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Cultural Diversity in Hospice Care
last updated:
Mon, 1/17/2011 12:06 PM

What does it really mean to have cultural diversity within an organization? As I pondered this statement, I looked back to my beginnings in northern Mississippi. I grew up in a time of segregation and separation in the south. This was during the 50’s, 60’s, and early 70’s. Surely this term was not invented then. I remembered neighborhoods with only one race in them. Sections of town were racially & culturally divided.

Cultural diversity is the variety of human societies or cultures in a specific region, or in the world as a whole. Cultural diversity within a hospice care program is typically a rarity. However, according to the research information listed below, African American participation in Memphis hospice care is far beyond the national average. During my tenure as a hospice chaplain, the area census listed more African Americans than Euro-Americans (Memphis is over 60% African American), but it also shows a greater number of Caucasians using hospice care.

It would seem that we here in Memphis are truly blessed. Research found that the ratio of African Americans to Caucasians is much lower than the national average. Listed below is a graph of hospice admissions by Methodist Alliance Hospice. It appears that the ratio is much closer here than I had envisioned. Clearly, African Americans lag behind Caucasian hospice usage. However, during the charted period (October 2007 - December 2009), Caucasians led African American hospice usage by only 110 patients. The ratio is nearly one for one. This is a rarity for hospice usage nationally. I think it is also important to note that the graph below includes not only Memphis and Shelby county but other outlying counties in west Tennessee and Northern Mississippi as well. 

Unduplicated Hospice Admissions by Gender and Race/Ethnicity: 

RACE/ETHNICITY  

MALE

FEMALE

UNDEFINED

TOTAL

Unknown

32

43

0

75

Native American

0

2

0

2

Caucasian

485

679

6

1,170

Asian

4

8

0

12

Other

2

1

0

3

Hispanic

5

6

0

11

African American 

437

614

9

1,060

<Undefined>

21

39

6

66

Total:

986

1,392

21

2,399

Cultural diversity in the Memphis area is constantly changing. In our hospice program, I have been privileged and blessed to minister to multiple races. I have ministered to Asians, Africans, African Americans, Hispanics, and Caucasians, just to mention some. Our hospice care in Memphis meets individuals where they are regardless of race, religion or national origin. I know we have not reached it yet but I believe that we are ever so slowly moving toward the “Beloved Community” spoken of by Martin Luther King Jr. 

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Chaplain Eddie L. Conner, DMin, BCC is a chaplain with Methodist Hospice in Memphis, Tenn. All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice. Call 888.777.5959 for more information.

Living Wills and Advance Care Plans
last updated:
Wed, 11/24/2010 3:28 PM

The most common types of Advance Directives are Living Wills and Advance Care Plans. Completing one of these can be one of the best gifts you can give your family and friends. In my practice, I have frequently seen people struggle with making health care decisions for their loved ones. Those charged with making decisions for someone else feel obligated to follow the patients’ wishes, but many times they may not be certain what those wishes may be. Advance Directives can ease the burden by providing direction for those who may be our decision-makers.

A Living Will is a legal document in which a person expresses in advance his or her wishes concerning life support and care, and can designate who is to make decisions. The Living Will is usually written with the assistance of an attorney and can be long and difficult to read.

The Advance Care Plan (ACP) is becoming the most popular way to communicate wishes regarding medical treatment. The ACP allows you to choose a decision maker and to share your perception of acceptable and unacceptable quality of life. Treatment options that can be addressed in the ACP include tube feedings, IV therapy, use of surgery, blood transfusions, and CPR (Cardiopulmonary Resuscitation). There is also an open space on the form where more detailed instructions can be included. The ACP requires either two (2) witnesses or be notarized. An attorney is not required.

Once the Advance Directive is completed, a copy should be given to your physician and to the person designated as the decision-maker. Keep a copy in your personal files. Most importantly, tell your family and/or friends that you have completed an Advance Directive and what decisions you have made.

You can print a copy of an Advance Care Plan and other useful documents from the state of Tennessee website: http://health.state.tn.us/advancedirectives/index.htm

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Cathy Hupf, BSN, CHPN is the Clinical Director for Methodist Hospice in Memphis, Tenn. All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice. Call 888.777.5959 for more information.

