INR P.O. Box 5757 ♦ Concord, CA 94524 ♦ (925) 609-2820 ♦ (925) 687-0860 Hospice & Palliative Care: End of Life Rights & Choices Participants completing this course will be able to: 1) Summarize the recent Medicare law regarding end-of-life discussions with patients and define options for patient and provider consideration. 2) Discuss the psycho-social implications of death and dying among varied cultures and religions and how this effects healthcare delivery. 3) Identify the concerns most expressed by the dying. 4) Identify patient rights to live with dignity and as much independence as possible until the end. 5) Cite the philosophy, history and tradition of death and dying over time and how current beliefs developed. 6) Discuss heroic measures verses natural death and discuss caregiver support. 7) Describe the stages of death, the timeline of what happens to the physical remains after death, and care of the body after death. 8) Identify necessary legal documents regarding death, disposition of the body, family and patient rights, and how these important statutes assist the poor and the marginalized. Copyright 2020, INR (Institute for Natural Resources). All Rights Reserved. Fifth Edition (06/2018) www.INRseminars.com
Participants completing this course will be able to:
1) Summarize the recent Medicare law regarding end-of-life discussions with patients and define options for patientand provider consideration.
2) Discuss the psycho-social implications of death and dying among varied cultures and religions and how thiseffects healthcare delivery.
3) Identify the concerns most expressed by the dying.
4) Identify patient rights to live with dignity and as much independence as possible until the end.
5) Cite the philosophy, history and tradition of death and dying over time and how current beliefs developed.
6) Discuss heroic measures verses natural death and discuss caregiver support.
7) Describe the stages of death, the timeline of what happens to the physical remains after death, and care of thebody after death.
8) Identify necessary legal documents regarding death, disposition of the body, family and patient rights, and howthese important statutes assist the poor and the marginalized.
Copyright 2020, INR (Institute for Natural Resources). All Rights Reserved. Fifth Edition (06/2018)
www.INRseminars.com
DISCLOSURE INFORMATION INR (Institute for Natural Resources) is a non-profit scientific organization dedicated to research and education in the
fields of science and medicine. INR has no ties to any commercial organizations and sells no products of any kind, except educational materials.
Neither INR nor any instructor has a material or other financial relationship with any health care-related business that may be mentioned in an educational program. If INR were ever to use an instructor who had a material or other financial relationship with an entity mentioned in an educational program, that relationship would be disclosed at the beginning of the program. INR does not solicit or receive gifts or grants from any source and has no connection with any religious or political entities.
INR’s address and other contact information follows: P.O. Box 5757, Concord, CA 94524-0757 Customer service: 1-877-246-6336 or (925) 609-2820 Fax: (925) 687-0860 E-Mail: [email protected] Tax Identification Number 94–2948967.
For American Disability Act (ADA) accommodations or for addressing a grievance, please fax the request to INR at (925) 687-0860. Or, please send the request by email.
Education expenses (including enrollment fees, books, tapes, travel costs) may be deductible if they improve or maintain professional skills. Treas. Reg. Sec. 1.162-5.
Recording of the seminar, or any portion, by any means is strictly prohibited. INR’s liability to any registrant for any reason shall not exceed the amount of tuition paid by such registrant.
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END OF LIFERIGHTS AND CHOICES
Hospitals Long Term Care Facilities
- Nursing Homes- Assisted Living Facilities
From World War II onward, hospitals transformed from a symbol of sickness and despondency to places of hope and cure.
Prior to WWII, the frail elderly were placed in a poorhouse
In 1946, Congress passed the Hill-Burton Act, which provided huge amounts of government money for hospital construction.
Nine thousand hospitals were added around the country in the following two decades
People were moved from poorhouses to hospitals for doctors to figure out what to do with them
1954: Beginning of the modern nursing home Hospitals lobbied the government for help with
people with chronic illnesses who had nowhere to go
Separate custodial units for patients were created to clear out hospital beds; thus the term “nursing homes”
By 1970, thirteen thousand nursing homes had been built, and today there are 15,600
Today, about half of all Americans will spend a year or more of life in a nursing home
Funded by Medicare (1965), Medicaid (1966), or long-term-care insurance
Conceptualized as a place that would eliminate the need for nursing homes
First assisted living home for the aged built in Oregon in the 1980s by Keren Brown Wilson
Concept was to build an alternative to nursing homes, not a halfway station
Elderly people were to maintain as much control over their care as possible; deciding when to eat, how to spend their time and manage their possessions
Concept has migrated to become more institutionalized and again control most details of residents lives due to “safety concerns” and government regulations
Today it is more like an intermediate station between independent living and life in a nursing home
All over the world, from the beginning of time, women have cared for family, friends, and neighbors in time of need – birth, illness, death
Beginning in the early 19th century, these women were called ”angels of mercy” – and women daily continue these acts of mercy the world over
Medicare, Medicaid, and Older American’s Act was passed in the 1960’s to include home health care
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Home health services help adults, seniors, and pediatric clients who are recovering after a hospital or facility stay, or need additional support to remain safely at home and avoid unnecessary hospitalization.
These Medicare-certified services may include short-term nursing, rehabilitative, therapeutic, and assistive home health care.
For terminally ill patients, home care may include hospice care. For patients recovering from surgery or illness, home care may include rehabilitative therapies.
These Medicare-certified services may include short-term nursing, rehabilitative, therapeutic, and assistive home health care. This care is provided by registered nurses (RNs), licensed practical nurses (LPN's), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), home health aides (HHAs) and medical social workers (MSWs) as a limited number of up to one hour visits, addressed primarily through the Medicare Home Health benefit.
Non-medical home care is paid for by the individual or family.
The term "private-duty" refers to the private pay nature of these relationships. Home care (non-medical) has traditionally been privately funded as opposed to home health care which is task-based and government or insurance funded.
Home health care is often a lower cost solution to long-term care facilities.
Began in London, England and France in early 1950s First came into existence in 1970 in the US More than 1/3 of dying Americans use this service Medicare added hospice to its coverage in 1982 The difference between standard medical care and
hospice is not between treating and doing nothing The difference is in the priorities Standard medicine – goal is to extend life for as long as
possible, even if it means sacrificing the quality of a patient’s existence now- (chemotherapy, radiation, surgery, intensive care, etc.)
Hospice - goal is to help someone with a fatal illness have the fullest possible life right now
Hospice is not an easy choice for patients – they understand they have a fatal illness but have not necessarily acknowledged they are dying. A hospice nurse once said, “ Ninety-nine percent understand they’re dying, but one hundred percent hope they’re not.” From the book Being Mortal, by Atul Gawande
Accepting one’s mortality is a process, not an epiphany
Death is certain – the timing isn’t Doctor certifies the patient has 6 months or less
to live – can be re-certified and re-certified
The objectives: Freedom from pain and discomfort Maintaining mental awareness as long as feasible Helping patient and family understand and cope
with the fatal illnessHospice nurse and the first visit:“ A nurse has five seconds to make a patient like you
and trust you. It’s in the whole way you present yourself. I do not come in saying, “ I’m so sorry.”
Instead it’s: I’m the hospice nurse, and here’s what I have to offer you to make your life better, and I know we don’t have a lot of time to waste. From the book Being Mortal, by Atul Gawande
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The average number of Medicare home health providers per U.S. county fell by 7.31 percent from October 2014 to March 2017
Hospice providers per county increased by almost 13 percent over the same time period, according to the Centers for Medicare & Medicaid Services (CMS) May 2018 trend analysis.
There were 61.5 Medicare-certified home health providers per U.S. county during 2016, but that number fell to 60.57 for the period from April 2016 to March 2016. The average number of home health providers increased from 18.08 to 18.45 per U.S. county.The average number of users per provider increased for both hospice and home health providers.Moratorium on new home health providers exists in Texas, Florida, Illinois, and Michigan.
Medical Definition of palliative care: medical and related care provided to a patient with
a serious, life-threatening, or terminal illness that is not intended to provide curative treatment but rather to manage symptoms, relieve pain and discomfort, improve quality of life, and meet the emotional, social, and spiritual needs of the patient
<Many still believe palliative care is appropriate only when nothing more can be done to treat a patient's disease and prolong life. But unlike hospice, palliative care can and should be delivered while patients continue treatment for their diseases.—Jane E. Brody, The New York Times, 3 Dec. 2013 Webster’s Medical Dictionary
There’s almost always something the medical profession can do to prolong life
How can we do better?
Being Mortal, Atul Gawande
The goal of healthcareis not singular “to save lives”- the goal is to save lives for the purpose of living
well. Being Mortal, Atul Gawande
Biological Disruption of internalized body image- loss of
normal health Physical impact of the disease itself Physical impact beyond the actual disease –
side affects of medications and treatment Generalized physical deterioration Life is not a constant – it is dynamic and ever
changing
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Psychological Shock of diagnosis Transformation from person to patient Impact on the person, family, and friends Fitting into the healthcare system Loss of personal power and control Free-floating anxiety Shaking the foundation Disorientation of the self
The meaning of life is paradoxical – life is fundamentally unnecessary
The meaning of life is an anomaly; an assignment we make our own
The meaning of life is unconditional, so don’t wait for conditions to “be right”
The meaning of life is relational – a parallel value system rather than a pyramid
Note: There may be no ultimate meaning – we don’t know yet!
The genetic legacy of our pre-human paleolithic past still rules. Edward O. Wilson
The indelible stamp of our lowly origins. Charles Darwin
Mid-level awareness: Sense of self in others, Willingness to share resources, Devotion to the welfare of others, Imagination-flights of fancy
Upper level awareness: Deliberate consciousness
Being present – stop, look, listen Being inclusive, taking it all into our awareness The healing power of the collective mindful –
not separate or alone; the illusion of separateness
The possibility of the collective unconsciousCarl Jung – Dream states
What we know about ourselves is shaky at best Fragility – subject to the laws of nature Randomness – luck of the draw The Illusion of Separateness Uncertainty – our largest pool of knowledge is
yet to be discoveredHere, on the edge of what we know, in contact with the ocean of the unknown, shines the mystery and the beauty of the world. And it’s breathtaking.
Seven Brief Lessons on Physics, by Carlo Rovelli
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Can’t run away from life The journey and how we do it, is what is
important The journey is more important than the
destination We are all going to die – we can show resilience
in the darkest of circumstances To forget time, to forgive life, to be at peace.
