I Graduated Law School — & Decided To Become A “Death Doula”


 
By Annie Georgia Greenberg

“Death is inevitable. My life span is ever decreasing. Death comes whether or not I am prepared.” These are three of the nine contemplations on death written by Buddhist teacher Atisha — and Alua Arthur reads them to clients during death meditations. As a death doula and owner of Going With Grace, an end of life and death care company, Arthur (who graduated from law school before shifting to work in the death industry) facilitates these sessions to help people who are uncomfortable with the idea of death or dying.

“Death meditation is an opportunity for people that are struggling with some fears around death and dying to confront those fears head-on,” Arthur says. “It’s not for the faint of heart. It’s an opportunity to really think about the body’s eventual decline, and to go there to see what the discomfort is, so that we can then talk about that and process that. It’s intended to soften the fear around death.”

And, true to her claim, Arthur’s work is meant to soften fears around death. “Doula” is a word derived from a Greek term meaning, “women who serve.” As a death doula, she works with clients to plan for the final stage of their lives, holds space to support them emotionally through their deaths, and ensures their wishes are met.

Arthur developed a nine-part “Advanced Care Directive” that allows clients to list how they’d like to be cared for in the event of terminal illness. It includes everything from personal grooming preferences to thoughts on life support. By filling out Arthur’s document, a client can clearly state how they’d like their social media to be handled in the event of their death and whether they’d prefer to be embalmed, buried in a bio-urn (a seed pod for ashes that nourishes the earth and grows into a plant), or anything in between. She’s helped prepare for end of life with healthy millennials, large family groups, and even her own father.

Alua Arthur

Of course, when it comes to her own funeral, Arthur, who thinks about death “all day, every day” knows exactly what she wants. If possible, she’d prefer to die outside, at sunset. And she wants to be buried in a pink or orange raw silk shroud. Her funeral will be a party filled with music (Michael Jackson is a must on the playlist). She’d like her jewelry — an extensive collection of bangles and big earrings — hung on trees and for attendees to take the pieces they like. This tendency toward bright colors, generosity and liveliness mirrors Arthur’s sensibility in life. Her smile is contagious. Arthur’s yellow and magenta and green African-print frocks are a far cry from the drab, stereotypical wares one might associate with the death industry. In fact, there’s nothing grim about her or the work she does.

Yes, Arthur’s death consultations can be heartfelt and tearful to be sure, but, as she puts it, “death can definitely be funny.” And so, she approaches each conversation with a seemingly effortless but effective sense of levity. Arthur is part of a new trend in the death industry that favors pre-planning, personalization, and, ultimately, the normalization of death as a topic of conversation. In Arthur’s vision of the world, everyone over the age of 18 has an end of life plan and is willing to talk openly about death, she says.

“I think people don’t talk about death, because we’re not really comfortable with it,” she says. “Yet, whenever I talk about my work, people always talk to me about death… I think my work gives people permission to talk about this thing that we all want to talk about anyway, yet we’re just not doing.”

So, while many of us may not all be ready to recite the nine contemplations just yet, we can take comfort in the words Arthur uses to signs off on all of her Advanced Care Directives: “Yes, one day you and I will die, but before that day, let us live.” When she says those words out loud, she can’t help but smile.

Complete Article ↪HERE↩!

How one student uses dance to understand the biology of grief

Erin Dong ’18 performs during the American Dance College Association Conference in Boston, which she attended in February.

By

[E]rin Dong ’18 knew from a young age that she wanted to study biology. While at the University of Rochester, she supplemented her coursework with stints as a volunteer in rehabilitation physical therapy at the Medical Center and as a research assistant in the School of Nursing. But what surprised her during her time at Rochester was that she also developed a love of dance, leading her to double major in both biology and dance.

For her senior capstone project, Dong created a dance called “The Beautiful Awful: Experiencing Grief Through Movement” that combines aspects of both her majors. Along the way, she learned important lessons about the creative process, taking risks, and the wisdom that can come from failure.

“I only started dancing when I came to college,” Dong says. “But I love how it’s this universal way of expression. In my senior project, I wanted to help people remember the loss they felt and experienced, connect to others who also shared that, and allow them to feel the emotions in their entire bodies, not just in their heads.”


