTANT
Location: Cleveland, OH

Provide Support for the procurement functions. Key purchase orders in MAS90 software. Coordinates necessary repairs on leased/purchased equipment at all sites as needed. Provides miscellaneous duties as assigned by the Purchasing and Contracting Team Leader.

Requirements:  High school diploma; Two (2) years experience in computerized procurement and accounting system, MAS90/SharePoint preferred; Two (2) years experience in a procurement environment.

Email application and/or resume to recruitment@hospicewr.org or fax to 216.298.0388.

Volunteer Opportunities

Back to job listings

 

About Hospice of the Western Reserve

Hospice of the Western Reserve provides palliative end-of-life care, caregiver support, and bereavement services throughout Northern Ohio.  In celebration of the individual worth of each life, we strive to relieve suffering, enhance comfort, promote quality of life, foster choice in end-of-life care and support effective grieving.

*Please do not submit resumes or any personal information in the comments section*

Rockwell Singers Fulfill Holiday Song Wishes

December 14, 2014

The Rockwell Automation Singers

For 17 straight years, the Rockwell Automation Singers have visited David Simpson Hospice House, bringing joy to patients and families during the holidays.

Each year, the choir sings in the Atrium for 30 minutes and then visits each room and offers to sing patients’ and families’ favorite holiday songs, including Christmas and Hanukah ones, around the bed.

This year was no different and last week the singers took numerous requests from patients and families including an 88-year-old gentleman who requested Broadway show tunes. Sure enough they new his favorite, “If I Loved You,” from Carousel and even though he is very short of breath, he sang right along in a beautiful deep voice, soft, but clear as a bell.

An 82-year-old woman was brought to tears with their rendition of “O Holy Night.” Requested for her by her HNA, they held hands together and she quietly shed a few tears reminiscing about her recently deceased husband and his favorite song.
A younger resident requested something “peppy” and the singers did a rousing version of Jingle Bell Rock, leaving family members dancing.

Hospice of the Western Reserve employees and volunteers have watched as patients with symptoms of dementia sing along with the choir as they offer old favorites like Rudolph the Red Nosed Reindeer, White Christmas and Silver Bells.

The group will stay at a patient’s bedside and continue to sing as many songs as the patient requests. Many times, it is the caregivers and family members sitting vigil that welcome the group into the room, requesting their loved one’s favorite song, sometimes cradling the patient, letting the singers know their loved one heard the song.

Pictured above are Bill Shinko, Lisa Martel, Bill Cook, Bruce Moore and Alice Geremia

Ohio’s Two Leading Hospices Announce Partnership

December 12, 2014

Alliance to Foster Statewide Quality through Creation of Best Practice Standards

Cleveland, Ohio (Dec. 12, 2014) – Ohio’s two largest hospice care providers – Hospice of the Western Reserve and Hospice of Dayton – have announced a collaborative initiative to ensure delivery of the highest quality of care for all Ohioans. The partnership will focus on creating best practice standards for hospice and palliative care, proactively sharing quality data, benchmarking performance to continuously improve care delivery and creating the most skilled workforce. All of the initiatives and their outcomes will be supported by fact-based research.

“Phase one of the partnership will emphasize the sharing of best practices, integration of evidence-based care, standardization of education, enhancement of community advocacy activities and the promotion of world-class hospice care across Ohio,” explained Hospice of Dayton President/CEO Kent Anderson.

“New programs for disease management and high-risk care management will also be initiated in partnership with health systems and managed care providers. Future initiatives will focus on refining operating efficiencies, sharing electronic medical records with our partners in care, and elevating the presence of best-practice hospice care.”

As not-for-profit, mission-driven, community organizations, Hospice of the Western Reserve and Hospice of Dayton are among the nation’s legacy providers with decades of experience and service to the Northeastern, Southwestern and Central communities of Ohio. The two hospice organizations combined provide care to more than 12,000 Ohioans annually.

The new partnership will advance the shared goals of:

  • Providing ideal patient care for every person needing hospice services regardless of ability to pay
  • Providing hospitality, respect and caring for each patient and family member
  • Preserving and enhancing patient dignity
  • Attending to the social, physical and spiritual needs of each person served
  • Reducing unnecessary suffering in the communities
  • Celebrating the life of each individual

William E. Finn, Chief Executive Officer, Hospice of the Western Reserve, said the long-term goal of the hospice collaboration is to enhance care, services and mission while cooperating in the following areas:

  • Quality of care and services backed by evidenced-based best clinical practices and demonstrating unsurpassed quality of care in the communities they serve
  • Creating a network of hospice and palliative care providers across Ohio with shared commitment to quality, service and access and development of pre-hospice palliative care management
  • Research and innovation through collaboration with community medical schools and institutions to improve end-of-life care
  • Community advocacy for local economies through the creation of jobs and use of community businesses for purchased supportive services
  • Improved stewardship and efficiency through collective purchasing and shared technology, enabling the reinvestment of savings into staffing and care delivery

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December 12, 2014

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Job Opening: Scheduling Secretary

December 12, 2014

 

SCHEDULING SECRETARY
Location: Cleveland, OH

Schedule staff for all shifts, as assigned; Assist with the coordination of staffing and assignments; Enter and retrieve data and maintain appropriate records; Assist in the processing and maintenance of medical records.