Oscar Wilde
Understand that throughout the experience of dying, coping is a process, not an epiphany
Acknowledge the real terrors – anxiety about suffering, loved ones, finances, and death
Determine what is most important to the person under the circumstances of each step of the process
After discovering what is most important, provide honest information and suggestions on the approach that gives the best chance of achieving that goal
Resist superimposing your desires on the person and family – This is not about you – You will have your turn
Living with permanent loss is learning to live with less, rather than more
Defining the loss – What is temporary? What is permanent?
Letting go, mourning the loss Creating a historical narrative – perspective
matters Take a look at that which is embedded in the
suffering that is not suffering - It’s not all bad
Reframing- the mighty Mississippi vs. the Dead Sea
Your personal view of how finite your time in this world is determines your narrative –narrows your world or expands it
De-reflection as a method for movement and healing the mind
Everything that has a beginning has an ending.Make your peace with that and all will be well.
Jack Kornfield
An end-of-life option that allows certain eligible individuals to legally request and obtain medications from their physician to end their life in a peaceful, humane, and dignified manner
No longer called Assisted Suicide Compassion & Choices is the nation’s largest and
oldest nonprofit organization working to improve patient rights, care, and individual choice at the end of life, including access to medical aid in dying
Promotes: Self-determination, Autonomy, and Balance between quantity and quality
compassionandchoices.org deathwithdignity.org
In order to qualify –1) 2 physicians must state the person has a terminal
illness and is reasonably expected to die within 6 months
2) The person’s medical condition must not affect cognitive ability
3) The person has the right to change their mind4) The person must be able to independently take the
prescription to end their lifeNOTE: Aid in dying is not euthanasia, which is illegal in all 50 states
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States with Death with Dignity law California Colorado District of Columbia Hawaii Oregon Vermont Washington New Jersey (August 2019) Maine (September 2019_
Louisiana New Hampshire North Dakota South Carolina Texas Virginia West Virginia
www.deathwithdignity.org
It is a comfort for some who are dying to have the choice to end their life; rarely do people choose to do it
In California, physicians across the state say the conversations that health workers are having with patients are leading to patients’ fears and needs around dying being addressed better than ever before. They say the law has improved medical care for sick patients, even those who don’t take advantage of it.
In Oregon, in 2017, 218 people received end of life prescriptions, 143 used them
In California, in 2017, 191 people were prescribed the end of life drugs, 111 used them
Most of those who use aid in dying prescriptions have terminal cancer, and are tired of fighting
Three kinds of relationships clinicians have withpatients Paternalistic – clinicians are the medical authorities
and do what they believe is best for patients Informative - the opposite of paternalistic. Patient
is told the facts and figures, the rest is up to the patient. Patient makes the decisions.
Interpretive – clinicians role is to help patients determine what they want. “What is most important to you?” “What do you want?” Shared decision making.
From a paper by medical ethicists, Ezekiel and Linda Emanuel
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Medicare reimbursement effective 1/1/2016 The Centers for Medicare and Medicaid Services (CMS) approved payment for voluntary end-of-life counseling as part of the 2016 Medicare physician fee schedule.
This new policy gives patients more decision making control over the type of care they receive and when they receive it and is an important part of advance-care planning (ACP).
A 2013 national survey by The Conversation Project, a non-profit that supports end-of-life planning and family discussions, found that 90% of people say that talking with their loved ones and health providers about end-of-life care is important, yet only 27% have actually done so.
“For Medicare beneficiaries who choose to pursue it, advance care planning is a service that includes early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the type of care that is right for them,” Medicare said last fall when announcing 2016 program changes.
Advance planning will also be covered if provided by “non-physician practitioners,” that includes nurse practitioners (NP), clinical nurse specialists (CNS), certified nurse midwives (CNM) and physician assistants (PA).
Advanced Care Planning (ACP) also can be an optional, and reimbursable, element of Medicare’s annual wellness visit.
There are two current procedural terminology (CPT) billing codes for ACP. CPT code 99497 covers a discussion of advance directives with the patient, a family member, or surrogate for up to 30 minutes. An additional 30 minutes of discussion takes the add-on code of 99498. Medicare will pay roughly $86 for 99497 in a physician’s office or $80 in a facility, and $75 or $70 for 99498, according to the AMA. Medicarewill only pay for advance care planning when the services are medically reasonable and necessary.
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When provided as a separate payable service, advance care planning is subject to a 20 percent coinsurance as required by law. The statute only allows a Medicare service to be provided not subject to coinsurance and deductible when it is provided as part of a preventive or screening service such as the “Welcome to Medicare Visit” (when a person first enrolls in Medicare) or the annual wellness visit.
Living Will
Health Care Proxy
Designation of Agent for After Death Arrangements
LIVING WILL: A document that takes effect while you are living, that tells your doctor or other health care provider whether or not you want life-sustaining treatments or procedures administered to you if you are in a terminal condition or an irreversible coma.
A LIVING WILL goes into effect when 1) Your doctor has a copy of it, and 2) Your doctor and one other doctor have
concluded you are no longer able to make your own health care decisions, and
3) Your doctor and one other doctor have determined you are terminally ill or are in an irreversible coma.
Note: A Living Will includes a DNR or Do Not Resuscitate order; but is not the same.
A DNR order is a document prepared by your doctor at your direction and is placed in your medical record.
It states that if you suffer a cardiac arrest (your heart stops beating) or respiratory arrest (you stop breathing), your health care providers are not to revive you by any means.
A legal document that allows you to appoint someone you trust to make medical decisions for you if your doctor decides you have become temporarily or permanently unable to make decisions yourself.
You may appoint someone as your Primary Agent and choose an Alternate Agent if the Primary Agent is unable or unwilling to act in your behalf.
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Your healthcare agent or your alternate agent cannot be held legally liable for healthcare decisions made on your behalf, nor can he or she be held liable for costs for your care because he or she is your agent.
If you fear your next of kin will not be willing or able to follow your after death instructions, you may appoint a person you trust (family member, friend, or attorney) who is designated the Special Power of Attorney or Designated Agent responsible for following your wishes for what happens to your body after death.
1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
2. I wish I hadn’t worked so hard.3. I wish I’d had the courage to express my
feelings.4. I wish I had stayed in touch with my
friends.5. I wish that I had let myself be happier.
The right to fully live until the end, honoring personal values and beliefs
Understanding and supporting individuality Narratives are not sound bites – stories take
time – the whole story, even more time Understanding the difference between the need
for emergency action and quality of life nurturing
When there is less time available, more time is required, thus, slow the process and make adjustments to priorities
Any goal that excludes “a life worth living” is an inferior goal – even in healthcare – or maybe, especially in health care
The worth of a life can only be fully determined by the person living it
The task of healthcare is to discover value, not determine it
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Insuring the balance through healthcare; training, institutional structure, and policy
Insuring the balance in social services; public policy, oversight of the systems, and continued progressive development
Insuring rights protected by legal and political means – the most difficult of all structures
1. Laws2. Interpretation and oversight3. Loss of rights through collusion and corruption
Probate guardianship fraud Private guardianship businesses (using the
court system) Guardians can sell the assets and control the
lives of senior citizens without their consent –without family knowledge- and reap a profit from it
Private guardianship businesses train personnel through video sessions and call them “Qualified Dementia Care Specialists”
National hot spots for guardianship fraud –Albuquerque, San Antonio, Palm Beach and others
Approximately 10% of people over 65 are victims of this elder abuse
Richard Black, became director of Americans Against Abusive Probate Guardianship after his father-in-law became a victim
Remembrance – leaving a legacy
Purpose – singular life had meaning
Forgiveness
Memories and wisdom Death is a personal journey that each person approaches in a unique way and ultimately leads to the physical departure from the body. A dying person is alone.
There are milestones along this journey but not everyone will stop at each milestone. Some may take months to reach that final destination of death while others will take only days.
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When the person realizes that death is approaching, may begin to withdraw from surroundings, beginning the process of separating from the world and those in it. May decline visits from friends, neighbors, and even family members.
A person may become more difficult to interact with and care for and begin to contemplate life and revisit old memories, sorting through any regrets.
May experience reduced appetite and weight loss as the body begins to slow down.
May sleep more. Altered body chemistry actually
produces a mild sense of euphoria. The person is neither hungry nor thirsty
and is not suffering by not eating.
Mental changes The person begins to sleep most of the time. Disorientation is common and altered senses of perception can be
expected. May experience delusions, such as fearing hidden enemies or feeling
invincible. May experience hallucinations, sometimes seeing or speaking to people
that aren’t there. (Or are they there??) Most often these are people who have already died.
Some see this as the veil being lifted between this life and the next. The dying person may pick at sheets and clothing and appear
agitated. The person makes movements and actions that make no sense to
others; moving further away from life on earth.
Physical Changes The body temperature may lower by a degree or more. Blood pressure lowers. Pulse becomes irregular and may slow down or speed up. There is increased perspiration Skin color changes as circulation becomes diminished; most
notable in the lips and nail beds as the usual color leaves the face and may appear bluish.
Breathing changes occur, often becoming more rapid and labored. Congestion in the lungs and airway may also cause a rattling sound and cough.
Speaking decreased and eventually stops altogether.
A few days to several hours prior to death There may be a surge of energy as death
approaches. Person may want to get out of bed and talk to
loved ones. May ask for food after days of no appetite. This surge of energy is at times less noticeable
but is usually the dying person’s final physical expression before moving on.
This surge of energy is usually quite short and the previous signs become more pronounced as death approaches.
Breathing becomes more irregular and often slower.
Cheyne-Stokes breathing may occur; rapid breaths followed by periods of no breathing at all.
Congestion in the airway can increase causing loud, rattled breathing.
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Hands and feet may become blotchy and mottled (purplish). The mottling may slowly work its way up the arms and legs.
Lips and nail beds are bluish or purple. The person usually becomes unresponsive and may
have eyes open or semi-open but not seem aware of surroundings.
It is widely understood that hearing is the last sense to go and loved ones often want to sit with and talk to the dying person during this time. However….
Eventually breathing ceases and the heart stops. Death has occurred.
Hour 1 Hours 2-6
Livor mortisRigor mortis
Hours 7-12 Hours 12 and beyond
Secondary flaccidity
At the moment of death, all the processes of the body relax; primary flaccidity. Eyelids lose tension, pupils dilate, the jaw may fall open and the body’s joints and limbs are flexible.