 
Dong started her project by examining other performances, specifically Bill T. Jones’s piece “Still/Here” and “Dying and dying and dying” by dance company MBDance, who visited Rochester in January. For his piece, Jones hosted a series of “survivor workshops” with the terminally ill and had them map out their lives and deaths by moving in a space. “Dying and dying and dying” depicted various endings in life, such as the death of an individual and of a culture.

Inspired by Jones, “I realized that if I wanted to make something that spoke to a larger audience, I had to first find a topic that resonated with me,” Dong says.

It was around this time that her beloved grandmother, Peggy, passed away. Dong was at a dance conference in Boston, during which she saw a dance by students at Bates College called “That’s All, Folks.” The choreographers had asked people from all different backgrounds how they would spend their last days on Earth. The dancers’ movements mirrored the answers, which ranged from “sitting and watching the sun rise” to “eating a gallon of ice cream with my childhood sweetheart.”

“Seeing this dance is when I finally cried about my grandmother, because I was able to connect to the joy, but also the pain and the sadness, evident onstage,” Dong says. “The piece really coaxed out my emotion and gave me a safe space to feel.”

Dong realized she wanted to create a similar kind of space in her own dance—one in which people would have an outlet to grieve freely. She turned to her knowledge of anatomy and physiology to create a piece that incorporated not only the emotional aspects of the grieving process, but the physical symptoms as well.

The body is the dancer’s instrument; therefore, a sound understanding of the body’s anatomy, mechanics, and the functions involved in movement are important in dance, says Anne Harris Wilcox, a senior lecturer in the Program of Dance and Movement at Rochester and Dong’s faculty mentor.

“Both dance and biology foster the principle of connection, proving that nothing works in isolation. Any effect on a part of the body, affects the whole,” Wilcox says. “Erin’s second major, biology, is a fabulous partner to her dance and choreography research; it helped her appreciate the multi-dimensional understanding of the human body and its inter-connected systems.”

Dong researched the somatic symptoms associated with grief, such as fatigue, chest pains, and shortness of breath. During her first attempt to choreograph the dance, she used the stage to represent the human body and dancers to represent different emotions. She wanted audience members to be up on stage and have the dancers talk and interact with them.

“When I tried to put it all together, it turned out to be an epic fail,” Dong says, laughing. “I was trying to do too much, and I lost sight of the human-nature side of my piece.”

Dong overhauled the project to better satisfy her vision of a piece that would walk the audience through the grieving process, similar to the way a counselor might guide patients through talk therapy.

“It’s rare to see someone have the courage to scrap an idea and keep digging, but that’s exactly what Erin did,” Wilcox says. “She saw the wisdom in ‘failing’ and learned that knowing what doesn’t work is just as important in any process.”

In her second attempt, Dong collected qualitative data, asking individuals to describe their emotions and bodily sensations when they first heard they had lost a loved one. She modeled each section of her new dance after a different element of grief and included spoken text, taken verbatim from what people had told her when recounting their own experiences.

She incorporated lighting design to suggest various emotional elements: dancers are at times isolated, shadowed, or completely removed from the light. “The Beautiful Awful” also has the dancers move into the audience, the opposite of Dong’s original idea to have the audience move to the dancers. “You never ask a grieving person to meet you where you are,” she explains. “You want to meet them where they are in their grief.”

The final product is a meditation on grief that brings together science, emotion, and creative movement. But it’s the lessons she learned from the process that Dong will carry with her as she begins graduate studies. This summer she starts a three-year, doctoral-track program for physical therapy at the University of Pittsburgh.

“When it comes to dance you have to learn how to take risks and do new things, and that also translates to the rest of life,” she says. “Coming into college as a freshman, I was really timid and not very confident in myself. Dance has given me a lot more self-assurance.”

Complete Article HERE!