Caregivers: Care for Yourselves Too
last updated:
Thu, 11/18/2010 3:00 PM

Methodist Hospice does not just care for the patient we care for the caregiver as well. As healthcare providers throughout the Methodist Hospitals in Memphis, this is true for all of us. The term "caregiver" refers to anyone who provides assistance to someone else who is in some degree, incapacitated and needs help. Learning how to help the caregiver will allow us to also help the patient as well in whatever are we provide care. One way we can help them is by encouraging them to care for themselves so they can better care for the patient and also what to do when they need to relieve the stress brought in their role of being caregiver.

Caregiver Survival Tips

  • Plan ahead by setting realistic goals for what you can do physically, emotionally, and financially. 
  • Accept that there are things you cannot control.
  • Learn about available resources that are available to help you in your role as a caregiver.
  • Develop Contingency plans.
  • Work to keep your care recipient as independent as possible in order to reduce your stress and maintain dignity for them. 
  • Participate in support network for caregivers and get respite care.
  • Take one day at a time.
  • Practice good communication skills.
  • Take care of your own medical needs.
  • Get some form of regular exercise.
  • Maintain healthy boundaries. Know when to say “No.”
  • Learn to ask for help.

Remember that almost everyone is a caregiver for a family member at some point, not just those with someone under hospice care. Plan ahead for those times when you will be stressed as a caregiver. It happens to everyone. If you have a plan of action, you will be better prepared to deal with the stress so that it does not interfere in your life or the care you are providing. No one will be helped if you become sick from too much stress.

Try these stress busters:

  • Take a bubble bath.
  • Engage in your favorite activity.
  • Read a Favorite Book.
  • Talk with a friend.
  • Take a walk or ride a bike.
  • Listen to soothing music.
  • Share favorite Memories.
  • Watch a favorite movie or go to the movies.
  • Write or record memories, poetry, thoughts.
  • Try artwork (calligraphy, painting, drawing).
  • Do puzzles (jigsaw, crosswords).
  • Allow for some quiet personal time.

Remember the little things, for one day you may look back and realize they were the big things.

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Helen Schlessinger is the Director of Clinical Services for Methodist Hospice. All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice. Call 888.777.5959 for more information.

A City United by Lorenzen Wright
last updated:
Wed, 9/15/2010 10:43 AM

The majority of my television watching occurs at work. Mind you; I don’t watch a lot of TV, so this means mostly that I catch snippets of shows while I’m making rounds, seeing patients. Nine out of ten rooms I enter have the TV on—sometimes blaring, sometimes silent, but always attendant. Even in rooms where patients are unconscious, the programming continues, falling on deafened ears and blinded eyes. It is as if patients, families, and the hospital staff can’t abide a silent space, as the contemplation of the uncertainty of mortality might slip in. So we fill the void with white noise—a requiem for the ill (and dying) composed by Oprah, Judge Judy, and the Kardashians.

On any given day, I’m bemused or annoyed, and occasionally entertained. Recently, I was transfixed.  In every room I entered, the television set was tuned to the same program. Black, white, Hispanic; young, old; marginally ill or approaching death—every patient and every family watched. Not the crowning of a new singing superstar; not the unraveling of yet another Gotham murder. Not even a new fishing season in the Bering Straight. Everyone was watching the funeral of a young black man, taken too early from us, by violent death.

I watched, too. I watched the seemingly endless line of well-wishers, mourners, and shell-shocked family members. I saw the ornate casket.  I tried to remember the flashing smile, the graceful athleticism, the seven-foot frame standing at the top of the key, hands raised almost to heaven to stop the entry pass in the zone defense. But all I could think about was how he must have looked at that last moment:  one hand on his cell phone, desperately calling for a help that would come a week too late, another outstretched toward the impossible task of stopping a hail of bullets.

Lorenzen Wright was one of us. Like Icarus, he slipped the bonds of earth for a sunward flight. We reveled in that trajectory, inspired by how talent and discipline could lift a man above poverty, violence, and want. When he fell, we fell too. United in disbelief and mourning, we all watched his eulogy. As in life, he united the city in his death.