Skin sags, causing prominent joints and bones in the body, such as the jaw and hips, to become pronounced.
Within minutes of the heart stopping, a process called pallor mortis causes the pinkish tone of a Caucasian person to grow pale as blood drains from the smaller veins in the skin. These changes are less obvious in a person of color.
At the same time the body begins to cool from the normal temperature of 98.6 degrees Fahrenheit (37 degrees Celsius) until reaching the existing temperature in the room; a process known as algor mortis.
This decrease in temperature follows a somewhat linear progression; 2 degrees Celsius in the first hour and one degree each hour thereafter (allowing forensic scientists to approximate the time of death, if necessary).
As the heart no longer pumps blood, gravity begins to pull it to the areas of the body closest to the ground, a process called livor mortis; with a reddish-purple discoloration in those areas from the accumulating blood. (Embalmers refer to this as the postmortem stain.)
Beginning in approximately the third hour after death chemical changes within the body’s cells cause all of the muscles to begin stiffening, known as rigor mortis.
The first muscles affected include the eyelids, jaws and neck.
Over the next several hours, rigor mortis spreads upward into the face and down through the chest, abdomen, arms and legs until it reaches the fingers and toes.
Due to the stiffening of muscles, it is best to prepare the body for natural burial within the first one to three hours after death.
It is not unusual for infants and young children who die not to develop rigor mortis due to their smaller muscle mass.
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Maximum muscle stiffness of the body occurs after roughly twelve hours due to rigor mortis, although this is affected by age, gender, physical condition, air temperature, and similar factors.
Limbs are difficult to move or manipulate. Knees and elbows will be slightly flexed and
fingers and toes can appear unusually crooked.
After reaching maximum rigor mortis the muscles will begin to loosen due to continued chemical changes within the cells and internal tissue decay.
This process occurs gradually, over a period of one to three days, and is influenced by external conditions such as room temperature (cold slows the process).
Rigor mortis dissipates in the reverse order in which it occurred, that is, fingers and toes loosen first, through arms and legs, and then up through the chest to the neck and face.
Eventually all the muscles relax again, a state known as secondary flaccidity.
Circle of life/death/life - Nothing ever truly dies. The universe wastes nothing, everything is simply transformed. The Day the Earth Stood Still ,2008
Native American Judaism Islam (Muslim) Buddhist Vietnamese/Hmong Catholic Protestant
Be humble, for you are made of earth. Be noble, for you are made of stars.
In New Mexico: Navajo, Ute, Jicarilla Apache, Sioux, and 19 Pueblo Tribes
Avoid generalizations regarding death practices–there are differences in all Indian tribes
Some bury their dead on tribal land within hours of death
Some perform “wakes” in the family home for 12 hours before burial
Some tribes wrap their loved one in a blanket or robe and bury on tribal land before sunrise
For some, it is taboo to bring a dead body into a home, therefore –
Most older patients would rather die in a medical facility as opposed to “dying in the comfort of their home”
Cost of a funeral is shared by relatives Some will utilize a mortuary and casket
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Some families have private ceremonies and bury on pueblo or reservation land, some use public burial sites
In a traditional Navajo burial a horse may be killed
Usually there is a dinner to send the deceased on their way
In the olden days: It was said that death should not be looked at.
Also, an abandoned dwelling should not be looked at if someone died inside.
The dead should not be talked about, thought about, or mentioned at all. To speak of death is to bring a curse upon yourself or loved ones.
Don’t touch- to touch a dead body is to bring unpleasantness upon yourself or loved ones.
Also important to know: When entering a patient’s room, it is cultural
etiquette to shake hands with everyone in the room, even small children and babies.
Sit at eye level and avoid staring at the patient. Palliative care may be perceived as less than
standard care by some patients; “The doctor has given up on me” or “ My doctor no longer wants to care for me.”
After the patient has been told of their diagnosis and prognosis-please do not keep repeating it, as they are not in denial-just holding on to hope.
If a patient is referred to hospice in what they feel is “too soon” they may accuse the doctor of giving up hope and will be upset with him/her.
A traditional person does not say “I’m dying”, rather “no more steps to take” or “nothing else to grasp onto”
Islamic and Judaic practices include specific rituals of bathing, shrouding, prayer rites, and immediate natural burial (preferably within 24 hours).
Reverential approach to honoring the dead Embalming, cosmetology, and cremation are
forbidden by both Jewish (Halakha) and Islamic law (Sharia).
Commonly in Judaism, a window will be opened if at all possible and the body will be covered with a sheet and otherwise left untouched
A guardian or witness (Shomer) will be appointed to be present with the deceased from death until burial
Ritual bathing and dressing will be handled by same-gender burial society members(Chevre Kadisha), in accordance with tahara or Judaic ritual purity rites.
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Jewish caskets are made entirely of wood. In construction they have been doweled, pegged, and glued together, no nails, metal, or unnatural materials. This makes the caskets "Kosher for Burial".
Jewish law requires the body be allowed to return to the earth as soon as possible. Therefore, the casket must be made entirely from wood, with several holes drilled in the bottom to hasten decomposition and the body's return to earth. The body should be buried facing east towards Jerusalem.
Death care practices in Islam often entail a team of three to four gloved people (same-gender) performing wajib (obligatory acts) which include ablution (wudu), ritual cleansing (ghusl), shrouding (kafan), funeral prayers (Salat-al-Janaza), and burial (dafan).
Ritual bathing follows a series of intentions (niyyats), steps and sequences as bathers work with the body on its side from head to toe, and right to left with warm, soapy water, as few as three and as many as seven times.
The last cleansing (ghusl) will be with camphor, rose or perfumed water.
The body is then wrapped in various white cotton or linen layers; the protocols for this vary by gender.
The shrouded body is lowered into the grave. Final prayers are said facing Mecca.
The body may often be left undisturbed for a period of time for the purpose of soul care and transition.
The body is believed to be returned to the elements of fire, water, earth, air, so natural burial is encouraged
Incense and candles are burned, a bathing ceremony is held, sutra prayers are sung or chanted, and flowers or significant items are often placed inside the casket to be buried or cremated with the body.
Traditionally bury in a casket, or outdoor cremation (funeral pyre)
Mourning period from 3 months to 3 years and indicated by wearing black arm band or black ribbon
Many Vietnamese and Hmong in U.S. communities are of the Catholic faith and follow Catholic burial practices
Mix of Buddhist and Shinto traditions Shinto is the native religion in Japan Nearly all families (91%) use a Buddhist priest The deceased is laid out in a simple wood coffin in the
family home with a white cloth covering the face, and ice is packed around the body
Friends and neighbors gather for a 3 day wake The priest kneels in front of the coffin to chant a sutra,
and the immediate family comes forward, one by one, and offer respect to the deceased.
The coffin is then transported to the crematorium for cremation
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After cremation, using a special pair of chopsticks (one bamboo, one willow: a bridge between two worlds), mourners pick out one particular neck bone that appears to contain a seated Buddha figure.
Everyone present, toddlers to geriatric, takes up chopsticks and transfers bones to a small pot.
Feet and leg bones are placed in the urn first, head bones placed last.
Collected bones are returned home and placed at an altar along with a picture of the deceased.
Various ceremonies take place over the following 35-49 days.
Then the urn is buried in a cemetery Japanese funerals cost an average of 200,000
yen, the equivalent of $25,000 U.S. dollars
It is customary for relatives to hold vigils over the dying, in order to accompany them until the very last moment before entering the afterlife
Family members take shifts to watch over the body and to show loyalty
Chinese funeral rituals comprise a set of traditions broadly associated with Chinese folk religion.
There are different rites depending on the age of the deceased, the cause of death, and the deceased's marital and social statuses.
Different rituals are carried out depending on what part of China the person is from
Many contemporary Chinese people carry out funerals according to various religious faiths such as Buddhism or Christianity.
In general, a funeral ceremony is carried out over seven days, and half are cremated and half are still buried in the traditional way.
Traditional burial customs show a strong belief in life after death and the need for ancestor veneration.
Confucian philosophy calls for paying respect to one's ancestors as an act of filial piety.
Prefer whole body burial, either natural or embalming, as it is deemed the most fitting way to express faith and hope in the resurrection of the body
The church recommends the bodies of the deceased be buried in cemeteries or other sacred places
Cremation permitted by Vatican and the Pope beginning in 1963, however, ashes CANNOT be scattered, but need to be placed in a container and buried , cannot keep ashes in the home
17
Also believe in resurrection of the body Burial practices vary, however all permit whole
body natural burial, embalming, or cremation with scattering of ashes or burying of ashes
Many are turning to natural burial for environmental reasons as well as desire to return to more natural, low cost, traditional burial practices
Traditional – Dying at home, verses dying in an institution; hospital, long-term care facility
Disposition of the body Embalming
Caskets and concrete vaults Cremation
Biodegradable urns and scattering urnsSpreading of ashes
Natural direct burial Pine or cardboard casketsOrganic natural fiber shrouds
Civil War to current war dead
The means of disposition of the dead defines a civilization
The right to choose must be respected Americans can reclaim the traditions that we gave
away to the funeral industry less than 100 years ago Most people, including those in critical positions such
as medical examiners, healthcare personnel, vital statistics staff, and even those in the funeral industry do not know that families have the legal right to care for their own dead.
The right to self-determination in funeral processes and practices
This is not a partisan matter, or a sectarian issue. Adherents of all political creeds and all faiths or none deserve this right.
This is a fundamentally American idea – that individuals and families are best equipped to decide how to carry out the duties we all experience when a loved one dies.
Most states do not legally require people to use a commercial funeral home, but the following ten do.
Alabama Connecticut Illinois Iowa Indiana Louisiana New York Michigan Nebraska New Jersey
18
The funeral industry is, by and large, a $20 billion for-profit enterprise, whose environmental impact has been greatly overlooked.
“A nation that destroys its soil, destroys itself.”Franklin D. Roosevelt
The average cost of a funeral in the United States is well over 8,000 dollars.