Going Green After Kicking the Bucket

How to Die Sustainably

By Katie Conley

The Sustainability of Death

In their 1976 classic, (“Don’t Fear) The Reaper,” Blue Öyster Cult sang that “40,00 men and women” die every day. Today, that number is more like 151,600. That’s a lot of bodies, and frankly, we’re running out of places to store them all. Ignoring sustainability entirely, how we dispose of our deceased is becoming a big problem. In Sweden, for instance, your grave is dug up twenty-five years after burial, your corpse is pushed farther into the ground, and another body is added on top—there simply isn’t space for new bodies. The Swedes are known for their compartmentalization (I see you, IKEA! Loveyour meatballs!) but when it comes to our final resting place, there’s got to be a better way.

Environmental activist Edward Abbey, famously buried in the desert in a sleeping bag, stated that “[After] the moment of death . . . we should get the hell out of the way, with our bodies decently planted in the earth to nourish other forms of life—weeds, flowers, shrubs, trees, which support other forms of life, which support the ongoing human pageant—the lives of our children. That seems good enough to me.” And today, you can do just that. Although cremation remains the number one choice of disposal in North America, and traditional burial a close second, green practices are quickly catching up.

Cremation does indeed create less waste than a traditional casket and land plot, but the “natural gas that goes into a cremation is [equivalent to] two full tanks of an SUV, or a 500-mile car trip,” as mortician, author and “Good Death” advocate Caitlin Moran told Jezebel. Perhaps more disturbing is the amount of mercury released into the atmosphere during cremation due to…brace yourself…our dental fillings. You don’t see a pamphlet about thatat the dentist’s office. Bestselling author Mary Roach notes in Stiff: The Curious Lives of Human Cadaversthat “the average amount of mercury released into the atmosphere” is “three grams per cremation.” Maybe we all should have flossed more?

If you lived your life sustainably, why wouldn’t you die sustainably? We’ve provided an intro to green burials, but this is just the tip of the iceberg. You can be buried on a funeral pyre, thanks to the help of organizations like the Crestone End-of-Life Project; you can donate your body to science, perhaps at The Body Farm, where your decomposition will help forensic scientists solve crimes; or you can go full-on Edward Abbey and decompose back to the earth. (The legality on that last one is iffy, but hey, chase your bliss). We’ve all got to go sometime. Know your options, create a plan with your loved ones and research, research, research. Make your memorialization an eco-conscious testament to the way you lived your life.

What Constitutes a Green Burial?

To be considered “green,” according to Ellen Newman of the Good Green Death Project and TalkDeath, a burial must adhere a few basic standards:

For the Body:

-No embalming fluid.

-Natural shrouds or compostable/recyclable “basket casket” are utilized. Youcanhave a casket, but it must be made from biodegradable materials. Remains (if in powder form) must be in a biodegradable container.

For The Gravesite:

-No grave markers. Naturally occurring markers like trees or stones are fine.

-No vaults or grave liners.

-No non-native species planted on burial grounds; no maintenance for the plants or grounds.

Complete Article HERE!

The 7 Stages Of Grief And How They Affect You

Grief is a horrible emotion to feel, because it means that something has happened in your life that you wish you could avoid. In most cases, it’s because of the loss of a friend, family member, pet or other loved one. But just what happens when you experience grief and what should you do about it? Understanding the 7 stages of grief will start you off right.

 

The 7 Stages of Grief

Shock & Denial

When someone first brings you that bad news it can be difficult to believe it’s even real. You want to just shake your head and say ‘no way.’ You may start to feel a little numb and may feel no pain at all at the loss because of this. The shock and disbelief are actually suspending your pain and this may last for several weeks.

Pain & Guilt

Once your shock starts to fade away you’ll start to notice the pain. This is when it first starts to hit you that your loss is real. The pain may be extremely hard to handle and it may feel physical as well as mental and emotional. You may even start to feel guilty about something that you could have done or should have done for the person (even if it’s illogical).

Anger & Bargaining

Next, many people start to feel angry. You may feel angry with your religion, with someone who was taking care of that person, with the person in the other car that hit them or anyone else. It may be completely unreasonable who you feel angry with but you seek out someone you can blame for the loss and may even attempt to bargain to bring that person back.

Depression, Reflection & Loneliness

Generally this is one of the later things to take effect. When many of your family or friends are starting to overcome their suffering or starting to think that you should be overcoming your own suffering, you start to feel depressed. Even though the pain towards the beginning is hard, this may hit you even harder, because you’re truly coming to terms with what you’re going through and the loss you’ve experienced.

