improving elderly relative's hospital stay & persuading her not to leave
December 18, 2015 12:25 PM Subscribe
Last week, for the second time in the past 12 months, my 95 year old relative had a bad fall and broke several bones. She had surgery and is now recovering in hospital. She absolutely hates being there, wants to go home, and is angry at the medical team. Is there anything concrete we can do to mitigate her unhappiness and persuade her not to check herself out against medical advice, like she did last time?
Background: She is very unsteady on her feet and last year she fell during the holidays and broke her leg. She had to stay in hospital for a few months after undergoing surgery because she was supposed to do physio until she was deemed able to perform daily functions. She didn't want to be in hospital (who can blame her) and wanted to go home very badly--eventually she signed herself out against medical advice and went home. This did not go very well and she is back in hospital again.
She is widowed, lives alone and has fired any home help that has been hired to take care of her, except for a house cleaner who comes once every ten days. The family got her a walker and she refuses to use it. No cane, no wheelchair. She was set up with a Life Alert type system (press a button on a necklace to call for help) but she doesn't like it and will not carry it with her. So when she falls down, she has no way to call for help and has to hope someone finds her.
The only family members who live near her are also elderly and thus cannot provide home care. She has some other extended family, and we all visit when we can, but none of us lives nearby (think between 2 hours drive and 10 hours drive away, each way). A neighbour picks up groceries for her once a week. She has not given power of attorney to anyone.
Several of us have been talking to the elderly relative in question over the phone and asking her what kind of homecare she'd be open to, so that she can remain in her home longer, more safely. Answer: none, except her current house cleaner. She says if we send anyone (including Meals on Wheels) she will just not open the door to them. Previous inquiries about whether she'd like to move into assisted living did not go well. We have attempted to get her mental health assessed because she is angry and sad most of the time, but she refuses to agree to the assessments (as is her right). Whenever we talk to her, she insists she is fine and just wants to live at home without help.
Mr. hgg and I are the ones who live 10 hours away, so our main contribution to this situation has been to take on researching options for her care and attempting to navigate our province's (British Columbia) health system so the relatives closer by who actually speak to the doctors and social workers have some idea of where to start and what to ask for. We have spent many hours on the phone and on the Ministry of Health website, attempting to find information and real people to speak to. All the advice we have received from medical teams, social workers, and Ministry of Health staff have been the same: they are sympathetic to our concerns, but she's an adult who is allowed autonomy over her own body, and unless she's deemed incompetent, no one can force her out of her home if she doesn't want to go. Period. No one can force her to stay in hospital once she decides she wants to leave, either.
QUESTION: The medical team has said she needs to stay in hospital, do physio, and recover for at least a few more weeks. What is the best way to persuade her not to check herself out against medical advice?
BONUS QUESTION: Have you had any success in a similar situation convincing someone to accept more home care, or moving into assisted living, if they were deemed mentally competent and you didn't have POA? My family is worried she will fall one day and die a slow painful death alone but we don't know how to convince her to accept help.
Background: She is very unsteady on her feet and last year she fell during the holidays and broke her leg. She had to stay in hospital for a few months after undergoing surgery because she was supposed to do physio until she was deemed able to perform daily functions. She didn't want to be in hospital (who can blame her) and wanted to go home very badly--eventually she signed herself out against medical advice and went home. This did not go very well and she is back in hospital again.
She is widowed, lives alone and has fired any home help that has been hired to take care of her, except for a house cleaner who comes once every ten days. The family got her a walker and she refuses to use it. No cane, no wheelchair. She was set up with a Life Alert type system (press a button on a necklace to call for help) but she doesn't like it and will not carry it with her. So when she falls down, she has no way to call for help and has to hope someone finds her.
The only family members who live near her are also elderly and thus cannot provide home care. She has some other extended family, and we all visit when we can, but none of us lives nearby (think between 2 hours drive and 10 hours drive away, each way). A neighbour picks up groceries for her once a week. She has not given power of attorney to anyone.
Several of us have been talking to the elderly relative in question over the phone and asking her what kind of homecare she'd be open to, so that she can remain in her home longer, more safely. Answer: none, except her current house cleaner. She says if we send anyone (including Meals on Wheels) she will just not open the door to them. Previous inquiries about whether she'd like to move into assisted living did not go well. We have attempted to get her mental health assessed because she is angry and sad most of the time, but she refuses to agree to the assessments (as is her right). Whenever we talk to her, she insists she is fine and just wants to live at home without help.
