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Current and Future Applications of Focused Ultrasound 2014 - 4th International Symposium
10/12/2014 - 10/16/2014
Focused Ultrasound Foundation

2014 Skin, Bones, Hearts & Private Parts - The Everything's Bigger in Texas Conference
10/13/2014 - 10/17/2014
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Primary Care Conference & Pharmacology Update
10/13/2014 - 10/16/2014
NPACE

The NPA's 30 Annual Conference
10/22/2014 - 10/26/2014
The Nurse Practitioner Association of New York State

2014 Skin, Bones, Hearts & Private Parts - The Dream Conference Encore
11/02/2014 - 11/05/2014
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QandA with Judith Redwing Keyssar, BA, RN, Author and Director of the Palliative and End of Life Care Program at Seniors At Home/Jewish Family and Children's Services | NEWS-Line for Long Term Care Professionals
11/15/2011
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Q&A with Judith Redwing Keyssar, BA, RN, Author and Director of the Palliative and End of Life Care Program at Seniors At Home/Jewish Family and Children's Services



Judith Redwing Keyssar (Redwing) is a nurse specializing in palliative and end-of-life care, and death midwifery in San Francisco, California. She has over 18 years of nursing experience and 30 years of experience in complementary medicine. Redwing has a BA in Fine Arts and is an RN with certifications in End of Life Nursing Education (ELNEC), Guided Imagery for Pain Management and "Being with Dying" for healthcare professionals by Joan Halifax, teacher at Upaya Zen Center. As Director of Palliative and End of Life Care, her responsibilities include overseeing all palliative clients, on-going program development and community education. Redwing wrote the book Last Acts of Kindness: Lessons for the Living from the Bedsides of the Dying, which is available through her web site (www.www.lastactsofkindness.com), Amazon and Kindle.

Q: What motivated you to become a nurse?

A: I was always interested in health and healing, but in non-traditional/complementary modalities. However, in 1988, my close friend Kate was in a motorcycle accident and spent three weeks in a coma before she died. She was 30 years old; I was 35. Every day of those three weeks I would walk into the ICU to be at her bedside, knowing and feeling that my work in this lifetime was to be a "midwife to the dying"—to be with people at the threshold between life and death. This was the gift that Kate gave me in her dying. I also understood that in order to do this I needed the skill-set of a nurse or doctor in order to be at the bedside. I had been a pre-med dropout in 1971, but times had changed, and it was nursing that called to me.

Q: Can you talk about your specialty in long-term care?

A: My specialty is palliative care, which can and should be incorporated into long-term care. Palliative care is the philosophy behind hospice but it is so much broader than hospice. It is about relieving suffering at any stage of an illness or decline—physical, emotional, spiritual, psychological suffering. Certainly all of these are part of long-term care.

The program I direct at Seniors At Home is in the context of a homecare agency. In a sense, this is about long-term care—as homecare is simply long-term care at home! Our goal is to keep people at home, in familiar and comfortable surroundings, as long as possible.

Q: Can you describe where you work?

A: I work for Seniors At Home, which is a division of Jewish Family and Children's Services (JFCS), a large non-profit serving the San Francisco Bay Area. We serve 60,000 people annually in a five-county region with the highest quality, research-based social services designed to strengthen individuals, families and the community.

Q: What services does your facility offer?

A: As the senior services division of JFCS, Seniors At Home offers a comprehensive range of programs to help older adults live more independently in their own homes, including award-winning home care and care management, palliative and end of life care, senior care consultation, skilled nursing, healthcare advocacy, counseling, money management and conservatorships, spiritual care, volunteer services, JFCS RIDES transportation service, caregiver support, and Holocaust survivor services.

The palliative care program that I direct provides consultations and on-going support at no cost, to anyone who is a client of our agency. This is a cutting edge model in providing palliative care in the community, and not just in a hospital setting. We also serve our clients by matching them with extensively trained volunteers.

Community education and outreach is part of our program as well. There is a strong sense in our agency that we are working together as a team to provide the best care possible in order to assist people in maintaining their health, comfort and dignity.

Q: When and how did you start at JFCS?

A: I was hired in 2007 to develop and implement a palliative care program in the context of Seniors At Home. Jewish Family and Children's Services recognized at that time that the biggest gap in the services they provided to the community was around palliative and end of life care. They provided everything else—from adoptions to parent-child education to counseling and homecare—but understood that the concepts of decline and the specific issues that concern clients and their families at end of life, needed to be addressed directly.

Q: Typically, what are your day-to-day responsibilities as the Director of the Palliative and End of Life Care Program?

