Month: July 2023

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The Rare Walking Corpse Syndrome

— How Could Someone Feel Dead?

The mind is truly an amazing — and strange — contraption, and few things demonstrate that better than Cotard’s syndrome. Learn about the bizarre condition of walking corpse syndrome.

By Avery Hurt

Cotard’s syndrome, or Cotard’s delusion as it is often called, is a rare neuropsychiatric disorder in which a person believes they are dead, that they do not even exist, or sometimes that the world itself does not exist.

The condition was described in 1880 by Jules Cotard, a French neurologist and psychiatrist. In a presentation to the Société Médico-Psychologique, Cotard ;reported the case of a 43-year-old patient who believed she had “no brain, nerves, chest or entrails, and was just skin and bone.” She claimed to need no food because she was “eternal and would live forever.”

What Is Cotard’s Syndrome?

Not all patients with Cotard’s syndrome expect to live forever in some Zombie-like state. In fact, most believe that they’re already dead or very close to death. Individuals with Cotard’s Syndrome experience a profound distortion of reality and beliefs about their existence.

They may adamantly assert that they do not possess a physical body or have lost their internal organs. This perception of self can lead to extreme apathy, self-neglect and detachment from the world around them.

A 2018 study analyzed the cases of 12 people who had been diagnosed with this disorder and found that eight of the 12 believed they had died. The other four believed they were in the process of dying. Three of the four who claimed to be dying said worms, viruses or bugs were eating their internal organs.

Patients with Cotard’s Syndrome Symptoms

The patient’s belief that they’re dead or dying is often accompanied by other delusions as well. A 44-year-old man diagnosed with Cotard’s also hallucinated spiders in the walls, rats running along the baseboards and people’s faces melting.

A 74-year-old patient reported that he had been stabbed while in his nursing home and referred to his hospital bed as his casket. This man also believed that his wife had been replaced by an imposter, a separate delusion known as Capgras syndrome.

A 35-year-old woman with Cotard’s believed that her brain was rotting and reported that she could feel worms crawling around in her brain. A 50-year-old male who believed he was dying insisted that his arm had been cut off and his fingers were being ground up. None of this, of course, was true.

Nevertheless, the patients were thoroughly convinced and could not be persuaded otherwise, even when the evidence (the arm was still attached to the body; no worms could be detected on brain scans) or logic (how can you talk with me if you have no brain?) seemed convincing to everyone else. The patients often used a logic of their own. When caregivers urged one Cotard’s patient to eat, she asked, “Why do I need to eat when I’m already dead?”

Causes of Cotard Delusion

Though very rare, Cotard delusion can be a symptom of schizophrenia; two of the 12 patients in the 2018 study also had schizophrenia. (Other studies have shown that fewer than one percent of schizophrenia patients also have Cotard’s.) However, the study also found that various neurological and psychiatric disorders were associated with the syndrome.

Three patients had been diagnosed with depression, and four had a history of addiction to opiates and benzodiazepines. Seizures, cluster headaches, evidence of stroke, lesions in the brain and loss of brain volume have also been found in various combinations in Cotard’s patients.

However, whether or not any of these conditions cause Cotard delusion is unknown. It seems that this bizarre constellation of delusions can result when any number of things go wrong in the brain.

Unsurprisingly, there is no specific criteria for a diagnosis, and there is no entry for Cotard’s in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the book psychiatrists and other mental health professionals use to guide them in diagnosing and treating mental illnesses.

How Is Cotard’s Syndrome Treated?

Devastating as these symptoms are, Cotard’s can be treated. Typically by treating any underlying neurological or psychiatric disorders with psychotherapy, pharmaceuticals or a combination of the two approaches. Electroconvulsive therapy (ECT), a treatment that involves electrical stimulation of the brain, has been shown to be effective in some patients as well.

Cotard’s syndrome is one of many neurological conditions that remind us just how little we understand how and why our brains do what they do. While treatment is available, researchers are still working on finding out more about Cotard’s syndrome.

Complete Article ↪HERE↩!

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How To Prepare For The Impending Loss Of A Loved One

— The Waiting Game Can Be Brutal

By Amanda Chatel

One of the few things that can make losing a loved one even harder is anticipatory grief. This is the grief that’s experienced when your loved one is still alive, but the end is near. It’s a waiting game on the inevitable, and the toll it takes can be debilitating. It’s a complicated grief that’s tied up with the fear of losing them, as well as the knowledge that when they do pass, there will be a sense of relief, something that can make people feel guilty.

