Learn how small choirs around the country are bringing beauty and solace to the bedsides of dying patients.
In this episode I share an interview with Kate Munger and Marti Mariette who have helped to spread the “threshold choir” movement across the U.S. and the world. You’ll hear clips of their beautiful singing! Learn more at www.thresholdchoir.org.
I’m still traveling in Italy and you can keep track of my journey by following me on Instagram (kwyattmd) or Facebook (Karen Wyatt MD). I’m supposed to be getting some research and writing done for my new book on grief … but we’ll see how it goes. I might be just eating my way through the country!
You can support this podcast and the EOLU Interview Series with a small donation of $1 or $2 per month! As a thank-you gift you’ll receive a the Top 10 Interviews from EOLU, a recorded Q&A session each month (where I’ll be answering YOUR questions), and a chance to have me promote your work on this podcast! Learn more at Patreon.com/eolu.
Today I welcome my special guests Kate Munger, the founder of the Threshold Choir movement, and Marti Mariette, who is the director of the Santa Cruz Threshold Choir. They will share with us:
How and why Kate started the first Threshold Choir
The benefits of bedside singing for patients and their families
The benefits experienced by the singers themselves
How to start or join a Threshold Choir in your area
It’s a brand new year! Let’s look ahead and see what’s possible in 2017!
In today’s episode of the podcast we’ll look ahead at the coming year, study the trends in the death-positive movement and discover where it might be possible to create new volunteer and career opportunities for ourselves and our communities in 2017.
First I’ll share my own goals for the coming year, which include revising, editing and publishing the two books I wrote in 2016. I also plan to release two new training courses this spring and have lined up a fascinating group of speakers for the End-of-Life University Interview Series. To stay up-to-date on all the latest interviews and offering from EOLU, be sure to to sign up for the mailing list here.
Thank you from the bottom of my heart to all the contributors to this podcast on Patreon.com/eolu. Your support helps pay for the expenses of creating this podcast and the EOLU Interview Series. If you’d like to become a patron just go to Patreon.com/eoluand sign up to contribute just $1 or $2 per month.
Here are some of the Trends I’ll be watching in 2017:
Increasing number of Palliative Care Programs in hospitals across the country. Though many of the current programs are either understaffed or underfunded, these problems are likely to be corrected in the near future. To meet current standards, each palliative care team must have a chaplain and a social worker so if you have training in either of those fields you might find employment opportunities in a palliative care program in your community.
Need for creative solutions for hospice care. Because for-profit hospices are taking over many of the smaller non-profit hospices there is a risk that uninsured patients or those with needs for expensive care might be turned away. There is a need for social-model hospices (see Episode 23) and possibly for community-based non-profit, non-Medicare-certified organizations that can help bridge gaps in services for hospice patients. Here are some recommended training programs for becoming an end-of-life doula or midwife:
Need for more caregivers. As baby boomers age and approach the end-of-life the caregiver shortage will become a much greater issue. Opportunities will exist to create caregiver training and support services in communities and even to start businesses that employ caregivers.
Community outreach can help support the changes that are slowly occurring in the healthcare system. One of the best ways to encourage change in healthcare is to empower consumers to demand changes from their physicians. This will require outreach and education in the community. Here are some ideas for outreach and links to learn more from previous podcasts:
Create an “Inreach” for members of the EOL community by starting a discussion group, networking event or collaboration opportunity for those who are already working in this arena.
Bring volunteer movements to your community. Consider starting a group of volunteer caregivers who can provide respite care for family caregivers or start your own chapter of Threshold Choir, Twilight Brigade, or No One Dies Alone.
Provide education for your community either as a voluntary act of service or as a paid instructor. Here are some possible ideas:
Assist people to correctly complete their advance directives.
Teach a community class on death and dying.
Teach about green burial, promote a natural burial ground in your community, help people access green burial supplies
I hope these ideas inspire your own personal goals for 2017! Stay connected with me and keep tuning in to the podcast. Let me know your own inspirations and plans for the New Year by adding your comments.
In this final episode of 2016 Dr. Wyatt thanks all of the patrons who have generously made contributions on Patreon.com/eolu this year! Thank you for offering your support for this podcast and the End-of-Life University interview series!