Mr. hgg and I are the ones who live 10 hours away, so our main contribution to this situation has been to take on researching options for her care and attempting to navigate our province's (British Columbia) health system so the relatives closer by who actually speak to the doctors and social workers have some idea of where to start and what to ask for. We have spent many hours on the phone and on the Ministry of Health website, attempting to find information and real people to speak to. All the advice we have received from medical teams, social workers, and Ministry of Health staff have been the same: they are sympathetic to our concerns, but she's an adult who is allowed autonomy over her own body, and unless she's deemed incompetent, no one can force her out of her home if she doesn't want to go. Period. No one can force her to stay in hospital once she decides she wants to leave, either.
QUESTION: The medical team has said she needs to stay in hospital, do physio, and recover for at least a few more weeks. What is the best way to persuade her not to check herself out against medical advice?
BONUS QUESTION: Have you had any success in a similar situation convincing someone to accept more home care, or moving into assisted living, if they were deemed mentally competent and you didn't have POA? My family is worried she will fall one day and die a slow painful death alone but we don't know how to convince her to accept help.
This is just my opinion, but if she is 95, capable (in terms of consent) and there is no POA, the best thing you can do is offer her a life-line alarm, offer a visit from an occupational therapist to make her home safe, and let her live the last few years of her life the way she wants. If it means that despite everyone's best efforts she *still* ends up falling, that is her decision and right. My Nonno wanted to die at home, in his garden. He didn't end up dying right at home, but he ended up having a fall at age 94, in the garden, that landed him in the hospital where he later passed away. Honestly, he wouldn't have wanted it any other way - and he would never have bothered with an alarm.
I think being compassionate while also respecting your relative's dignity and wishes is the best thing to do, even though it's truly hard, and you may have to accept her accepted level of risk for falls.
posted by Dressed to Kill at 12:38 PM on December 18, 2015 [26 favorites]
I think being compassionate while also respecting your relative's dignity and wishes is the best thing to do, even though it's truly hard, and you may have to accept her accepted level of risk for falls.
posted by Dressed to Kill at 12:38 PM on December 18, 2015 [26 favorites]
It seems like the only thing you can do is make her home safer. Can you install one of those go-up-the-stairs chair things and some shower safety things (a bar to hold on to? A seat? a walk-in?) and do anything else around the house to make it a little safer. Also, there exists a lifeline-like alarm thing (I think by phillips) that is basically a little necklace pendant that A) is shower proof, so she wouldn't have to take it off, which means she would have to put it on and B) doesn't require activation -- if she fell she wouldn't have to push a button. The suddent descent of the pendant would trigger the alarm.
Finally, does she have wifi? If so, could you set up some kind of monitoring system? Nothing creepy like cameras...my original thought was to get her a fitbit and then set up some sort of IFTTT that notifies you or a family member if there are no steps for 4(?) hours during the day or more than 10 hours at night or something. That's probably not exactly the best solution, but something like that that would let you know if there were no activity on her part for hours would probably be useful. This wouldn't require anyone to regularly come into her home and help her. Maybe motion sensors? They wouldn't send actual video but could tell you if nothign in her home moved for hours.
posted by If only I had a penguin... at 1:10 PM on December 18, 2015 [3 favorites]
Finally, does she have wifi? If so, could you set up some kind of monitoring system? Nothing creepy like cameras...my original thought was to get her a fitbit and then set up some sort of IFTTT that notifies you or a family member if there are no steps for 4(?) hours during the day or more than 10 hours at night or something. That's probably not exactly the best solution, but something like that that would let you know if there were no activity on her part for hours would probably be useful. This wouldn't require anyone to regularly come into her home and help her. Maybe motion sensors? They wouldn't send actual video but could tell you if nothign in her home moved for hours.
posted by If only I had a penguin... at 1:10 PM on December 18, 2015 [3 favorites]
Having just been through end of life care with my dad (diagnosed with an aggressive brain tumor at 79) I'd say that this really comes down to an honest assessment of her competence to manage her care (both from her and from the rest of the family).
ANSWER: What worked for us was that my dad was generally willing to do whatever the doctors told him was best, despite the fact he didn't like being in the hospital. He really wanted to get better, not just to live out his days. I think that's really the question to ask her: does she want to get better? Or does she just want to live this thing out? If she wants to get better, let her set the rules on how she does it. If she hates the PT so much that she'd rather just be on her own and hasten the end, such as it is, well, I'm sorry.
BONUS ANSWER: My dad really wanted to be at home but he became an extreme fall risk and my mom wasn't capable of picking him up. When he fell once she got EMTs out to help him up. When he fell three times in a single day the EMTs were called the first and third times (the second time, my niece managed to help him up with the assistance of a family friend) and they, uh, suggested that he go to the hospital. He never came home after that, bouncing from hospital to skilled nursing care and back (and finally into long term care, which, thankfully, didn't drag out).