“Anticipatory grief starts as soon as your loved one’s life is put into question,” bereavement counselor and founder of Grief Specialists, Maria Bailey told Refinery 29. “When you know your loved one is going to die, it’s like death by inches — you start losing little pieces of them, rather than the whole of them at once.”

There’s no easy way to lose someone we love and there’s certainly no right or wrong way to grieve. But setting time aside to deal with grief and taking steps to prepare yourself for the impending loss can help you navigate those emotions that will become all too real once they pass away. Preparation won’t erase the pain, but it will ease a bit of the emotional toll. It’s this easing that will help you get through this process.

Acknowledge your grief

woman sad on her bed

You are grieving. Accept it. Don’t try to ignore it, don’t try to outrun it, don’t try to suppress it. Grief can manifest in many ways. It can result in anger, guilt, sadness, anxiety, confusion, and even joy. These emotions can be felt at any time during your grieving process and you should lean into them and feel them. If you’re angry, let yourself punch a pillow. If you’re sad, cry your eyes out until it feels like you have nothing else. If you feel joy (yes, joy), embrace it as a momentary relief from the more complicated feelings that come with grief.

Grief doesn’t go away. It’s a human experience that must be felt in order to move forward. Putting it on a shelf won’t get rid of it. Instead, you’re just putting off something that is a necessary part of loving and losing. Every loss requires a grieving period. So embrace your emotional vulnerability – let yourself grieve now and let yourself grieve when they’re gone. This is a must for your mental, emotional, and physical health. Acknowledge that you’re grieving and expect the unexpected in regard to how you internally process your grief. That’s really the best thing you can do for yourself during this difficult time in your life.

Surround yourself with support

women showing support

According to a 2020 study published in Omega, people who are experiencing anticipatory grief have an easier time proactively coping and growing from the experience due to social support. That support can come from friends and family, or from the outside, like a therapist or grief counselor. Hanging with your friends and loved ones is good for the soul, and when you’re surrounded by people who validate your feelings and tell you it’s okay to feel as you’re feeling, it can provide a safety net to just feel, feel, feel — and that’s what you need to do.

“What we see in science is, if you have a grief experience and you have support so that you have a little bit of time to learn, and confidence from the people around you, that you will in fact adapt,” clinical psychologist Mary-Frances O’Connor told NPR. Adapting is the key here. You won’t get over the loss, nor are you expected to. What you will end up doing is moving forward and adapting. The hole that a loved one leaves in their passing never goes away and it can’t be filled. You just learn to steer your way around that hole and try not to fall in.

Be kind to yourself

woman on couch thinking

Taking care of yourself can help in overcoming the physical toll of anxiety and depression that can often accompany anticipatory grief. As much as you’re struggling, you need to be kind to yourself. You need to take a break when you feel it, eat when you’re hungry, sleep when you’re tired, and cry when you need to cry. You’re not only doing this for your physical and mental well-being, you’re doing it for your loved one as well.

“You have to put your own [oxygen] mask on first,” licensed psychologist Mekel Harris told The Washington Post. “Anticipating a loss of a family member is exhausting mentally, physically, and spiritually. If you’re exhausted, it makes it difficult to be present for the moments that you do have with your loved one.”

During this challenging time, the last thing you want to do is miss out on these final moments together. You don’t want to run yourself sick when you could be making lasting memories. As much as you’re suffering and trying to juggle complicated emotions like obligation, guilt, fear, and more, take a step back and check in with yourself. Ask yourself how you’re doing — really doing — and where you can make tweaks in your current situation to feel better. It’s important to keep yourself strong and healthy so you can handle not only what’s happening now, but the emotions that will come after your loved one passes away.

Avoid unhealthy coping mechanisms

woman drinking and eating

When faced with an impending loss, some people turn to things that will numb or at least dull the pain. That can be drinking, drugs, spending exorbitant amounts of money, and similar behavior that feels good in the moment but is toxic more than anything else. You can’t wallow in a haze forever. Eventually, you have to come up for air and face the reality of the situation.

“As humans, we often choose the path of least resistance by ignoring the cues designed by our bodies and minds to help us learn from our history and each other,” Paula Pavlova of Pavlova Wellness told Real Simple. “We use substances like drugs, food, and alcohol to drown our worries, pick little fights to avoid feeling our feelings, point out others’ flaws and hold grudges instead of looking closely at ourselves… These tactics are attractive because they’re easy — but they work until they don’t.”

