End-of-Life, Healthcare

End of Life Care in Canada

I came across a wonderful article in CIM, volume 36, no. 3, June 2013 by Deborah Cook, MD and Graeme Rooker, MD, Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University in Ontario, Canada.

In Ottawa on September 20, 2012, the Canadian Academy of Health Sciences held a forum entitled, ‘End of Life Care: the Last 100 Days’ which included presentations, discussions, research, current controversies, and future directions. I am sorry to have missed this.

Canada has used/focused energy and finances to improve the birth experience, but has yet to match the effort when it comes to death, dying, and end of life. How do we change this? How do we improve this?

Open lines of communication, dialogue, discussions, training of professionals no matter the discipline, are needed. This includes, nurses, physicians, social workers, occupational therapists, physical therapists, other medical staff, home care workers, companions, healthcare administrators, psychologists, psychiatrists, etc.

No matter where one works, the emotional ‘toll’ can be high. Staff needs to offer assistance and support to the dying patient and family should there be any, but they also need the skills, the training, and the support in the work environment to be able to do this.

Going a step further, when does the medical staff and healthcare staff make the change from ‘continue to focus on life-saving treatments and plans’ to ‘make a referral or change in the plan to palliative or hospice?

If the change to Palliative or Hospice; is there space in-patient or can the patient be best served and assisted in the community where they are at home with services? Is there family to assist? Community resources or private?

I want to open a dialogue, encourage discussions, witness training opportunities for staff and witness a supportive work environment which includes regular supervision and debriefing.

A movement or idea begins with one…..

By Victoria Brewster, MSW

Social Work/Helping Profession/Mental Health

My Superpower? Seeing Inside People

By Kelly Mitchell – Guest Blogger

If you asked me what one of my strengths is, perhaps I’d choose to tell you that I see things in other people that they themselves either don’t see at all, or they are surprised because so few people see it. Many others have this skill and ability, and it’s probably why we gravitate to the helping professions; jobs and careers where much of our time is spent helping other people.

If you think I’m boasting, I’m not. What I’m doing is stating an ability that I have, which is one of my strengths. If put to the test or asked for an example, I could do it in a relatively short period of time, even when meeting someone just once and within a few moments. It’s my superpower. You yourself undoubtedly have skills and abilities that have become well-developed in your job over time, so it stands to reason that I’ve developed job-specific skills too, and this is just one of them.

I’ll give you two examples that just happened yesterday. In one situation I was speaking with a group of seven people about a number of options they might want to pursue in order to become financially independent. It was when addressing the topic of self-employment that I looked right at one man and said, “You for example may have not only one idea, but three or four businesses in mind, and your problem is you can’t focus on one and so you’ve never got started.” At that point I could have stuck an Italian sausage in his mouth as it opened in wonder that I’d identified his key stumbling block to even getting going. “Wow! How did you know that? It’s been my problem for years, but nobody knows that!”

In the second case, a woman in the same group was sitting with her legs entwined like a pretzel, her shoulders hunched, way too much foundation on her 18-year-old face, and her wide eyes and downcast head screamed that she was shy, introverted, and probably hiding acne; as a result feeling insecure. In talking with her 1:1 a short time later, I ventured that as a teenager myself, I had once had an acne problem which had affected my self-confidence, but over time it disappeared and I gained the confidence to look in the mirror and like what I see. “You and I both know that there’s a beautiful face emerging and that acne is only temporary.” I said. She shifted in an instant to a talkative young woman who had great eye contact and she said, “Really? Do you really believe that? I mean some people say that but then I think they have to. Do you really believe that?” And I do.

Now sometimes this ‘super power’ is one I keep to myself or reveal gently rather than with fanfare. There are times I’ll look at a person and tell them that I suspect they’ve been told over a number of years by someone who should have treated them the best that in fact they are worthless and will never amount to anything. And in those moments, sometimes tears start, heads drop, or heads raise and they’ll say, “Is it that obvious?” or, “How did you know that? My dad always told me I’m a loser.” They generally don’t believe me when I then go on to name several characteristics and personality traits they have that I admire and in which they might like to acknowledge.

Now on the sad side, I’ve sat listening to people tell me how successful they plan to be and drone on about their long-term employment goal or entrepreneur idea, and I’ve seen enough in a few moments to tell me that it is never going to happen. And I mean ever. While I’m not one to intentionally put an end to someone’s life-long dreams, there is often a gulf between what a person is really capable of and what they think they are capable of, even with support and advice. Sometimes it’s best to say nothing, and sometimes it’s best to tell it like I see it and then help to reconstruct a realistic plan in which someone can move forward.