Requirements: High school diploma or equivalent; Receptionist or switchboard experience; Typing ability of 50 wpm; Computerized data entry and retrieval, spreadsheet and word processing experience.

Email application and/or resume to recruitment@hospicewr.org or fax to 216.298.0388.

Volunteer Opportunities

Back to job listings

 

About Hospice of the Western Reserve

Hospice of the Western Reserve provides palliative end-of-life care, caregiver support, and bereavement services throughout Northern Ohio.  In celebration of the individual worth of each life, we strive to relieve suffering, enhance comfort, promote quality of life, foster choice in end-of-life care and support effective grieving.

*Please do not submit resumes or any personal information in the comments section*

Job Opening: Patient Accounts Coordinator

December 12, 2014

 

PATIENT ACCOUNTS COORDINATOR
Location: Cleveland, OH

Perform accounts receivable functions including verifying insurance coverage, generating claims for services rendered, and collection of revenue including deductibles/co-pays from all payors, in compliance with Hospice of the Western Reserve policies and regulatory standards

Requirements: High school diploma; Two (2) years experience in insurance billing, accounting or statistics; Two (2) years experience with computerized data entry and retrieval.

Email application and/or resume to recruitment@hospicewr.org or fax to 216.298.0388.

Volunteer Opportunities

Back to job listings

 

About Hospice of the Western Reserve

Hospice of the Western Reserve provides palliative end-of-life care, caregiver support, and bereavement services throughout Northern Ohio.  In celebration of the individual worth of each life, we strive to relieve suffering, enhance comfort, promote quality of life, foster choice in end-of-life care and support effective grieving.

*Please do not submit resumes or any personal information in the comments section*

Job Opening: Patient Family Advocate

December 12, 2014

 

PATIENT FAMILY ADVOCATE – AT HOME SUPPORT
Location: Cleveland, OH

The At Home Support Social Worker, in collaboration with the transdisciplinary team, provides and/or facilitates the acquisition of economic, social and emotional support services to At Home Support patients and their families. This position is responsible for psychosocial consultation to other agency personnel and transdisciplinary team members, referrals to outside agencies, and provides direct services to patients and their families. The Social Worker maintains complete and accurate patient records following established standards of documentation practice and regulatory and licensure requirements.

Requirements:  Graduation from an accredited college or university with a master’s degree in social work, and considerable hospice and palliative care experience, including some supervisory experience, or any equivalent combination of training and experience; Master’s degree in Social Work from a school of social work, accredited by the Council of Social Work Education and registered and licensed in the state of Ohio; Minimum of one (1) year social work experience within a recognized agency or health care organization, prefer experience in inpatient, outpatient, or home based Social Work; Considerable knowledge of hospice and palliative care clinical standards of practice, policies and procedures; Knowledge of community and social services resources.

Email application and/or resume to recruitment@hospicewr.org or fax to 216.298.0388.

Volunteer Opportunities

Back to job listings

 

About Hospice of the Western Reserve

Hospice of the Western Reserve provides palliative end-of-life care, caregiver support, and bereavement services throughout Northern Ohio.  In celebration of the individual worth of each life, we strive to relieve suffering, enhance comfort, promote quality of life, foster choice in end-of-life care and support effective grieving.

*Please do not submit resumes or any personal information in the comments section*

Shaw High School Band Rocks Hospice House, Honors Patient

December 10, 2014

They’ve performed for the president and earned trophies around the world. But on December 9, the Shaw High School band literally rocked the house at David Simpson Hospice House.

The performance was particularly meaningful for one Hospice of the Western Reserve patient and Shaw High graduate. The patient had a connection to many of the students, and coached them in junior high school. It was a wish fulfilled as he was able to hear the band play one last time before he passed away that evening.

Thirty six members of The Shaw High School Mighty Cardinals Marching Band, under the direction of Donshon Wilson performed, amazed and delighted those watching at Hospice of the Western Reserve’s east side care facility. Family members, staff and patients were all able to enjoy the sounds.

Patient family members, staff and patients came out to enjoy the performance, which was organized by Volunteer Service Manager Lori Scotese, as part of the Hospice of the Western Reserve’s life enrichment program.

