First ever recording of moment someone dies reveals what our last thoughts may be

Does your life really flash before your eyes when you die?

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What happens when we die?

Scientists may finally be in a position to answer that question after they recorded the brain waves of a patient as her life ended.

Crucially, they didn’t set out to capture this data – instead it ocurred by happenstance.

Researchers in the United States were running an electroencephalogram (EEG) on an 87-year-old man who suffered from epilepsy.

An EEG measures the electrical activity of your brain and, in this case, was being used to detect the onset of seizures.

However, during the treatment, the patient had a heart attack and died.

As such, the scientists were able to record 15 minutes of brain activity around his death. And what they found was extremely interesting.

Focusing on the 30 seconds either side of the moment the patient’s heart stopped beating, they detected an increase in brain waves known as gamma oscillations.

These waves are also involved in activities such as meditation, memory retrieval and dreaming.

We can’t say for sure whether dying people really do see their life flash before their eyes, but this particualar study seems to support the idea.

And the scientists say the brain is capable of co-ordinated activity for a short period even after the blood stops flowing through it.

‘Through generating oscillations involved in memory retrieval, the brain may be playing a last recall of important life events just before we die, similar to the ones reported in near-death experiences,’ said Dr. Ajmal Zemmar, lead author of the study, which was published in the journal Frontiers in Ageing Neuroscience.

‘These findings challenge our understanding of when exactly life ends and generate important subsequent questions, such as those related to the timing of organ donation.’

In the study, the researchers point out that similar changes in brainwaves have been detected in rats at the time of death.

However, this is the first time it’s been seen in a human.

Dr. Zemmar and his team say that further research needs to be done before drawing any definite conclusions.

This study arises from data relating to just a single case study. And the patient’s brain had already been injured and was showing unusual activity related to epilepsy.

It’s not clear if the same results would occur in a different person’s brain at the time of death.

‘Something we may learn from this research is: although our loved ones have their eyes closed and are ready to leave us to rest, their brains may be replaying some of the nicest moments they experienced in their lives,’ Dr. Zemmar said.

Complete Article HERE!

Understanding Respite Care

by S. Behring

Full-time caregiving is an around-the-clock job. Caregivers are often managing caring for a loved one with work, other family responsibilities, their own health, home upkeep, and more.

Respite care is care designed to give live-in caregivers a short-term break. Whether this break involves hours or weeks, respite care can help caregivers attend appointments, run errands, work outside their home, or simply take some time to relax and recharge.

Respite care helps provide a break for live-in caregivers including family members or professionals. Caregivers may need respite care for just long enough to run important errands, or they might need help to care for their loved ones while they’re out of town for several days or weeks.

Respite care arrangements are made in advance by the family caregiver and the respite care professional. Respite care may take many forms. It may be provided by:

  • family and friends
  • home care agencies
  • some nursing and assisted living facilities
  • adult day centers
  • individual care professionals

Respite care services

The exact services you’ll receive with respite care depend on your individual needs and situation. As a rule, respite care professionals are responsible for keeping the person in their care safe and healthy. Depending on the client, this might include:

  • Assistance with household tasks. Respite care professionals who visit clients at home can help complete everyday chores, such as laundry and meal preparation.
  • Assistance with dressing and bathing. Respite care professionals can assist clients with bathing, dressing, using the bathroom, other essential daily tasks.
  • Transportation to medical appointments. Respite care services can ensure clients get to all medical appointments safely and on time.
  • General medical care. Respite care professionals won’t be able to give a hospital-level of care, but they’ll be able to help with medications, check on wounds, and perform other basic medical care. Some respite care professionals can handle more medically complex clients.
  • Companionship. Respite care professionals can keep clients company and make sure they’re well cared for.

There are several types of respite care to fit different situations and fill different needs. The most common types of respite care are discussed below.

Informal respite care

Informal respite care is care offered by friends or family members. This is often a great solution for occasional errands or appointments, especially if you have trusted loved ones who live close by.

Adult day services

Adult day services are great options for seniors who enjoy spending time out of their homes. Adult day services are provided at locations like senior centers and churches. These services offer the chance for seniors to have socialization along with supervision and medical care. They can allow you to work or complete needed tasks during the day.

In-home care

In-home care comes to you. You can find in-home respite care for temporary situations or work out a regular schedule with a home care aid. You can find respite in-home care through home health agencies or by looking for individual caregivers.

Residential care

Residential care is respite care in a senior community, such as a nursing or assisted living facility. This type of care allows for overnight stays and can last for several weeks. You can use this type of respite care if you’ll be out-of-town or need a longer break.

One of the primary reasons for respite care is to help reduce caregiver burnout. Caring for a loved one full-time is a big responsibility. Many family caregivers are happy to take care of someone who is such an important part of their lives, but that doesn’t mean it can’t be stressful.

In fact, caregiver burnout is incredibly common. Family caregivers often find themselves overwhelmed, frustrated, and anxious. Over time, this can damage the caregiver’s own health.

Respite care is a great way to step back and take a breath. It can help you relax and lessen some of the symptoms of caregiver burnout. When you know your loved one is being cared for in a safe environment, even for a few hours, it’s one less thing for you to juggle. That can make a significant difference in your overall mental and physical well-being.

