Family is biggest influencer of older adult housing and care preferences: study

Author: Lois A. Bowers, Senior Editor, McKnight’s Senior Living

Family support is the biggest influencer of housing and care preferences among older adults, according to a study published Wednesday (March 7, 2018) in the Journal of the American Geriatrics Society.

Often, the authors found, older adults changed their preferences based on the concerns of family members or a wish to avoid “being a burden” to others. This basis was especially true for preferences regarding the places where people wished to receive care — for example, at home or in a residential care setting, they said.

The researchers, all of whom were affiliated with the Cicely Saunders Institute of Palliative Care Policy and Rehabilitation at Kings College London, examined 57 previous studies about the preferences of older adults with advanced illness. They included research that investigated preferences for where people wanted to be cared for, the kinds of communication and decision-making they wanted and the quality of life they hoped to have over time.

Family involvement is key in care decisions

Although support from family was the most important influence on their care preferences, older adults usually formed their preferences based on several other factors, too, including their experiences related to previous illness and caring for others as well as having a serious illness, according to the study.


Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

The Other Side of the Conversation

Author: Christopher M. Thompson, MD, HMDC

This article originally was published in Winter 2017 NewsLine.

In this post, a physician connects his personal and professional caregiver roles.

As palliative care providers, we spend our careers talking about end-of-life care and helping families make difficult choices about life and death. Have you ever been on the other side of the conversation, answering questions and making decisions for your own loved ones? I have cared for thousands of patients at the end of life, but recently I’ve been on the other side of that conversation – twice.

My first conversation began with “Momma,” my wife’s 91-year-old paternal grandmother. Her decline started with a kidney stone, which then led to urinary tract infections and tremendous pain. Momma made the decision to have lithotripsy. During the procedure, she had respiratory distress and required intubation. Her heart was not strong enough to tolerate this “routine” procedure. She developed right-sided heart failure and pulmonary edema. Doctors were able to extubate her; however, she continued to have more respiratory distress. She was not doing well. They placed her on Bi-pap but she did not tolerate this. She was in the hospital, agitated, dyspneic, and did not want to be re-intubated.

So now what? Our family had to begin those difficult discussions. Do we continue to push aggressive care? Momma told the family she was tired and ready to die. It was hard for our family to acknowledge what this meant even knowing her wishes. Added to that, it was two weeks before Christmas and my family lived six hours away from Momma. We decided my wife and our three-year-old daughter would travel to Georgia while I stayed home to work. I wanted my wife to be there for the conversation in person and to see her grandmother, as I knew this might be her final days on earth. After discussing options, the family agreed to inpatient hospice care.

I was too involved with work and like many times before chose work over family. My wife was at Momma’s bedside for less than 24 hours when she called me telling me that Momma was asking for me, “The Doctor.” I pulled myself away from work in the middle of the day and headed to Georgia.

I was now being asked medical questions as well as “what about Christmas?”, “what do we tell the great-grandchildren?”, and “is this the right thing to do?” I did not have answers. I had memories and emotions for this woman I loved; I did not want to think, “Momma is dying.”

All the signs were there; it was her time to die. The family began the journey with Momma. I have worked in three different inpatient hospice facilities. It’s easier for me to study the staff, their workflow, their EMR, their census, their medical director – this is what I know. My wife reminded me that this time, I was there for Momma and our family. I was not “The Doctor” now; I was family.

Staff managed Momma’s symptoms quickly and she had two good days talking and interacting. We had made the right choice, albeit not an easy one. Long days and nights at the hospice home wear a family down. Hospice staff participate in these experiences daily. We think how hard it must be for the patients and families. When you are on the other side, you feel the sorrow and you learn a lot about the value of hospice care.

Momma died peacefully four days later. We returned home to North Carolina, only to receive a phone call that “Granny” was in the hospital. Granny was my wife’s 78-year-old maternal grandmother. She had Alzheimer’s disease, had fallen at home, and had developed altered mental status. She was not eating, she had a UTI, and a CT scan showed a small hemorrhage in the frontal lobe. Granny was agitated, not eating, and declining. So now what?

Just three weeks earlier we had lost Momma. Now our family was deciding on inpatient hospice for Granny.
My wife, daughter, and I packed the car and headed for Florida. I took the time from work, but I was still on call and was on the phone, giving orders the entire trip. Once again, it was easier for me to do my work as a hospice physician than confront what I had no control over. We were losing both our grandmothers within three weeks.

