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The Ohio Assisted Living Association FALL CONFERENCE

& TRADE SHOW

Sharing Success

“Upstream Palliative Care”

Tuesday October 30th, 2018

10:15-11:45

Presented By:

Sarah Brown, RN, LNHA

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Who is Empira?Empira is a non-profit collaborative quality

improvement organization.

Empira inspires innovation programs and solutions to

improve the aging experience with practical

application of evidenced based research and

collaboration.

It challenges the status quo with commitment to

know and do better.

Empira is nationally recognized as a leader who

strengthens the aging service industry by sharing the

empirical results of applied research signature

programs.

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• Fall Prevention and Management

2008-2011

• Restorative Sleep

2011-2014• Behavioral

Expressions

2017-2017

• ResoLute

2018

Empirical Learning Through Applied Research

Root Cause Analysis

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Climbing The Mountain of Needs

Maslow’s Hierarchy of Needs

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Objectives

• Challenge the current status quo around how we approach health care and dying in the elderly

• Strengthen the learner’s understanding of truthful prognostication

• Inspire teams to embrace the “Work of Aging”

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“I did then what I knew, when I knew better I did better”

–Maya Angelou

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Increased Aging Population

Health

Health

Decline

Morbidity

Life Expectancy

Health Morbidity

Morbidity

Medical

Intervention

Anti-Aging

Past

Present

Future

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Living In The Gap

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The Problem:

“A greater fate than death in this

country is dying poorly or having

someone you love die poorly.

It is a crisis and embarrassment to

our society.”

-Dr. Ira Byock

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“A greater fate than death in this

country is living poorly or having

someone you love live poorly.

It is a crisis and embarrassment to

our society.”

-Empira

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Root Cause:

Lack of Conversations

Resulting in missed opportunity and urgency to discover, plan, reflect and prepare leading to dying “living” poorly with priority on biological needs over psychological and social needs.

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Barriers to Conversations

• Societal Taboo

• Fear of diminishing hope

• Lack of training

• Lack of comfort and support

• Lack of time for the conversations

• Complicated family dynamics

• Failure to acknowledge the need

• Cultural differences

• Assumption that someone else had the conversation

• Belief that code status, POLST, Advanced Directives are enough

• Quality measures focus on clinical outcomes

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Avoidance of truthful prognostication is one of the chief drivers of

patient suffering at the end of life, healthcare provider moral distress

(see www.moraldistressproject.org), and increased healthcare costs.

– Patients wait for clinicians to bring it up

– Families try to protect each other

Healthcare providers may procrastinate such discussions until it

becomes too late for the patient to act on the information effectively

Avoidance of truthful prognostication

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Timely and truthful

prognostication

gives people time to

focus on priorities.

“How many people

in the world can

have an opportunity

like this?”

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ResoLuteResident

Empowered

Solutions

on

Living

until

the

End/Eternity

• ResoLute: capital R and L in the

title, emphasizes RESIDENT

LIVING.

• Strives to support residents in the

gap of healthy adulthood and

end of life along with their loved

ones embrace the work of aging

with purpose and determination

through unwavering commitment

to uphold what matters most.

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Palliative: The ability to promote comfort, decrease suffering, make something

less painful or unpleasant, or to calm fears by alleviating a problem.

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The Work of Aging

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Late Life Milestones

Integrity vs Despair

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Lars Tornstam

Gerotranscendence:

• Highlights growth, interconnectedness, wisdom and understanding that come decades of life lived.

• Increased attachment and

curiosity with younger

generations.

• Fear of death disappears and a new understanding of life and death emerges.

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Work of Aging

This work begins when people start to reflect

on their life and confront their own mortality.

The Work of Aging is used to describe

conversations or actions that support one in

reaching wisdom recognizing what matters

most in living and dying.

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Create a fullness to life through a balanced

focus on the “Work of Aging” needs.

Work of AgingMind

(Psychological Needs)

The emotional state of a person –

Thoughts

Life Integrity

Gerotranscendence

Body

(Biological Needs)

Related to the functioning of the body –

Health

Dichotomy of Decline

Interdependence

Spirit

(Social Needs)

Relating to love and belonging -

Relationships

Interdependence

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Has my life had meaning?

How long will I live?

How do I want to live the rest of my life?

How will I be remembered?

Will my loved ones be ok when I am gone?

What matters most to me now?

Work of Aging questions

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Areas of exploration

Life story Build trust and better understand the individual

Condition/ Truthful

prognostication

Reconcile understanding of conditions, impact on

quality of life.

Purpose/

Living today

Promote living with a sense of contribution

Relationships Acknowledge and reconcile important relationships

Spirituality Identify religious and spiritual needs related to late

life

End of Life Explore and document end of life wishes

Legacy Give residents a voice in how they are remembered

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Dedicated Late Life Specialists

• Dedicated resource

for “Work of Aging”

conversations

• Trained in the “art” of

conversation

• Integrate with

communities IDT

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Ultimate goal of ResoLute/Work of Aging

Residents will have peace, hope, re-framed hope and/or

acceptance in response to:

• How long they will live?

• How they want to live the rest of their lives?

• Has their life has meaning?

• What matters most to them now?

• What happens when they die?

• Will their loved ones be ok when they are gone?

• How they will be remembered?

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What Happens when we do the Work of Aging ?

• Living based on What Matters Most

• Peace

• Acceptance

• Hope for the Future

• Preparedness

Better Ending...

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The Work of ResoLute• Identify late life goals.

• Maintain a purpose in daily life that aides residents in reaching a sense of closure and completeness to ones life.

• Bravely acknowledge the hard work of aging on the mind, body, spirit.

• Identify and validate priorities and fears.

• Recognize the significance relationships with loved ones have on quality of life.

• Involve loved ones in the process through discussion, education and validation.

• Anticipates the likelihood of grief with major life changes and provide resources for coping to both the resident and their loved ones.

• Supports resident’s concerns for loved ones they are leaving behind and provides opportunity for legacy planning.

• Most importantly, assists the individual to live until the very end because their life maintains integrity.

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Peak End Theory

Peak

End

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How is ResoLute changing lives?

• Grief Group

• Game Night

• Facebook post – teacher found children

• Nurse/purpose

• Native American gentleman/hair

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Benefits

“I had great peace knowing that nothing was

left unsaid.

When nothing is left unsaid, there is

importance in time together.

Love is more important than death.

Gratitude is greater than sorrow.

Life has fullness.”

-Ira Byock

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Self Reflections

• When did you first realize you would die from ?

• Image you have just been given a terminal diagnosis, from that point on are you living or dying?

• Based on who you are, what would you want your care team to know about you as a person?

• What words would you want people to use when they remember you?

• How do you feel about being dependent on other people?

• How would you live your life differently if you knew you has 3 years or less to live?

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Let’s revisit our Objectives

• Challenge the current status quo around how we approach health care and dying in the elderly

• Strengthen the learner’s understanding of truthful prognostication

• Inspire teams to embrace the “Work of Aging”

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“I did then what I knew, when I knew better I did better”

–Maya Angelou

“Now you know better, it is your turn to do better.”

–Empira

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Empira Inc @empira.org

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www.empira.org

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is intellectual property of Empira.

To protect the fidelity of our

programs, redistribution without

consent and proper attribution is

prohibited.