The Sacred Moment of Death

By Barbara Karnes

The sacred moment of death - that is the goal for those of us who work with end of life. Guiding, supporting and teaching those present what is normal in dying and what is not. What is fixable and what is not. What is painful and what is not. What to do and what not to do. What to say and what to be silent about.

All the work we do leads up to the moment of death. Our goal is to guide and support those present through the moment the last breath occurs.

How do we do that? How do we support and guide? We first give information. We teach the signs of approaching death. Teach what is normal and what is more challenging. We give guidance as to what families or significant others can do while labor is progressing.

Here are my thoughts:

In the hours before death, when the person is not responsive, suggest that each person present spend time alone with the person who is dying. To talk with them, tell them everything they have wanted and need to say, the good, and even the challenging. 

Sit by or on the bed, hold a hand, lay down in the bed, cuddle, whatever your heart guides you to do. This is their gift as well as a gift to the person who is dying. The opportunity to address “loose ends,” to say those things that were never said. 

The person that is dying is processing their life. By sharing innermost thoughts and feelings with them they are giving their special person more pieces to their puzzle of life.

Now is the time to talk with those present as to what is about to occur. Explain how the breathing changes, about the sounds they may hear, the words that won’t make sense, the often strange and unusual facial expressions they may see. All that is part of the labor of dying. 

By guiding them you are showing those present that nothing bad is happening, nothing pathological is happening. This is how people die. Dad or grandmother or friend or husband are expressing the effort to release them from their body.

Once death has occurred  encourage those present to say goodbye to the body again before calling the funeral home. This will be the last private time they will have with their special person, give them that opportunity.

Through this support and guidance you are creating the sacred experience for those present and that experience will become their sacred memory. They will carry that memory with them forever.

This is the work we do. This is the goal, the culmination of our time spent with families and significant others. This is the gift we can give them.

‘All Options are on the Table’: NAHC, NHPCO Form Joint Exploratory Committee

Home Health Care News | By Joyce Famakinwa
 
The National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) announced Wednesday that the two organizations have formed a joint exploratory committee.
 
The aim of the committee is to determine how best to collaborate on some of the overlapping issues that are the focus of both organizations.
 
“The Boards of Directors of both NAHC and NHPCO believe the time is right to explore how a stronger, unified, and more intentional approach to collaboration could accelerate the impact of work around our respective missions and on behalf of our members,” the two organizations wrote in a joint press statement.
 
In the past, NAHC and NHPCO have often teamed up for projects and initiatives that fall under the common purview of both organizations, in an effort to raise greater awareness and leverage their combined firepower.
 
“These discussions follow naturally from our history of collaboration and are rooted in our shared belief that the more united our voices and actions are, the more we will serve and benefit our respective members and the patients and families they serve,” NAHC and NHPCO wrote.
 
Though both organizations have shied away from offering up more concrete details about what the committee may lead to in the end, a NAHC spokesperson relayed, in an email, that “all options are on the table.”
 
For now, NAHC and NHPCO have agreed to pause their executive recruitment and succession planning during the course of these discussions.
 
Plus, the organizations are working with the consulting firm McKinley Advisors for additional support. The firm will aid in providing an objective analysis of potential opportunities for NAHC and NHPCO.
 
“As part of this evaluation, McKinley will be conducting in-depth interviews with industry stakeholders over the next several weeks and will report findings and recommendations to the Boards of both organizations,” NAHC and NHPCO wrote. “The exploratory committee expects to issue additional communications about these findings and our collective next steps regarding the collaboration opportunities in May.”

What’s in Biden’s Budget

CNN | By Katie Lobosco and Tami Luhby
 
President Joe Biden released his annual budget Thursday, outlining his policy priorities for the year ahead.
 
Make no mistake, the proposed budget has no chance of making it through the Republican-controlled House. But Biden’s plan will frame upcoming political battles on Capitol Hill, where the GOP has yet to unveil its own spending plan.
 
Biden’s budget comes out after the US hit the debt ceiling, a cap set by Congress, earlier this year. The Treasury Department is now taking extraordinary measures to allow the government to keep paying its bills. But the country could start to default on its obligations over the summer if Congress doesn’t address the debt ceiling before then. Republicans are calling for some spending cuts in exchange for voting to raise the cap, while the White House does not want to negotiate on resolving the debt limit drama.
 
 Many of the provisions in the budget rehash the president’s earlier proposals to expand the social safety net and to pay for it by raising taxes on the wealthy and corporations. He wants to restore the expanded child tax credit and make permanent enhanced Obamacare subsidies, both enacted in the American Rescue Plan in 2021. And he wants to provide universal free preschool, make college more affordable and establish a national paid family and medical leave program, which did not make it into prior packages when the Democrats controlled Congress over the past two years.
 
Biden’s spending plan also calls for shoring up Medicare and capping the price of insulin for all Americans.
 
The administration says these proposed policies will result in a nearly $3 trillion reduction in the deficits – the difference between what the government spends and its revenue – over the next decade.
 
Here’s what’s in Biden’s budget proposal

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Biden Pledges $150B for HCBS in New Budget

McKnight’s Home Care | By Diane Eastabrook
 
President Joe Biden is calling for $150 billion in funding for home- and community-based services over the next decade. The money, which is earmarked in his $6.8 trillion 2024 budget unveiled Thursday, would allow older Americans and those with disabilities to receive personal care services in their homes and improve the quality of jobs for home care workers and family caregivers.
 
Biden provided highlights of the budget Thursday afternoon to a crowd in Philadelphia, saying it is important to give seniors the choice to age in place, just as his own parents had.
 
“It’s cheaper if we provide for the ability for them to stay in their homes,” Biden added. “It’s not only the right thing to do, but it’s cheaper for the taxpayers.” 
 
The Home Care Association of America praised the president for recognizing the value of home care in the proposal.
 
“This budget demonstrates the commitment to ensure all Americans have the opportunity to age in their own homes, living as independently as possible,” HCAOA President Vicki Hoak told McKnight’s Home Care Daily Pulse in an email.  
 
Separate from the HCBS funding, the proposed budget also includes additional funding to address the healthcare workforce shortage. It funnels $32 million in training for nurse faculty and $28 million in innovative approaches to recruit, support and train the next generation of healthcare providers. The plan would also expand the National Health Service Corps, which provides loan repayment and scholarships to clinicians working in underserved areas. 
 
This is the second time Biden has made a run at HCBS funding. The president proposed $400 billion in home- and community-based services funding as part of his Build Back Better initiative in 2021. The amount was eventually pared back to $150 billion but stalled in the Senate later that year.
 
Earlier this year, leaders of the National Association for Home Care & Hospice and HCAOA expressed optimism there would be movement in Congress on legislation supporting HCBS. 
 
Still, the president’s budget faces an uphill battle in Congress. Sen. Charles Grassely (R-IA) of the powerful Senate Budget Committee told The New York Times the proposed budget has the “highest sustained levels of taxes, spending and deficits in American history” and is “a roadmap for financial ruin.”