And please don’t think I believe I’ve got all the answers. I’m not playing God here and telling people what they should be when they grow up or do to live their lives as I think they should. It’s only about helping them, and sometimes helping people means being honest and direct. Having an ability to anticipate how someone will likely react and delivering things they probably need to hear but don’t want to hear can actually be what they’ll thank you for later. It’s how the message is relayed more than the message itself at times; with compassion and sensitivity.

So if you are in the helping profession, do you have this super power too? I bet the more you deal with people, the better you have become at reading them; seeing the good and the potential when they can’t see it in themselves. I’m guessing you have provided a word or two of encouragement when they were so low they didn’t think anyone could like them, believe in them, and see them as valuable.

Well done Superhero’s.

*The original post can be found at: http://myjobadvice.wordpress.com/2014/07/31/my-superpower-seeing-inside-people/

End-of-Life, Social Work/Helping Profession/Mental Health

End-of-Life Care

This is an article worth reading in The Windsor Star on End-of-Life Care. This area is only going to continue to grow as more and more enter the 65+demographic. What is holding health professionals and helping professionals back from bringing this issue to the forefront?

According to Dr. Scott Wooder, President of the Ontario Medical Association, “The most important stat to me is only 20 per cent of Canadians have had a meaningful discussion with their family or substitute decision maker about what care they want to have at the end of their life. We need to improve those numbers significantly.”  I could not agree more!

He also said, “This is usually a very emotional discussion. We have to change the cultural around it. All of us are going to die. We need to change the culture so that it’s OK to have this discussion.”

I find the biggest obstacle to end-of-life discussions is professionals are not so willing to go there. It’s like a client or patient bringing up the topic of sex, some professionals are comfortable and others are not to discuss the topic. Both are a part of life and require ongoing discussion. One tends to be a more joyful topic and the other not, but both are also taboo in some sense. This needs to change. More workshops, trainings and education is needed for both professionals and individuals in society. “To be born, one must die.” Death is part of the cycle of life and as one wants to be involved in life so must one be involved in death……we cannot necessarily control the how and when, but we can decide to some extent in what circumstances we want the control should we be diagnosed with a terminal illness or chronic and progressive heath condition that will slowly rob us of our autonomy.

Think perhaps in the context of, ‘If I was diagnosed with a terminal illness and told I had 6 months to live, how would I want to spend that time?’ How would I tell my family, friends and colleagues? Would I want to be kept alive with oxygen and tubes, medication, surgery, in a hospital or hospice OR would I want no treatment and to be at home surrounded by my family and friends?

Discussions are needed by individuals in society, within the medical profession, by helping professionals and between professionals and clients/patients.

Will you be part of this process or will you continue to hide behind discomfort and fear?

By Victoria Brewster, MSW

Social Work/Helping Profession/Mental Health


Dreams are real
and without them life is a sad existence.

Dreams hold us together and give us a vision,
something to aim for,
the road leading to our destination.

Dreams are the magic,
the magician making us laugh,
or the sun which makes us warm.

Dreams are like the rain,
when it ends there is a rainbow,
that streaks across the sky in shimmering colors
and where it ends,
is a new beginning.

Dreams are our imagination
and they are what we make of them.

Without dreams, we are nothing,
for dreams are the child, the joy, the sadness the imagination,
the goals in all of us.

I wrote this poem quite awhile ago, but the poem signifies our journey in life, both personal and professional. Dreams, imagination, goals and inspiration are part of our creative drive. I cannot picture my life without creativity. We all have it in us; we just need to listen. Do not be afraid to try something new, something different. Take a chance and see what happens.

To start the process, picture in your mind ‘you’ doing something different, whether it is a new career, starting a new hobby or sport, making new friends or going on an adventure. How do you feel after imagining this new you? Do you feel better? Do you feel relaxed? Has your stress levels lessened or increased? Are you happy?

By doing activities like this in your mind, you are trying something new without taking a risk. It is a good way to begin and perhaps after doing this ‘mind exercise’ a few times and noting a positive reaction after both physically and mentally, you may be willing to take action and implement change in your life.

Written by Victoria Brewster, MSW

*First posted at: http://www.socialjusticesolutions.org/2013/02/18/dreams/

News, Social Work/Helping Profession/Mental Health

Mind Vacation

For those that live in the north, winter can be difficult. Not just in the sense of the snow and cold and all the responsibilities that come with the winter season, but in the sense of a lack of sunlight.

Many people thrive in the sunshine and warmth both physically and mentally. The cold weather keeps many indoors. Visions of sandy beaches, sun, the ocean, palm trees and drinks with umbrellas in them go through our minds.

For those not able to travel due to physical limitations, health reasons, financial reasons or a lack of vacation days available through work; the vacation must take place in your mind. I call this a ‘Mind Vacation.’

Browse online for touristy destinations, choose the activities you would participate in, the guided tours, perhaps the historical sites you would visit, the hotel or bed and breakfast that you would want to stay at. Imagine yourself being at this destination with all your senses. Feel the warmth of the sun on your face, imagine you feet walking along the beach, feel the sand on your feet, the warm ocean on your skin. Smell the food cooking on an outdoor fire pit or grill.

Where have you visited in your mind, Florida, California, Mexico, Hawaii, Thailand? How do you feel? This exercise is similar to guided imagery where another verbally asks you to think of a place in your mind that makes you happy. You are asked to breathe deeply, to visualize this happy place whether it is in nature, a house, people from the past you spent time with….you are asked to hear the sounds around you, to smell the air, the food cooking and to touch something whether it is a tree, hugging a person or holding a book on the beach. You link your body with your mind by using all your senses. By breathing deeply and slowly, you relax both your body and your mind.

The end result is a ‘Mind Vacation.’ Enjoy your destination!

Written by Victoria Brewster, MSW

News, Social Work/Helping Profession/Mental Health

Leadership and Teamwork in Helping Professions

Leadership, teamwork, management, structure of an organization; these are not typical words used in social work or any helping profession from the professionals themselves as they are often very focused on the clients, patients, clientage and recently I heard the term service user (from workers in the UK). Personally and professionally I find the term service user to be extremely impersonal. Client can be used in any profession and patient tends to have a medical basis to it.

I have come across a lot of information, articles and discussions lately that have to do with leadership, management, teamwork and coaching. I soaked it all in and then reflected. I thought of past jobs both in the social work field and otherwise and further reflected.

Ask, listen and talk; 3 basic words that hold so much leverage and potential in them. Now, these concepts are easily linked to social work and other helping professions. I like to think we are some of the best listeners out there. We have been trained to be that way, but are we truly? Are these 3 words woven into the fabric of your organization? Are they an integral part of your employment/employer and have you ever stopped to think about it? Or maybe they are ideas you would like to see take shape in your organization between management and front-line?

What about the words consensus, conformity and creativity? In discussing potential changes or voting in a case review as to the best way to approach a client or situation we would like to reach consensus-is it truly possible? Sometimes and other times we have to be happy with the majority. Conformity-here is a tricky word as it depends on the situation. There are times as a professional you want to see conformity from a client, but in an organization? Do we really want all the employees to be the same? To think the same? To approach problems and difficulties the same way? What about creativity? I love this word and as a professional, in the organization I work for-I want to see this from leadership, management and front-line staff. There is no one way to approach a problem or to find a solution-creativity gets the gears turning.

How about 12 words that can be addressed, sought and reflected upon by any organization? Empathy, forgiveness, humanity, humility, recognition, discretion, thoughtfulness, consideration, compassion, gratitude, appreciation and compliance. Now as a social worker, one who works in the social services field, mental health field or other helping profession, these 12 words for the most part are known to us and used often. Think of them as a reminder. As front-line staff I find it is easier to focus on these words as we use them daily in our interaction with clients. When it comes to management, sometimes a review is needed as they are removed from the daily interaction with clients and dealing with issues that do not need to enter the front-line workers thoughts. When it comes to interaction with management and front-line-these same 12 words need to be remembered, reflected upon and used in the interactions between levels in any organization to encourage participation, solutions, new ideas or areas to focus on and to increase moral.

How can you increase the performance of your team?

  • Listen at a deeper level and stay focused on the person in conversation.
  • Expect something special to come out of every dialogue.
  • Encourage the heart and acknowledge their gifts.

Be intentional about listening at a deeper level, and acknowledge with authenticity. I guarantee, if you improve these two things, your team will increase their performance. Asking both employees and colleagues how they learn best; visual, auditory, written, discussion, kinesthetic or a combination thereof. We learn: 10% of what we read 20% of what we hear 30% of what we do 50% of what we both see and hear 70% of what we discuss with others 80% of what we experience personally 95% of what we teach other. (Glasser, in Taylor S. and McKenzie, I. The Team Solution. Curriculum Perspectives (1995), p.23)

Encourage growth of the individual, learning how that person has grown/learnt within the team or can learn within the team. Two key elements for me are to create a professional relationship built on mutual respect and accept that the people I am working with have as much knowledge and ability as me.

“An essential part of true listening is the…temporary giving up or setting aside of one’s own prejudices…so as to experience…the speaker’s world from inside his shoes. True listening…involves a total acceptance of the other. Sensing this acceptance, the speaker will feel less and less vulnerable and more and more inclined to open up the inner recesses of  his or her mind to the listener. As this happens, speaker and listener begin to appreciate each other more and more, and the duet dance of love is begun again.”~ Scott M.Peck, MD

Written by Victoria Brewster, MSW

Aging/Gerontology, News, Social Work/Helping Profession/Mental Health

Dementia: A Feared Diagnosis and the Emotional Journey

I attended a lecture on Long Term Care Placement from the Perspective of a Caregiver a few days ago at a local private non-profit Alzheimer’s organization. Even though I am a professional, I wanted to further learn the process from the caregivers perspective. Although the placement process was focused here on the province of Quebec, much of the information shared about the emotional journey, the questions to consider in readiness for placement was for everyone, anywhere.

Someone you know and love has been diagnosed with Dementia. Now what? A plan needs to be created. Caregiving whether informal or formal decided upon by family, friends, public and private sector professionals with the choices of: at home with assistance coming in, a residence or LTC (nursing home).

“Unfortunately, we don’t get a course in school telling us what to do and how to be helpful when an aging parent develops dementia. We may not even be clear about what the word means. A startling reality is that by the time a person is 85 years of age, the odds of developing Alzheimer’s Disease, presenting as dementia, are about one in two” –Carolyn Rosenblatt.

Questions to Consider:
•One question at a time-do the evaluation in stages and start the process early.
•What can the person diagnosed with Dementia still do on their own?
•What do they need help with?
•What is their cognitive state?
•Has their condition deteriorated, health wise?
•Can the person with dementia be part of the process as in what are their thoughts?
•Pay attention to non-verbal cues as well.
•Do you wait until the person who has dementia has progressed to the point that cognitively they do not understand and will not resist placement?
•As a caregiver, what are you values and preferences re: placement?
•For the one with dementia, what are their values and preferences?
•Legalities re: paperwork and who makes decisions needs to be decided, power of attorney or mandate by all involved.

Further Tips:
•For those who are not the official caregiver, avoid criticizing the main caregiver.
•Listen, work as a team to discuss the various wishes.
•Budget cuts and a lack of funding for local health services and what this means for support services like local Alzheimer’s Associations & organizations, support groups, lectures and presentations along with turning to the internet to learn about the disease, what to expect, i.e., symptoms and characteristics of the disease are important.
•Acknowledgement by the family that this is happening and real!

One of the most difficult tasks is for the family whether child, parent or spouse, is to go through your own emotional process or you will have great difficulty in making these future decisions. ‘Losing’ a parent, spouse or child to Dementia has its own grieving process. The person is not who they once were. They cannot do for themselves what they used to do. The memories slowly disappear along with the ability to recognize family and friends-none of this is their fault and is part of the disease, but as an onlooker is hard to witness and be part of.

“It was vital for me to recognise that Alzheimer’s (the underlying cause in Mum’s case), debilitating and horrible as it is, also brings moments of catharsis, laughter and joy. The key was the realisation that the source of my overwhelming sadness had little to do with her. It stemmed from either my comparisons with the past, my anxieties about the future, or my fear over my own eventual frailty. The result was that I was missing being in the present, and upsetting her by lacing our time together with regret and sadness. I was treating her as already incapacitated, not truly being with her even though we were in the same room. She would talk to me, but all I could hear were my own questions: where is the woman I knew so well? What happens next? But when I managed to switch off this destructive internal dialogue and be with her in the “now” (which is what people with difficulty in forming short-term memories do a lot of the time), we actually had a blast.” – Alex Andreou

One could compare their parent to children in some ways, emotionally, verbally, behavior wise. It is a mental switch to see an adult parent as both an adult (because of the size and age) and then see and be witness to the fact that their behavior and needs are more like a childs.

“We love our children unconditionally – regardless of their ability at a particular age, or their relative lack of complex cognitive ability, memories and experience. We recognise the gift that is their near-Buddhist ability to exist in the moment. Why not our parents?” – Alex Andreou

Words to live by…..

Written by Victoria Brewster, MSW

*First posted at: http://www.socialjusticesolutions.org/2013/02/05/dementia-a-feared-diagnosis/