Wednesday, 18 May 2016

Care Partner Wednesday--The Dilemma of the Hospital

The care partner's life is full of gut-wrenching decisions.

When and how do I tell my mother she can no longer drive?

How do I broach the subject of getting help for her?

The doctor said she isn't safe living alone--how do we have that conversation?

How do I even begin looking for a place for her where she's treated well and given the kind of care I want for my mother?

All of these are difficult topics. They require many conversations, as well as the wisdom and patience of several old testament characters. In the end, the care partner makes the best decision possible. It's never easy.

There is one decision, however, that has to be made with lightening speed, which is why it's helpful to think it though before the situation arises. It's when you hear the doctor say, "Your mother has to go to the hospital."

For many years, the words would no sooner be out of the doctor's mouth and you would hear the whine of the ambulance siren rounding the corner. There was no question. The doctor said go, so you went.

These days, that's not always the case. Care partners are wondering if the hospital is the best place for their elderly relative. And as in many decisions, there are times when the answer isn't clear. There can be nothing more devastating than knowing your loved one's life and comfort hangs in the balance and the decision is yours.

Let's look at some instances when going to the hospital was definitely the right decision:

Ruth was a frail elderly woman with osteoporosis. She walked with a walker. One day, while in the dining room, she turned to push in her chair and let go of her walker. She lost her balance and fell on her arm. Staff rushed to her aid, but because of the pain, were not able to lift her. Her arm was in extreme pain and her leg was lying at a strange angle.

The ambulance was called, and the paramedics were able to lift her off the floor through the use of a special stretcher. Ruth was sent to hospital and had surgery for a broken hip and elbow. It took months, but now Ruth is walking well and has regained almost full use of her arm.

Betty fell as well, in her bedroom, but got up again and seemed fine. The next day, however, she was experiencing severe pain in her hip and couldn't walk.

Betty had and x-ray at hospital and it was discovered she had bruising, but no fracture. In a few days, she was gingerly walking the halls, and by the next week, she was fine.

Hazel  was diagnosed with pneumonia, and was given an antibiotic. After a few days, she seemed to be getting worse. Drowsy and short of breath, the doctor recommended she be sent to hospital for IV antibiotics and oxygen therapy. Although in her nineties, Hazel was active and generally healthy, and had been lawn bowling the week before she got sick.

Hazel was sent to hospital, where she stayed for a week. The recommended treatments were successful, and after another week of rest at home, she began to lawn bowl again.

There are also times when a trip to the hospital is the wrong decision:

Over the last six months, Margie had increased trouble swallowing. Her diet had been changed to minced and then to pureed. Margie enjoyed her food, but hated the pureed diet. Then one day, she couldn't swallow even that. The doctor recommended sending her to hospital to get a feeding tube.

Margie's family struggled with the decision. She had several complicated medical issues, and it was evident that her organs were beginning to shut down. However, they weren't comfortable with letting that happen, so she had the feeding tube inserted. Over the next few months, she had multiple problems, as her body wasn't absorbing the nutrients it was being given. Finally, the family saw what this was doing to Margie. The feeding tube was removed and she passed away peacefully several days later with her family at her side.

Agnes is 102, but has all her cognitive abilities and is interested in others and life in general. She also has a skin cancer that is spreading in her leg. Her pain is well controlled, and every day the wound nurse dresses her leg. She enjoys going to the dining room and chatting with her friends, and sitting outside with the sun on her face. The wound nurse, however, has been strongly suggesting that she get treatment at the hospital for her leg. Agnes and her family had already decided not to do this, but with the wound nurses' continued insistence, Agnes is wondering if she made the right decision.

After talking again with the doctor, her family and other staff, Agnes was reassured. She concentrated on pain control and quality of life.

It's never an easy decision, and often not a clear one. Here are some questions to ask:

Will going to hospital increase quality of life or just prolong life?

Is it possible to go just for an assessment and return home?

What will be the probably outcome of whatever decision is made?

And here's an important consideration--what would your loved one want? If they aren't well enough to tell you, then consider conversations you've had in the past about this topic. If you've never discussed it, then find a way to do that.

"Sometimes the hardest thing and the right thing are the same thing." unknown

Keep the conversation going--have you ever had to make this kind of decision? What did you decide? Were you happy with your decision and the outcome?

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