You’re not feeling the pain as much as feeling the change to your life that losing this person has made. Maybe you’ve lost someone you spend a lot of time with or the person you always told secrets to. These difficulties are going to start to cause depression, reflection on the old way things were and loneliness as you realize those times are gone.

The Turn

Finally, just when you think there can’t possibly be anything good coming ever again, you’ll start to experience the turn. You’ll start to feel a little better each day. It may be so slight that you don’t even realize it at first, and you won’t feel happy all at once. What you may feel is a little less pain, a little less sadness and more of a feeling of being okay.

Reconstruction & Working Through

This is where you’ll start to work your way through the aftermath of losing that loved one. Maybe you have to take care of some financial troubles either caused by the loss or the grief you went through while dealing with the loss. Maybe you need to just put yourself back together. This is the stage where it all begins.

Acceptance

The final stage is the one you’ll be in for the rest of your life. This is the one where you start to accept the loss fully and start to move on with your life. That’s not to say you ever ‘get over it’ but that you start to feel okay about it and you’re able to think about them and even talk about them again without feeling the despair or intense pain. It may make you sad to think about them, but it may also make you happy because now you can remember and be happy about the good times.

Keep in mind that the stages of grief are different for everyone. You may only spend a few days in disbelief and your sibling may spend weeks there. You may never go through a bargaining stage while your best friend spends a lot of time with it. There’s no right or wrong way to grieve, and there’s no timetable for an acceptable length of time to grieve. Getting through this pain, however, can be extremely difficult to do on your own. Seeking out professional help, like what you can get from Better Help, can make a huge difference in your life and in your healing process.

Complete Article HERE!

When someone hovers at the edge of death, these singers step in to ease the passage

Threshold Choir members pray before visiting a patient at the Halquist Memorial Inpatient Center in Arlington, Va.

by Debra Bruno

[I]t’s a quiet afternoon at the Halquist Memorial Inpatient Center, a hospice, as four women huddle close, talking quietly in a tight circle before walking through the doors to sing to men and women on the threshold of death.

These women are part of the Threshold Choir, a group that brings the comfort of song to dying people.

A thin woman, who is in the last weeks of life, is the choir’s first stop. She is sitting nearly upright in a hospital bed, her daughter beside her. Leslie Kostrich, the group’s leader for this day, asks the older woman if she would like to hear a few songs. She nods; the singers set up folding stools and pull up close to her bed.

“We sing in a circle of love,” the women sing, a cappella and in three-part harmony. “In music we are joined.” As they sing, the woman gazes off with a faraway look in her eyes, as if she’s trying to remember something.

The group sings another song, and as they finish, the older woman claps softly. “Thank you,” she says. “Nice.”

It takes sensitivity, situational awareness and a dash of emotional intelligence to sing to the dying. The sound of soft harmonious voices can be very comforting as life closes down, but the songs can also bring forward the immediacy of death to family members sitting nearby. Singing in such an emotional environment takes practice and a recognition that it is less a performance than a service.

For the dying and their families, the singers are hoping to bring peace, comfort and a feeling of love. “We call it kindness made audible,” says Jan Booth, who with Kostrich is co-director of the Washington-area Threshold group.

It is also very life-affirming for those who sing in this unusual choir.

“When I tell people I’m in a choir that sings at the bedside of the dying, they’ll say, ‘Oh girl, what a good thing,’ or ‘Girl, you must have lost your mind,’ ” says Kadija Ash, 66.

But the opposite is true. “Sometimes I run” to rehearsals, she says, “because of the healing.” In the two years she has been a member of Threshold, Ash says, she has gone from having a fear of death to an ability to be more accepting of life’s ups and downs.

Kostrich, 60, who has been with the group for three years, likewise says: “This has changed my life. That’s not an exaggeration. It gave my life a spiritual dimension that I was totally unprepared to receive.”

Threshold Choir — which has more than 200 groups around the world — seems to have tapped into something both primal and much-needed: a growing desire not to recoil from death or abandon the dying but to face that ultimate truth and figure out how to help ease the isolation of those near the end.