As we arrived in the middle of the night, we received a call letting us know Granny died. She had declined quickly. That was truly a blessing. After all the heartbreak and tears, we went to Granny’s house and celebrated her life. This is what she would have wanted.

Those two experiences remind me how hard end-of-life conversations are for families. We as palliative care providers need to remember it is different when there are memories and emotions involved. No matter how informed our families are, these decisions are not easy. And, it’s hard being on the other side. We are no longer medical professionals, we are family. All our medical training leaves our mind and we become an emotional basket case. We find it hard to think straight or make rational decisions. It’s difficult living with the decisions and through those choices.

I’m 40 years old, my parents are approaching retirement, and my grandparents are dying. I have friends who are struggling with acute and chronic illnesses. All of this has made me a better hospice and palliative care physician and I’m glad I can reflect on my training and life experiences to help my patients and families. I make the conversations personal and emotional. I have more empathy during family meetings. I think this adds a new dimension to the work I do, the work I’m proud to do.

These two experiences brought our family closer together and I’m grateful I could help in the decision-making process. My family saw firsthand how our jobs as hospice and palliative care providers are intensely emotional. We all need to realize the impact we have on the families we care for, how a well-trained hospice and palliative care staff can have an impact on a family.

During our trip home from Florida, my wife looked at me and asked, “How do you do this day after day? I am proud of you and now understand your job even more and how rewarding it must be.”


Christopher M. Thompson, MD, HMDC, assisted in developing the palliative medicine programs at two hospitals prior to joining Transitions LifeCare as Medical Director for Transitions Kids, Transitions LifeCare’s pediatric hospice program. Dr. Thompson is board certified in Family Medicine. After completing his Fellowship, Dr. Thompson became board certified in Hospice and Palliative Medicine with the added qualification of Hospice Medical Director Certification.

Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

March Celebrates Social Work

Professionals who care. Helping improve people’s lives is at the heart of social work

In honor of National Social Work Month in March, below are facts about social workers from the National Association of Social Workers:

About Social Workers

Social workers seek to improve the lives of others.

Social work is a profession for those with a strong desire to help improve people’s lives. Social workers assist people by helping them cope with issues in their everyday lives, deal with their relationships, and solve personal and family problems.

According to the Bureau of Labor Statistics, there were almost 650,000 social workers in the United States in 2014. With an expected growth in jobs of 12 percent by 2024, social work is one of the fastest growing professions in the United States.

Who are social workers?

Social work is a profession for those with a strong desire to help improve people’s lives. Social workers assist people by helping them cope with issues in their everyday lives, deal with their relationships, and solve personal and family problems.

Some social workers help clients who face a disability or a life-threatening disease or a social problem, such as inadequate housing, unemployment, or substance abuse. Social workers also assist families that have serious domestic conflicts, sometimes involving child or spousal abuse.

Some social workers conduct research, advocate for improved services, engage in systems design or are involved in planning or policy development. Many social workers specialize in serving a particular population or working in a specific setting.

What do social workers do?

Who employs social workers?

Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

The Road to Healing Takes Time

Originally Published in Pocketful of Chelles Blog

By Michelle Kohlhof / February 19, 2018

Last week was tough. The world witnessed a tragedy that has become all too familiar, another school shooting. A day that was supposed to be about love and peace, turned dark and cold for so many. On the day after, when I dropped my little dude, Jason, off at his school, he dashed into his classroom shoving his backpack into his cubby, and my heart just broke into pieces for the families of the victims in Parkland, FL.

How could one person take seventeen beautiful souls, most of them being children? We ask ourselves why did this have to happen, we say prayers for the families who now have to learn how to move on without their child, and we call on congress for change, yet again. It’s hard to imagine how you go on after such a devastating tragedy. Simple things like going back to work, seem like mountains to climb. While we look for answers, one thing is for sure; time doesn’t stand still for the ones who need it to the most. Instead, you learn how to compromise with time, and make the most of what he gives you. We find ourselves pleading for time to just stand still, to have just five more minutes with the ones we love. But you see, time doesn’t wait for no one, and this is why there is more to life than the nine-to-five grind.

We find our humanity—our will to live and our ability to love—in our connections to one another.― Sheryl Sandberg, Option B: Facing Adversity, Building Resilience, and Finding Joy

As I mentioned at the beginning of this post, last week was tough. Sometimes you don’t get a “do over”. What you do get is a chance to put things in perspective, and not take the life you’ve been blessed with for granted. So on a whim, my husband, Travis, says to me, “you know, we can take a road trip, South, and hang out with your parents”. So, we took advantage of the long weekend (President’s Day), loaded up the truck, and off we went! And as you can imagine with a nine hour drive, I had time to reflect, time to think, and time to write…

All this time got me thinking, how can employers and HR support employees through grief and loss? Are bereavement leave policies enough? I started to research this and one article from SHRM stood out. Click here to read more. In a time of unspeakable loss, what are some big things that HR can do to support their employees and organization?