You also run the risk of these coping mechanisms becoming dependencies. When that happens, you’re going to turn to these toxic behaviors every time you suffer a blow that you feel you can’t manage on your own. A glass of wine after an emotional day? Sure. The whole bottle? Put it away; it will be there tomorrow.

Know there’s no right way to grieve

sad woman in bed

Many of us have been taught that there are five stages of grief and that when we go through those stages, we’ll be on the other side of the pain. If only it were that easy. According to a 2018 study published in the Journal de Thérapie Comportementale et Cognitive, these stages don’t exist. The research found that strong yearning was the only emotional state linked to grieving, and the theory that grief stages are experienced in a certain order was untrue. While it would be nice to wrap up things into perfect little boxes, the human condition doesn’t work like that. There is no step-by-step grieving process because there is no one way to grieve.

If you grieve for months, so be it. If you grieve for years, then that’s what you’ll do. When it comes to grief, we’re here without a compass and we just have to go with it. Where it takes us, emotionally and mentally, is anyone’s guess — which is ultimately a good thing. If grief fell into specific stages, we’d all be running around with a checklist, which probably wouldn’t help the situation. So go with Rilke when it comes to grieving: “Let everything happen to you: beauty and terror. Just keep going. No feeling is final.” You will get to the other side eventually. No matter how you get through or how long it takes you, don’t sweat it; that’s your journey.

Complete Article ↪HERE↩!

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Hospice care has a big problem


A terminally ill hospice resident sits with a music therapist in her bed in Lakewood, Colorado.

By JOANNE KENEN

A LITANY OF WRONGS — A number of years ago, when I had a fellowship to write about end of life care across the United States, a geriatrician in California told me, “There are no do-overs in death.”

A group of prominent physicians who specialize in end of life care think it may be a do-over time for hospice. Or at the very least a gut-check. Once a movement, hospice is now an industry dominated by publicly-traded companies and private equity firms, and it’s been the subject of critical government reports and withering exposes, including a New Yorker-ProPublica investigation of the “for profit hustle.” Today, with half of all Americans dying in hospice care, some doctors believe its challenges are in urgent need of fixing.

In a six-page “call to action” recently published in the Journal of Palliative Medicine, 325 prominent doctors in this field wrote that “in recent years, we have observed an increasing prevalence of serious deficiencies in hospice care and high variability in quality of care.”

Instances of “poor care,” they said, are “increasingly common.” The signatories (some of whom are retired) include pioneers in the field, including two-thirds of the living former presidents of the American Academy of Hospice and Palliative Medicine, the professional society for these physicians.

Ira Byock, a long-time hospice and palliative medicine physician who was the lead author, told Nightly that the Academy and the main hospice trade group should do more to set quality standards and promote transparency. That would help government regulators focus on what matters to patients and families, rather than generating a lot more administrative hassles.

The essay in the journal cited a litany of wrongs — not enough physician involvement in patient care, unmanageably large nurse caseloads and inadequate, interdisciplinary care teams. The nurses, doctors, social workers, chaplains and others who are the core of hospice care, which generally takes place in patients’ homes, are overworked or not properly trained. They also said some hospices don’t have the required backups for emergencies, such as intense pain or difficulty breathing that families can’t take care of themselves. That means families dial 911, and patients end up back in the very hospitals that they chose hospice to avoid.

Some issues the essay cites reflect challenges in U.S. health care across the board — like nursing shortages after the pandemic. Others reflect the changing nature of hospice ownership and the Medicare payment system. The authors want the statement to be a roadmap as physicians negotiate with employers so they can provide consistently good care.

Ben Marcantonio, interim CEO of the National Hospice and Palliative Care Organization, the trade group, told Nightly that a small number of hospices that have committed “actually fraudulent behavior” have tarnished how hospice overall is perceived. The industry, he said, has also called for federal resources to educate health providers in the field, which will help with both workforce shortages and quality. And they’re working with the Center for Medicare Services on quality measures “that really do put the focus in the right place.” They also want Medicare to pay hospices more.