Bedside singing is a way of “normalizing death,” says Kate Munger, 68, who founded the first group in the San Francisco area 18 years ago. Many of the choirs are started and run by baby boomers, who are comfortable shaking up the accepted way of doing things, Munger says. “We’ve done that for childbirth, for education, and now for our impending death.” She says the number of people participating in Threshold Choir has grown to about 2,000.

Similar deathbed choirs have also surged, including Hallowell Singers, based in Vermont, which recently celebrated its 15th year, says founder Kathy Leo. She estimates that Hallowell has as many as 100 spinoffs, mainly in the United States.

Although they sing some requested songs, such as “Amazing Grace,” Threshold Choir mostly uses a repertoire designed for singing around a dying person. The pieces tend to be limited to just a few words, and sung without accompaniment in three-part harmony.

The idea is to keep things simple and not tied to any spiritual tradition — for instance, “Thank you for your love” and “We are all just walking each other home.” Complicated verses could intrude on the process of dying, which often involves people retreating from the day-to-day and reviewing their lives.

During the afternoon at Halquist, the four Threshold singers — Booth, Kostrich, Ash and Margo Silberstein — move out into a hallway after their first group of songs. One hospice staffer says, “I love working on Thursdays because I love listening to this group.”

The group slips into another large room with four beds separated by curtains. A frail woman with brilliant blue eyes smiles at the group. In another bed, someone is making noises that are halfway between breathing and groaning.

The blue-eyed woman asks, “Do you know ‘A Mighty Fortress?’ ” The group knows some of the words to the hymn but ends up mostly singing “oooo” to its tune. After they finish, Kostrich offers, “We do have ‘Amazing Grace.’ ” “Oh yes,” the woman answers and quietly sings along with them. After they finish, she says: “Oh, thank you. That was just wonderful.” They go on to sing “Simple Gifts” and “He’s Got the Whole World in His Hands” and then a few Threshold songs.

A TV next to a different bed blares.

After they finish, they approach a man sitting at the bedside of a woman. Can they sing?

“She’s pretty well gone out, but you can try,” he says.

As they sing “Hold this family in your heart,” the man’s eyes redden. He shifts in his seat. They sing, “Rest easy, let every trouble drift away.” His chin starts to tremble. As they begin to sing “You are not alone,” the woman begins to breathe more loudly but doesn’t move. The woman in the bed across the room, where they first sang, calls out, “Beautiful!”

An hour later, as the group gets ready to leave the hospice, Kostrich says that singing with Threshold has given her a way to process her own family’s experiences with death. When her parents were dying in the 1980s, Kostrich says, no one acknowledged they were close to death, which didn’t allow her and her family to come to terms with the losses themselves. The Threshold Choir has both helped her in a small way alleviate her own loss and help others avoid that kind of pain, she says.

There’s another thing that comes out of Threshold singing: community. And that feeling is evident when group members get together for a twice-a-month rehearsal, often in a church basement in the District. All but one singer at this rehearsal is female, but they range in age from 20-somethings to 70-somethings, African American, Chinese and white, those with tattoos and those with carefully coifed hairdos. There are a lot of hugs and laughter.

Olivia Mellon Shapiro, 71, says that group members are her “kindred spirits.” When she retired from her work as a psychotherapist, she told a friend, “Now I want to sing people out in hospices,” Shapiro says. “My father sang himself out — he died singing, and I was very moved by that.” Her friend said, “Oh, that’s the Threshold Choir.”

“Now I have a new group that feels like home to me. It really does,” she says. “I’ve also always been a little afraid of death and dying, but I’ve always loved the idea of hospices. So the idea of singing people out in hospices to get more comfortable with the idea of death and dying appealed to me.”

(The group sings several times a month at Halquist in Arlington and also at Providence Hospital in Northeast D.C. through the nonprofit hospice provider Capital Caring.)

One of the singers, Lily Chang, 28, notes that the choir is helping her confront her own fears of loss.

Chang says she’s very close to her grandmother and, given her age, worries about her. “I remember telling my mom, ‘I don’t know what I would do’ ” if she died. “Thinking about it, engaging with it in different ways makes me feel better.”