Statistics compiled by Mary Woodsen, Funeral Consumers Alliance, 2016
22,500 traditional cemeteries put the following into our soil:
827,060 gallons of embalming fluid, including formaldehyde
1,636,000 tons of reinforced concrete for vaults 90,272 tons of steel for caskets and 14,000 tons
of steel for vaults 2,700 tons of copper and bronze for caskets 30-plus million board feet of hardwoods
(including tropical wood) for casketsStatistics compiled by Mary Woodsen, Funeral Consumers Alliance, 2016
On average, one cemetery buries 1,000 gallons of embalming fluid, 97.5 tons of steel, 2,028 tons of concrete, and 56,250 board feet of high quality tropical
hardwood in just one acre. A typical 10-acre cemetery has enough wood in
the form of caskets to construct 40 houses, and there are also concerns about the pollution of groundwater near cemeteries.
Statistics compiled by Mary Woodsen, Funeral Consumers Alliance, 2016
Unfortunately, each cremation releases between .8 and 5.9 grams of mercury (between 1,000 and 7,800 pounds of mercury each year in the U.S.) as bodies are burned. These fumes are neurotoxic, especially to infants.
75% goes into the air and the rest settles into the ground and water.
You could drive about 4,800 miles on the energy equivalent used for one cremation, or a distance to the moon and back 85 times from all U.S. cremations in one year.
Statistics compiled by Mary Woodsen, Funeral Consumers Alliance, 2016
The Environmental Protection Agency does not currently regulate crematoriums.
Attempts to legislate regulations reducing emissions have successfully been blocked in many states.
Statistics compiled by Mary Woodsen, Funeral Consumers Alliance, 2016
Available in 6 states – CA, CO, MN, OR, MA, MD; legal in 12
Body is immersed for 3-12 hours in a large tank or chamber filled with water and potassium hydroxide (lye), heated to at least 200 degrees Fahrenheit
Dissolves the body, and after the tank is drained, some bone fragments and residue may remain and be given to family
Water is emptied down the drain Not allowed by the Catholic church as it is deemed
disrespectful to the body.
19
Offers an alternative to the financially expensive and environmentally costly conventional burial and cremation.
A body may be buried naturally, safely, and respectfully.
There are now over 300 natural burial sites in the U.S.
Natural burial is burial without embalming chemicals or cremation using a pine, bamboo, or wicker casket, or a bio-degradable, natural fiber blanket or shroud
When enlisting the services of a funeral home, average total cost is upwards of $8,000; depending on family involvement, total cost of a natural burial can be less than $1,000
After death the body can be claimed by next of kin such as spouse, adult child, or parent, or the person’s Designated Agent; or a traditional funeral home
The next of kin or Designated Agent has the right to transport the body, as does a funeral home
Transporting the body by next of kin or Designated Agent requires the family to file the death certificate following each state’s Health Department guidelines
The body may stay in, or be moved to, the person’s home, the home of the next of kin, or turned over to a funeral home
There is no law stating a body has to be embalmed or cremated
A deceased body has far less bacteria than a live body!
If embalming or cremation is chosen, a funeral home or direct depositor must be used
If the body is to remain in the home longer than 24 hours, gel packs, Techni-ice, or dry ice should be packed around the body.
It is only necessary to cool the diaphragm and abdominal areas (the core) to about 40 degrees Fahrenheit.
This traditional way of caring for our dead can help survivors during the grief process, while providing peace to the dying – knowing that their loved ones will be with them until the very end.
Death is not an emergency – Please do not insist on whisking the body away immediately. Allow the family time to say good-bye.
It is best to wash and dress the body within the first three hours after death due to the effects of rigor mortis, however, with massage, rigor mortis can be reversed
Two people, for instance a family member and hospice nurse, are necessary in order to roll, clean, bathe, shampoo, and dress the body.
20
Roll the person gently to the side to clean the small amount of leakage that may occur from the anus. After washing the area, pack the anus with a large amount of cotton. If the person has been bedridden, a disposable diaper can be put on as well.
If there are bed sores, clean and cover with DuoDerm or plastic wrap.
When the person is rolled to the side, there may also be some blood and mucous drainage from the mouth (usually less than a cup). A baby aspirator can be used to suction fluids from the nose or mouth.
Clean and swab the mouth and gently brush the teeth with a small amount of toothpaste or antiseptic mouthwash, or clean dentures and place in the person’s mouth.
Gently give the body a sponge bath May lotion the body using the person’s favorite
lotion. Close the eyes and place a soft cloth over the
eyes followed by a sock filled with dried beans or rice to keep the eyes closed. Leave in place for several hours.
Dress the body in clothes chosen by the person or by the family. This works best with two people.
Clothing can be cut up the back and tucked around the person if the person is large and difficult to dress.
Make-up can and should be applied if the person is the type that “wouldn’t be caught dead” without it.
What will you set out to achieve or change before you die?
Describe what you want loved ones to do with your body after death.
How do you want to be remembered?
Live well-not in spite of death-but because of it.
INSTITUTE FOR NATURAL RESOURCES (INR) ADMINISTRATIVE POLICIES
(Effective January 1, 2019)
1. To obtain the 6 hours of credit (0.6 CEU) associated with this course, the health care professional will need to sign in, attend the course, and complete program evaluation forms. At the end of the program, the health care professional successfully completing the course will receive a statement of credit.
2. Individuals canceling their registrations up to 72 hours before a seminar will receive a tuition refund less a $25.00 administrative fee. Other cancellation requests will only be honored with a voucher of equal value -- good for one year -- to a future seminar. All requests for refunds and vouchers must be made in writing. Vouchers are not redeemable for cash and are not transferable.
3. Registrations are subject to cancellation after the scheduled start time. Nonpayment of full tuition may, at the sponsor’s option, result in cancellation of CE credits issued.
4. If a seminar cannot be held because of reasons beyond the control of INR (e.g., acts of God), the registrant will receive free admission to another seminar but no refund, or a full-value voucher, good for one year, for a future seminar.
5. Course completion certificates will be available at the conclusion of the seminar. INR strongly recommends that you keep a copy of the course brochure with your course completion certificate in your professional portfolio to satisfy any Board concerns in case of audit.
6. Certain individuals will need to sign a roster sheet at the seminar’s conclusion. In order to receive continuing education credit for an INR seminar, attendees must sign all necessary attendance verification sheets. Please see the instructor for more information. Attendees must attend the entire seminar to receive full course credit.
7. A $15.00 charge will be imposed for the issuance of a duplicate certificate.
8. A $25.00 charge -- in addition to the amount owed -- will be imposed on all returned checks.
9. Electronic recording of any INR seminar or the copying of any part of or all of an INR syllabus, without the express written consent of INR, is strictly forbidden.
10. Syllabuses are available only at seminar sites. Only one syllabus per registrant will be provided. Syllabuses cannot be obtained from INR’s headquarters. Copies of program slides will not be provided.
11. All letters of inquiry written to INR and its instructors must contain a day-time and evening-time telephone number.
12. INR does not accept collect telephone calls.
13. INR, a nonprofit scientific and educational public benefit organization, is totally supported by the tuition it charges for its seminars. INR does not solicit or receive gifts or grants from any entity. Specifically, INR obtains no gifts or grants from any company involved in the sale or distribution of food, food supplements, pharmaceuticals, health care, insurance, printed materials, computers, software, or telecommunications. Nor does INR receive funds from religious, political, or governmental sources.
14. INR lecturers are prohibited from discussing, accepting and/or distributing unsolicited products, services and information. Neither INR nor any of its instructors has a material or financial interest with any entity, product, or service mentioned in the seminar unless such relationship is disclosed at the beginning of the program.
15. While this syllabus and presentation may contain descriptions of ways of dealing with health, health care, nutrition, diet, various health conditions, and the electronic retrieval and use of health care information, the information presented is not intended to substitute for a health care practitioner’s diagnosis, advice, and treatment. Before using any food, drug, supplement, or procedure described in the syllabus and/or presentation, each individual should consult with his or her health care provider for individual guidance with specific medical problems.
- R1 –
REFERENCES (IN ORDER OF CITATION) • Arnold, E.M., Artin, K.A., Griffith, D., Person, J.L., & Graham, K.G. (2006). Unmet needs at the end of life: Perceptions of hospice social
workers. Journal of Social Work End-of-Life Palliative Care, 2(4), 61-83.
• Butler, L. & Brizendine, K. (2005). My Past is Now My Future: A Practical Guide to Dementia Possible Care. Warwick House Publishing
• Byock, Ira M.D. (2014) The Four Things That Matter Most-10th Anniversary Edition: A Book About Living. ATRIA books, A Division of
Simon and Schuster, Inc.
• Callanan, M., Kelley, P. (2012) Final Gifts: Understanding the Special Awareness, Needs and Communications of the Dying. Simon and
Schuster Paperbacks, Inc.
• Canadian Integrative Network for Death Education and Alternatives CINDEA/ca.com: cms.gov, nih.gov, and cdc.gov
• Chochinov, H. M., & Cann, B.J. (2005). Intervention to enhance the spiritual aspects of dying. Journal of Palliative Medicine, 8 (Suppl. 1), 103-
115
• Cousins, Norman (1990). Head First: The Biology of Hope and the Healing Power of the Human Spirit. Penguin Books
• Cousins, Norman (2005) Anatomy of an Illness: As Perceived by the Patient (Twentieth Anniversary Edition). W.W. Norton and Company
• Doughty, Caitlin (2014). Smoke Gets in Your Eyes and Other Lessons from the Crematory. W. W. Norton and Company, Inc.
• Essentials for Practicing Home Funeral Guides. National Home Funeral Alliance
• Estes’, Clarissa Pinkola (1995). The Faithful Gardener: A Wise Tale About That Which Can Never Die. HarperSanFrancisco
• Gawande, Atul M.D. (2014) Being Mortal – Medicine and What Matters in the End. Metropolitan Books, Henry Holt and Company, LLC
• Gawande, Atul, M.D., Is Health Care a Right? The New Yorker, Oct. 2, 2017
• Gourdji, I., McVey, L., & Purden, M. (2009). A quality end of life from a palliative care patient’s perspective. Journal of Palliative Care, 25(1),
40-50
• Hoffner, Ann (2017), The Natural Burial Cemetery Guide: Where, How, and Why to Choose Green Burial, Published by Green Burial Naturally
• Hunter, E. G., (2008). Legacy: The occupational transmission of self through actions and artifacts. Journal of Occupational Science, 15(1), 48-
54.
• Jacques, N.D., & Hasselkus, B.R. (2004). The nature of occupation surrounding dying and death. OTJR: Occupation, Participation and Health,
24, 44-53.