Dr. Holly Yang, president of the American Academy of Hospice and Palliative Care and a practicing palliative care physician in San Diego, said she doesn’t think hospice’s challenges revolve so much around nonprofit vs for-profit ownership, but about the Medicare hospice benefit itself. A lot has changed since Congress added hospice to Medicare in 1982 — how we age and die, and where and how families live and work and who is available to stay home and care for a dying relative.

The hospice benefit “has not changed with the times,” said Yang, who also trains upcoming hospice and palliative care doctors. Hospice in its early days was very focused on cancer, which had a more predictable and shorter course than it does with today’s treatments. And more people in hospice have conditions like dementia or congestive heart failure, where the trajectory is uncertain. People can live with serious illness for a long time but need support.

For Byock and his colleagues, calls for legislative change aren’t enough, particularly as advocates have been calling for remedies for several years and Congress isn’t racing to comply. Hospice, they say, needs to do more to protect quality, to protect “vulnerable seriously ill people with their families” on its own. There may be no do-overs in death. But maybe it’s time for a do-over of hospice.

Complete Article ↪HERE↩!

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Water Cremation

— What It Is and How It Could Reduce the Environmental Impact of Funerals

Water cremation may offer a more sustainable approach for the funeral sector

By Valentina Morando

As society becomes more environmentally conscious, the funeral sector is under increasing pressure to adopt sustainable practices.

On July 3, Co-op Funeralcare, a leading funeral service provider in the UK, announced that it will be the first company in the country to offer Resomation, also known as water cremation.

This innovative approach could be a more sustainable alternative to burial or gas cremation, which currently account for 20% and 80% of funerals in the UK, respectively, according to Co-op.

“With much of the research having been undertaken overseas to date, there is a strong evidence base to suggest that Resomation may be a more sustainable option than Gas Cremation,” Co-op writes in their press release announcing the new offer. “This is something which the Co-op and providers of Resomation will be working in conjunction with sustainability experts and academia to further validate and understand through an initial pilot.”

Water cremation would also be the first alternative to burial or cremation in the UK since 1902.

“For decades there have been just two main choices when it comes to their end-of-life arrangements: burial and cremation. By starting to make Resomation available in the UK, Co-op will be providing people with another option for how they leave this world because this natural process uses water, not fire, making it gentler on the body and kinder on the environment,” Resomation service Kindly Earth Director Julian Atkinson said.

According to a YouGov poll conducted on behalf of Co-op, 89% of adults in the UK adults had not heard of Resomation. However, once it was explained to them, 29% said they would choose Resomation for their funeral. Meanwhile, 17% of adult respondents who had organized a funeral in the last five years said they would have considered Resomation if it had been an option.

Do you know what Resomation is?
29% of UK adults said they would choose Resomation for their own funeral if it was available ⬇
Find out more here: https://t.co/uwcKWtxsfQ https://t.co/rvGdGXCvrr
— Co-op Funeralcare (@CoopFuneralcare) July 3, 2023

How it works

Water cremation, scientifically known as alkaline hydrolysis or resomation, is a process that dissolves the human body through the use of water, heat, and alkaline chemicals.

As the Co-op press release specifies, “each cycle takes approximately four hours. At the end of the cycle, the soft bones which are left are dried, then reduced to a white powder, similar to ash.” The ash is then “returned to relatives in a sustainable urn.”

Water vs traditional cremation

One of the key advantages of water cremation, according to Resomation, the pioneering company for water cremation in the UK, is its significantly reduced carbon footprint compared to traditional cremation.

As the organization writes, water cremation “has been independently shown to have the lowest and indeed little environmental impact at all compared to burial and flame cremation.”

This reduction is achieved through the decrease in fuel consumption associated with the combustion process, making water cremation a more sustainable choice.

Moreover, water cremation also addresses concerns related to mercury emissions, which have been associated with traditional cremation methods.

Dental amalgams (a dental filling material), which contain mercury, are often present in human remains, and during the incineration process these mercury emissions can contribute to air pollution. With water cremation, the mercury can be captured and safely recycled, further reducing the environmental impact of cremation.

Not entirely new

While Co-op Funeralcare will be the first funeral service provider in the UK to offer water cremation, the practice is not entirely new. It has been gaining traction in other countries, such as Canada, many American states, and South Africa, where it is already legal and widely used.

Water-based disposal has garnered significant attention worldwide, and one prominent advocate of this approach was Archbishop Desmond Tutu, the late anti-apartheid campaigner.