In addition to reducing general burnout, there are several situations respite care can help with. These include when the primary family caregiver:

  • works outside the home
  • has out-of-town obligations
  • has a scheduled vacation
  • has an upcoming major medical procedure
  • has been showing signs of severe burnout

The cost of respite care depends on many factors, such as:

  • the type of respite care you choose
  • your insurance
  • your location

For instance, in-home care and assisted living both cost an averageTrusted Source of around $150 per day, while adult day services cost an average of $78 a day. Most insurance plans won’t cover the cost of respite care. However, there are resources you can turn to for assistance.

  • Informal respite. Informal respite with friends and family is normally a free or low-cost way to arrange respite care.
  • Medicaid. Medicaid doesn’t cover respite care as a standard benefit. However, many states offer a Medicaid Waiver program that does include coverage toward respite care. You can use this locator to find your state’s Medicaid office.
  • Veterans Benefits. If you receive a VA pension, you might also qualify for a benefit called Aid and Attendance that can be used for respite care. Many VA facilities also offer up to 30 days of respite care or qualifying Veterans.
  • Long-term care insurance. You can generally use your long-term care insurance policy to pay for respite care. However, this varies by policy, so it’s best to call your insurance company and check.
  • Sliding scale adult day services. Many adult services, especially those offered by community-based senior centers, nonprofit organizations, or churches, have sliding scale payment options. Some day service providers employ social workers or financial counselors who can help you find ways to cover the cost of respite care.

It can be difficult to choose the right respite care professional. Many family caregivers are anxious about leaving their loved ones with an unfamiliar person or in an unfamiliar location. It’s a good idea to take your time and choose a facility or professional you feel comfortable with.

If they’re able, it’s a good idea to have your loved one be a part of the interview process. Ideally, they can talk to any potential respite care professionals and ask questions of their own. After the interview, you can talk with your loved one and get their feedback before you make your final choice.

If you’re selecting an adult day services or residential care facility, it’s a good idea to ask:

  • What training does your staff have?
  • Do you have nurses or other medical professionals on staff?
  • What safety procedures are in place?
  • Are there daily activities offered?
  • Can you provide meals and snacks that meet my loved one’s dietary needs?

There are a few different ways to find respite care. If you know of any friends or family who might be able to provide care, they might be the best place to start. If not, you can use these resources:

  • Eldercare Locator. The Eldercare Locator will connect you with your local Area Agency on Aging. Your local Area Agency on Aging can help you secure respite care, find adult day services, and get other caregiver supper.
  • ARCH National Respite Network. The ARCH Respite Network can connect you to respite services in your community.
  • National Adult Day Services Association (NADSA). NADSA is a directory of adult day services around the country that you can use to find care in your community.

Respite care can help full-time family caregivers take a break. It’s a great way for caregivers to work, complete important errands, travel, and reduce the impact of caregiver burnout.

You can find respite care from family and friends, home care professionals, adult day services, and resident care facilities. Respite care generally isn’t covered by insurance, but there are resources available to help pay for care.

Complete Article HERE!

Palliative Care is Not Just for Dying People

The COVID pandemic has shown how palliative care can also be valuable for managing the pain and stress of illness

By Nora Macaluso

Palliative care can provide relief to people with severe, but not necessarily life-ending, health conditions. But often patients — and their doctors — don’t realize they can take advantage of a team-based treatment approach that may include social workers and community support.

“The big misconception about palliative care in general is that you need to be dying to get it,” said Dr. Andrew Esch, a palliative care specialist and consultant for the Center to Advance Palliative Care (CAPC) in Tampa, Fla.

The pandemic has helped counter that view, Esch and others told Next Avenue, as physicians see the benefits to people living with COVID-19 and their families. A palliative care team aims to take a holistic view of the patient’s world rather than focusing solely on treating the primary condition.

Dr. John Mulder, of Spring Lake, Mi., executive director of palliative care training center Trillium Institute, uses “life-defining” or “life-altering” to identify conditions that might benefit from palliative care.

“Getting palliative services doesn’t mean that you are somehow giving up on treating an illness. It’s quite the opposite.”

“Many, many individuals as they navigate their lives are going to be diagnosed with something that is going to forever change them, and it’s going to impact their longevity, impact their quality of life, and can place some burden of suffering upon them,” he said.

“What we do in palliative care is acknowledge the fact that we have something we can’t fix,” Mulder continued. “It might be modifiable, it might be manageable, but we can’t fix it.”

The Symptom-Based Approach of Palliative Care

He added, “You don’t have to be imminently dying to get palliative services. Getting palliative services doesn’t mean that you are somehow giving up on treating an illness. It’s quite the opposite.”

People with cancer, for example, can rely on the symptom-based approach of palliative care to build their strength so they’re better able to withstand chemotherapy, he said. People with conditions like multiple sclerosis or Parkinson’s disease can also benefit, as can those with Alzheimer’s disease.

Palliative care is “really appropriate for anybody with a diagnosis of a serious illness, regardless of prognosis,” said Brynn Bowman, CAPC’s chief executive officer. Most insurance plans cover palliative care just as they would any other specialist service. CAPC manages a website that can help patients find palliative care providers by ZIP code.

“What palliative care aims to do is provide relief from the symptoms and stress of the illness,” Bowman said. That may include managing pain and other symptoms, supporting the family, or helping people match their treatment options to their goals.

“The point is to improve the quality of life for patients and families,” she said.

“Palliative care is based on need, not prognosis,” Esch said, adding that the earlier the team gets involved, the better.