So, is she competent to manage her care? If so, let her understand the risks and set her own ground rules, and maybe get her to sign a limited POA that outlines the conditions under which someone else can make decisions for her care. If not, there is a procedure in place by which the doctors can declare her incompetent, at which case somebody in the family will be appointed to make decisions on her behalf. My mom had a limited medical POA for my dad, and a second legal POA that could only be exercised after two doctors declared it necessary. After he bounced back into the hospital from the first skilled nursing facility and was talking about selling stocks and buying gold, mom exercised the legal POA and never told him she'd done it.
If she's competent and wants to be home, let her be home. Let her set the ground rules on how and when people can check on her, and make sure she understands that if she sets a ten day schedule and she falls on the second day, she'll be stuck where she falls for eight days. Maybe she'll consent to phone calls (e.g. if she doesn't answer two calls half an hour apart, she agrees that the family can call EMTs), but if she wants to be home alone, let her be home alone as long as she can make that decision herself. When the EMTs suggested to my dad that he go to the hospital, he agreed with them. Mom tried really hard not to exercise any POA if we could get him to agree to whatever was being recommended, so that was our big thing. As long as he agreed, we wouldn't have to force the issue.
It sucks, but so do hospitals. My condolences.
posted by fedward at 1:11 PM on December 18, 2015 [1 favorite]
ANSWER: What worked for us was that my dad was generally willing to do whatever the doctors told him was best, despite the fact he didn't like being in the hospital. He really wanted to get better, not just to live out his days. I think that's really the question to ask her: does she want to get better? Or does she just want to live this thing out? If she wants to get better, let her set the rules on how she does it. If she hates the PT so much that she'd rather just be on her own and hasten the end, such as it is, well, I'm sorry.
BONUS ANSWER: My dad really wanted to be at home but he became an extreme fall risk and my mom wasn't capable of picking him up. When he fell once she got EMTs out to help him up. When he fell three times in a single day the EMTs were called the first and third times (the second time, my niece managed to help him up with the assistance of a family friend) and they, uh, suggested that he go to the hospital. He never came home after that, bouncing from hospital to skilled nursing care and back (and finally into long term care, which, thankfully, didn't drag out).
So, is she competent to manage her care? If so, let her understand the risks and set her own ground rules, and maybe get her to sign a limited POA that outlines the conditions under which someone else can make decisions for her care. If not, there is a procedure in place by which the doctors can declare her incompetent, at which case somebody in the family will be appointed to make decisions on her behalf. My mom had a limited medical POA for my dad, and a second legal POA that could only be exercised after two doctors declared it necessary. After he bounced back into the hospital from the first skilled nursing facility and was talking about selling stocks and buying gold, mom exercised the legal POA and never told him she'd done it.
If she's competent and wants to be home, let her be home. Let her set the ground rules on how and when people can check on her, and make sure she understands that if she sets a ten day schedule and she falls on the second day, she'll be stuck where she falls for eight days. Maybe she'll consent to phone calls (e.g. if she doesn't answer two calls half an hour apart, she agrees that the family can call EMTs), but if she wants to be home alone, let her be home alone as long as she can make that decision herself. When the EMTs suggested to my dad that he go to the hospital, he agreed with them. Mom tried really hard not to exercise any POA if we could get him to agree to whatever was being recommended, so that was our big thing. As long as he agreed, we wouldn't have to force the issue.
It sucks, but so do hospitals. My condolences.
posted by fedward at 1:11 PM on December 18, 2015 [1 favorite]
B.C. had excellent physio coverage when I lived there, admittedly not too recently. Is there any way a physio can come to her house if she insists on leaving the hospital?
If she is aware that her risk of another fall is high, but doesn't want in-person aides...is there anything that can be done to better her odds in the event of a fall? Cheap old flip phones that still dial 911, placed all around the home. Some sort of reaching aids also sitting underneath every bit of furniture so as to better the odds of being able to reach one of the phones? I'm trying to think of unobtrusive ways to make it less likely that she will have a long and unpleasant wait before somebody finds her. Would it be possible to get an occupational therapist in ASAP to do small home modifications before she is out of hospital?
posted by kmennie at 1:20 PM on December 18, 2015 [1 favorite]
If she is aware that her risk of another fall is high, but doesn't want in-person aides...is there anything that can be done to better her odds in the event of a fall? Cheap old flip phones that still dial 911, placed all around the home. Some sort of reaching aids also sitting underneath every bit of furniture so as to better the odds of being able to reach one of the phones? I'm trying to think of unobtrusive ways to make it less likely that she will have a long and unpleasant wait before somebody finds her. Would it be possible to get an occupational therapist in ASAP to do small home modifications before she is out of hospital?