One day, this city will be known for more than infant mortality, foreclosures, and capital crime. We will rally around urban renewal, biotech creativity, and spiritual rebirth. For now, though, we are united through the pride and exhilaration of sport. Rest well, our Icarus.  Men weren’t made to fly. But for a few fleeting moments, you made us all lift our eyes.

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Dr. Clay Jackson is the medical director for Methodist Hospice & Palliative Services team. For more information about Hospice & Palliative Care Services in Memphis, Tenn., call 901.516.1616 or 800.726.2559. All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice.

Hospice: It Takes a Village
last updated:
Thu, 7/15/2010 9:39 AM

‘It takes a village.’ Our former first lady made her pronouncement regarding the benefits of communal participation in the care of a child, but I often think it could be equally applied to the process of caring for a loved one who is terminally ill. Although many family members I meet are dedicated and committed to seeing their loved one through the process of a dignified death, the task is often a long one, fraught with questions, long nights at the hospital or home, and physical weariness from the mundane duties of caretaking—changing bed linens, bathing or turning the patient, and keeping the vigil to ensure that the patient is not in discomfort. 

Multiple studies have proven what we’ve known instinctively for years--no lone caregiver, however heroic, can succeed day-in and day-out with such challenges. Without adequate support, caregivers suffer increased risks of depression, physical illness, and spiritual distress. That’s when hospice can help in a variety of ways, supporting the caregiver and becoming part of the ‘village’ where good care happens as many give of their varied talents, rather than one or two individuals exhausting all they have and who they are, only to be frustrated. 

There are many Common Misconceptions about Hospice. When many people think of hospice, they picture the continuity nurse visiting the patient within the home, and envision the nurse carrying out doctors’ orders to ensure the patient’s comfort. That’s certainly a core component of the hospice effort, but there’s much more on offer. 

  • Social workers can help negotiate the myriad of papers to be filed for family leave, establishment of benefits, and assist with life review for the patient. 
  • Home health aides often become a functional part of the family, providing such physically intimate care as bathing or changing the patient.
  • Chaplains help the patient and/or family communicate about meaning, and negotiate the difficult but rewarding mental and spiritual work that impending death brings to a family. 
  • Volunteers may take the patient out for a drive, help with shopping, give a haircut, or read a story.

I hope that when it’s time for me to quit midnight rounds and busy schedules, and prepare for my own death, my family will take time to be with me, to ensure my comfort and to honor my life with their presence. But I pray they won’t try to go it alone. I’ll probably be a handful. Don’t go for the individual heroics, guys. Get the village—get hospice.

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Dr. Clay Jackson is the medical director for Methodist Hospice & Palliative Services team. For more information about Hospice & Palliative Care Services, call 901.516.1616 or 800.726.2559. All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice.

The Room I Die In
last updated:
Wed, 5/26/2010 4:55 PM

Many of you know that as the medical director of Methodist Hospice and Palliative Services, I help to supervise the care of over three thousand patients a year, most of whom die. Out of that experience, I’ve had a good bit of time and context in which to reflect on my own death, and how I’d like for it to be. Choosing the time and place of death is beyond our normal human capacity, but if I had my wishes, here are some thoughts about place. 

I want a fairly open room, with a line of sight to a clear window, with the blinds drawn. I’d prefer the window be at home, but a hospice residence would do. What would most definitely not do would to be in a hospital room, with flourescent lights, lots of tubes, and someone I don’t know awakening me every four hours to take my blood pressure, then tell me to get some rest (well, I was before you came in). 

I’d like a few books, and some friends and family. They can come and go as they please, as long as they laugh twice as much as they cry. I’d like big, blown-up pictures on the wall of my family (so I could still see them, as long as possible). I’m okay with having a television, but I wouldn’t want it on 24/7. I refuse to have my solemn moments polluted with the babblings of a talk-show guest, or a commercial to cut my credit card payments. And leave the dog outside, unless he’s quite old (too old to jump on the bed and hurt me). 