Misconceptions About Palliative Care

Misconceptions about palliative care don’t appear to be limited to the public. Physicians often associate it with end-of-life care and are hesitant to recommend it early in a patient’s illness journey, palliative care specialists said.

“It’s really clear that the medical system isn’t telling patients at the front line of their disease” what to expect, said Katy Lanz, chief strategy and product officer at Personal Care Medical Associates, a geriatric and palliative care company in Pittsburgh.

“Many well-intended, wonderful, smart physicians still are confused about what options people have,” she said.

Often, a doctor will diagnose a patient with a serious condition “but not tell them it’s a disease that one day ends their life,” Lanz said. “There are decisions associated with that disease we should talk about with them while they’re well.”

‘Long COVID’ Brings a Shift in Perspective

The COVID-19 pandemic has boosted demand for palliative care and shifted medicine in ways that are likely to bring the specialty to the forefront, practitioners said.

“COVID has shined a light on the value of palliative care, especially now that we’re seeing ‘long COVID’ patients,” said Esch.

The complex nature of the disease and its effects on family members and caregivers make COVID-19 well suited to a team-based approach. “There’s been a real acceleration” in reliance on palliative care since the pandemic started, Esch said.

“Our volumes are way up,” Esch said. “Most teams are busier now than they’ve ever been.”

According to Esch, a palliative care approach helps with the “brain fog” many people experience after spending time in an intensive-care unit, as well as the “lingering malaise” many COVID sufferers report.

The general malaise brought about by the pandemic has also brought palliative care into focus, Esch said.

“There’s almost a parallel epidemic of a mental health crisis right now,” and people with underlying conditions are seeing their symptoms exacerbated by stress even if they haven’t contracted the virus themselves, he said, adding, “There’s a lot of suffering right now, and that’s really the intersection we sit in.”

“COVID has helped both providers and patients really focus on the need to think about what’s most important to them, where they want to get their medical care, and how,” said Dr. Kim Bower, of San Diego, Calif., medical director of the palliative care program at Blue Shield of California.

“I think it’s opened up discussions,” she said. “It’s been a reason for families to sit down and discuss priorities.”

The pandemic has also addressed barriers to telemedicine, and “really let us see what can we do effectively by video visit and what do we really need to do in the home to meet the patient’s needs,” Bower added.

Health Insurers and Hospitals See Value in Palliative Care

In 2019, 72% of U.S. hospitals with 50 or more beds reported having a palliative care team, according to CAPC. That was up from 67% in 2015, 53% in 2008, and just 7% in 2001. The number of palliative care programs in community settings is also rising, said Bowman.

Some health plans are being proactive about palliative care, sorting through records and identifying members who might benefit from palliative care, Bowman said.

In California, insurers are required to cover home-based palliative care for Medicaid recipients under a law that became effective in 2018. Blue Shield of California, which started a palliative care program in 2017, now offers palliative services through many of its plans, Bower said.

“We’ve taken a multi-pronged approach” to reaching out to members, she explained. Physician and case manager referrals, along with research into medical records and discussions with providers, can identify those who might benefit, she said. Some may need something as simple as more time with a primary care provider or a telemedicine visit.

“I think about palliative care as a continuum, from the palliative care that can be provided by your primary care doctor to the type that can be provided by a specialist in your home,” Bower said. “The final part of that continuum would be hospice care.”

“COVID has helped both providers and patients really focus on the need to think about what’s most important to them, where they want to get their medical care, and how.”

“One of the gaps we have in the United States is, though we have a way to pay for hospice care, we don’t really have a great way to pay for palliative care providers” in a clinic or by telemedicine, Bower said.

The philosophy of palliative care — an interdisciplinary team taking care of the family as well as the patient — isn’t exactly matched with the existing reimbursement system, though that’s changing. “We’re starting to see a network of outpatient palliative care providers form,” Bower said. Still, “access is still spotty.”

Some 65% of Blue Shield members who take advantage of palliative care “discharge” from the home-based program after their symptoms stabilize or their needs are met, Bower said. They may still access services such as office-based palliative care visits, “but they don’t really continue to need that high-acuity palliative care.”

“I think it’s important for patients to be able to access palliative care across that continuum, whether that’s most appropriate in their primary care doctor’s office, a clinical setting, telehealth, or hospice,” Bower added.

The state’s passage of SB 1004, the law mandating coverage for Medicaid recipients, “was a huge win in terms of improving access,” Bower said. “I think having something like that nationally would be a great step forward for palliative care.”

Care for Caregivers and Families

Caregivers for people with serious diseases are themselves at risk for social isolation and exhaustion, and a palliative care team can connect them with community resources such as adult day care, according to Bowman. The team can also teach a caregiver about disease progression and how to manage pain and possibly avert a crisis.

For example, palliative care can provide immediate benefits such as alleviating symptoms so patients aren’t bedridden, said Esch.

“I could come up with about two-thousand and five hundred stories of patients who were in unmanaged pain,” he said. “You get that pain under control, it changes their life.”

As Esch sees it, one of the real values of palliative care is “coordinating care and communicating with the patient’s family and other clinicians” so “we’re not doing things in silos,” he said.

“Palliative care takes the lead and makes it so the patient feels they have four doctors and nurse practitioners taking care of them, and they have four of them talking to each other.”

Complete Article HERE!