posted by kmennie at 1:20 PM on December 18, 2015 [1 favorite]
Is she religious? Can you get a hospital chaplain or someone from her church involved? I hate to say this, but it sounds like she's done living and wants to die in her own home on her own terms. Perhaps a religious person can help her come to terms, and she might be more open to talking to them than a psychologist or social worker.
posted by desjardins at 1:32 PM on December 18, 2015 [1 favorite]
posted by desjardins at 1:32 PM on December 18, 2015 [1 favorite]
What a crappy situation. I'm sorry.
Have you been in contact with her primary care physician? If the two of them have a longstanding working relationship then she might be more receptive to talking with him about assisted living.
You could also contact an assisted living facility on your own. Sometimes they will send a care manager to a hospital or rehab facility to evaluate possible new admissions. These nurses are generally very good at working within the type of situation you describe.
Do not, do not pack up her house until she gives you permission to do so.
posted by pintapicasso at 1:48 PM on December 18, 2015 [1 favorite]
Have you been in contact with her primary care physician? If the two of them have a longstanding working relationship then she might be more receptive to talking with him about assisted living.
You could also contact an assisted living facility on your own. Sometimes they will send a care manager to a hospital or rehab facility to evaluate possible new admissions. These nurses are generally very good at working within the type of situation you describe.
Do not, do not pack up her house until she gives you permission to do so.
posted by pintapicasso at 1:48 PM on December 18, 2015 [1 favorite]
If she's comfortable with the current house cleaner, perhaps that person might be open to getting paid for "just dropping by" wellness-type check-ins. Or consider the neighbor who does the weekly shopping. Or, maybe between that grocery delivery and the every-10-days cleaning visit, the timing can be arranged so that someone's at least seeing her every four days.
Another thought - if her home has grounds that need to be maintained, that may be another way to schedule a regular visitor. Again, not true medical care, just so that if she falls discovery is in a narrower time frame.
posted by Iris Gambol at 1:51 PM on December 18, 2015 [9 favorites]
Another thought - if her home has grounds that need to be maintained, that may be another way to schedule a regular visitor. Again, not true medical care, just so that if she falls discovery is in a narrower time frame.
posted by Iris Gambol at 1:51 PM on December 18, 2015 [9 favorites]
In the same vein as above (and so as not to abuse the edit window) - a weekly flower delivery, if she'd like that sort of thing. If the issue is avoiding strangers, maybe the delivery is to that neighbor first.
posted by Iris Gambol at 1:54 PM on December 18, 2015
posted by Iris Gambol at 1:54 PM on December 18, 2015
I could have written this question about my frail and very elderly granny who was fiercely independent, was widowed, lived alone, kept falling down, couldn't bathe herself anymore, wouldn't use a walker, or a cane, or a Healthcare Assistant etc etc.
My granny kept falling down and eventually, the family was forced to put her in a home. It's a very nice, private home in the UK, but my Granny hated being there - hated every minute of it.
For the first few months she was visited by her 4 children regularly and she kept insisting she just wanted to die, because what was the point?
She's now been in the home for over a year and well, she doesn't love it, but she loves SOME of the people and she definitely acknowledges that she NEEDS to be there.
I don't have any great advice for you though, sometimes I think the family just needs to do the right thing, and it sounds as if your Granny needs to be in a safe place.... She likely won't admit it but I'd say she may come round if she had no other option!
Hugs
posted by JenThePro at 2:50 PM on December 18, 2015 [2 favorites]
My granny kept falling down and eventually, the family was forced to put her in a home. It's a very nice, private home in the UK, but my Granny hated being there - hated every minute of it.
For the first few months she was visited by her 4 children regularly and she kept insisting she just wanted to die, because what was the point?
She's now been in the home for over a year and well, she doesn't love it, but she loves SOME of the people and she definitely acknowledges that she NEEDS to be there.
I don't have any great advice for you though, sometimes I think the family just needs to do the right thing, and it sounds as if your Granny needs to be in a safe place.... She likely won't admit it but I'd say she may come round if she had no other option!
Hugs
posted by JenThePro at 2:50 PM on December 18, 2015 [2 favorites]
If this is how she feels, and she's competent, it might be that she won't go back or consider other options until events force them again (2nd JenThePro).