1) It’s more than policy – It’s about having a plan:

To my fellow HR professionals, let’s work together with management and executives to create a plan to support employees in their time of need. We should do more than just contact the employee and share information about our organization’s bereavement policy. One great example is what Ernst & Young did last year. They provided dedicated HR support to the family of one of their employees who was critically hurt in the Las Vegas mass shooting tragedy. Thankfully, this EY employee survived, and her story showed us that having a plan can lessen the burden on the employee and her family. It shows us that an employer can really champion for their employees when they need us to the most.

2) It’s time to lead the way:

What can we do to prepare fellow employees for a grieving employee’s return to work?  There are a lot of emotions that the employee will still be dealing with upon his return. There will be lack of focus, and difficulty with concentrating, even on the simplest of tasks. We as HR professionals have to partner with management on creating a smooth path for the grieving employee as they return to the workplace. We need to lead the way in helping the grieving employee navigate back into the environment. It is vital for his success.

3) Give some space – It takes time:

I think the single most important thing we can do to help a grieving employee return to work is to give space. What if we created a private place where the grieving employee can go to take a break when she is feeling overwhelmed with emotions? These emotions will come in waves and it is important to give space.

Some “Chelles” find their way to shore, while some live in the sea for eternity. ― Michelle Kohlhof

My closing thought, take the time to set eyes on the ones you love, and are blessed to still have in your life. It’s another chance to fill your pocket full of “Chelles”.


Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

Tags :

Study Encourages Having a Bucket List Talk

Talking to Doctors About Your Bucket List Could Help Advance Care Planning

February 8, 2018 by Stanford University Medical Center

For physicians, asking patients about their bucket lists, or whether they have one, can encourage discussion about making their medical care fit their life plans, according to a study by researchers at the Stanford University School of Medicine.

A bucket list is a list of things you’d like to do before you die, like visiting Paris or running a marathon. It’s a chance to think about the future and put lifelong dreams or long-term goals down on a piece of paper.

For doctors, knowing their patients‘ bucket lists is a great way to provide personalized care and get them to adopt healthy behaviors, said VJ Periyakoil, MD, clinical associate professor of medicine, who said she that she routinely asks her patients if they have a bucket list.

“Telling a patient not to eat sugar because it’s bad for them doesn’t work nearly as well as saying, for example, if you are careful now, you will be able to splurge on a slice of wedding cake in a few months when your son gets married,” Periyakoil said.

The study will be published Feb. 8 in the Journal of Palliative Medicine. Periyakoil, an expert in geriatrics and palliative care, is lead author.

The researchers, who surveyed 3,056 participants across the United States, found that by far the majority of respondents—91 percent—had made a bucket list. Survey results also showed that respondents who reported that faith and spirituality were important to them were more likely to have made a bucket list. The older the respondents were, the more likely they were to have a bucket list, and, not surprisingly, those younger than 26 tended to include more “crazy things” on their lists, such as skydiving.

Bucket list categories

Six general themes tended to describe the items on respondents’ bucket lists: 79 percent included travel; 78 percent included accomplishing a personal goal, such as running a marathon; 51 percent included achieving a life milestone, such as a 50th wedding anniversary; 16.7 percent included spending quality time with friends and family; 24 percent included achieving financial stability; and 15 percent included a daring activity.

“When you just Google the term ‘bucket list,’ it’s huge how much interest there is in this,” Periyakoil said. “It provides a very nice framework for thinking about your life goals, health and your mortality.”

Past research has found that when doctors talk to patients—especially those with chronic or terminal illnesses—about the patients’ goals for future care, it can be a vital part of the advance-care planning process. But it’s often awkward to have these conversations, particularly when they are about the end of life, the study said.

“If a patient wants to attend a beloved grandchild’s wedding or travel to a favored destination, treatments that could potentially prevent her from doing so should not be instituted without ensuring her understanding of the life impact of such treatments,” the study said.

Discussing a patient’s bucket list is just a good way to start these conversations, Periyakoil said. Most people are far more open to talking about their life’s goals in this context before filling out an advance directive, a written statement of a person’s wishes regarding medical treatment at the end of life, Periyakoil said.