Signs You Are Experiencing Disenfranchised Grief

By Melissa Porrey LPC, NCC

Disenfranchised grief is a natural emotional reaction following a loss that is not openly accepted by society. It is normal and expected to grieve after any loss, but not all losses are viewed equally by those around us. Not feeling welcome or comfortable to outwardly mourn or express the emotions that come with a loss can be isolating and can prolong and complicate the grieving process.

This article will define disenfranchised grief through examples, show how to recognize disenfranchised grief, and explain how it compares to other forms of grieving. It will also provide coping techniques and ideas for finding validation in mourning.

What Causes Disenfranchised Grief?

Grief affects everyone differently. Childhood experiences, attachment style (ways we relate to and interact with others), individual definitions of meaning and closeness, and the types of relationships we hold contribute to the ways we grieve and mourn.

In addition to how individuals grieve, culture and societal norms play a role in how we express grief and in defining the acceptable and unacceptable circumstances in which to grieve.

Having social support and validation of the pain that comes with loss allows bereavement to be a productive time of mourning. Grieving is more difficult when a loss isn’t validated by those around us or by society at large, and the feelings associated with the loss can be intensified.1

5 Categories of Disenfranchised Grief

There are five categories of disenfranchised grief, as outlined by Kenneth J. Doka, a mental health counselor who initially defined disenfranchised grief. These are:1

  1. The loss isn’t seen as important by others.
  2. The type of loss isn’t acknowledged or is stigmatized.
  3. Some people are not seen as entitled to grieve.
  4. The circumstances of the death are denied.
  5. The way grief is expressed is judged by others.

The specific circumstances around these definitions vary by culture, community, and individual family norms.

Some examples of loss that may not be accepted by social groups or society include:

  • Pet loss
  • Death of someone who was incarcerated or a former inmate
  • Pregnancy loss
  • Death of someone who was not considered to be in an appropriate or acceptable relationship, such as in the case of an affair or the loss of a same-sex partner in societies where those relationships are not accepted
  • Death of a former spouse

Some losses are not related to death but still cause disenfranchised grief, because they bring significant loss and are not commonly accepted as losses. These include:2

Recognizing Disenfranchised Grief

In Yourself

When grief is disenfranchised, other people don’t recognize the relationship that existed, the loss experienced, or the pain and feelings of the person who is grieving.3 This can be a lonely way to grieve, and it might feel as though it’s not OK to mourn the loss. Experiencing disenfranchised grief usually forces a person to grieve alone and in silence.

In some situations, people cause self-disenfranchised grief. This occurs when we deny ourselves the right to grieve an experienced loss. This can be intentional or unintentional and is characterized by separation from or lack of acknowledgment of the loss.1

In Someone Else

Grief should be expected after any major loss. Grief is natural and normal and allows us to work through the pain of coping with loss. When someone experiences a significant loss that isn’t commonly accepted by society and that person never talks about the loss, the subject of the loss, or how they are doing, they could be experiencing disenfranchised grief.

Societies establish rules and expectations about how to grieve. Even when a person is surrounded by people who care, they may feel isolated and unable to communicate how they are feeling for fear of judgment or lack of understanding. The person likely won’t want to discuss their experience even when directly asked.4

Other Types of Grief

There are many ways to experience grief. Grief is a unique and individual process, and the responses and reactions that follow a loss depend on the person, the circumstances surrounding the loss, the individual’s support system, and other stressors and traumatic experiences from the person’s life.

Grief that naturally follows a loss and allows a person to mourn in a way that brings meaning over time is considered normal grief. Though there is no timeline within which to grieve, in a normal grieving process, emotional reactions usually diminish within the months following the loss.

Sometimes, grief is complicated by different factors related to the individual who is grieving, the surrounding community, and societal expectations. These are some other ways grief is categorized:5

  • Anticipatory grief is grief that is generally expected, such as when a person is an older adult or has been sick for a long time.
  • Traumatic grief occurs when a loss is sudden or unexpected and is followed by feelings of shock and trauma.
  • Complicated grief occurs when the circumstances of the loss prevent the intensity of grief symptoms from lessening over time. This is usually associated with violent or complex losses, such as homicide and suicide.
  • Ambiguous grief happens when a loss does not bring emotional or psychological closure. This occurs either when the person is physically present but psychologically absent, as in the case of dementia, or when the person is psychologically present but physically gone, such as when a person is missing.

How Disenfranchised Grief Differs

Disenfranchised grief is different from other ways of grieving in that the outward expression of grief is not publicly accepted. This puts a person’s feelings in conflict with what others deem to be a real loss or one worth grieving.

Disenfranchised grief can occur even when there are other types of grief present, however. A loss can be anticipatory and also disenfranchised. Similarly, a loss can cause disenfranchised grief that turns complicated over time or that is traumatic in nature.5

What sets disenfranchised grief apart is that it does not bring out sympathy in others. This sends the message that it is not acceptable to feel or express the pain and emotions that naturally follow loss.5

Coping and Finding Validation

Finding validation can be difficult when the loss is not recognized by others. If common rituals like attending funerals and holding remembrance ceremonies are not an option, creating new rituals can bring meaning to the loss and provide a way to cope. Things that allow for honoring the loss, the person, and the relationship can bring comfort and a path to begin healing.6

Talking with a mental health professional can also be a way to find validation and sympathy when grief is disenfranchised. Grief therapy provides the space to talk about the pain of the loss and discover different ways to mourn.