My grandmother was stubborn about using her walker, and didn't want to hear about leaving her home. She was also falling. Medical events saw her into a hospital. There was no choice but to move her into a home from there, because the person who is local and had been taking care of her until that point also became gravely ill at the same time. My grandmother was in a grey area in terms of competence; in that particular moment, she was confused enough that she didn't oppose the move (also because her health was compromised - heart and other things). I'm not sure she would have gone to the home, otherwise.
(fwiw, she adjusted. She decided she preferred having people around at night in case of worry, talking to cheerful nurses, and having her pains tended to than mostly being alone and very restricted in movement. )
If your grandmother will accept adjustments to the home environment to reduce risk, that's something. If someone is able to visit her frequently (face to face), this might open the door to more trust; regular calls might help a bit that way (with a focus on listening to her needs and worries, that might offer some leverage…). Otherwise, you've got to work within her bounds, or wait. Maybe stay in regular contact with the housekeeper, just keep communication as open and regular as possible.
I'm sorry, it's frustrating, and incredibly scary.
posted by cotton dress sock at 3:00 PM on December 18, 2015 [1 favorite]
My grandmother was stubborn about using her walker, and didn't want to hear about leaving her home. She was also falling. Medical events saw her into a hospital. There was no choice but to move her into a home from there, because the person who is local and had been taking care of her until that point also became gravely ill at the same time. My grandmother was in a grey area in terms of competence; in that particular moment, she was confused enough that she didn't oppose the move (also because her health was compromised - heart and other things). I'm not sure she would have gone to the home, otherwise.
(fwiw, she adjusted. She decided she preferred having people around at night in case of worry, talking to cheerful nurses, and having her pains tended to than mostly being alone and very restricted in movement. )
If your grandmother will accept adjustments to the home environment to reduce risk, that's something. If someone is able to visit her frequently (face to face), this might open the door to more trust; regular calls might help a bit that way (with a focus on listening to her needs and worries, that might offer some leverage…). Otherwise, you've got to work within her bounds, or wait. Maybe stay in regular contact with the housekeeper, just keep communication as open and regular as possible.
I'm sorry, it's frustrating, and incredibly scary.
posted by cotton dress sock at 3:00 PM on December 18, 2015 [1 favorite]
One thing I didn't hear you mention is the 'why'. Why does she want to leave? Why does she not want anyone at the house? How does she want to live out her remaining years? What would make her happiest, bring her the most contentment? Without answers to who she is as a person, there can't really be a two sided conversation about it.
I would start by getting to know her true desires.
posted by Vaike at 3:04 PM on December 18, 2015 [4 favorites]
I would start by getting to know her true desires.
posted by Vaike at 3:04 PM on December 18, 2015 [4 favorites]
no one can force her out of her home if she doesn't want to go. Period
Does she know this and does she believe it? I ask because if you have used language like "remain in her home longer" to her or in front of her -- as though remaining forever is not a choice, or as though the choice isn't hers -- she maybe thinks that giving in on any point at all is the beginning of the end - first an aide, then a home nurse, then a nursing home. Like maybe she is afraid if she requires physical help it's the first step towards proving her incompetent, or afraid that if she stays in the hospital long enough people will just keep finding excuses to keep her until she risks dying there instead of at home. This apart from any simple objections she might have to strangers in her home.
If this is a potential issue, I would not necessarily recommend trying to convince her yourself. Instead, I would recommend having an authority (doctor, social worker) explain this to you in front of her, as forcefully as possible. I am generally dead against manipulating people for their own good, but if she is suspicious of your motives (re: previous attempts to get her mental health assessed) it may improve her temperament to have her doctors make it clear that they're on her side against you, not working with you to maneuver her. might help her to take their recommendations more seriously as well.
posted by queenofbithynia at 3:28 PM on December 18, 2015 [3 favorites]
Does she know this and does she believe it? I ask because if you have used language like "remain in her home longer" to her or in front of her -- as though remaining forever is not a choice, or as though the choice isn't hers -- she maybe thinks that giving in on any point at all is the beginning of the end - first an aide, then a home nurse, then a nursing home. Like maybe she is afraid if she requires physical help it's the first step towards proving her incompetent, or afraid that if she stays in the hospital long enough people will just keep finding excuses to keep her until she risks dying there instead of at home. This apart from any simple objections she might have to strangers in her home.
If this is a potential issue, I would not necessarily recommend trying to convince her yourself. Instead, I would recommend having an authority (doctor, social worker) explain this to you in front of her, as forcefully as possible. I am generally dead against manipulating people for their own good, but if she is suspicious of your motives (re: previous attempts to get her mental health assessed) it may improve her temperament to have her doctors make it clear that they're on her side against you, not working with you to maneuver her. might help her to take their recommendations more seriously as well.
posted by queenofbithynia at 3:28 PM on December 18, 2015 [3 favorites]
Response by poster: Just to set people's minds at ease, we have no plans to just pack up her home without her prior knowledge and consent.