‘Find out what actually motivates them’

“It’s important for physicians to talk to patients and find out what actually motivates them,” she said. She encourages both doctors and patients to bring up the topic of a bucket list. By discussing how a treatment or surgery might affect the patient’s life, and then discussing what the patient’s goals are, the best possible care plan can be laid out, she said.

“I had a patient with gall bladder cancer,” Periyakoil said. “He was really stressed because he wanted to take his family to Hawaii but had treatment scheduled. He didn’t know he could postpone his treatment by two weeks. When doctors make recommendations, patients often take it as gospel.”

After an informed discussion about his options and the side effects of the cancer treatments, he and his physician decided to postpone the treatment. He made the trip to Hawaii with his family, then returned to start cancer treatments, the study said.

“Patients don’t see the relevance of an advance directive,” said Periyakoil. “They do see the relevance of a bucket list as a way to help them plan ahead for what matters most in their lives.”

Explore further: Most physicians would forgo aggressive treatment for themselves at the end of life

More information: Vyjeyanthi S. Periyakoil et al, Common Items on a Bucket List, Journal of Palliative Medicine (2018). DOI: 10.1089/jpm.2017.0512

Journal reference: Journal of Palliative Medicine


Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

From Oil Executive to Hospice Volunteer

Changing Roles

At the end of 2016 Judy Calabria faced a life event that most of us encounter several times. She was leaving a job — the only job she’d ever had. Judy joined Shell Oil Company as a programmer in 1984. Her work took her to places like The Hague and Kuala Lupur occasionally, but Houston remained home base. At the time of her retirement, Judy was managing people and processes related to major IT outages, disaster recovery and crisis response. Even though Shell had been her only employer, Judy wasn’t leaving all of her work routine behind. Rather, she decided to engage more fully into her role as a Houston Hospice Volunteer — a position that was already vying with the oil business to define her.

Judy began volunteering at Houston Hospice in February 2009, and she was named Houston Hospice Volunteer of the Year for 2017. Volunteer Coordinator, Elisa Covarrubias says that Judy assists with anything that needs to be done. “She delivers meals at Thanksgiving and gifts and cards to our patient families for Christmas. Every Friday she visits patients in the inpatient care unit. She has even made numerous emergency visits to be with patients who were in distress at the request of our nursing staff. Judy spends hours visiting and comforting as many patients as necessary. Truly, she does anything we ask. She visits patients, assembles and delivers Angel Bags of groceries and hygiene items for our families in need, trains new volunteers, works in the office and stocks and cleans the snack bar.”

VolunteerismJudy Calabria

Judy credits Shell with encouraging her volunteerism. “When I got to Shell in 1984 they had a really robust volunteer program for their employees. For many years I got involved in Veteran’s Day parties at the VA Hospital, Martin Luther King, Jr. Community Center Easter egg hunts, chaperoning kids to the zoo, holiday projects, fixing up homes, and many other volunteer projects that Shell offered to their employees. I liked being able to give back and help others. In the late 1990s I got away from volunteering for 7 or 8 years because I was traveling internationally. When my father passed away in 2008, I started thinking about things in my life that I missed and that made me happy. Volunteering was one of them. Both of my parents were under hospice care up in Ohio, and I really liked how hospice helped my family, so I asked the Ohio hospice for advice on how to select a hospice in Houston.”

The staff at nonprofit Valley Hospice in Ohio suggested Judy look for a nonprofit hospice in Houston. They also told her to look for specific accreditation. Houston Hospice met the criteria, so Judy signed up and applied the skills she’d learned at Shell to help hospice patients.

Applying Executive Skills to Hospice

“At Shell, I learned the importance of truly listening to what is being said and not assuming too much too fast. At Houston Hospice, these qualities are just as important. Communications is key when volunteering at hospice; knowing when to say something to a family member, patient, or a hospice employee, and knowing what to say during difficult or emotional interactions. It’s even knowing when to listen versus talk.”

Judy believes the tight deadlines at Shell taught her how to prioritize. “I prided myself on being able to juggle my work and the work of my team based on priorities. My motto when volunteering at Houston Hospice is that I’ll do anything the Volunteer Coordinators ask me to do. That’s why I have been so lucky to be involved in so many different activities at Houston Hospice. I look forward to continuing to help Houston Hospice in any capacity they need. I also appreciate all the Houston Hospice volunteers who do a smaller subset of hospice activities. They are just as vital to making Houston Hospice such a special place.”