Summary

Disenfranchised grief occurs when family members, social groups, and/or society don’t recognize a loss. This nonrecognition can be of a loved one who died, the relationship that existed, the person who is grieving, or the value of the loss that occurred.

When a person is unable to express their feelings and pain associated with grief, it can prolong the intensity of bereavement, cause feelings of isolation and loneliness, and complicate the natural grieving process. Seeking support from a grief therapist can provide validation and the support needed to recognize and work through the loss.

A Word From Verywell

Working through grief can be difficult even under normal circumstances. If you are grieving a loss that is not recognized or accepted by others, or if you feel you cannot talk about the person who died or the pain you are experiencing with loved ones, you could be experiencing disenfranchised grief.

To work through the most intense parts of grief, it’s helpful to find validation and support, which can come from a grief therapist. Talking with a mental health professional can provide the sympathy and space to process the loss and allow you to mourn in a healthy way.

Frequently Asked Questions

  • When was disenfranchised grief first recognized?

    The term disenfranchised grief was first published by licensed mental health counselor Kenneth J. Doka in the 1980s. Since then, Doka and other bereavement professionals have published many findings on the topic.

  • Why is grief overlooked for some people and validated for others?

    There are many factors that determine whether a person’s grief will be validated, including the type of loss, the relationship to the deceased, societal norms, and family culture and values. Circumstances like suicide, romantic relationships outside marriage, and other stigmatized situations can isolate those who are grieving. This makes them unable to talk about their loss, seek support from others, and outwardly mourn.

  • Is ambiguous loss the same as disenfranchised grief?

    Both ambiguous loss and disenfranchised grief are types of complicated losses that can cause prolonged grieving. Ambiguous loss occurs when there is no emotional closure, and disenfranchised grief happens when a person’s loss is not supported by others.

    Though they are different classifications of grief, a person can experience both at the same time. For example, a person in a same-sex relationship in a place where homosexuality is not accepted would experience ambiguous loss if that person went missing, and disenfranchised grief because the loss could not be openly grieved.

  • How long does disenfranchised grief last?

    Grief does not follow a specific timeline. For many people, grief takes different forms and comes and goes for a long time. For those experiencing disenfranchised grief, the intensity of the feelings from the loss can be prolonged due to not being able to outwardly mourn. For most people, the pain of grief will lessen in the weeks to months following the loss. For those experiencing complicated or prolonged bereavement, the intense feelings of grief could last years.

Complete Article HERE!

Living-Will, Advanced Directives Can Be Saved in a New Video App

By: Kathleen Gaines

End-of-life decisions may be amongst the hardest decisions any family member might have to make for a hospitalized loved one. But with the proper advanced health care directives, it can make those decisions easier and less confusing. Unfortunately, most patients do not have advanced directives, especially those in the younger generations. The reality is that unless someone has a terminal illness or works in healthcare, they may not even know what an advanced directive is.

MIDEO Card is changing the conversation.

A revolutionary new app, MIDEO Card which stands for My Informed Decision on VidEO, is a video advance directive as well as a video medical order for life-sustaining treatment. The video is in the patient’s own words and has been formulated to translate all wishes into medical provider understanding.

What is an Advanced Directive?

Generally, advanced directives are done via a paper form that can be filled out in the hospital or online and printed. These forms discuss life-sustaining medical treatment and prolonging life.

According to the American Cancer Society, “life-sustaining medical treatment is any medical intervention, medication, or anything mechanical or artificial that sustains, restores that would prolong the dying process for a terminally ill patient.” These may include :

  • Breathing machines
  • CPR (cardiopulmonary resuscitation) including use of an AED (automated external defibrillator)
  • Medications such as antibiotics
  • Nutrition and hydration (food and liquids) given through feeding tubes or IVs

Once an advanced directive has been filled out it then needs to be given to your healthcare provider and placed into your health file. This can be problematic, especially in the case of an emergency. If an advanced directive is completed at home and never given to the primary healthcare team, it is possible that no one will know a patient’s true end-of-life wishes. Furthermore, if the patient is taken to a hospital out of state or not associated with their primary healthcare provider, then there will not be accessible to the advanced directive.

This is problematic.

MIDEO eliminates this by creating a digital footprint for the advanced directive and allows all providers access to it regardless of the healthcare system or state. It’s all done with a QR code and smart device.

According to a 2017 study, of 795,909 people in the 150 studies analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. The proportions of terminal individuals to healthy individuals were similar. Based on this large study as well as others, it is evident that end-of-life discussions are essential to properly care for patients.

“Improving end-of-life care has been a national conversation for some time now, presumably because it will affect all of us at some point and is a very personal matter,” said senior study author Dr. Katherine Courtright of the Fostering Improvement in End-of-Life Decision Science Program at the University of Pennsylvania in Philadelphia.

Why MIDEO?

MIDEO is designed to allow patients to directly speak their wishes with a representative and is stored on a digital identification card.

MIDEO takes the planning and consultation out of the hands of the hospital and hospital healthcare providers. MIDEO has a team of healthcare specialists that work with patients to find the options that are not only personalized but also the best for them and their loved ones.

As hospitals continue to feel the strain of the ongoing pandemic and nursing shortage, there are fewer and fewer resources dedicated to informing patients about advance directives and end-of-life decisions. MIDEO is helping to remove the strain.

Currently, there are three options available for MIDEO Card. Each provides a personalized virtual meeting with a specialist to discuss all aspects of advance directives and end-of-life wishes.

Essential Package (designed for healthy individuals):

  • Includes a standardized guided process with a Qualified Healthcare Professional to create your safety statement
  • 2 Copies of the Identification Cards.

Vital Package (designed for individuals with multiple medical problems or ages 60 & above):

  • Includes a guided process and detailed healthcare evaluation with a Board Certified Physician to create your safety statement
  • 2 Copies of the Identification Cards.

VIP Healthcare Concierge Advocate (designed for Individuals (e.g.: those with cancer) Who Require Navigation Through the Complex Medical System Who Have Specific Goals to Be Achieved): 

  • Includes the Vital Package, but also includes a designated Concierge Physician Advocate who will be available to assist and provide guidance 24 hours a day.

While there is a fee associated with the use of MIDEO Card, most major health insurance plans including Managed Medicare and Medicare with supplemental insurance plans have covered the cost of MIDEO in full or for a small co-pay.

As of January 1, 2016, Medicare-approved billing codes allow individuals to receive Advance Care Planning Education & Counseling. Commonly, this is considered the end of Life planning or counseling.

How It Works?

According to the website, the MIDEO video is accessed by any type of smart device including a smartphone and/or tablet. The camera feature scans the QR code technology on the MIDEO ID card of the patient. The video is then quickly retrieved within seconds in a safe and secure manner. 

MIDEO suggests informing all healthcare providers of the QR code and having it stored in your patient file so that it can be accessed immediately if needed. 

The video aspect is essential to the success of MIDEO and the future of advanced directives and end-of-life planning. Because many states allow individuals to complete advanced directives online without assistance, it is possible that individuals do not fully understand the choices presented to them or that they can make their own that are listed.

“As I like to say, the form is only as good as the conversation and the shared understanding that goes along with it,” said Dr. Rebecca Sudore of the University of California, San Francisco School of Medicine who wasn’t involved in the study.

“Some people do fill out these forms with families or lawyers, and then the forms sit in the dusty recesses of a back drawer and they are not available or shared with family and friends, especially before they are needed,” she told Reuters Health by email.

As Americans live longer, especially with chronic medical conditions, and healthcare continues to make advancements against the fight of once terminal diagnoses, it is essential that individuals make their end-of-life wishes known to not only their families but also to their healthcare providers. MIDEO Card takes away the guesswork. It leaves a lasting gift to families and loved ones having to make difficult decisions.

Complete Article HERE!

What Ambiguous Loss Is and How To Deal With It

A psychologist shares ways to cope with a lack of closure

It’s been more than 40 years since family therapist Pauline Boss, PhD, first coined the term “ambiguous loss” and published her book by the same name.

In its simplest sense, “ambiguous loss” refers to loss without closure. And today, the term has never been more relevant, especially as we continue grappling with the many ways the COVID-19 pandemic has upended our lives.

Psychologist Kia-Rai Prewitt, PhD, delves deeper into this concept, including its original meaning and how it’s especially applicable today.

“Dr. Pauline Boss created this term to refer to a lack of information and closure that surrounds the loss of a loved one,” Dr. Prewitt says.

At its core, ambiguous loss is all about a lack of resolution — but Dr. Boss created categories to differentiate between physical and psychological loss.

Type-one ambiguous loss

Type-one deals with physical loss, like when you don’t know for sure whether someone you love has died or what has happened to them. Think, for example, of a parent whose child has been kidnapped or a person whose spouse has gone missing on military deployment.

Dr. Boss calls this category “physical absence with psychological presence,” a type of ambiguous loss that occurs when someone you love is physically absent under unknown, uncertain or unresolved circumstances.

Examples include loss as a result of:

  • Unexplained disappearances, like kidnapping.
  • War and acts of terrorism.
  • Deportation and genocide.
  • Natural disasters.

This type of ambiguous loss can also come from a loss of contact, even if you know where the person is or what has happened to them. This kind of ambiguous loss includes circumstances like:

  • Divorce.
  • Adoption.
  • Estrangement.
  • Incarceration.
  • Separation due to immigration.

“As an example, think about what happens after a divorce,” Dr. Prewitt says. “You know your ex-spouse still exists, but they are no longer in your life the way they used to be when you were married. That’s ambiguous loss, too.”

Another modern example is the trend toward ghosting — when someone you’re dating just stops responding and falls out of touch, leaving you without answers.

Type-two ambiguous loss

This type of ambiguous loss refers to a psychological loss, including a mental or emotional disappearance (like when someone’s personality has changed so much that they no longer seem like the person you once knew).

Dr. Boss describes it as “psychological absence with physical presence.” Your loved one is physically present, but they’ve changed, whether emotionally or cognitively (or both).

Examples include changes caused by:

  • Alzheimer’s disease and other forms of dementia.
  • Traumatic brain injury.
  • Drug and/or alcohol addiction.
  • Depression or other chronic mental illness.

“A common example I see is when I work with couples,” Dr. Prewitt notes. “A spouse says they want the person their partner used to be, especially if that partner has a mental or physical illness or has experienced a traumatic event during the course of the relationship.”

Why ambiguous loss is so hard to handle

​Usually, closure is an important piece of the complicated puzzle that is grief. It provides us with some way to process what’s happened. “We typically crave closure because our brains are wired to analyze information and our environment,” Dr. Prewitt explains.