Thank you all for your answers--there are some very good suggestions in here, like the one about paying the housekeeper a little extra to do wellness drop-ins more often.
She does have a yard and had a gardener until she fired him.
She does not have a good relationship with her primary care physician and is suspicious of his motives.
One thing I didn't hear you mention is the 'why'. Why does she want to leave [the hospital]? Why does she not want anyone at the house? How does she want to live out her remaining years? What would make her happiest, bring her the most contentment? Without answers to who she is as a person, there can't really be a two sided conversation about it. I would start by getting to know her true desires.
When we asked her last year and this year why she wanted to leave the hospital, she said the doctors and nurses ordered her around and made her do things she didn't like (physio). When we asked her why she wants to stay at home and not go to assisted living, she said she doesn't want to live with a bunch of people she doesn't know, and she doesn't want to be told what to do by the staff. I think this is pretty understandable and can empathize with that. When we have asked her why she fired the care aides and the gardener, she said they were too nosy, poked into her business, asked her all kinds of questions, were after her money, and didn't do things the way she liked them done (e.g. laundry, bedmaking, raking, etc.).
posted by hurdy gurdy girl at 4:51 PM on December 18, 2015 [2 favorites]
Thank you all for your answers--there are some very good suggestions in here, like the one about paying the housekeeper a little extra to do wellness drop-ins more often.
She does have a yard and had a gardener until she fired him.
She does not have a good relationship with her primary care physician and is suspicious of his motives.
One thing I didn't hear you mention is the 'why'. Why does she want to leave [the hospital]? Why does she not want anyone at the house? How does she want to live out her remaining years? What would make her happiest, bring her the most contentment? Without answers to who she is as a person, there can't really be a two sided conversation about it. I would start by getting to know her true desires.
When we asked her last year and this year why she wanted to leave the hospital, she said the doctors and nurses ordered her around and made her do things she didn't like (physio). When we asked her why she wants to stay at home and not go to assisted living, she said she doesn't want to live with a bunch of people she doesn't know, and she doesn't want to be told what to do by the staff. I think this is pretty understandable and can empathize with that. When we have asked her why she fired the care aides and the gardener, she said they were too nosy, poked into her business, asked her all kinds of questions, were after her money, and didn't do things the way she liked them done (e.g. laundry, bedmaking, raking, etc.).
posted by hurdy gurdy girl at 4:51 PM on December 18, 2015 [2 favorites]
Response by poster: My parents just called with an update. The neighbour (N) who picks up our relative's groceries has just brought her home from the hospital, at her request. N has now organized a group of fellow retirees in the neighbourhood to bring her a meal and check in on her once a day.
Our relative seems okay with this arrangement, and although when I talked to her on the phone, she said they were busybodies and always trying to push help on her, she admits she prefers this to staying in hospital. She's not thrilled, but she's more okay with this than with actual strangers like care aides or home help nurses.
Of course we will continue to be in touch with N and phone our relative regularly, but this outcome is one that makes her happier than being in hospital, and provides us with reassurance that she is being cared for in a way that respects her autonomy but keeps her as safe as possible. (I forgot to say, we did get her home assessed last year and fitted with some safety measures like grab bars etc.)
Thanks again to everyone who contributed suggestions, and all the best to those of you trying to care for relatives in similar difficult situations.
posted by hurdy gurdy girl at 5:21 PM on December 18, 2015 [5 favorites]
Our relative seems okay with this arrangement, and although when I talked to her on the phone, she said they were busybodies and always trying to push help on her, she admits she prefers this to staying in hospital. She's not thrilled, but she's more okay with this than with actual strangers like care aides or home help nurses.
Of course we will continue to be in touch with N and phone our relative regularly, but this outcome is one that makes her happier than being in hospital, and provides us with reassurance that she is being cared for in a way that respects her autonomy but keeps her as safe as possible. (I forgot to say, we did get her home assessed last year and fitted with some safety measures like grab bars etc.)
Thanks again to everyone who contributed suggestions, and all the best to those of you trying to care for relatives in similar difficult situations.
posted by hurdy gurdy girl at 5:21 PM on December 18, 2015 [5 favorites]
When we asked her why she wants to stay at home and not go to assisted living, she said she doesn't want to live with a bunch of people she doesn't know, and she doesn't want to be told what to do by the staff.