In this look back at 2016 we talk about the following positive events in the end-of-life arena:
In January JAMA dedicated a special issue to “Death, Dying and the End-of-Life”, which represents a positive breakthrough in awareness of EOL issues by the medical profession
Medical schools began adopting new training programs for students in pain management, palliative care, and communication skills around advance care planning. There is a college-level program that pairs pre-med students with hospice patients
Nursing homes and long-term care facilities are bringing in children and college students to interact with patients
Dementia rates in the US have dropped in the past year
Pilot studies are underway involving providing education and training to family caregivers and providing a small stipend to caregivers
A demonstration project is underway to study the benefits of providing curative care simultaneously with hospice care
Studies showed that palliative care lowers healthcare costs along with providing increased quality of life, improved pain management and fewer hospital days
Harvard study of adult development showed that relationships are a key to longevity
California and Colorado both passed assisted dying laws in 2016
The nation’s first conference on VSED was held this year
Conversation Sabbath took place for the first time in November, bringing discussions about death and dying into places of worship
Dying to Know Day was held in the US, inspired by the movement in Australia
Miss Norma, a 90-year old woman who refused treatment for her cancer, spent most of the year traveling around the country in an RV with her son and daughter-in-law, fully enjoying the last days of her life
Thank you for tuning in to the EOLU Podcast during 2016! I hope this has been a positive and productive year for you. May 2017 be filled with growth, surprises, peace and joy! See you next year and until then …
In this episode Dr. Wyatt thanks her latest supporter on Patreon.com/eolu, Suzanne O’Brien RN, founder of Doulagivers. If you would like to help support this podcast and End-of-Life University Interview Series for the small contribution of $1 or $2 per month, go to Patreon.com/eolu and sign up to become a supporter!
In other personal news, Dr. Wyatt just reached the 50,000 word goal on her novel-writing challenge for the month of November! Stay tuned for more information on Starry Night, a novel about living and dying!
Go to DeathExpo.com if you are interested in getting the downloadable filed from Death Expo 2016. Tune in to Episode 65 to hear the highlights and take-aways from this fantastic educational event!
Next Dr. Wyatt shares the latest news and information about end-of-life issues that caught her eye during the month of November:
Survey of seniors in the U.S. shows that 27% have done absolutely no planning or preparing for the end of life. Those least likely to have prepared correlate with the following characteristics: age between 65-74, black or Hispanic, low-income, low education level, and diagnosis of Alzheimers.
Canadian study shows that for seniors who have completed Advance Directives, Values and Choices do not always align, showing a lack of guidance for choosing end-of-plans and confusion about basing choices on underlying values
a paper cited in the Journal of Pain and Symptom Management calls for improved consistency in honoring the EOL choices of patients in nursing homes and hospitals
Go Wish Card Game found helpful for patients completing their advance directives; helps them identify their values and priorities
Home-based Palliative Care shown to lower healthcare expenses in last year and 3 months of life, decrease hospital admissions and increase hospice utilizations. 87% of patients who receive palliative care at home are able to die at home, compared to only 24% of all Medicare patients who die at home
Review of 43 palliative care clinical studies shows that palliative care improves quality of life but does not extend life
UC Santa Cruz has started a program to pair pre-med students with hospice patients
Study shows doctors are reluctant to discontinue routine medications that are no longer indicated for their patients at the end of life due to lack of awareness, low priority, and fear of causing patient to feel abandoned
Colorado became 6th state in the U.S. to approved medically aided dying during the November election
AARP and the National Association of Area Agencies on Aging have a launched a campaign to identify seniors suffering with loneliness and isolation in order to connect them with community resources; 43% of seniors report loneliness which leads to medical consequences
new movie Collateral Beauty deals with grief and death and will be released on Dec. 16th
Canadian singer-songwriter Leonard Cohen died on November 7th at the age of 82
In this episode Dr. Karen Wyatt shares her favorite “take-aways” from the 12 presentations of the recent Death Expo event. If you missed Death Expo you can still purchase the recordings from the event for just $36 (which is a great price for 12 hours of education.) Go to this link to learn more.The speakers she highlights are:
Andrew George – LA photographer and creator of the “Right, before I die” photo series
Dr. Wyatt thanks her newest Patreon.com supporter Tracy Zagata. You can become a supporter as well by going to Patreon.com/eolu and signing up!
Sign up for Death Expo which will take place Nov. 10-13, and hear 12 speakers on EOL issues. Go to DeathExpo.com to register free to tune in to these excellent presentations.