• Kalanithi, Paul (2016). When Breath Becomes Air. Random House
• La Cour, K., Josephsson, S., & Luborsky, M. (2005). Creating connections to life during life- threatening illness: Creative activity experienced
by elderly people and occupational therapists. Scandinavian Journal of Occupational Therapy, 12, 98-109.
• La Cour, K., Josephsson, S., Tishelman, C., & Nygard, L. (2007). Experiences of engagement in creative activity at a palliative care facility.
Palliative and Supportive Care, 5(3), 241-250.
• Laqueur, Thomas W. (2015). The Work of the Dead: A Cultural History of Mortal Remains. Princeton University Press
• Lin, H.R., & Bauer-Wu, S.M. (2003). Psycho-spiritual well-being in patients with advanced cancer: An integrative review of the literature.
Journal of Advanced Nursing, 44(1), 69-80.
• Marshall, Hunter (2015). Going Green When You Die: An Alternative to Toxic Funerals. Waging Nonviolence
• Nuland, Sherwin B. (1995). How We Die: Reflections of Life’s Final Chapter. Vintage Books, a Division of Random House, Inc.
• Nuland, Sherwin B. (1997). How We Live. Vintage Books, a Division of Random House, Inc.
• O’Donahue, John (2008). To Bless the Space Between Us: A Book of Blessings. Doubleday
• Poer, Nancy Jewel (2004). Living into Dying: A Journal of Spiritual and Practical Deathcare for Family and Community. White Feather
Publishing Company
• Prince-Paul, M. (2008). Relationship among communicative acts, social well-being, and spiritual well-being on the quality of life at the end of
life in patients with cancer enrolled in hospice. Journal of Palliative Medicine, 11(1), 20-25.
• Rehm, Diane (2016). On My Own. Alfred A. Knopf
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• Roach, Mary (2003). Stiff: The Curious Lives of Human Cadavers. W. W. Norton and Company, Inc.
• Ryan, P.Y. (2005). Approaching death: A phenomenologic study of five older adults with advanced cancer. Oncology Nursing Forum, 32(6),
1101-1108.
• Saarik, J. & Hartley, J. (2010). Living with cancer-related fatigue: Developing an effective management programme. International Journal of
Palliative Nursing, 16(1), pages 8-12.
• Sehee, Joe. GREEN BURIAL: IT’S ONLY NATURAL. The Property and Environment Research Center PERC Report, Volume 25, No.4.
Winter 2007
• Singer, P.A., Martin, D.K., & Kelner, M. (1999) Quality end-of-life care: Patient’s perspective. Journal of the American Medical Association,
13(2), 163-168.
• Slocum, Joshua; Carlson, Lisa (2011). Final Rights: Reclaiming the American Way of Death. Upper Access, Inc., Book Publishers
• Svidon, G.A., Furst, C.J., von Koch, L., & Borell, L. (2009). Palliative day care- A study of well-being and health-related quality of life.
Palliative Medicine, 23(5), 441-447.
• Terrell, Kenneth (2017) What you need to know about America’s Nursing Home. AARP Bulletin, Nov. 2017. Vol. 58, No. 9
• The Hospice Foundation of America: The Dying Process: A Guide for Caregivers: theconversationproject.org, Walker, Emily P. (2015).
Medicare reimbursement for physician discussion with patients regarding end of life options.
• The Top Five Regrets of the Dying. Balboa Press InternationalWebster, Lee (2015).
• Washington Correspondent, MedPage Today Ware, Bronnie (2011).
For each item below please circle the correct response. Circle only one response per item. 1. The Centers for Medicare and Medicaid Services (CMS) approved payment for end of life discussions:
a) As part of the 2016 Medicare physician fee schedule b) To give doctors more decision-making control over patient care c) As an important part of advance-care planning d) A and C
2. Advanced Care Planning includes: a) Living Will b) Health Care Proxy c) Designation of Agent for After Death Arrangements d) All of the above
3. Standard medicine: a) Extends life for as long as possible b) A person’s current quality of life may be sacrificed c) Has the same priorities as hospice d) A and B
4. Palliative care: a) Is only appropriate when there is nothing more that
can be done to extend a person’s life b) Is intended to provide curative treatment and manage
symptoms c) Is also expected to meet the social and spiritual needs
of the patient d) None of the above
5. Aid in Dying: a) Eight states and Washington D.C. now have a Death with Dignity Law b) Aid in Dying or Death with Dignity was never
called Assisted Suicide c) There are currently only three states considering
Death with Dignity laws this session d) Anyone can be considered for Aid in Dying at any
time
6. Power of Attorney for Healthcare: a) Is not a legal document b) A doctor decides if a person is unable to make
medical decisions c) A healthcare agent can be held legally liable
for the decisions made on a person’s behalf d) All of the above
7. In most Native American cultures:
a) Burial practices are the same b) Some older Native American patients would rather
die in a hospital than in their own home c) A mortuary is never used d) All of the above
8. The Catholic church:
a) Permits cremation, but the ashes need to be kept in a container in the family home
b) Permits cremation, but the ashes must be scattered
c) Prefers whole body burial d) None of the above
9. According to a book by Bronnie Ware, the top 5 regrets of the dying include:
a) I wish I had worked harder when I was younger b) I wish I’d had the courage to live the life others
expected me to live c) I wish I could have controlled my feelings better d) None of the above
10. Death:
a) Is a personal journey that each person approaches in a unique way
b) There are common milestones, and every dying person has to go through each one
c) When the person realizes death is imminent, he/she usually wants lots of visitors
For each item below please circle the correct response. Circle only one response per item. 11. One to two weeks prior to death: a) The person begins to sleep most of the time b) May pick at sheets and clothing and appear agitated c) Blood pressure increases d) A and B 12. Several hours prior to death: a) A person will never ask for food or try to get out of bed b) Breathing becomes irregular and often slower c) Vision is the last sense to go d) Lips and nail beds become white 13. After death occurs:
a) It takes about three hours for primary flaccidity to occur
b) Pallor mortis is more obvious in people of color
c) Algor mortis is when the body cools until it reaches the temperature in the room d) The first muscles affected by rigor mortis
are in the fingers and toes
14. Rigor mortis: a) Is caused by chemical changes within the body’s cells
b) Muscles begin to stiffen approximately the third hour after death c) After reaching maximum rigor mortis, muscles relax in reverse order d) All of the above
15. Embalming: a) Began in the United States at the time of the Civil
War b) Is required by law in most states. c) Uses toxic chemicals that affect ground water d) A and C
16. Cremation: a) Can be done in an outdoor funeral pyre in
every state b) Is not harmful to the environment c) The Environmental Protection Agency does
not regulate crematoriums d) One could drive about 2,000 miles on the
energy equivalent for one cremation
17. Natural burial: a) Is legal in every state in the United States
b) After death the body can be claimed and transported by next of kin except in 10
restrictive states that must involve a funeral home
c) Is a fraction of the cost of embalming or cremation d) All of the above
18. According to the national non-profit, The Conversation Project: a) 80% of people in the United States have told family what they would like to have done with their body after death b) 72% of people have a DNR in place c) Only 27% of people have talked with loved ones about their end of life wishes d) A and B
19. In Jewish and Islamic law: a) It is important to embalm or cremate the body after
death b) There are specific rituals of bathing, shrouding, and
prayer done within 24 hours of death when possible c) The use of cosmetics and perfumes to prepare the
body is allowed d) Kosher caskets are built with metal nails
20. A Designated Agent for After Death Instruction:
a) Is only necessary if the person fears next of kin will not follow their end of life wishes
b) Has to be witnessed and notarized in every state in order to be legal
c) There may not be an alternate designated agent appointed
Course Title: Hospice & Palliative Care SEMINAR LOCATION:________________________________ INSTRUCTOR: ______________________________________
I. Please circle the appropriate number indicating the extent to which you agree or disagree with the following statements. The rating scale ranges from 1 to 5, where 1 = disagree and 5 = agree.
Strongly Disagree
Strongly Agree
A. The course content was consistent with stated learning objectives 1 2 3 4 5 B. The course content was appropriate for the intended audience. 1 2 3 4 5 C. To what extent did you achieve each of the course’s major objectives?
1) Summarize the recent Medicare law regarding end-of-life discussions with patients and define options for patient and provider consideration.
1 2 3 4 5
2) Discuss the psycho-social implications of death and dying among varied cultures and religions and how this effects healthcare delivery.
1 2 3 4 5
3) Identify the concerns most expressed by the dying. 1 2 3 4 5
4) Identify patient rights to live with dignity and as much independence as possible until the end. 1 2 3 4 5
5) Cite the philosophy, history and tradition of death and dying over time and how current beliefs developed.
1 2 3 4 5
6) Discuss heroic measures verses natural death and discuss caregiver support. 1 2 3 4 5
7) Describe the stages of death, the timeline of what happens to the physical remains after death, and care of the body after death.
1 2 3 4 5
8) Identify necessary legal documents regarding death, disposition of the body, family and patient rights, and how these important statutes assist the poor and the marginalized.
1 2 3 4 5
D. The length of time to complete this course matches the number of CE credits approved. 1 2 3 4 5 E. The teaching and learning methods, including active learning strategies, were appropriate. 1 2 3 4 5 F. The instructor was knowledgeable of the subject and was well qualified. 1 2 3 4 5 G. The learning assessment activities, including the post-test, were appropriate. 1 2 3 4 5 H. Overall, the seminar met my educational needs, and the educational materials were useful. 1 2 3 4 5 I. Useful, new knowledge was presented at this program. 1 2 3 4 5 J. The physical facilities were conducive to learning. 1 2 3 4 5
_____________________________________________________________________________________________________________________________________ II. I would recommend this course to a professional colleague. Yes ________ Not sure ________ No ________ III. I would recommend this instructor to a professional colleague. Yes ________ Not sure ________ No ________ IV. Did this course provide you with helpful and useful information to change your practice? Yes _______ No _______ If yes, how do you intend to change your practice? ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Copyright 2020, INR (Institute for Natural Resources). All rights reserved.
V. The presentation was balanced and free of commercial influence or bias.
Yes ________ No________
If no, please explain: VI. How much did you learn as a result of this CE program? VII. How useful was the content of this CE program for your practice or other professional development?