Assisted living doesn't necessarily mean living with anyone, anymore than a person in an apartment building lives with anyone. And it doesn't necessarily mean having people intrude on her life. My cousin works in an assisted living building in Ontario - Each resident (or each couple) has essentially their own apartment. It's small and the kitchen is bare bones, but it's an independent apartment with it's own locking door and their own space that no one is going to come in and out of anymore than anyone comes in and out of my condo.
There is a dining room downstairs where residents can eat if they don't want to cook. It's not a cafeteria or a dining hall like in a dorm, it's essentially a restaurant. People order what they want to eat, the waitress brings it. The one thing different from a normal apartment building is that every morning by some hour (9am?) residents have to slide a card out under their doors into the hallway (or open the door and put the card in the hallway). Every morning an employee walks by and makes sure every unit has its card out and slides the cards back under the door. If there is no card, THEN they can knock or if necessary enter the unit. Of course residents who are going to be away can just let the staff know that so there's no panic over the missing card.
Residents can come and go when they please. There's a shuttle to the mall, or they can just take the subway. There are also health care workers (podiatrists, I recall, but likely others) who basically hold regular clinic hours in the building so residents don't have to go elsewhere if they don't want.
And of course the apartments are set up to be very safe -- chairs and bars in the shower, etc. etc.
This is covered by Ontario's health insurance plan.
So yeah, if she doesn't want to ive people or want people in her business or her space or telling her what to do, there are assisted living facilities with those options! It's not a choice between living alone with no help in a dangerous space or being in something that is essentially a hospital.
posted by If only I had a penguin... at 7:05 PM on December 18, 2015 [2 favorites]
Assisted living doesn't necessarily mean living with anyone, anymore than a person in an apartment building lives with anyone. And it doesn't necessarily mean having people intrude on her life. My cousin works in an assisted living building in Ontario - Each resident (or each couple) has essentially their own apartment. It's small and the kitchen is bare bones, but it's an independent apartment with it's own locking door and their own space that no one is going to come in and out of anymore than anyone comes in and out of my condo.
There is a dining room downstairs where residents can eat if they don't want to cook. It's not a cafeteria or a dining hall like in a dorm, it's essentially a restaurant. People order what they want to eat, the waitress brings it. The one thing different from a normal apartment building is that every morning by some hour (9am?) residents have to slide a card out under their doors into the hallway (or open the door and put the card in the hallway). Every morning an employee walks by and makes sure every unit has its card out and slides the cards back under the door. If there is no card, THEN they can knock or if necessary enter the unit. Of course residents who are going to be away can just let the staff know that so there's no panic over the missing card.
Residents can come and go when they please. There's a shuttle to the mall, or they can just take the subway. There are also health care workers (podiatrists, I recall, but likely others) who basically hold regular clinic hours in the building so residents don't have to go elsewhere if they don't want.
And of course the apartments are set up to be very safe -- chairs and bars in the shower, etc. etc.
This is covered by Ontario's health insurance plan.
So yeah, if she doesn't want to ive people or want people in her business or her space or telling her what to do, there are assisted living facilities with those options! It's not a choice between living alone with no help in a dangerous space or being in something that is essentially a hospital.
posted by If only I had a penguin... at 7:05 PM on December 18, 2015 [2 favorites]
oh, and I hope someone already does this, but does she speak to someone every day (i.e. the same person who would notice if she missed a day)? I know someone whose son would call her every morning. Sometimes they didn't connect (she wasn't disabled or elderly and still worked, but had a chronic condition), but pretty much every morning they did. One morning they didn't get to talk. The next morning, no answer again, so the son called a neighbour to have them check in on her (he lived far away). So anyway, having regular contact with someone, even someone far away, can put your mind at ease that she isn't lying at the bottom of the stairs injured and unable to get help.
posted by If only I had a penguin... at 8:20 PM on December 18, 2015
posted by If only I had a penguin... at 8:20 PM on December 18, 2015
We had good luck with a friend/neighbor who was available to do some light work on the property who was acceptable and then he had a daughter who need some extra work who she was willing to have come in and clean. Between them, we had familiar faces doing the work instead of having pushy strangers in the house.
Also, see if she would be willing to have an alarm pendant as way to call for help. The local services here (US) let you choose who gets to be called. So she could arrange to have a call go out to someone she trusts not to overreact - better than the alternatives, this way she can get help asap when she falls instead of waiting helpless and then ending up in hospital.
posted by metahawk at 10:43 PM on December 18, 2015
Also, see if she would be willing to have an alarm pendant as way to call for help. The local services here (US) let you choose who gets to be called. So she could arrange to have a call go out to someone she trusts not to overreact - better than the alternatives, this way she can get help asap when she falls instead of waiting helpless and then ending up in hospital.
posted by metahawk at 10:43 PM on December 18, 2015
Response by poster: If I only had a penguin... We had her scheduled for a tour of that type of assisted living home last year, which she initially agreed to but she refused to go at the last minute. However, we should broach the subject again--maybe she will be more amenable now.