Judy’s global experiences taught her about diversity and respecting the value that everyone brings to the table. “That has helped me a lot in working at Hospice, whether I’m talking to patients, family members, friends, or hospice employees. I’m always amazed at our similarities and our differences, and how there always seems to be a way to bond us together, even during difficult times.”

Opportunities to Smile

People often ask Judy why she volunteers for a hospice because they assume it would be depressing. Judy tells them that there are some conversations that are sad, but there are opportunities to smile and help people in ways that she would not have imagined. “I don’t sing, but one day I was asked to hum Christmas carols to a patient. I was amazed at the calming effect my humming had on the patient. Once I sat with a gentleman who was alert but rarely spoke or responded to anyone. I was telling him a little about me and how lucky I was to have been able to see and do things I never imagined. He actually spoke to me and even held my hand.”

Volunteers are an integral part of nonprofit Houston Hospice’s team. To learn more about volunteering at Houston Hospice, call 713-467-7423 or visit

—Karla Goolsby, Houston Hospice Communications Specialist

Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

They’ve Made Houston Better: Spirit Award Recipients Sally and Bob Thomas

We all have that friend. The person who has seemingly endless energy and creativity. They accomplish more by noon than most of us do all day. This describes Sally and Bob Thomas — and when you Sally and Bob Thomasharness that kind of energy for good, you make a difference. They have had a positive impact on Houston and we are delighted they will receive the 2017 Laura Lee Blanton Community Spirit Award on October 12, 2017.

Sally Thomas

Sally Thomas was born in Tulsa, Oklahoma and earned a BS in Geology from the University of Oklahoma. She worked as a geologist with Humble Oil Company when she met Bob Thomas. After marriage and the birth of their four daughters, Sally has dedicated her life to her family and community. She organized and taught Red Cross and Girl Scout swimming programs for over 32 years; taking her synchronized swimming team all the way to the Junior Olympics in Nebraska. Sally is currently an Advisory Trustee of the Retina Research Foundation, and she has served as a member of the Interfaith AIDS Respite Team at St. Cecilia Catholic Church where she is also a Lector and Eucharistic Minister.

Sally has shared her love for geology as a docent at the Houston Museum of Natural Science Gem and Mineral Hall. She was President of Memorial Women’s Club, and Houston Hospice previously honored Sally with the Betty Evans Award for Service as both a patient volunteer and board president. In 2012, The University of Oklahoma recognized her as a Distinguished Alumna of the Mewbourne College of Earth and Energy.

Bob Thomas

Bob Thomas was born in Maramec, Oklahoma and graduated from the University of Oklahoma with a BS in Geological Engineering. After graduation, he served in the United States Air Force as a pilot, including a combat tour during the Korean War. Bob returned to the University of Oklahoma for graduate studies and joined Tenneco’s domestic exploration and production operations as a junior engineer in 1956. His distinguished career culminated in his election as Chairman and Chief Executive Officer in 1990. Bob retired in 1994.

Like Sally, Bob has dedicated his life to community service. He served on the Houston Hospice Board of Directors from 2002-2012 and co-chaired two major fundraising campaigns. Bob has served as Trustee of the Houston Museum of Natural Science and as a member of the Board of Governors for Houston Forum.

Bob is a lifetime member and past Chairman of the Board of Stewards of Chapelwood United Methodist Church. He served on the church’s Building Committee and supervised the construction of a $25 million expansion of church facilities. Bob is currently serving as a Life Member of the Association Board of Directors for the YMCA of Greater Houston. He was elected to the Board in 1988 with past service including terms as Vice Chairman and Chairman of the Board. Bob’s service to the YMCA has included leading major fundraising efforts in 1996, 2004 and 2005, helping The YMCA of Greater Houston become the third largest YMCA in the U.S.

The 19th Annual Community Spirit Award Dinner

“Sally and Bob have made a profound, positive impact on Houston Hospice and our entire community,” says Cynthia Nordt, Vice President of Development and External Affairs for Houston Hospice. “They personify the essence of the Laura Lee Blanton Community Spirit Award. They have made Houston a better place.”

The public is invited to celebrate Sally and Bob Thomas as they are recognized for their unwavering service at the 19th Annual Laura Lee Blanton Community Spirit Award Dinner on Thursday, October 12, 2017 at River Oaks Country Club at 1600 River Oaks Blvd., Houston, Texas. Dinner tickets and table sponsorships will help fund nonprofit hospice care in Houston and 10 surrounding counties. Visit or contact Cynthia Nordt at 713-677-7123 for tickets and table sponsorships.

—Karla Goolsby, Houston Hospice Communications Specialist

Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter