Sharing gifts

Sunrise at Island View Beach
Hello and welcome to December!

In the past months, summer and camping came to an end and the 2nd wave of the COVID-19 pandemic flourished. We are being asked to commit once more to physically distancing ourselves from those outside of our households. This is a difficult time that we all share. Globally people are preparing for December celebrations, including Christmas, Hanukkah, Yule (winter solstice) and Kwanzaa, in ways that honour the celebration but also follow the COVID restrictions. This year’s festivities will be quite different and will be coloured by the losses of not being able to gather with family and friends to celebrate, and the losses of our loved ones in the past year. Together we can get through this. In the words of Dr. Bonnie Henry, be kind, be calm, be safe.

We wish you and your loved ones peace and good health through the holiday season and in the new year.

Sharing Gifts

In keeping with the season, I would like to share some of the good experiences that came my way this year and to offer you these following resources.

Grief and Bereavement Resources

If you or someone you know is finding the holidays difficult, or more difficult this year, know that there is support for you. In BC, we are fortunate to have the BC Bereavement Helpline. Each province has their own resources – find them using the search terms “grief support [your province].

Working with FNHA to Support Family After Sudden Death

We know it is difficult when a loved one dies and that it is a more difficult experience for the family when the person’s death is sudden. Working with First Nation Health Authority in BC, I was honoured to develop webinars for nurses and health care assistants as they support people in their end-of-life journey.

   Using the Wellness Wheel to Learn About the End-of-Life Journey

In collaboration with Darien Thira, and in response to the opioid crisis, we offer and will offer the following webinars.

   Colonization and Sudden Death: First Response and Critical Incident Checklist

   Trauma Braid and a Three Step Approach to Support Family and Community Wellness (December 9, 2021)

   Walking Four Traditional Cultural Pathways of Health Grieving with the Bereaved (January 13,2021)

You are invited to listen to any or all these webinars from this website. We thank FNHA and Darien for making these wonderful presentations available.

NEW Online Program for PSWs/HCAs

Canadian Palliative Care Education Program for Personal Support Workers – Online Program

We have launched an exciting new education option for Health Care Assistants / Personal Support Workers, to  support HCAs/PSWs to build skills to feel confident and competent when supporting people to live and to die. The pilot class began this week with more than fifty HCAs and community members from across British Columbia.

Contact us if you are interested and want to know more!

Supporting HCAs During COVID and Beyond

This project’s goal was to support Health Care Assistants (HCAs, also known as Personal Support Workers) across BC dealing with COVID stresses. I was honoured to work with the BC Centre for Palliative Care (BCCPC), where we met with HCAs, heard their fears and concerns, as well as a few of their stories of caring during COVID. The result was a series of interactive webinars titled, “Kitchen Table Chats with Kath and Misha” with presentations by either Misha Butot or myself, followed with time for HCAs to talk about their work and stresses of caring during COVID. I invite you to listen to the webinar recordings on the following topics:

  • Social Connection in a Time of Physical Distancing
  • Adapting Rituals of Grief for Growth
  • Self Reflection to Support Grief for Growth
  • Fear and Anxiety – Caring for People During COVID.

Stories of the Heart

From the HCA stories described above, Kathleen Yue from BCCPC produced a video titled, “Stories of the Heart.” The stories are a celebration of the work of HCAs, and are inspiring and educational. The full video as well as short clips of less than 30 seconds are available.

Preparing PSWs to Meet the Challenges Identified in the Ontario LTC Report

This is an important report with information that can help all health care providers and decisions makers to prepare for the coming years. This key paper from the Ontario Ministry of Long-Term Care, published in July 2020, reports on staffing in long term care. Their report identified the multiple challenges experienced daily by PSWs and indicated that one reason for staffing shortages was the high rate of PSWs leaving their careers. Significant recommendations included ways to help support and retain PSWs in the workforce, including the need to integrate PSWs as full members of the health care team.

We were excited by this report because it echos the challenges we have heard from PSWs/HCAs across the country over the past years. If was a great coincidence that the new PSW text, which identifies ways for PSWs to meet the challenges identified in the Ontario report, was released the same month!

I hope you and your colleagues will read the report or the executive summary, as a way to stimulate conversations on how to prepare, engage and retain PSWs/HCAs in the workforce.

NEW Textbook and Workbook for PSWs/HCAs

Second Edition, Integrating a Palliative Approach: Essentials for Personal Support Workers

The biggest accomplishment for LDM this year was the launch of the Second edition of the PSW text, Integrating a Palliative Approach: Essentials for Personal Support Workers. This new edition includes new content to help PSWs/HCAs and their educators to address current issues in health care. You can watch the launch video that highlights the new features in the text and companion resources.

The text, workbook and Instructor resources were updated, including new teaching decks (Powerpoints). Plus all resources are available online in the virtual classroom.

If you’re looking for excellent readable options for teaching palliative care, then take a close look at these!

Free Resources: Managing Difficult Breathing Related to COVID
Videos on dyspnea

One of the common symptoms experienced by people with COVID is difficulty breathing. We offered and continue to offer videos and textbook excerpts on how to support a person experiencing breathlessness related to COVID free to the community. These videos may be of interest to HCAs/PSWs/ other health care providers and family members.

Addressing barriers to providing optimal end-of-life care

Physicians providing care in the community and long term care (LTC) facilities in Alberta, Canada, were interviewed to determine what they perceived as barriers and facilitators to providing optimal end-of-life care.1 Among their concerns, they reported motivational barriers related to families, citing the family’s lack of knowledge about frailty, unrealistic care expectations and expressions of grief as barriers to providing optimal end-0f-life care. Also, providing optimal end-of-life care was difficult if the physician and care team had limited knowledge of the person’s spiritual, emotional, and mental health needs.

Providing optimal care at end-of-life is essential. However, it becomes near-to-impossible when end-of-life care is not discussed until end-of-life.

The need to provide excellent end-of-life care for all people is acknowledged worldwide. The issues arise in knowing how to prepare for optimal end-of-life care.

Fortunately, the recommendations in the Framework on Palliative Care in Canada2 in part, address the barriers mentioned in the research. The recommendations of Harasym et al, (2020) from their research align well with the principles of palliative care and include:

  • Using standardized tools to help address understanding of pain with dementia
  • Assessing routinely to help prevent crisis
  • Engaging spiritual care providers who also had some medical knowledge would help to support family
  • Improving staffing ratios to ensure caregivers were available to provide more intensive end-of-life care

These strategies will help the care team to support the person and family in providing optimal care at end-of-life. However, it becomes very difficult when end-of-life care is not discussed until end-of-life.

Preparing for optimal end-of-life care is what a palliative approach is about

Integrating a palliative approach to care early in the person’s illness, possibly when they are still living in the community, enables appropriate information sharing with the person and family about the illness and helps them to understand what to expect. With a palliative approach, information sharing and serious illness conversations can be approached gently over time, instead of in urgent situations when the person is at end-of-life.

Integrating a palliative approach also means that palliative care is not the sole responsibility of the specialist, in this case, the physician. The entire care team—PSWs, nurses, socials workers, care directors, and so on, are involved in supporting the person and family through the person’s illness and death. Together with the family and community, the team gathers information about the person, their beliefs, values and goals of care. With this knowledge the care team is better able to meet the person’s physical, spiritual, emotional and mental health needs at end-of-life. And with a palliative approach, care planning conversations that occur long before end-of-life in both formal and informal ways, can help decrease fears and help prepare the person and family for future changes.

Educating all care providers

One thing that 2020 has made apparent is that health care is woefully unprepared to support greater numbers of people living and dying with life-limiting illness. The predicted number of Canadians with dementia who will need care in the year 2030 is astounding – an increase of 66% to an estimate of 937,000 people.

It is possible to prevent or address the barriers mentioned by Harasym et al (2020) and provide optimal end-of-life care—by educating all members of the care team, including physicians, in providing basic palliative care and integrating a palliative approach. To meet the care needs of people in the coming years, all members of the care team will need to be able to integrate a palliative approach now. Today. Tomorrow and next month and next year.

This means educating all caregivers to be confident and competent in preparing to care, opening doors to serious illness conversations, managing physical comfort, ways of responding to serious illness questions from the person and family, and palliative care best practices in communication. With this training, the health care team will be able to provide optimal end-of-life care for people dying in the coming years.

1 Harasym P, Brisbin S, Afzaal M, et al. Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians’ experiences, perceptions and perspectives. BMJ Open 2020;10:e037466. doi:10.1136/bmjopen-2020-037466

2 Health Canada, Framework on Palliative Care (2018)

Comfort Basket For The Caregiver

In the palliative care books, Integrating a Palliative Approach: Essentials for Personal Support Workers, and Essentials in Hospice and Palliative Care: A Practical Resource for Every Nurse, I use the image of a comfort basket to refer to non-pharmacological (non-medicinal) items that can help promote comfort and provide support when caring for a person who is unwell, and when supporting family members and other caregivers. The motto for the comfort basket is to

Respect the individual and individualize the care

The COVID-19 global crisis is stressful for professional and family caregivers. Fears of infection, lack of personal protective equipment, concerns about food shortages (and toilet paper shortages) combined with stress related to social distancing and quarantining are causing many to feel anxious.

One way to help manage stress and anxiety is through self-care.

A comfort basket can be filled with items for self-care. When a person engages in activities that bring them peace, calm, and a sense of being cared-for and of not being alone, their stress and anxiety diminishes.

I would like to dedicate this post to the family and friends whose loved ones are ill with COVID-19 and those whose loved ones are in care and they may not be able to provide care or see them.

Ways to support family and friends during COVID-19

Consider providing certificates and coupons for:

  • Online music services
  • Online meditation, guided imagery, yoga resources and courses…. and perhaps support to help access on the caregivers’ computer or mobile device
  • Gift certificate for meals (take out, delivery or meals that you make for their freezer)
  • Gift certificate for extra hours of caregiver services from an agency or private caregivers
  • Coupon to help with household work and activities for a specified time period, e.g., walk the dog daily for one week, or take the garbage out for one month, or mow the lawn 5 times, or do two hours of errands
  • A group of fabulous teenagers to come and sing to them for half an hour.

The key is to provide items or services that give comfort to the person

Consider creating a comfort basket for the caregivers and family that could ease their anxiety and bring them comfort. Items to consider are:

    • Hand cream, massage cream Comfort Basket with selfcare items
    • Bath bombs
    • Heating bags
    • Gel booties or gloves
    • Foot roller
    • Eye pillow
    • Journal & pen, coloured pens, tools for creative expression
    • Books to soothe the soul – choose topics that interest the person the book is for.
    • Mug with special teas, e.g., camomile, mint; hot cocoa, plus cookies or other delicious treat
    • Candles, candle holder
    • TV subscription to access a wider range of entertainment, e.g., Apple TV, Acorn TV, Amazon Video, Netflix, PBS
    • Noise-cancelling headphones for listening to music or videos when others are resting

What items would you like to receive, or what items have you given that were appreciated?

We’d love to hear your ideas! Leave a comment below

For more information, join the conversation in the Life and Death Matters Community

Read more about self-care for caregivers here

COVID-19 resource: Recognizing difficult breathing and strategies for supporting comfort

image of difficult breathing page 1One of the challenges health care providers are facing with COVID-19 is managing breathlessness or shortness of breath in infected patients.

For some caregivers and health care professionals, it may not be logical to consider applying palliative care principles and practices for managing difficult breathing when supporting people with breathlessness due to COVID-19. Know that applying palliative care principles and practices does not indicate that the person with COVID-19 is dying imminently. Repeat: Applying palliative care principles does not mean that a person is dying imminently. It does, however, mean that you may help the person to feel more comfortable while they are ill.

We’re offering an excerpt from the textbook, Integrating a Palliative Approach: Essentials for Personal Support Workers, titled “Common Symptoms – Difficult Breathing” to assist you when supporting a person with a COVID-19 infection.  This section describes key signs indicating a person is experiencing breathlessness and discusses comfort measures for supporting a person experiencing difficult breathing. We hope that it helps you as you support people ill with COVID-19.


Enter your information below to receive instant access to the text excerpt, “Common Symptoms – Difficult Breathing.”

CAUTION * For some people with COVID-19, difficulty with breathing progresses very quickly and becomes severe. When you recognize that a person is experiencing any difficulty with breathing, regardless of severity, connect first with your local health care professionals for guidance, assessment and treatment options.

This resource should not be considered a replacement, substitute or alternative to seeking appropriate and timely medical care.

Get access to our resource, Common Symptoms: Difficult Breathing

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