VIII. Please use this space for additional comments.
Hospice-08-18
Very Little
Great Deal
1 2 3 4 5
Not Useful
A Little Useful
Some what Useful
A Good Deal Useful
Extremely Useful
Category a: Home-study Books (Please complete the purchase form on page 8)
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also v is i t WWW.INRSEMINARS.COMHealth UpdateHOME-STUDY COURSES
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Globesity: Ten Things You Didn’t Know Were Making You Fat by Clare Fleishman, MS, RD
5 CONTACT HOURS *Not for Dietetic (rD/rDN) creDit (credit available for other professions)It is estimated that 1.4 billion adults—one in three across the globe—are overweight. Registered dietitian and health writer Clare Fleishman explores surprising new suspects contributing to our planet’s expanding girth. This important work examines how we live in a new century and why obesity has become a major
killer from the American Midwest to the cities of Europe and across the deserts of Africa.
Healing Power of Sleep - 2nd Editionby Mary O’Brien, MD
5 CONTACT HOURSMillions of us struggle with sleep several nights a week, if not every night. In The Healing Power of Sleep, Dr. O’Brien explains the basics of sleep architecture, the effects of common illnesses on sleep, how our daily habits can help or hinder sleep, and straightforward solutions.
The Hungry Brainby Laura Pawlak, PhD, MS
5 CONTACT HOURSThe Hungry Brain explores new discoveries about the brain’s hunger for pleasure and calories—the so-called “irresistible” foods—and how one can control temptation. The book discusses the latest scientif ic f indings about nutrients that speed memory processing and protect against Alzheimer’s disease—including a brain homework plan and a
grocery list to make it happen!
Integrative Healingby Z Altug PT, DPT, MS, CSCS
4 CONTACT HOURS Connect your mind and body for maximum wellness with this beginner's guide to Eastern and Western philosophies of body movement. Licensed physical therapist and health writer, Dr. Ziya Altug shows you exactly how to achieve total wellness by incorporating mindfulness and meditative practice into a healthy lifestyle. His book is filled with practical exercise photographs, tables, checklists and charts to help
patients and clients track their progress toward their wellness goals. This book is one of the winners of the 2018 Clinician Non-Research Publication Award from the California Physical Therapy Association.
Love Me Trueby Jason B. Whiting, PhD, LMFT
4 CONTACT HOURSThis course will explore ways partners get caught in patterns of subtle and blatant deception. It will use fun stories from real couples and examples from research to examine how cognitive and emotional processes cause blindness and rationalization, and distort couples’ perceptions. This course will identify research-based strategies to increase trust and connection, and professionals can use this information
to identify and appropriately address issues related to self-deception and honesty in the individuals with whom they work.
Media Mazeby Eric Rasmussen, PhD
4 CONTACT HOURSThis course will explore the prevalence of children’s media use, many of the media effects that are of most concern to those interested in the well-being of youth, and the social scientific theories that explain how children’s brains cognitively and emotionally process media content. Finally, the course identifies specific strategies that can be taken to help youth avoid the potentially negative effects, and enjoy the potentially
positive effects, of media exposure.
Pain Reliefby David Cosio, PhD, ABPP
4 CONTACT HOURSHaving worked as a pain clinic psychologist for over 10 years, Dr. David Cosio shares a wealth of strategies for dealing with this evergrowing epidemic in everyday circumstances—without relying on addictive medications. Pain Relief combines new insights into the perception of pain with practical, interdisciplinary treatments. Discover key coping skills for helping people with chronic pain, steps to
creating a comprehensive pain management plan, and over 20 different available pain management modalities.
Screen Savvyby Ryan J. Anderson, PhD
4 CONTACT HOURSThis course will help the reader examine the impact of common digital media usage on individuals, families, and society. Course participants will learn about both positive and negative effects of modern media, and will explore the concerning trends of societal norms in this area. Readers will receive an in-depth explanation of process addictions and the phenomenon of Internet Gaming Disorder (IGD). Guidelines and strategies
for creating a sustainable relationship with digital media are set forth.
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Category a: Home-study Books (continued)
Buy more, Save more: Buy all 16 BookS, Save $75
FREESPECIAL OFFER: for a limited time at webinar ONLY!
*w/any purchase: “Addiction – 4th edition” *Limited to one per customerw/purchase of $99 or more: “Emotional & Social Intelligence – 2nd edition”w/purchase of $199 or more: Pain Relief (See page 8 for more details)
WEB_ Page 2 2012020
Successful Aging - 2nd Editionby Mary O’Brien, MD
4 CONTACT HOURSThis home-study course describes the best ways to age healthfully and improve your patients’ quality of life at any age, including tips on how to cultivate a youthful attitude, safeguard against stress and chronic illness, improve dietary and exercise habits, maximize memory and beef up energy, enhance financial security, and live a long and rewarding life.
4 CONTACT HOURSThis home-study course outlines the various factors that make foods palatable. It provides evidence that the "hyperpalatability" of our current food supply is undermining our normal satiety signals, motivating the drive to eat even when there is no physiologic need for food. This course presents evidence that repeated exposure to high quantities of palatable foods (i.e., those high in sugar, fat and salt) can
alter the brain in ways similar to drugs of abuse, essentially "rewiring" the brain to promote compulsive eating and loss of control over food.
*Not for ce creDit*Learn to use traditional yoga routines to relieve the pain from common injuries and conditions. With simple lists of asanas and sample sequences for different proficiency levels and physical limitations, this in-depth guide to teaching and sharing yoga is perfect for yoga instructors and fitness and healthcare professionals. Learn which specific poses to suggest for injury prevention as well as which to recommend for those
who are struggling with spinal or back injuries.
The Fearless Mindby Craig L. Manning, PhD
*Not for ce creDit*Life is a performance whether you're on the field, in the courtroom, or running a household. But many of us, when asked to perform, are overcome by fear. We lose our confidence and allow our insecurities to hinder us. In The Fearless Mind, sports psychologist Dr. Craig Manning will help you overcome your fears, expel anxiety, build confidence, and become a high-performing individual no matter what your field. Learn
how to unlock your mind and reach your greatest dreams. There are many mental pathways to performance, but there is only one pathway to true success having a fearless mind.
Weight Perfect - 3rd Editionby Mary O’Brien, MD
6 CONTACT HOURSThis home-study course describes the newest research on losing weight and maintaining weight loss for life. The book provides details about the connection between weight gain and medical conditions, and obesity and sleeplessness. It also gives information about popular weight loss plans, describes scientific studies on the effectiveness of these plans, and discusses research on the connection between
emotions, cravings and overeating.
Irritating the Ones You Love by Jeff Auerbach, PsyD
4 CONTACT HOURS Irritating the Ones You Love explores how “unconscious” reasons control so much of our choices and behavior in relationships—the hidden reasons we are drawn to particular partners, and how, unknowingly, the past affects our reactions in present situations. This book provides tools to help readers uncover the hidden influences on them so that they can choose partners for the “right” reasons, grow as human beings, stop
making the same mistakes when issues arise with their partner, and make their relationships more intimate and happy.
Living to be 100 - 2nd Editionby Michael Howard, PhD
4 CONTACT HOURSDo you want to live the longest, healthiest, happiest life you can with the best mental and physical functioning? This home-study course is literally about the secret to life: the lifestyle choices you can make that wll increase the odds of having the longest and healthiest life you can. You will find out that there are 16 lifestyle characteristics that these oldest people tend to have in common, no matter where they live in the world.
Major Depression & Bipolar Disorders - 3rd Editionby David Longo, PhD
4 CONTACT HOURSThis book contains a synopsis of the genetic, biological, and psychological theories pertaining to bipolar spectrum disorders. An update of diagnostic considerations, assessment instruments, and evidence-based treatment techniques commonly employed in diagnosing, assessing, and treating bipolar spectrum disorder patients is provided. The most recent literature is presented throughout the book
concerning the appropriate data-based applications, outcomes, and limitations of the assessment and treatment procedures.
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• Addiction: Alternatives to Abstinence - 4th Ed. (B. Sternberg, PhD): Identifies the three major treatment models for addictive behaviors and a brief history of each: a) the moral model, b) the medical model, c) the harm reduction model.
• Alzheimer's - 3rd Ed. (M. O’Brien, MD): Describes Alzheimer’s disease. Identifies the 10 warning signs of Alzheimer’s disease.
• Antioxidants: A Balancing Act with Free Radicals - 3rd Ed. (N. Katz, MD, PhD): Identifies what free radicals and antioxidants are, their functions, and how they interact.
• Appetite Control & Suppression (G. Willett, PhD, RD): Describes how appetite is normally regulated. Cites how appetite can become dysregulated and contribute to weight gain and obesity.
• Autism - 3rd Ed. (N. Katz, MD, PhD & B. Sternberg, PhD): Describes the differences between the previous DSM-IV, and the current DSM-5 in terms of how autism, autism spectrum disorder (ASD), and related disorders are viewed and diagnosed,
• Brain Food - 3rd Ed. (A. St. Charles, PhD, RD, LDN): Discusses how foods and vitamins may improve memory and brain function. Describes how the DASH and Mediterranean diets may play a key role in brain health.
• Cancer Prevention - 4th Ed. (A. St. Charles, PhD, RD, LDN & M. O’Brien, MD): Describes the lifestyle and dietary changes that can help prevent the development of cancer. Discusses the benefits and drawbacks associated with some of the tools used to screen for cancer.
• Caring for Patients with Alzheimer’s & Other Dementias - 2nd Ed. (B. Sternberg, PhD): Lists methods to assist patients with memory and communication problems.
• Cognitive Behavior Therapy - 3rd Ed. (M. Howard, PhD): Identifies the major components of cognitive behavioral therapy and the causative relationship between environmental events, thoughts, emotions, and behavior.
• Diabetes: A Comprehensive Overview - 2nd Ed. (A. St. Charles, PhD, RD, LDN): Describes the key features of prediabetes, type 1, type 2, and gestational diabetes. Identifies the hormones involved in blood glucose control.
• Eating Right at Midlife & Beyond (A. St. Charles, PhD, RD, LDN): Identifies the physiological changes that typically occur with age. Outlines a healthy eating plan for older adults.
• Emotional & Social Intelligence - 2nd Ed. (B. Sternberg, PhD): Explains the concept of emotional intelligence. Describes the relationship between emotions and the brain. Explains the concept of social intelligence and its components.