Metahawk--the Life Alert I referred to earlier is an alarm pendant--it's the one she took off and refuses to use. We will see if the neighbours can convince her to put it back on.
posted by hurdy gurdy girl at 12:47 AM on December 19, 2015
Metahawk--the Life Alert I referred to earlier is an alarm pendant--it's the one she took off and refuses to use. We will see if the neighbours can convince her to put it back on.
posted by hurdy gurdy girl at 12:47 AM on December 19, 2015
When my elderly relative was in this situation, we phoned her every day. That way, we at least knew she wasn't lying on the floor for days with no help. Eventually, when she became ill and wasn't picking up the phone anymore, she was persuaded to go to the hospital and was assessed and found incompetent.
I have definitely seen instances where hospital staff are dismissive of legitimate concerns of the very elderly and jump to conclusions about mental illness that are unwarranted, so she may be picking up on something that's real. I understand how difficult and frustrating it is, but as long as she is not found incompetent, she can make her own decisions about how to live.
posted by FencingGal at 5:57 AM on December 19, 2015
I have definitely seen instances where hospital staff are dismissive of legitimate concerns of the very elderly and jump to conclusions about mental illness that are unwarranted, so she may be picking up on something that's real. I understand how difficult and frustrating it is, but as long as she is not found incompetent, she can make her own decisions about how to live.
posted by FencingGal at 5:57 AM on December 19, 2015
Response by poster: I'll make this my last comment for now for fear of thread sitting, but I just wanted to thank If I only had a penguin... and FencingGal for reminding me, we need to revisit our daily check-in phone call for her. We used to do this until fairly recently when she got mad at the intrusion because we sent the neighbour over a couple of times when she did not pick up the phone. It's probably an area where we should have pushed back more against her objections, because calling a neighbour to check if she's lying incapacitated isn't actually that intrusive or trying to control her life. We will try to work out a plan with her for what to do if she does not pick up; it's possible she may have mellowed on this if she sees it as preferable to other options and seems more accepting of the neighbour now.
As I'm sure you can tell, it's hard to know when to be gently assertive with her (if you don't pick up the phone after a couple of times, we are sorry but we WILL send the neighbour to make sure you are okay) and when to just let things be, in order to preserve her sense of autonomy. She has quite a different personality than the other elderly relatives we have arranged care for, so it's a learning experience for everyone.
Thanks again to everyone for your suggestions and advice.
posted by hurdy gurdy girl at 1:38 PM on December 19, 2015
As I'm sure you can tell, it's hard to know when to be gently assertive with her (if you don't pick up the phone after a couple of times, we are sorry but we WILL send the neighbour to make sure you are okay) and when to just let things be, in order to preserve her sense of autonomy. She has quite a different personality than the other elderly relatives we have arranged care for, so it's a learning experience for everyone.
Thanks again to everyone for your suggestions and advice.
posted by hurdy gurdy girl at 1:38 PM on December 19, 2015
It's morbid, but I wonder if this exists: A button (or buttons) placed in some high circulation portion of the house. Get into the habit of pressing the button each time she walks past and if the button isn't pressed for some period of time, someone is alerted. I would think it would feel wierd to constantly be pressing this button knowing it means "i'm not gravely injured." but it would be something she does actively herself, which is some sense of autonomy. And it wouldn't require her to have forced interactions with anyone.
Hey, I was just thinking "what if the button were somehow triggered by flushing the toilet? that would be great." and it occurred to me that if she has a smart water metre, then maybe there's an angle there...can someone check her water usage online every day? No water use would be a bad sign and water use (assuming she doesn't have automatic sprinklers) would me she's up and doing stuff.
posted by If only I had a penguin... at 7:10 PM on December 19, 2015 [1 favorite]
Hey, I was just thinking "what if the button were somehow triggered by flushing the toilet? that would be great." and it occurred to me that if she has a smart water metre, then maybe there's an angle there...can someone check her water usage online every day? No water use would be a bad sign and water use (assuming she doesn't have automatic sprinklers) would me she's up and doing stuff.
posted by If only I had a penguin... at 7:10 PM on December 19, 2015 [1 favorite]
« Older What are the good, but non-academic London... | Getting money back at the end of a car lease by... Newer »
This thread is closed to new comments.
posted by erst at 12:30 PM on December 18, 2015 [3 favorites]