Complete Article HERE!

Truly understanding the differences between palliative care and hospice

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[C]are at the end of life should address all of the important elements that play a critical role in ensuring a positive end-of-life experience for patients and families. Therefore, quality end-of-life care extends beyond managing physical pain to include psychosocial and spiritual needs.

Not all long-term care professionals carry the same understanding of the issues.

Frequently, nurses serve as advocates to support patients and families in making care decisions based upon their goals and values. Ideally, physicians, nurses and other team members work together to create an atmosphere of care and compassion in accordance with patient and family wishes.

Although hospice and palliative care both aim to deliver quality holistic care, there are key differences.

The dimensions of hospice care

Hospice is the model for quality compassionate care for people facing a life-limiting illness. Hospice clinicians focus on pain and symptoms, and attend to the patient and family’s emotional and spiritual needs. Hospice is offered at a patient’s residence, such as their home or nursing home, or, if needed, in a hospice facility.

Hospice programs utilize an interdisciplinary team (IDT) approach to plan the care needed by patients and their families during the final weeks and months of life. The IDT is comprised of nurses, chaplains, social workers, physicians and medical directors, hospice aides, volunteers, bereavement specialists and other clinicians who develop and implement a plan of care that is formulated to relieve anxiety and suffering during the final months and weeks of a patient’s life. This approach allows the team to address physical, emotional, spiritual and social concerns that arise with advanced illness.

Hospice is available to people with all types of conditions and diseases, and focuses on comfort — not cure. Hospice provides care for the “whole person,” including physical care, counseling, spiritual needs, drugs, equipment and supplies related to the conditions that comprise the terminal prognosis. It also supports family caregivers, including bereavement support for up to a year after the patient’s death.

Financing hospice

Hospice care is reserved for people at the end of life who meet Centers for Medicare & Medicaid Services eligibility requirements and elect a comfort approach to care. The Medicare Hospice Benefit (MHB) requires that two physicians certify that a patient has less than six months to live if the disease follows its usual course. However, if a patient is still alive after six months, he or she can continue to receive hospice services if he or she meets eligibility requirements and demonstrates signs of progressive decline.

When a patient elects hospice, they sign off their Medicare Part A (hospital insurance) and enroll in hospice under the MHB. From that point on, hospice covers all services and care related to the terminal diagnosis and related conditions through Medicare, Medicaid and most commercial insurance.

The hospice IDT, together with the patient’s attending physician, is responsible for determining the plan of care. Under terms of the Medicare Hospice Benefit, the hospice agency is responsible for the plan of care and may not bill the patient for services. All costs related to conditions that affect the terminal prognosis are paid from a per diem rate that the hospice agency receives from Medicare. This per diem rate includes all drugs and equipment, nursing, social service, chaplain visits and other services deemed appropriate by the hospice agency. Care and medications not related to the terminal illness or related conditions continue to be paid for through original Medicare.

Distinctions of palliative care

The biggest differences between hospice and palliative care revolve around where the patient is in their illness related to prognosis, their goals/wishes regarding curative treatment, and how palliative care is financed.

Palliative care focuses on relief from physical suffering and caregiver burdens for individuals who are living with a chronic disease that may or may not be terminal, addressing their physical, mental, social and spiritual well-being. Atul Gawande recently defined palliative care “as the field devoted to providing people with serious life-limiting illness with expert care that serves their goals for quality of life, not just quantity of life.”

Similar to hospice, palliative care utilizes an interdisciplinary approach with highly trained professionals, including physicians, nurse practitioners, nurses, social workers, chaplains, and other disciplines.

Palliative care can be offered to people of any age, without restriction as to disease or prognosis. It may be appropriate for anyone with a serious, advanced illness, whether he or she is expected to recover fully, live with chronic illness for an extended time, or experience disease progression. Unlike hospice, patients receiving palliative care may continue to receive aggressive treatments, including life-prolonging therapies.

Conditions appropriate for palliative care include cancer, congestive heart failure, end stage renal or liver disease, chronic obstructive pulmonary disease, and dementia, among others. While palliative care is often appropriate earlier in the disease trajectory, referrals to palliative care clinicians are often not made until late in the disease process.