His adoption of water-based disposal has brought increased visibility to the practice.

“We have seen interest in water-based disposal build in many countries, with Archbishop Desmond Tutu being the most high-profile person to recently use this method,” said Professor Douglas Davies from Durham University. “The reduced carbon footprint that may come with Resomation compared with other forms of body disposal, means it will no doubt be of interest to many people as the practice is increasingly made available in the UK.”

As water cremation gains momentum and acceptance worldwide, it holds the potential to become a more environmentally conscious alternative to gas cremation or, as Co-op put it, “to revolutionize the way we say goodbye to loved ones.”

Complete Article ↪HERE↩!

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‘A delicious distraction’

— The truth about sex and dating after your partner dies

Nicky says Andy was the ‘John to her Yoko’

By

‘On our first date he told me the songs he wanted played at his funeral – I just didn’t know that I’d be playing them as soon as I did,’ says Nicky Wake.

The 51-year-old met her late husband, Andy, online in 2002, before their ‘fabulous first date together’ at a bar in Manchester.

Soon, wedding bells chimed, and the pair welcomed their ‘beautiful baby boy’ Finn, now 15, in 2007.

Speaking to Metro.co.uk, Nicky says: ‘Andy was the John to my Yoko. We were just destined to be together, and he got me like no one else did.

‘He was the introvert to my extrovert, we complimented each other beautifully.’

Tragically, in July 2017, when Nicky was 49, and Finn was barely 10-years-old, she began what she describes as her ‘widow journey’.

Nicky and Andy in April 2017, four months before Andy suffered his heart attack
Nicky and Andy in April 2017, four months before Andy suffered his heart attack

Andy suffered a heart attack, leaving Nicky with no option but to perform CPR for 40 minutes while she waited for the paramedics. Andy survived but suffered a catastrophic brain injury.

‘My late husband, my soulmate…ended up in a care home being looked after 24/7 with little or no quality of life,’ Nicky says.

‘So I spent a few years in what they call “anticipatory grief,”‘ says Nicky, who discusses this in more detail in this week’s Mentally Yours podcast episode.

‘His doctors told me there wasn’t going to be a happy ending, that I just needed to try and navigate a way forward. Eventually we lost him to Covid in 2020.’

Three months prior to Andy’s heart attack, in April 2017, the married couple had had a poignant conversation.

‘He said “if anything ever happens to me you have to promise me that you will move forward”, and I said “absolutely, the same applies to you”,’ Nicky says.

Nicky and Andy in Australia
Nicky and Andy making memories on holiday in Australia

So, twelve months after Andy passed away, Nicky ventured back into the world of dating.

‘I knew at 49 that I was too young to sit in black and wait at home and mourn the loss of my husband,’ says Nicky.

‘And he would have wanted me to find a way forward, I know he would.’

Nicky downloaded Tinder, Hinge and Bumble, saying she ‘knew that it worked, it certainly worked for me last time’.

Online dating…it’s full of dick pics and being ghosted

‘But oh my goodness online dating has moved on so much in 20 years,’ she says. ‘It’s full of dick pics and being ghosted, none of that happened back then.’

Nicky’s says her first date after Andy died, ‘wasn’t the best first date’.

She says: ‘I felt nervous, totally terrified at the prospect. If you’ve slept with the same person for 20 years, you’re so incredibly comfortable, and Andy was my soulmate.

‘If he wasn’t dead already, I could have bloody killed him for making me part of this dating world that I never wanted to be back in.’

The facts: experimenting sexually after being widowed

Three in five people said they are more experimental in the bedroom since the death of their partner.

Over half of widows and widowers have found a new kink or fetish.

About 52% either have, or have considered experimenting with a gender different to their deceased spouse.

Of those surveyed 57% said they have a higher sex drive than before
About 53% said they are more open to exploring sexual relationships with younger partners.

More than half say they are more open to exploring sexual relationships with older partners.

Over two-thirds (67%) are now more confident in the bedroom and 56% said they enjoy sex more now than before their partner died.

About 48% of widows and widowers have more sex now than with their late partners.

Nicky also says she experienced ‘widow’s fire’ – an uncontrollable and all-consuming desire for sex following bereavement, which is regularly talked about in widow Facebook groups and forums.

Nicky says: ‘Widow’s fire is a very real thing. I met someone that scratched an itch and that’s sometimes what you need.