• Fibromyalgia - 3rd Ed. (N. Katz, MD, PhD): Examines fibromyalgia treatments. Reviews the pathogenesis, etiology, and clinical presentation of fibromyalgia. Discusses the role of sleep disorders in the clinical management of fibromyalgia.
• Gluten & the Brain - 2nd Ed. (A. St. Charles, PhD, RD, LDN): Discusses the role gluten may play in contributing to celiac disease and non-celiac glucose sensitivity. Lists the main food sources of gluten.
Depression & the Brain by N. Katz, MD, PhD15 CONTACT HOURS Loss of Control: Fighting Back with Full Strength - 2nd Edition
by B. Sternberg, PhD (3 hrs) Neurotransmitters: The Bridges of the Brain - 2nd Edition (3 hrs) Poles Apart: Unipolar vs. Bipolar Depression - 3rd Edition (3 hrs) Achieving Remission in Depression - 3rd Edition (3 hrs) Eating Disorders - 3rd Edition (3 hrs)
Tranquility Time by N. Katz, MD, PhD15 CONTACT HOURS Stop Losing Sleep - 4th Edition (3 hrs) Stimulants: Caffeine, Amphetamines, etc. - 4th Edition (3 hrs) Anti-Anxiety Drugs - 4th Edition (3 hrs) Non-Traditional Approaches: Anxiety, Insomnia, & Depression -
4th Edition by B. Sternberg, PhD (3 hrs) Brain & Stress: PTSD & Adjustment Disorder - 4th Edition (3 hrs)
REMINDERS1. Health Update courses are approved by most licensing boards. Approvals may vary within each profession and each state. Books are approved for varying numbers of CE hours.
To claim CE credit, complete the examination and mail the examination page to BIOMED. Your diploma/certificate will be forwarded to you within three working days of receipt of your exam. It is your responsibility to notify your licensing board to receive credit.
2. Most home studies will be accepted up to three years after purchase. Although courses within a package may be “split” among several people, only one diploma will be issued per submitted exam. Only the original exam page will be accepted. BIOMED and most professional licensing boards will not accept photocopies or faxes of the examination page. Credit will not be issued for unused home studies. Copies of exam will be accepted for an additional fee based on the number of contact hours. Please attach check to copy. If you have any questions, please call BIOMED at (800)229-4997.
Single Home-study Courses Available Only from INR Webinars!Webinar Price $20 Regular Price $30 3 contact hours
(Please complete purchase form on page 8)
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• Hospice & Palliative Care (M. O’Brien, MD): Discusses the goals and challenges involved in palliative care. Describes major symptoms encountered in terminal illness and treatment options.
• Humor & Healing - 2nd Ed. (B. Sternberg, PhD): Discusses the use of humor in health care settings and the role of humor for health care professionals.
• Inflammation - 3rd Ed. (A. St. Charles, PhD, RD, LDN): Differentiates between acute and chronic inflammation. Identifies the mechanisms of combating infection/disease.
• Irritable Bowel Syndrome - 4th Ed. (M. O’Brien, MD): Identifies the differences between functional gastrointestinal disorders and inflammatory bowel diseases.
• Keeping Balance & Preventing Falls - 3rd Ed. (M. Howard, PhD): Lists causes and health hazards of falls. Outlines methods of preventing falls among the elderly.
• Knee Pain - 4th Ed. (R. Hullon, MD, JD): Describes the anatomical structure of the knee. Identifies the different types of knee injuries and their manifestations. Differentiates between major and minor injuries and the causes of knee pain. Explains strategies for preventing knee pain.
• Leg & Foot Pain (W. Schroeder, PhD, OTR, & W. Dubner, DPM): Describes how leg and foot pathologies can impair functional ability. Outlines evidence-based interventions for each condition.
• Low Back Pain - 5th Ed. (R. Hullon, MD, JD): Defines low back pain. Describes the prevalence of this condition within the U.S. Identifies the different causes of low back pain. Describes some of the treatment approaches employed. Discusses ways to prevent low back pain.
• Medical Ethics - 4th Ed. (R. Hullon, MD, JD): Explains the issues surrounding patient consent, including formed consent, voluntary consent, and competent consent.
• The Mediterranean Diet - 3rd Ed. (A. St. Charles, PhD, RD, LDN): Describes the food-based guidelines that make up the Mediterranean pyramid. Explains the significance of physical activity, diet, and social interaction as part of the Mediterranean way of life.
• Memory Loss & Forgetfulness - 3rd Ed. (B. Sternberg, PhD): Identifies the memory changes that take place in normal aging. Discusses how mild cognitive impairment (MCI) differs from memory loss in normal aging and from dementia.
• Neck & Shoulder Pain - 3rd Ed. (R. Hullon, MD, JD): Defines the differences in presentation of signs and symptoms among neck and shoulder disorders.
• Omega-3 Fatty Acids - 3rd Ed. (N. Katz, MD, PhD): Covers the benefits and risks associated with the popular dietary supplement, omega-3 fatty acids. Examines the role of these acids in preventing heart disease and breast cancer and brain health.
• On Loss & Grief - 3rd Ed. (A. St. Charles, PhD, RD, LDN): Identifies emotional, cognitive, behavioral, social, and physical responses to loss. Discusses the role of grief counseling and when it may be useful.
• Osteoporosis (A. St. Charles, PhD, RD, LDN): Describes the signs and symptoms of osteoporosis and its main risk factors. Identifies the role of diet and exercise in the prevention and treatment of bone loss.
• Pet Therapy - 3rd Ed. (B. Sternberg, PhD): Describes the aspects of the relationship between humans and their pets that contribute to health and well-being.
• Positive Psychology - 3rd Ed. (B. Sternberg, PhD): Describes the origin and goals of the “positive psychology.” Lists the factors that contribute to happiness and life satisfaction.
• The Power of Walking - 2nd Ed. (M. O’Brien, MD & A. St. Charles, PhD, RD, LDN): Describes the health benefits of walking. Explains how walking can reduce the risk of various diseases, including diabetes, heart disease, cancer, depression, and dementia.
• Probiotics - 3rd Ed. (B. Sternberg, PhD & C. Fleishman MS, RD): Discusses how probiotics affect the healthy immune system. Identifies good food sources of probiotics and prebiotics.
• Psychology of Bullying - 3rd Ed. (B. Sternberg, PhD): Describes individual, family, and social factors related to child and youth bullying. Discusses cyber bullying and associated problems.
• Reducing Stress - 3rd Ed. (B. Sternberg, PhD): Explains how the body responds to and processes stress. Understands the impact of stress on risk for heart disease and the physiological mechanisms that may mediate this link. Identifies a number of interventions for reducing stress.
• Skin Care, Allergies, & Wrinkles - 3rd Ed. (B. Hayes, MD, PhD, FAAD): Explains the diagnosis and newest treatments for skin conditions and skin allergies. Describes new laser treatments for wrinkles and other skin conditions.
• Social Anxiety- 2nd Ed. (B. Sternberg, PhD): Defines social anxiety. Describes the symptoms, causes, and treatment strategies for social anxiety.
• Understanding Anxiety- 3rd Ed. (B. Sternberg, PhD): Explains the difference between normal anxiety and an anxiety disorder. Describes the causes of anxiety.
• Understanding Cholesterol - 2nd Ed. (A. St. Charles, PhD, RD, LDN): Lists the various lipid components of total cholesterol and describes how they are formed in the body. Describes the physiological function of each lipid faction.
• Vitamin D: Vitamin, Hormone, & Protector - 3rd Ed. (A. St. Charles, PhD, RD, LDN): Describes the role that vitamin D may play in the physiological function of various systems. Lists the current guidelines for supplementation of vitamin D.
• Vitamins, Minerals, & Supplements (A. St. Charles, PhD, RD, LDN): Identifies the vitamins and minerals needed for growth and normal development. Discusses the drawbacks/concerns of over-supplementation.
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Obesity, Diet, & Behaviorby Michael E. Howard, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Explain the complex nature of body fat and why both too much and too little are deleterious to health. 2) Describe how genes, eating behavior, macronutrients, physiology, microorganisms, and the environment
interact to produce obesity. 3) Outline how the food industry’s production of hyperpalatable foods fuels sweet, fat, and salt addiction and the obesity epidemic. 4) Identify the most effective diets that could produce long-lasting results in weight loss.
Opioids & Marijuanaby Nikita Katz, PhD, MDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Outline the neurologic, genetic, and social mechanisms of opioid abuse, especially in relation to the nationwide, opioid health emergency. 2) List diagnostic signs and psychological “red flags” common in opioid abuse and opioid
overdose. 3) Summarize the current guidelines for the use of opioids in patients with acute and chronic pain. 4) List the parameters of opioid use and abuse to be documented in all clinical, dental, and health care settings. 5) Explain opioid replacement therapy and the use of opioid antagonists in acute overdose.
Probiotics, Food, & the Immune Systempresented by Laura Pawlak, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Identify the human microbiota, including benecial bacteria (probiotics). 2) Describe the effects of probiotics with regard to the digestive, nervous, and immune systems. 3) List the pro- and anti-inflammatory influences, including those
influences related to such substances as essential lipids and amino acids. 4) Compare and contrast approaches used to reduce inflammation. 5) Recognize ways to prevent disease and disability in the aging population.
PTSD, Trauma, & Anxiety Disordersby Michael E. Howard, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Describe the structure and function of neurons, glia, neurotransmitters, and brain regions. 2) Explain how the brain produces and is affected by anxiety, trauma disorders, and depression. 3) Determine how stress
is the foundation for anxiety, PTSD (post-traumatic stress disorder), trauma, and many depressions. 4) Describe the new criteria for the diagnosis of PTSD, trauma disorders, and anxiety disorders.
The Science of Fat & Sugarby Laura Pawlak, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Identify metabolism and physiology of lipids and carbohydrates in health and disease as well as in the aged individual. 2) List the approaches to a patient suffering from metabolic disease from the nursing,
pharmacological, psychological, and physical therapy standpoints. 3) Compare and contrast appetite suppressants and other medications that induce weight loss. 4) Discuss the recent discoveries in neurochemistry and neuroscience of the link between behavioral pathology and metabolic disease. 5) Compare and contrast the healthy and the potentially dangerous weight loss strategies and long-term effects of fad diets.