A: As the Director of the Palliative and End of Life Care Program, I am responsible for:
• On-going program development;
• Oversight of all palliative care clients;
• Consultation and assessments with new palliative care clients and families;
• Acting as a liaison to hospice teams;
• Oversight of the Palliative Care volunteer program, including curriculum development, yearly intensive training seminars, monthly follow-up meetings; and
• Community education and outreach around issues of palliative and end of life care.

Q: What are the greatest challenges you face in your job?

A: I am not in a typical "long-term care setting;" however, I do see the challenges ahead in this field. First of all, the baby boomers are not going to be satisfied with what most of us have experienced as "nursing homes" or standard "long-term care" facilities. In California there is a group called the Culture Change Coalition, (www.calculturechange.org) which is working to do exactly that—change the culture of the standard nursing home. We need to look to models like the Eden Alternative and the Green House Projects. We need to consider the co-housing and Village movements, as alternative types of long-term care. And then we need to re-invent the facilities that exist—make them aesthetically pleasing, bring in the arts, hire chefs—actually provide "care" for our elders, not just warehouses. Dr. Bill Thomas, founder of the Eden Alternative tells us, "You can judge a lot about a culture by how it cares for its elders." We have a long way to go in respecting and improving the lives of our elders.

One of the biggest challenges is the fact that insurance (private or Medicare) does not cover the cost of residential facilities or homecare. Without that, there are going to be millions of people without adequate resources or services. Another challenge is that long-term care is a multi-cultural industry, and because of that there is a need for much more education, understanding and competency around multi-cultural issues. Our aging population is varied in ethnicity, religion, spirituality and race, and those at the bedside providing care are most often from mixed cultural backgrounds. All of this must be taken into account as we prepare for change in long-term care.

Q: What do you like most about your job? What do you dislike most about your job?

A: I love the fact that I do not only do one thing. I do different things every day. I love developing curriculum and teaching, but my inspiration comes from my "clients/patients"—especially the ones who have already suffered so much, and yet they are still able to smile and appreciate the small and beautiful moments of life. When I work closely with someone who is dying, I receive the incredible gifts of understanding the preciousness of every moment we have on this earth, and also of witnessing the amazing transformation of spirit that each and every one of us will experience some day.

Of course, what I dislike is what everyone dislikes: paperwork and data collection!

Q: Do you feel that the role of nurses has changed over recent years?

A: My mother was a nurse in the 1940s. She wore a cap and a white dress, did not start IVs or make decisions about what a patient might need, and was not allowed to offer her opinion about cases. (Until she married a doctor!) And she was paid very little!

Nurses in this day and age are so much more empowered. The advent of Nurse Practitioners and "mid-level" practitioners has helped this, but the feminist movement has also helped improve the working conditions of women over the past 30 years. Nurses used to be "subservient" to doctors. Although this is still the case in some places (and there is certainly still a hierarchy in hospitals), I also feel that nurses and doctors and social workers and chaplains, especially in the field of palliative care, which is inter-disciplinary by nature, are seeing each other as equals.

When I was an ICU nurse, it was so clear that nurses were the ones truly "in charge" of patient care, because they are the ones at the bedside, seeing the constant changes and using their critical thinking skills to determine outcomes. Doctors depend on nurses in hospital settings, and we must continue to demand the equality and respect we deserve.

Q: What do you feel is of the greatest concern to nurses today?

A:
• Having a healthcare system that truly provides care for all people;
• Being able to have the time to understand their patients, and address patient issues adequately and appropriately;
• Appropriate salaries and benefits (it is shocking to see how little nursing professors make at large universities);
• R-E-S-P-E-C-T, as Aretha would say!
• Jobs! After all the discussion about the "nursing shortage" (which is still real), new graduates are not able to find jobs; and
• Putting "healing" back into "healthcare."

Q: What is the most important thing you've learned over the course of your career?

A:
• Healing is not always about living;
• Compassion is the most important tool we have;
• Love is the most potent healing force in the universe; and
• Respect your elders.

I wrote a song as the valedictorian of my nursing class and sang it at graduation. The refrain was:

"It's about healing of the body; it's about healing of the heart; It's about healing of the planet; it's about healing, and that's about where we start."

Q: What advice do you have for others thinking of entering a long-term care specialty?

A: I believe that we know in our hearts what work we are drawn to do, and we must do that work. Nursing is never easy, but the rewards are plentiful. Working with those who have lived long lives and are filled with wisdom and stories is a privilege. Educate yourselves so that you can be an advocate for change in the field of long-term care.

Q: How has working in long-term care allowed you to grow professionally?

A: Working with front-line caregivers from so many other cultures and learning to understand where they come from, as well as helping them understand how to relate to their patients/clients who are frail and elderly, has helped me grow professionally and personally.

Q: If you could sum up your job in one word, what would it be and why?

A: Compassion. That is the basis of the healing work that we do as nurses.




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