‘That first time you kiss somebody is weird. If you’ve only kissed the same person for 20 years then that’s a real thing, but you ache for physical comfort.

‘If you’re used to sharing a bed with someone for 20 years and that person is gone, it’s a physical pain almost.

‘I had a fling with someone who was entirely inappropriate in terms of a long term relationship.

‘He was a delicious distraction from the pain and grief that I was feeling, and will always feel probably.

‘But did it have any future? No, absolutely not. Was I going to take him as my plus one to various things? No. But he was a lot of fun.’

After suffering from online dating burnout, Nicky had ‘a lightbulb moment’ at a Widowed and Young charity get together. She decided to set up a dating app exclusively for those who have lost partners, called Chapter 2.

Those joining the app have to prove they have lost a partner by providing a death certificate, or a link to a memorial page.

Nicky and Andy had a conversation about moving on if the other passed away there in Australia
Nicky and Andy had a conversation about moving on if the other passed away

Nicky explains that the app is so important, because widows and widowers are uniquely placed to understand each other.

She says: ‘It’s so hard for anyone who hasn’t lost a partner to date someone who has.

‘For example, my house is full of photographs of my husband and my heart is full of our memories and I need someone to respect that if they are going to date me,’ she adds.

Widows and widowers also understand the outside influence of loved ones, saying, ‘they wrestle with it in terms of approval by friends and family’.

She points out: ‘I was very nervous about telling my mother-in-law that I was dating again, but she was wonderfully supportive.

‘She had also been widowed many years ago and she said “you’re too young to spend the rest of your life on your own”.

My house is full of photographs of my husband and my heart is full of memories – my date needs to respect that

In a new study by Chapter 2, which surveyed 500 widows, about 58% of widowers begin feeling sexual urges within six months of their partner’s death.

However, when it comes to actually having sexual relations with someone new again, the average widow waits one year, three months and two weeks to lose their ‘widow virginity’.

Those aged between 18 to 30 wait the shortest time – an average of nine months, two weeks and four days.

Nicky and Andy have a 15-year-old son together
Nicky and Andy have a 15-year-old son together

For now, Nicky is still on the dating scene.

She adds: ‘I am always a glass of rioja full kind of girl. I’ve tried to get positivity out of tragedy.

‘I often say if I can help some people find some joy that helps me make sense of my loss.

‘It’s not the big things that you miss. It’s the little things. It’s having someone to come back home to. To talk about your day with. Dating is hard work.

The facts: Orgasms and masturbation in widowhood

One in five widows and widowers said that they have more frequent orgasms with their new partner(s), and another one in five (19%) said they have better orgasms.

Regarding self-pleasure, 30% of widows and widowers said they began masturbating more than before their partner died.

Almost half (47%) said they bought their first-ever sex toy for masturbation, and 41% began watching porn for the first time during masturbation.

‘But I’m ever the optimist and think that hopefully, if I kiss enough frogs, I will find my prince.’

Nicky is soon to be launching a sister-app to Chapter 2 in June 2023 called WidowsFire. The app is ‘all about the physical’, for those seeking a fun and flirty place to explore natural urges.

Nicky sat on a bench dedicated to her late husband Andy
Nicky has a bench dedicated to her late husband Andy

Nicky explains that people think the sex lives of widows ‘must be really depressing’ but actually says that non-widows, whom she and her widowed friends refer to as ‘muggles’, aren’t ‘blessed with the same magical powers that we are’.

She says: ‘You think that widows spend their lives crying into their gin, but actually widows know to live for the moment.

‘They’ve seen someone they love die in front of them. If that doesn’t give you a wake up call to live in the moment and breathe every second of every day and love your life, then what will?’

Complete Article ↪HERE↩!

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How Gender-Affirming Care Bans Could Impact Hospice Access, Utilization

By Holly Vossel

Hospice providers are growing increasingly concerned about how state laws related to transgender rights may impede access to their services among LGBTQ+ communities.

A rash of states have recently passed legislation to ban the delivery of gender-affirming health care, including Idaho, Indiana, Mississippi and Tennessee, among others.

What’s happening in these states has caused mounting concern around access to quality hospice care for LGBTQ+ individuals, according to Kimberly Acquaviva, social worker and professor at the University of Virginia’s School of Nursing.