Palliative care focuses on relieving symptoms, such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping and depression. Palliative care providers also support patients in carrying on with daily life so that they can tolerate medical treatments. In addition, patients receive support that empowers them to have more control over their care by improving communication so that they can better understand their choices for treatment. Helping patients and their caregivers coordinate care across care settings is a hallmark of palliative care.

Financing palliative care

Unfortunately, palliative care programs struggle financially because there is no reimbursement code specifically for palliative services and Medicare does not reimburse for interdisciplinary care management. Hospital-based palliative care is paid by the health system with some fee-for-service (FFS) billing for physician services. Medicare Part B covers physician and nurse practitioner (NP) fees for outpatient care delivered in the community or in clinics. Therefore, most community-based palliative care programs utilize NPs and physicians for home visits.

Other disciplines, such as nurses and social workers cannot bill Medicare for palliative home visits. Palliative care is also paid for through flexible bundled payments under Medicare Advantage, Managed Medicaid, ACOs and other commercial payers.

While Medicare doesn’t have a palliative care benefit, CMS has authorized demonstration projects that are testing different ways of meeting the needs of seriously ill patients. The Medicare Care Choices Model allows patients to receive hospice-like support services while concurrently being treated for their illness.

Demonstrated value

Costs for palliative care teams and programs are offset by fewer trips to emergency departments and lower hospitalization and rehospitalization rates. In addition, patients and families rate the value of palliative care services highly. This explains why 80% of hospitals with 50 beds or more have established palliative care teams and some are starting to consider outpatient palliative care programs. In addition, health plans and payers, including Accountable Care Organizations (ACOs), Integrated Delivery networks (IDNs) and other types of provider-driven managed care organizations, are beginning to offer community-based palliative care programs to their patients/members to extend the benefits of palliative care into the home.

Palliative care programs and advance care planning that include earlier conversations about patient and family goals of care are consistently demonstrating their value in helping patients live their final days in accordance with their wishes. Data shows that in communities that provide greater access to palliative care programs, patients are less likely to die in the hospital.

Furthermore, findings show that patients experience fewer admissions to the intensive care unit in the last six months of life and are less likely to die in an ICU

Today, palliative care is becoming recognized as option at any stage of advanced illness, not simply reserved for care at the end-stage of life. Its use should be driven by patient need, not disease prognosis. Hospice care remains the gold standard for end-of-life care. Together, hospice and palliative care offer compassionate care when it is needed most.

Complete Article HERE!

How Virtual Reality Can Help You Face Your Own Mortality

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[I] was in elementary school when I first became aware of my own mortality. It was early in the morning. My mom was in the bathroom getting ready for work, and I was on her bed covered in tears, thrashing around and yelling “I don’t want to die!” over and over.

Like a lot of people, dying terrifies me, the finality of it so unthinkable that I try not to acknowledge it in my day-to-day life. So when an opportunity came to go to “Second Chance” — an interactive experience that uses theater and virtual reality to help people come to terms with their demise — I was both scared and intrigued. It was one of 175 activities that took place during Reimagine End of Life week in San Francisco, an event that consisted of panels, film screenings, and other experiences that encourage people to talk openly about death and how it affects us.

SF-based art collective Lava Saga spent three months creating “Second Chance,” transforming a two-story gallery in the city’s Mission district into an ethereal environment.

“We believe that immersion is a way to experience things, and when we have those lived and bodied experiences, we can start to answer some of those big questions around death or around life itself or any other big topic we’d like to explore,” said co-producer Scott Shigeoka in an interview.

“Second Chance” only allowed 10 people in at a time, and they all had to be strangers (one of Lava Saga’s few hard rules). It unfolded across four different rooms, with VR serving as a key piece of the production. My group entered the first space — a darkened room lit only by blue and purple lights — and found black futons on the floor, all of which had pillows and neatly folded white sheets. Next to them were Samsung Gear VR headsets and wired headphones that attendants asked us to put on after we sat on the beds.

The nearly four-minute VR sequence pulled me through a monochrome landscape filled with massive planets, intricate caverns, and pulsating tendrils that pierced the sky. An otherworldly hip-hop track from electronic artist Shigeto made the 360-degree journey feel lonely and isolating.

