Death. It can be an uncomfortable topic in long-term care, but new innovations are enhancing how senior living providers cater to residents at the end of life.
One nonprofit continuing care retirement community (CCRC) in Norridge, Ill. offers the Chrysalis Room (pictured above), a dedicated space to celebrate and honor the end-of-life experience. Created in collaboration with Loretta Downs, founder of Chrysalis End-of-Life Inspirations, and a team of designers in 2013, the Chrysalis Room provides a sacred and functional space for families to be able to hold vigil, explains Dawn Mondschein, administrator at Central Baptist Village (CB Village).
The name, Chrysalis, refers to the stage in which a caterpillar transforms into a butterfly.
“Some long-term care organizations don’t seem to feel end of life is within their realm of responsibility,” Mondschein says. “It’s being empowered and bold enough to step up and embrace the idea and confront it head on.”
The alternative for many residents of long-term care is to wind up in a hospital, often undergoing painful and unnecessary procedures and tests in their final hours, she says. By providing the Chrysalis Room, CB Village says it has fewer residents transferred to a hospital for end-of-life care.
“CB Village helps prepare residents and families for difficult end-of-life decisions and care options well in advance,” Mondschein says. “They discuss the Chrysalis Room as a compassionate alternative offering strong emotional support, palliative care and clinical expertise, right here in the resident’s ‘home.’”
Last year, the Chrysalis Room earned CB Village a Mather Lifeways Institute on Aging Promising Practices Award, which recognizes innovations in the aging services industry. Mather Lifeways is an Evanston, Ill.-based nonprofit that creates programs, places and residences for the area’s aging population.
“In honoring the Chrysalis Room with a Promising Practices Award, Mather LifeWays Institute on Aging recognizes the importance of end of life as an important part of the aging services conversation for individual residents, families, and the industry overall,” says Mary Leary, CEO and president of Mather LifeWays. “By spotlighting Central Baptist Village’s important work with this award, we hope to recognize, inform and contribute to that dialogue.”
A Welcoming Space
The room, strategically located in the skilled nursing wing in a quiet area, can accommodate family members who wish to spend the night with their loved one in their final hours. The now spacious space was created from an existing semi-private room.
The room features a sleeper sofa, mini refrigerator, toys for children and other amenities to create an inviting space.
Soothing hues and nature-inspired artwork create a sense of peacefulness and calm, Mondschein says, noting that every characteristic of the room was deliberately designed. The room was developed as part of CB Village’s partnership with Rainbow Hospice and Palliative Care to focus on several goals to enhance the comfort of residents at end of life.
Prior to the Chrysalis Room, CB Village created private rooms for residents at the end of life, and soon saw a need for a more “formalized approach,” says Karen Haedo, director of nursing.
“Family members wanted to spend the final 24 hours or two days with their loved one, and we were trying to do whatever we could to accommodate them,” Haedo says. “This is the physical manifestation of what we’ve been trying to do for years. There’s nothing more important than spending time with a dying person. This takes it a step further and accommodates the whole family.”
Impact on Staff
The Chrysalis Room also empowers staff and “gives them a sense of purpose,” Haedo says.
Previously, death was an uncomfortable topic for some care staff, but the room has helped to create a healthy environment in which to appreciate and discuss end of life. The room has also inspired staff to discuss the topic with family members early on.
“They see themselves as coaches and guides,” Mondschein says. “Some of our CNAs have really embraced this role and they want to participate.”
Indeed, the Chrysalis Room helps move discussions with prospective residents from independent living options to the more difficult but crucially important topic of end-of-life care, which too often is avoided, says Julie Stevens, director of sales and marketing at CB Village.
Staff and other residents are invited to visit those in the Chrysalis Room and participate in various activities including singing, praying and saying final goodbyes.
“After seeing staff visit the Chrysalis Room we hear family members say, ‘I never knew the caregivers had such a bond with my mother; I couldn’t believe the stream of staff that came through to kiss my mom goodbye,’” Mondschein says. “We are a family here, and it shows.”
Addressing a Need
The need for end-of-life care services such as the Chrysalis Room is underscored by research showing that the perception of U.S. care for the dying has worsened over the decade.
“People are less satisfied with care at the close of life, and I think it’s now urgent for us to start thinking about what interventions we can do to improve care at the end of life given that we are facing a Silver Tsunami,” says Dr. Joan Teno, lead author of the study in the Journal of Palliative Medicine and professor of health services, policy and practice in the Brown University School of Public Health.
The study compared data from two surveys — one conducted in 2000 and the National Health and Aging Trends Study done between 2011 and 2013 — in which more than 1,200 people who had lost close loved ones rated aspects of the decedents’ end-of-life care. In 2000, 56.7% of 622 respondents rated care as excellent, but a decade later only 47% of 586 people could say the same.
In the last decade, people have also become more likely to end up in intensive care and to experience burdensome transitions between institutions in the last few days of life, Teno’s research shows.
“In long-term care we know people are at the end of life, but everyone wants to deny that,” Haedo says. “That’s a disservice to our elderly. This room is a gift to our residents, and staff too.”
Written by Cassandra Dowell