{"id":18741,"date":"2016-05-13T00:17:50","date_gmt":"2016-05-13T07:17:50","guid":{"rendered":"http:\/\/www.jewishindependent.ca\/?p=18741"},"modified":"2016-05-11T10:52:50","modified_gmt":"2016-05-11T17:52:50","slug":"caring-for-people-at-lifes-end","status":"publish","type":"post","link":"https:\/\/www.jewishindependent.ca\/index.php\/2016\/05\/13\/caring-for-people-at-lifes-end\/","title":{"rendered":"Caring for people at life\u2019s end"},"content":{"rendered":"

Henry Fersko-Weiss, president of the International End of Life\u00a0<\/strong>Doula Association. (photo from Henry Fersko-Weiss)<\/em><\/strong><\/span><\/p>\n

Doulas offer support to expectant mothers, guiding women and their partners through the childbirth process and into their first steps of parenthood. Now, a similar concept is gaining ground to fill a need at the end of our lives.<\/p>\n

Fear, exhaustion and uncertainty often leave us unsure of how to best support a loved one during their last days, while we also try to deal with our own impending loss.<\/p>\n

The idea for end-of-life doulas was conceived by licensed clinical social worker Henry Fersko-Weiss, who works in hospice care in New York and New Jersey.<\/p>\n

\u201cThere seemed to be a gap in the services that were traditionally available to people,\u201d Fersko-Weiss told the Independent<\/em>. \u201cAs wonderful as hospice is in the U.S., where most people die in their own homes \u2013 which is the ideal, unless there\u2019s a cultural reason not to \u2013 that\u2019s when people really need help the most.<\/p>\n

\u201cThey recognize that death is very close and now they can\u2019t avoid thinking about it. They are exhausted and the care demands have increased. They need more help than they were able to access through normal programs. So, I started to think about how to figure this out … and, at the time, a friend of mine was learning how to become a birth doula.\u201d<\/p>\n

Fersko-Weiss had not heard about doulas before then. But, as his friend shared with him what she was learning in her training, he increasingly felt this would also be an ideal way to approach the end of life.<\/p>\n

\u201cThere are a lot of tremendous similarities between birth and death, clear differences as well,\u201d he said. \u201cI became intrigued and started learning more about birth doulas. And, I took the training myself, so I would learn exactly what they were learning.\u201d<\/p>\n

By then, Fersko-Weiss was convinced that there were many tools, techniques and principles of care from the birthing world that could be transferred in a very positive way to the end-of-life sphere. So, he went to Carolyn Cassin, the chief executive officer of Continuum Hospice Care in New York City, where he was working at the time, and presented the idea to her. She encouraged him to follow it through.<\/p>\n

By 2015, Fersko-Weiss had established a not-for-profit organization that trains and supports end-of-life doulas.<\/p>\n

\u201cCurrently,\u201d he said, \u201cmy work is focused on promoting the use of end-of-life doulas through organizations that care for people at end of life, as well as training people publicly and helping them to achieve certification through the organization that I head: the International End of Life Doula Association.\u201d<\/p>\n

To create the program, Fersko-Weiss incorporated some of the concepts from the birth doula training, such as visualization and guided imagery, techniques used by birth doulas to help ease pain.<\/p>\n

\u201cI started building on that and writing the training, looking for material that would support some of the things that were important and created a model of the different phases of care that this would offer,\u201d he said. \u201cAt that first training, I had 17 people. Once we went through that first training, which was a weekend \u2013 which has become the standard for us, about 22 hours \u2013 we went on and kept training, and developing the program, and serving patients and their families.\u201d<\/p>\n

There are three phases to the model Fersko-Weiss has created, the first of which is summing up and planning. This occurs as early as possible, when the patient and the family are shifting their focus to end-of-life comfort care and away from a cure.<\/p>\n

\u201cBut, even if they were still focused, to some degree, on a cure, parts of what we do would still make sense, probably even months before somebody would be at the point of dying,\u201d said Fersko-Weiss. \u201cWe work on exploring the meaning of their life, as they look back over their life, and help them think about what they might want to leave behind as a legacy that reflects that meaning that they\u2019ve uncovered or what they think is important for their loved ones and friends to remember them by or to carry into their lives.\u201d<\/p>\n