I don’t want a ventilator. I don’t want a nasogastric or gastrostomy tube, unless I’m throwing up regularly, and it can’t be controlled with medicines. I don’t want a Foley catheter, as long as I can urinate on my own (better the indignity of diapers than the pain of snagging the tube on the side of the bed as I roll over at night). And I definitely refuse to have those fake, plastic-wrapped-up-in-plastic hospital food service utensils. If you can’t feed me with real ceramic and metal, don’t feed me. When I’m perishing, I don’t want to be surrounded by styrofoam things that will outlive the rest of the planet.   

There are my rambling thoughts about place of death. Remember, though; I’ve seen a lot, so there might be a bit of weight in the words.

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Dr. Clay Jackson is the medical director for Methodist Hospice & Palliative Services team. For more information about Hospice & Palliative Care Services, call or . All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice.

Family Grief Camp Helps Kids Cope
last updated:
Thu, 5/13/2010 8:34 AM

Death is hard to deal with. It can be even harder for the young ones around us who do not yet understand all of life’s ups and downs.

Why did this person die? Why does it hurt so much? Could I have done something to help them? Is it ok to cry? Will I ever stop hurting? These are some questions that kids may ask themselves when dealing with the loss of a loved one. Fortunately, Methodist Hospice provides children and their families with grief guidance through the annual Camp BraveHearts Family Grief Camp in Memphis, Tenn. The camp, held at St. Columba Episcopal Center, is a safe place where feelings of grief can be expressed without having to worry about the reactions of others. Trained professionals and volunteers help kids and their families explore issues related to grief, walking beside them as they take the steps needed to heal. By sharing their grief with others, kids and adults begin to let go.

Who is Camp BraveHearts for?
Children ages 6-16 who have experienced the death of a family member or friend within the past two years. A complete program is also available for parents and caregivers of the children attending camp. This family grief camp is open to the community and free of charge for campers.

What will my child do at Camp BraveHearts?
At the family grief camp, your child will work through grief by participating in arts and crafts, creative learning, games, counseling and building friendships.

  • Laugh
  • Cry
  • Talk
  • Remember
  • Make friends
  • Learn to let it go

When is the camp?
June 10th-12th (Thursday & Friday 8:30 am - 4:00 pm and Saturday 8:30 - 12:30)

How do I sign my child up?
Please call 901.516.1744 and ask to speak with a family grief camp intake person.

More to Hospice & Palliative Care
last updated:
Fri, 4/16/2010 9:36 AM

As director of Methodist Hospice and Palliative Services, I supervise the medical care of about three to four thousand patients per year, most of whom die. It’s a unique job, in that the careers of most physicians are focused on healing, whereas mine involves a different portion of the illness spectrum. I see a good bit of healing, as well, but I’ve had to reframe how I view the concept—it may be coming to terms with illness, rather than ‘beating it’ to rejoin the flow of life as it was before the dreaded diagnosis.

I often field questions from patients and colleagues about what it is that drew me to this work, or how I keep from being drained by the emotional toll of dealing with death on a daily basis. In the first instance, I’ve felt called to palliative medicine for a long time. I ‘backed into’ medicine as a way of leveraging science to try an understand people. Having trained as a minister, working with the hospice and palliative care teams seemed a natural progression as I explored the ultimate questions of meaning, purpose and hope that humans encounter in our journey.

With respect to keeping my battery charged, that’s pretty easy. Although this work can be emotionally draining, it’s also incredibly rewarding. I get the chance to collect stories—sixty-year marriages, prodigals who returned (and those who didn’t), and all the backdrop of the lives lived by the ‘greatest generation.’ I also take time to get away from the work with the imminently terminal, whether it’s in my private family practice, with my church community, or with my family and friends. All in all, it makes for a fulfilling life—one I wouldn’t trade.

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Dr. Clay Jackson is the medical director for Methodist Alliance Hospice and Palliative Services Director. For more information about Hospice & Palliative Care Services, call 901.516.1616 or 800.726.2559. All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice.

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Methodist Healthcare is an integrated health care delivery system, dedicated to the art of healing through our faith-based commitment to minister to the whole person. 1211 Union Avenue, Memphis, Tennessee 38104 • (901) 516-7000

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