When someone dies of known causes, even when it’s sudden or particularly traumatic, we are, at least, able to comprehend that a loss has happened. Death is concrete — but ambiguous loss doesn’t offer any sense of closure.

This is especially true in the case of open-ended disappearances — say, if your child has run away from home or your partner is presumed dead after a hurricane. But there’s also no closure when a parent’s personality changes as a result of Alzheimer’s or when a friend’s mental illness makes them nearly unrecognizable to you.

“When we don’t have all the information, we lose our sense of control, and our thoughts fill in the blanks,” Dr. Prewitt says. “Those thoughts can be terrifying because there is nothing to confirm if what you’re thinking is right or wrong.”

How ambiguity impacts the grief process

“I see ambiguous loss as a type of complicated grief,” Dr. Prewitt says. “You’re often left longing for what used to be or for answers to questions.”

Grief looks different for everyone, and there’s no one “right” way to grieve. But it’s common to move through five stages of grief:

  1. Denial.
  2. Anger.
  3. Bargaining.
  4. Depression.
  5. Acceptance.

People who are grieving a loss go in and out of these stages of grief in no particular order — but when you’ve experienced an ambiguous loss, you may become stuck in any one stage. This is sometimes referred to as “frozen grief” or “grief limbo.”

“It can feel like an ongoing trauma because there is no answer,” Dr. Prewitt says.

And if you’re experiencing type-two ambiguous loss, other people may not even recognize that you’re grieving at all.

“Ambiguous losses can feel isolating because they can be ignored,” Dr. Prewitt says. “This makes it especially difficult for the person experiencing the loss.”

Ambiguous loss and the COVID-19 pandemic

Ambiguous loss has historically referred to individual loss — when a person has disappeared, left or somehow changed. Now, though, so many of us are experiencing loss, and it’s not always centered on a person.

“Everyone has lost something during the pandemic, whether they recognize it or not,” Dr. Prewitt says. “People lost access to social connections, jobs, childcare and being able to go places without doing a risk assessment first. A lot of couples’ relationships either withstood the stress of being together constantly, or their issues were exacerbated.”

In other words, things have changed. And if you wish things could go back to the way they used to be before the pandemic, you’re not alone.

“Humans crave consistency and predictability, so when things are unpredictable, such as the pandemic, we often feel anxious, depressed and isolated,” Dr. Prewitt says.

None of us got any closure on our old way of life before the pandemic forced us to transition into a stressful new one. It seems like this version of life is our new normal, but it’s understandable to experience grief for everything we’ve lost.

Other factors that contribute to ambiguous loss

It’s not just the pandemic, either. Researchers are also looking into how social and political conditions — like climate grief and the trauma of racial injustice — can lead to feelings of ambiguous loss, too.

“For communities of color who identify with Black Americans like Ahmaud Arbery and George Floyd, there is a constant reminder that society views and treats them differently,” Dr. Prewitt says.

Tips for coping with ambiguous loss

If you’re experiencing ambiguous loss, here are some suggestions for dealing with the grief, stress and sadness that can accompany it.

1. Name what you’re going through

The kind of ambiguous loss brought on by the pandemic, in particular, can be a sneaky kind of loss. You might not even recognize your grief for what it is — but now you have a name for it. Sometimes, just being able to put a label on what you’re experiencing can help you begin healing.

2. Work toward acceptance

Acceptance isn’t the same as closure. But in the absence of closure, Dr. Prewitt says it’s important to try to make peace with this new reality.

“It takes work to accept that things are different and may never go back to the way they used to be,” Dr. Prewitt says.

3. Reach out for support

Depending on the circumstances of your loss, other people in your life might realize that you’re struggling, which can be especially isolating. Dr. Prewitt recommends identifying and connecting with family or a close friend who can help support you. And especially in pandemic times, you may be surprised to learn that they’re having similar experiences

You can also look for a support group for people who’ve experienced the kind of loss you have.

4. Look for silver linings

Without veering into toxic positivity territory, try seeing some of the good within the bad. What has come your way — like new friendships or personal growth — that wouldn’t have if your life had stayed the same?  

“It can feel overwhelming and disheartening to know that things won’t go back to the way they were,” Dr. Prewitt says, “but it can also be an opportunity to create new meaning for yourself or with others.”

5. Get involved in a cause

“Some people cope with loss through action, like joining organizations focused on different issues that have personal meaning,” Dr. Prewitt says.

And if you choose to get involved with an organization related to the sort of loss you’ve experienced — say, an Alzheimer’s charity if your loved one has dementia, or a relief organization if you’ve lost someone to a natural disaster — you may also end up connecting with other people who’ve been where you are.

6. Be kind to yourself

Try giving yourself grace and gentleness as you work through your grief. “This is a time for self-compassion,” Dr. Prewitt encourages. “Be kind to yourself when you’re struggling with difficult emotions, the same way you would provide compassion to someone else if they were experiencing what you are.”

When to ask for help

If you find that you’re having trouble coping, look for a therapist who can help you work through your pain. It may be helpful to search for a therapist who specializes in grief or who has training in the particular type of loss you’re experiencing. You don’t have to deal with ambiguous loss on your own.

Complete Article HERE!

Death Is No Laughing Matter.

But on DeathTok It Is.

Americans struggle with talking about death. To remedy that, some hospice nurses have taken to TikTok to soothe people’s qualms with macabre humor.

An unlikely group of influencers on TikTok is using cheeky skits and viral songs to change our relationship to mortality.