This episode is taking place on Halloween and the Day of the Dead. Dr. Wyatt includes the following updates:
CMS report 52% increase in Medicare spending on hospice between 2007 and 2015 due to 38% increase in the number of patients receiving hospice care, primarily patients with dementia
the DEA is mandating 34% decrease in opioid production due to dramatic increase in opioid-related deaths since 1999 – rate has quadrupled during that time frame
JAMA Oncology reports that the cost of secobarbital, the drug most frequently prescribed in assisted dying cases, has increased by $25oo; there is no explanation except that drug companies can get away with it
California is the first state to require that palliative care teams have a chaplain for those patients who want to receive spiritual care
Debra Beaulieu writes in HealthLeaders Media that all clinicians should know the following about palliative care: 1) that it’s not just for dying patients 2) that it is often underutilized and 3) all clinicians should have basic palliative care skills
Study in J. Palliative Med showed that home-based palliative care (as opposed to hospital-based care) meets more of patients’ needs in the last 3 months of life and costs $12,000 less per patient
Controversial “doll therapy” for dementia patients
Study shows that 11% of female caregivers over the age of 50 have to leave their employment to fulfill caregiver duties, costing $300,000 in lost wages, benefits, and Social Security over time
Census data reveals that currently 25% of seniors are considered “Elder Orphans,” meaning that they have no children or close family to care for them; these numbers will only grow as Baby Boomers age, reinforcing the need for more caregivers
Medicare Care Choice Pilot Program is currently underway; patients can receive home-hospice care while continuing curative treatments if they have a diagnosis of cancer, COPD, CHF, or HIV; there are 140 participating hospices in the program
Survey shows that 1/2 of MS patients would consider medically assisted dying in the case of unbearable pain, being a financial burden to others, or if unable to enjoy what makes life worth living
Study reveals the 69% of MOLST or POLST forms have incomplete information and 14% have conflicting choices, making them nearly impossible for care providers to follow
the nation’s first conference on VSED was held in October at the Seattle U. School of Law and was featured in an article in the NY Times. Phyllis Shacter was a speaker – you can hear her EOLU interview in episode 25
Conversation Sabbath will take place November 11-20 with >30 congregations from various faiths participating; the focus will be on EOL conversations and theconversationproject.org will provide tools and resources for the event
Andrew Henderson, 28 year old performance artist who is terminally ill has created an art performance called Taking it to the Grave and will tattoo the secrets of his audience on his body before he dies
Miss Norma, the 90 year old woman who chose to go on a cross-country RV tour with her son and daughter-in-law rather than undergo treatment for cancer, has died
Have a safe and meaningful Day of the Dead! Tune in every Monday for a new episode and support EOLU at Patreon.com/eolu. Until next week remember to:
Marggie Hatala – author and teacher of a writing class related to end of life; her books are “Sally: A Memoir” and the forthcoming “Life as Prayer”; learn more at www.marggiehatala.com
Next she begins the Update for September by talking about the new documentary film currently streaming on Neflix: Extremis, which won 1st place at the Tribeca Film Festival. Please see this film which takes place in the ICU at Highland Hospital in Oakland and features Dr. Jessica Nutik Zitter. This is a must-see film that brilliantly depicts the conundrum that exists at the end of life when painful decisions must be made. By showing the real-life conversations that take place in the ICU between staff, family members and patients, a case is made for everyone to complete their advance directives and prepare their loved ones to honor their wishes at the end of life. But the painful process of decision-making becomes apparent as each individual struggles with the unknown and the unknowable in these dire situations.
The other topics covered this month include:
BMJ Online report that patients who receive hospice care for the last 6 months of life have better pain control, fewer hospital days, and are less likely to die in the hospital or ICU.
Researchers at John Hopkins found that their palliative care program led to savings of ~ $19 million over 5 years in addition to improved quality of care and patient satisfaction.
Study originally published in Health Affairs and reported on Reuters online showed gaps in palliative care in the US. Read the article.
“What it feels like to die,” an article in The Atlantic discusses the active dying process from the patient’s perspective. Read the article.
Friends and Family Letter Project by Dr. VJ Periyakoil at Stanford includes 7 prompts for letter writers to leave messages for their loved ones. Read the article.
“7 Songs for a Long Life” documentary from Scotland that depicts how terminally ill patients use singing as therapy. Read the article.
The Friendly Atheist Julie Stahl reminds us not to impose our own religious or spiritual beliefs on those who are grieving and may not share your perspective. Read her blog.
Thanks for tuning in to the podcast! I hope you enjoy this information. If you feel inspired to offer a little support go to Patreon.com/eolu to join the community!