“It’s not difficult to imagine that transgender individuals living in those states may be hesitant to seek hospice care,” told Hospice News in an email. “If they receive hospice services in an inpatient facility like a hospice house, will they be addressed by their name and supported in their efforts to dress and groom themselves in a manner that affirms their gender 100% of the time? I’m not confident the answer to either question would be ‘yes.’”

Currently, 19 states in the United States have enacted bans or restrictions on the delivery of transgender health care, according to a recent report from The British Medical Journal (BMJ). Out of these states, 10 have already enacted such laws. Other states have similar laws that will take effect beginning July 1, in October or in January 2024, the BMJ report indicated.

Approximately 560 bills have been introduced thus far in 2023 across 49 states nationwide that include legislation related to transgender rights, according to the most recent data from the Trans Legislation Tracker. Around 83 of these laws have passed, 364 are actively in consideration and 113 were blocked, the data showed.

This compared to 26 bills out of 174 pieces of proposed legislation that passed the prior year, or roughly 15% of those proposed in 2022, the Trans Legislation Tracker reflected.

The volume of legislation that has been mulled or passed limiting transgender rights has been “disheartening” and makes it difficult for hospice providers to improve access and address quality, according to Dr. Noelle Marie Javier, internist at Mount Sinai Health System.

“There are roughly 29 states that do not have anti-discrimination protections in place for the LGBTQIA+ community,” Javier said during a recent American Academy of Hospice and Palliative Medicine webinar. “This number has grown tremendously and exponentially. At the end of the day, the LGBTQIA+ community simply wants to be accepted, supported, respected and treated humanely across the board. We are still dealing with the very same issues that our predecessors have long fought.”

The risks for transgender individuals in violation of current state laws has created health care access barriers for many in the LGBTQ+ community, according to Acquaviva.

“Hospice and palliative care professionals have an obligation to ensure transgender individuals have access to care and are treated with dignity and respect,” Acquaviva said. “If laws at the state level impede access and care delivery that aligns with those obligations, hospice and palliative care professionals need to speak up, speak out, and advocate for changes to the laws.”

Complete Article ↪HERE↩!

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How to talk to your children about death and dying

— Death will touch our children. They will have questions, some of which are unanswerable.

By the time children enter elementary school, they begin to understand that everyone — including their families and themselves — will die.

BY Hayley Juhl

It can be unnerving when your child works death into their imaginary play. It’s the thing we most want to shield them from, and their game feels dark and frightening.

Playing pretend is how children build order in their expanding worlds and gain control over situations that are far bigger than them. It is no different than adults turning a series of possibilities around in their minds — it’s just that youth offers the freedom to play each of the parts out loud. It is natural and good.Does it hurt to die? Where does the person go? Why did it happen to them? Are you going to die? I am going to die?

Every one of those questions must be addressed, even if you have to say, “I don’t know, but we can talk about it together.” Use clear, age-appropriate language and avoid phrases like “gone away” and “departed,” as younger children don’t understand forever and might struggle with reality that the person isn’t coming back. “They have left us” is wrapped in an extra layer of abandonment; “gone to sleep” will terrify them come bedtime.

Children under 2 do not comprehend death, though they have strong feelings of attachment and insecurity, according to Child Bereavement UK, which breaks down children’s understanding by age. Once they are teenagers, they are more likely to deal with death and grief by withdrawing and seeking the support of their peers.

Preschoolers might not react the way we expect them to when they are told someone has died, and might frequently ask when the person is coming back. This is the time they are most likely to talk and play about death and show interest in how it works. Keep answers short and clear and don’t offer more information than they ask for, as it can confuse them and heighten their anxiety.

By the time they are in elementary school, they begin to understand that everyone — including their families and themselves — will die.

“Children’s imagination and ‘magical thinking’ can mean that some children may believe that their thoughts or actions caused the death, and they can feel guilty,” Child Bereavement UK says. If their questions aren’t answered, they might fill in the gaps on their own. They must be made to feel comfortable asking questions, and we should take this opportunity to reassure them they could not have done anything to prevent the death.

Children who experienced the death of a loved one at a young age might need to reprocess their feelings as their understanding grows, Child Bereavement UK says. Conversations about death are not a one-and-done.

Don’t wait until the last moment. The Montreal Children’s Hospital advises thinking and talking about death before it touches our children’s lives.

“Many parents wait until a death occurs to work with their children on dealing with the idea of death,” the Children’s says, “But that can be especially difficult if the parents are dealing with grief themselves.”

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