The Sleep-Loss Epidemicby Raj Hullon, MD,JDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Describe the stages, cycling, and circadian rhythms of sleep. 2) Cite evidence connecting sleep deprivation and sleep disorders to heart disease, stroke, diabetes, and dementia. 3) List the major sleep medications
with their uses and adverse effects. 4) Describe the connection between dental pain and sleep disruption. 5) Cite the diagnostic criteria, symptoms, course, and treatment for the major sleep disorders.
Better Habits, Better Healthby Michael E. Howard, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Describe how personality types, core beliefs, and behavioral habits affect chronic illness. 2) Discuss the most common chronic illnesses and the key factors in prevention and management. 3) Explain how stress, anxiety,
and depression influence chronic illnesses. 4) Describe practical behavioral habits for coping with disabling chronic conditions like pain, cancer, arthritis, and other diseases. 5) List ways to help patients develop healthier habits in terms of nutrition, activity, preventive medical and dental care, and emotional well-being.
Brain Health: Mood, Metabolism, & Cognitionby Gina Willett, Ph.D., R.D.VIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Describe key factors that are essential for a healthy brain, and how these impact both cognitive function and mental health. 2) Characterize Alzheimer’s disease as a neurodegenerative disorder of the brain; characterize
depression as a neuropsychiatric disorder of the brain. 3) Describe how obesity and diabetes impact cognitive and mental health.
Brain Trauma, Concussion, & Dementiaby Michael E. Howard, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Describe the brain structures and functions that are most vulnerable to trauma. 2) Outline the major steps in assessing patients with brain trauma and predicting disability. 3) Discuss key clinical features of concussions,
penetrating head injuries, and blast injuries. 4) Describe the relationship between brain trauma and dementing illness such as Alzheimer’s and chronic traumatic encephalopathy. 5) Outline the rehabilitation strategies most likely to improve outcomes in patients with brain trauma. 6) Discuss the practical steps to prevent brain trauma from motor vehicle accidents, falls, and sports.
Coping with Chronic Pain by David Cosio, PhD, ABPPVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Explain the current state of pain management in the United States. 2) Describe the multidisciplinary approach to pain management. 3) Summarize the 23 different pain management modalities currently available. 4) Describe
steps to create a comprehensive pain management plan. 5) List the five key coping skills for helping chronic pain patients. 6) Discuss treatment options for chronic dental and facial pain.
The Gut-Brain Connectionby Gina Willett, PhD, RDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Explain the concept of the gut-brain axis, and its implications for health and disease. 2) Describe how microbes and their metabolites communicate with the body and the brain. 3) Explain how the microbiome-gut-
brain axis influences the development of neurodegenerative, neuropsychiatric, and neurodevelopmental disorders. 4) Describe how microbial metabolites regulate immune and metabolic pathways in the body, and how this may impact risk of allergies, autoimmune diseases, obesity and diabetes. 5) Explain how the ecology of the oral microbiome impacts both gut and systemic health; discuss implications for modern-day oral healthcare.
Inflammation, Chronic Illness, & the Brainpresented by Michelle Albers, PhD, RDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Identify clinical signs & symptoms of inflammation. 2) Demonstrate the connections between inflammatory processes and chronic illness. 3) Describe the role of inflammation in specific illnesses such as heart
disease, COPD, diabetes, arthritis and dementia. 4) List practical strategies to reduce levels of inflammation in clinical practice. 5) Explain the rationale for good dental prophylaxis and skin care in patients with chronic illness.
Stress, Resilience, & Happinessby Michael E. Howard, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Describe how perception, thinking, emotions, and memory combine to produce cognitive appraisals and behavior. 2) Outline the causes, components, and management of psychological stress. 3) Define resilience and
explain the factors that compose the ability to “bounce back” from stressful events 4) List the major components of the positive-psychology approach to increasing life satisfaction. 5) Determine the elements of happiness and optimism and how to apply them to increase well-being.
Understanding Addictionsby Michael E. Howard, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Describe the main brain functions that contribute to addictive behavior. 2) Explain the major ways that addiction changes the brains of addicts. 3) Describe how drugs mimic and alter neurotransmitters which provoke the
psychological effects of addiction. 4) Explain the difference between drug dependence, tolerance, and addiction. 5) Describe the clinical consequences of addiction to food, opioids, street drugs, and alcohol. 6) List and compare the major treatment options for legal and illegal drug addictions.
Understanding Aging & Longevityby Michael E. Howard, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Describe how the biopsychosocial model of health and how disease impacts aging, health, life span, and longevity. 2) Explain the differences between normal aging and age-related disease and their effects on life span
and longevity, including periodontal disease. 3) Determine the effects of genetics, epigenetics, and the environment on aging. 4) Describe how the body and brain age at the cellular, tissue, organ, and organ system levels. 5) Determine the causes of recent increases in life expectancy in the world and the United States.
Understanding Diabetesby Gina Willett, PhD, RDVIDEO PRESENTATION - 2 DVDS (6 contact hrs)Participants completing this course will be able to: 1) Compare and contrast the different forms of diabetes. 2) Explain why the number of cases of Type 2 diabetes is expanding worldwide. 3) Describe how gut health impacts metabolic health and diabetes risk. 4) Outline potential
complications of diabetes as well as appropriate interventions. 5) Characterize how insulin resistance and Type 2 diabetes are linked to other conditions such as cognitive decline, depression, cancer sleep disorders, and periodontal disease.
Understanding Mental Disordersby Michael E. Howard, PhDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) Describe how the brain produces behavior and how learned patterns of behavior become a personality. 2) List the personality disorders and explain how they disrupt relationships. 3) Determine how to diagnose and treat the
major anxiety disorders, including dental anxiety, and outline the effects of early life stress, medical disorders, and medications on anxiety. 4) Describe the characteristics of posttraumatic stress disorder and obsessive-compulsive disorder and explain why they are no longer grouped with anxiety disorders.
Understanding Painby Nikita Katz, PhD, MDVIDEO PRESENTATION - 1 DVD (6 contact hrs)Participants completing this course will be able to: 1) List the neurologic processes causing pain and suffering and the principles of pain assessment. 2) Discuss treatment modalities for primary and secondary headaches, including migraine and rare cephalagias.
3) List the “red flags” of medication abuse and approaches to reduce opioid addiction. 4) Describe the differential diagnosis of dental vs. cervical and cervicogenic pain and the appropriate intervention for both. 5) List steps involved in the diagnosis and management of spinal pain, including physical and occupation therapy.
Mindful Stress Reduction Practices by Kent HowardAvailable Format: VIDEO PRESENTATION - 1 DVD (not for cE crEdit) This DVD introduces stress reduction techniques using: Tai Chi and Qi-Gong Chair-Assisted Yoga Stretches Meditation Postures and Practices Breathing Techniques for Relaxation
Mindful Stress Reduction Volume II by Kent HowardAvailable Format: VIDEO PRESENTATION - 1 DVD (not for cE crEdit) This DVD includes more stress reduction techniques, including meditative movement routines and mindful breathing exercises.
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42. Medical Ethics 4th ed
43. The Mediterranean Diet 2nd ed 44. Memory Loss & Forgetfulness 3rd ed
45. Neck & Shoulder Pain 3rd ed
46. Omega-3 Fatty Acids 3rd ed
47. On Loss & Grief 3rd ed 48. Osteoporosis 49. Pet Therapy 3rd ed
50. Positive Psychology 3rd ed
51. The Power of Walking 2nd ed
52. Probiotics 3rd ed 53. Psychology of Bullying 3rd ed 54. Reducing Stress 3rd ed
55. Skin Care, Allergies, & Wrinkles 3rd ed
56. Social Anxiety 2nd ed 57. Understanding Anxiety 3rd ed
58. Understanding Cholesterol 2nd ed
59. Vitamin D 3rd ed
60. Vitamins, Minerals, & Supplements61. Other Items:
21. Alzheimer's 3rd ed
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23. Appetite Control & Suppression24. Autism 3rd ed
25. Brain Food 3rd ed 26. Cancer Prevention 4th ed
27. Caring for Patients w/Alzheimer’s 2nd ed
28. Cognitive Behavior Therapy 3rd ed
29. Diabetes: A Comprehensive Overview 30. Eating Right at Midlife & Beyond 31. Emotional & Social Intelligence 2nd ed
32. Fibromyalgia 3rd ed
33. Gluten & the Brain 2nd ed 34. Hospice & Palliative Care 35. Humor & Healing 2nd ed
36. Inflammation 3rd ed
37. Irritable Bowel Syndrome 4th ed
38. Keeping Balance & Preventing Falls 3rd ed
39. Knee Pain 4th ed
40. Leg & Foot Pain 41. Low Back Pain 5th ed
Category a: Home-study Books 1. Irritating the Ones You Love (4 contact hrs) 2. Living to be 100 2nd ed (4 contact hrs) 3. Major Depression & Bipolar Disorders 3rd ed (4 hrs) 4. Successful Aging 2nd ed (4 contact hrs) 5. Sugar, Salt, & Fat 2nd ed (4 contact hrs)
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6. The Fearless Mind (not for cE crEdit) 7. Yoga Forma (not for cE crEdit) 8. Globesity (5 contact hrs) *not for diEtEtic (rd/rdn) crEdit 9. The Healing Power of Sleep 2nd ed (5 contact hrs) 10. The Hungry Brain (5 contact hrs) 11. Integrative Healing (4 contact hrs) 12. Love Me True (4 contact hrs) 13. Pain Relief (4 contact hrs) 14. Media Maze (4 contact hrs) 15. Screen Savvy (4 contact hrs) 16. Weight Perfect 3rd ed (6 contact hrs)
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Free w/purchase of $199 or more: Pain Relief - book (4 hrs)
Category C: Hot Topics (3 contact hrs each) 20. audio/Video home-study seCtion # of A/V items
Name_______________________________________ ProfessioN________________________ Date________________aDDress_____________________________________ City_____________________ state __________ ZiP__________Day PhoNe_________________________________ email aDDress___________________________________________PaymeNt methoD: CVV________ sigNature __________________________________ CarD# --- exP. - QUEstions? Please email us at [email protected]
* Webinar Price good only until 10 (ten) business days after date of webinar. For orders placed after 10 business days of webinar date, Regular Prices will apply.
WEBINAR COURSE TITLE: _____________________________________________________________DATE OF WEBINAR: _______________________INSTRUCTOR: ______________________________
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Hot Topics
Webinar Price($30 regular)
_________$20 ea.
hot toPiCs total $_______
Webinar prices expire 10 business days after date of webinar