“You could hear the band throughout the house, and our resident’s family was thrilled with their visit,” Scotese said. “They shared with us that our patient heard the band and let them know he was honored he responded to his friend Mr. Wilson, the Marching Band Director, when he visited him.

“The outstanding talent and heartfelt respect the band showed in honor of our resident moved many to tears as we witnessed the profound appreciation the family shared on behalf of their loved one.”

Band director Donshon Wilson said playing at the David Simpson Hospice House was special.

“The experience was fulfilling for us,” Wilson, who has directed the band for 15 years, said. “The resident was very special to us during his profession and his extracurricular activities. We wanted to show him our appreciation as well as the staff.”

The students performed for almost half an hour, in a style that has earned them numerous awards and accolades.

“They had great respect for the patient and the band members were wonderful ambassadors for Shaw High School,” Scotese said. “We are so grateful for the band’s visit here today and his family will treasure that memory, as we all will.”

The highly regarded band and its director have traveled to Michigan, Alabama, China and more than a hundred trophies, including a national first place for the dance line. They performed at Severance Hall and for President Obama at the Wolstein Center during a 2010 rally.

The visit exemplifies Hospice of the Western Reserve’s mission: embracing life-affirming recognition of patients, while ensuring comfort as a priority.

 

50-Year Breast Cancer Survivor Honored By Susan G. Komen

December 9, 2014

Rebecca Solinsky one of the longest breast cancer LEE B. Solinsky (20)survivors alive

When Rebecca (Becky) Solinsky was diagnosed with breast cancer in 1963, she was treated the way most women with that diagnosis were at the time: She was effectively left on her own.

Becky, then a married mother of two young children, underwent a radical mastectomy, her lymph nodes and part of her arm muscle were removed. But the operation, not usual for those diagnosed at the time, was a success.

“It saved her life,” Becky’s daughter, Jeanette Van Horn said. “The survivability rate at the time was low. She went through her life afraid it would come back.”

The cancer never returned, making Becky, now 89, and a patient in Hospice of the Western Reserve’s Navigator Program, one of the longest breast cancer survivors alive today.

Becky was presented with a certificate, cake, flowers and a goody bag at a “50-year survivor” celebration Nov. 18 at Fairways Assisted Living in Wickliffe, where she lives. In addition to celebrating her beating cancer for more than five decades, the occasion honored her for being an advocate to others diagnosed with breast cancer when the subject was still not discussed.

“It was 1963 and nobody talked about it,” Van Horn, a Hospice of the Western Reserve employee, said. “We didn’t talk about it in the family. We didn’t talk about it outside the house. It was hidden back then. She had no support group to attend. The only person she talked with was her female doctor.”

Van Horn, who was still a child at the time, had to help Becky while she was recovering and recalled being told her mother just had surgery on her arm.

After she recovered, Becky began reaching out to other women who were diagnosed with breast cancer, helping alleviating their fears and providing living proof that a diagnosis of breast cancer was not a death sentence.

“She would talk toSolinksy survivor (5) people who’d been diagnosed, either friends, or women from church,” Van Horn said. “She was an inspiration to others that it was survivable.

“She is my hero; she’s helped so many people. I give her a lot of credit.”

Patricia Terstenyak, from Susan G. Komen, presented Becky with a certificate marking the 50th year of surviving the cancer at the occasion.

“It’s a great opportunity for Komen to be part of this,” Terstenyak said.

The occasion proved a celebration not just for the 50-year milestone, but as an indicator of the significant advancements in breast cancer treatment and society’s openness of the disease.

“Survivability was low back then,” Terstenyak said. “Today there are 3 million breast cancer survivors and a 99 percent five-year survival rate if there is an early diagnosis.”

Becky’s survivability marks one of the longest on record. According to the Susan G. Komen organization, one woman, diagnosed in 1957 is still alive.

Sharon Richman, a Volunteer Service Manager with Hospice of the Western Reserve’s Navigator ProgramSolinksy survivor (1) said the party emphasized the much-different attitude toward breast cancer these days.

“What a celebration of how far we’ve come, of how far our society has come in reaching out, acknowledging (breast cancer) and providing support,” Richman said.

Becky has been in Hospice of the Western Reserve’s Navigator Program for several years. Reserve Navigator provides a range of services to individuals living with an advanced illness. Qualified individuals who enroll in the program can receive palliative care and curative care prescribed by their personal physicians at the same time, and can remain in the program indefinitely.  This extra support helps individuals to continue living independently, keeps patients comfortable and helps to reduce hospital admissions.

Western Reserve Navigator can complement the medical care an individual is already receiving.