When the experience was over, I took the headset off and laid on the bed; another person came to pull the white sheet up to my neck. A cellist at the corner of the room began playing a peaceful but melancholic tune. I closed my eyes as our end-of-life doula (who had spoken to the group beforehand to address any concerns) read a poem from Buddhist monk Thich Nhat Hanh.

As far as the “Second Chance” narrative was concerned, we were dead.

Simulating Death
Surprisingly, the VR music video wasn’t made for “Second Chance.” It’s a pre-existing project (known as “Hovering”) from creative studio 79 Ancestors. Lava Saga worked with VR and augmented reality curator Dream Logic to determine what kind of piece would best represent the transition between life and death.

It wasn’t easy. For awhile, they wondered whether they should even have a symbolic representation of death. After all, how do you visualize an experience that, by definition, is impossible to come back from?

“We picked [‘Hovering’] because it feels like going through a portal. And with VR in ‘Second Chance,’ we wanted it to serve that function, to be a transporting mechanism that people could go inside, be transported, and come out into a shifted reality,” said Dream Logic producer Kelly Vicars.

Though “Hovering” wasn’t created with “Second Chance” in mind, its abstract graphics made it a fitting choice for the production. During the design process, Lava Saga interviewed people who had near-death experiences, with many of them saying they were moving through a tunnel or seeing black-and-white images before being resuscitated. “Hovering” also worked well because it wasn’t scary and didn’t adhere to any specific religious beliefs.

“It was important for us to honor the diversity of cultures, traditions, and wisdom around death. … We wanted to make sure that whatever experience we used was really inclusive,” said Shigeoka.

Lava Saga and Dream Logic knew that for a lot of people, “Second Chance” would be their first opportunity to be in VR. So they tried to make the experience as seamless as possible, with attendants giving clear instructions on how to use the equipment. And Gear VR offered the least amount of friction due to its portability and ease of use (when compared to PC-based gaming headsets like Oculus Rift and HTC Vive). Participants just had to put it on and wait for “Hovering” to begin.

“My team’s goal is to use immersive technology to elevate art, to have the technology disappear,” said Vicars.

Breaking through taboo topics
After dying in VR, my group entered a series of rooms that represented a kind of liminal purgatory state. One had thin sheets of white fabric hanging from the walls and ceiling, with actors and dancers (Lava Saga refers to them as spirits) talking to each other about their previous lives.

From there, “Second Chance” starts to pull back on its mystical interpretations of an afterlife and morphs into something a little more grounded: group therapy.

In the third room, we broke into two smaller groups with trained facilitators who asked us questions about our own lives. Shigeoka said this was often an “emotionally charged” space because of the stories people would share — about their hardships, mourning for loved ones who died, or anything else they just needed to talk about. This vulnerability is why it was so vital to go through “Second Chance” with strangers instead of friends or family members.

I didn’t let my guard down completely. I couldn’t quite squash the skeptic voice in my head, which was too loud and too stubborn to go away. But I still felt comfortable in those discussions, as well as in the 1-on-1 meetings that followed in the last room, where we were randomly paired with another person from our group. That I was able to share personal details about my life at all was remarkable given that we had only met an hour before.

“Second Chance” wasn’t a perfect experience; at times, I was bored or confused about what was going on. But the core conceit — getting people to express their feelings about a sensitive topic — was sound. It reminded me that sometimes, it feels good to have someone just listen to you.

“I hope that people emerge [from ‘Second Chance’] with a new perspective and a new relationship with what it means to die. And that’s [to] live,” said Vicars.

Lava Saga and Dream Logic consider this first run as a prototype. If the show ever returns (whether in San Francisco or elsewhere), they want to keep refining it based on the feedback they receive. One day, they might make their own VR experience to replace “Hovering,” or maybe even depict that life and death transition in a totally different way.

But the idea of using theater and immersive technology to break through cultural taboos is something both teams want to keep exploring.

“It’s so important for us to open up about [death] and it’s so important for us to change the narrative around it, to make it something that should be discussed and talked about. … We need to have a conversation that goes beyond the medical world around the end of life,” said Shigeoka.

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