Psychologist Erik Erikson has examined the different developmental stages that we go through within our lifespan and refers to the last of these stages as \u201cintegrity versus despair.\u201d<\/p>\n

\u201cWhen somebody is dying and facing death, they are automatically propelled into that final developmental stage, no matter what age,\u201d said Fersko-Weiss. \u201cIn that stage, they have to contend with coming to the point of a positive completion of their life as they go through reviewing their life. Or else, they move towards despair, anguish and feeling that their life either didn\u2019t matter or didn\u2019t fulfil their dreams.\u201d<\/p>\n

The other aspect of the first phase of Fersko-Weiss\u2019 program is planning what one\u2019s last days of life will look like. This entails finding out what would be most helpful to them and their family to allow those last days to unfold in a way that honors who they are, carries deeper meaning for everyone involved and makes it easier for the person to approach death.<\/p>\n

The second phase of the program is when the person is actively dying, which generally comprises the last two to four days of life.<\/p>\n

\u201cWe stay with people as much as possible, around the clock,\u201d said Fersko-Weiss. \u201cWe help them understand what is coming next. We support the family emotionally and spiritually, and we assist with physical care in a basic way.<\/p>\n

\u201cWe will stay [with the family] through the death,\u201d he continued. \u201cWe will wait hours afterwards to give them time to process it and have the death experience sink in a bit. We sometimes call the funeral home for them, or friends, if they are too emotional. We stay with them through the body being removed from the home and also up to the point where they feel more comfortable being on their own.\u201d<\/p>\n

Phase three of the program has the doula returning to the family three to six weeks following the death to review and tell the story of the dying process. This helps the family see some of the many beautiful and loving things they did together during that time, reminding them how things went, as they may have not have been thinking clearly during that time due to the pain of loss.<\/p>\n

\u201cThis is done as a way to reframe some of the negative pieces that they are carrying that may be coming back to them over and over again in their mind, and help them to begin the very early stage of grief, understand what grief work is about,\u201d said Fersko-Weiss. \u201cWe help them through some of the early grief work and then refer them to programs in the community or within the organization that were perhaps involved with the care as well. We may, at that point, do a final ritual to bring closure to our work with them.\u201d<\/p>\n

The end-of-life doula service is provided primarily by hospice and out-care programs, which may be part of a hospital. Fersko-Weiss is working to spur interest in this service at assisted living facilities and nursing homes. This type of care is also starting to be done by groups of people getting together to provide the service to a dying person and their family.<\/p>\n

Fersko-Weiss has been teaching at the Institute of Traditional Medicine in Toronto, doing a compressed form of the doula training he offers in the United States. Students attend classes one weekend a month for six months, and graduate as certified contemplative end-of-life-care practitioners.<\/p>\n

\u201cMy understanding of hospice in Canada is that many people are very underserved,\u201d he said. \u201cThere are a lot of people who are dying without the ability to access hospice care in Canada.\u201d<\/p>\n

Fersko-Weiss has also been working with a Canadian organization called the Home Hospice Association.<\/p>\n

\u201cThey are still in the process of forming, but their intention is to provide home hospice in Canada and to solve the problem of lack of access,\u201d he said. \u201cTheir intention is to build into that program the utilization of end-of-life doulas.\u201d<\/p>\n

Rebeca Kuropatwa<\/strong> is a Winnipeg freelance writer.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Henry Fersko-Weiss, president of the International End of Life\u00a0Doula Association. (photo from Henry Fersko-Weiss) Doulas offer support to expectant mothers, guiding women and their partners through the childbirth process and into their first steps of parenthood. Now, a similar concept is gaining ground to fill a need at the end of our lives. Fear, exhaustion […]<\/p>\n","protected":false},"author":2,"featured_media":18715,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[5810,5413,5812,3225,5811],"class_list":["post-18741","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-world","tag-death","tag-doula","tag-fersko-weiss","tag-health-care","tag-hospice"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":8}},"_links":{"self":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts\/18741","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/comments?post=18741"}],"version-history":[{"count":0,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts\/18741\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/media\/18715"}],"wp:attachment":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/media?parent=18741"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/categories?post=18741"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/tags?post=18741"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}