By Jessica Lucas

Casual TikTok viewers might think of the app as just a feed of Gen Zers doing viral dances and lip-synch reenactments. But the social network has also provided a space for some unlikely influencers: hospice workers, morticians, and funeral directors. These content creators hope that their comedic takes on mortality will help people who find death hard to discuss, especially during the pandemic, in which more than 900,000 Americans have died. DeathTok, as it’s called, is a corner of the platform where skits about end-of-life care, funeral arrangements, and death-worker mishaps bring comfort to those suffering through grief and loss, and clarity to those who are curious about an oft-avoided topic.

Our inability to plainly discuss death and its circumstances stems, in part, from the American ethos of self-reliance, according to Cole Imperi, a well-known author and speaker on the subject of death and thanatology. “We value the story of somebody coming to the U.S with $5 in their pocket and they make it … needing nobody,” she told me over Zoom. The end of life, Imperi explained, sits in direct opposition to this philosophy: As people age and approach death, they rely on others for help. The fear of lost autonomy (be it one’s own or a relative’s) makes planning for, grieving, and processing death hard for many Americans. “We don’t have a lot of practice with knowing how to talk about something that’s painful, scary, or difficult all the way through,” Imperi said. She believes that the humor DeathTok offers can be a useful tool for pushing through this discomfort. “Having humor is critically important when it comes to death and dying,” she said. “Humor is necessary. Humor helps us heal.”

Although some find death-based comedy unpalatable, many TikTok viewers agree with Imperi’s estimation that the levity of a well-placed joke can sometimes make difficult situations easier. When I spoke with Penny Hawkins, a 59-year-old hospice quality-control manager from Washington, she explained how she uses comedy to educate others. “If you’re talking about a really heavy subject like death and you’re able to put kind of a funny spin on it, it makes it a little more palatable. It’s not quite so scary,” said Hawkins, who has more than 300,000 followers on her nurse_penny TikTok account. She encourages viewers to be curious about human anatomy by explaining what happens to failing bodies. For example, to tackle the misconception that hospice patients need to stay hydrated, Hawkins danced to the viral song “Just Water,” by the TikTokers Bryansanon and Tisakorean. To caption her video, she wrote: “If your dying person isn’t taking fluids, that’s ok. Their body is shutting down and doesn’t need it.” The chorus, which repeats the line “It’s just water!,” serves as a whimsical background to Hawkins’s blunt explanation.

Three scrolling tik tok feeds with a hospital gurney and ekg machine in background.

Hawkins has also used macabre comedy to illuminate the realities of hospice care. In one video, about the use of morphine at the end of life, an exasperated Hawkins appeals to the camera and feigns anger at a family who wants to withhold morphine from a dying loved one out of fear that they’ll become addicted. “They’re suffering and they’re dying,” Hawkins’s caption reads. “Addiction is the least of their worries.” Hawkins told me hospice patients aren’t typically at risk of developing an addiction, because many of them are not in end-of-life care long enough to become addicted (for instance, the median length of stay for Medicare recipients in hospice is about 18 days). As uncomfortable and dark as the video may be, it underscores Hawkins’s overall message that learning more about dying bodies and end-of-life care can only help.

Beyond the medical aspects of death and dying, some videos also warn people about one of the largest hurdles after a loved one’s passing: logistics. Lauren Taylor, a 28-year-old former funeral director who lives in Florida, shares farcical family stories on TikTok—such as a quarrel between a mistress and a wife over the burial of a shared lover—to make the point that planning is key. “Being preplanned, having everything written down ahead of time, and letting others know what your wishes are is so important,” she told me over the phone. Taylor, who asked to use her maiden name to protect her family’s privacy, has more than 400,000 followers on her account, @lovee.miss.lauren, and said she has witnessed how traumatic unplanned funerals can be for families and wants to inspire forethought. “These comedic situations where you kind of wonder, Is this real? It happens more often than people think,” she said. “It can be comical to talk about after the fact, but when you’re living in the moment, it’s the most stressful thing ever.”

While DeathTok has been a useful tool for families navigating their relatives’ mortality, it’s also helped death workers themselves cope with the demands of their job. Julie McFadden, a 39-year-old hospice nurse in California, told me that of her close-to-700,000 followers, her fellow medics are the loudest voices in her comments section. “Any of my videos that are more dark, that could be slightly offensive to some, I’m always 100 percent supported by nurses,” she said. In one video, she recounts the time she noticed that a patient was dead even though the rest of their family did not (set to the audio of a person screaming “Don’t worry!” in a panicked tone). The clip spurred other nurses to share similar stories, and one thanked her for her “positive outlook” on such difficult situations. McFadden told me that though nurses are taught how to care for and save patients, many aren’t coached on how to handle death psychologically. “As a community, it’s nice to come together and make light of the things we know are messed up,” she said. “What else are we going to do if we don’t laugh about it?”

When death workers make these short, funny videos, they provide more than just comfort to their colleagues or the bereaved. Their TikToks can be soothing even for patients dealing with a terminal diagnosis. Val Currie, a 32-year-old undergoing treatment for Stage 3 recurrent metastatic cancer, told me that DeathTok provides a much-needed release, and has helped her have discussions with her partner about end-of-life care. “I’m learning to laugh at the process,” she said. If viewers can laugh at death, then they can talk about it. And if they can talk about it, healing may not be too far behind.

Complete Article HERE!