On the Loss of My Parents – 10
[Exploring Life] As We Get Older: Macleans Magazine has published an important article entitled Don’t Seniors Deserve Better? in which Ken McQueen explores the reality of how the elderly are treated in our hospital system. In the years leading up to their deaths, part of the care I provided for my parents was to help navigate them through the hospital system first as their son, then as their son and Power of Attorney. The points Ken McQueen raises in his article resonate with me as being strikingly true. Though criticism is often all too easy an approach to take, my intent here is to in fact take a critical look at my parents experiences in the hospital (nursing homes are just as challenging but will not be discussed here), and to relate those experiences to the issues raised in Don’t Seniors Deserve Better?
My first and most immediate response to Ken McQueen would be, “Yes, based on my experiences with my own parents you are absolutely right.” Not only do seniors deserve better, the glaring and obvious lack of care in “health care” for the elderly is a serious condemnation on our society and culture. In other words, we as a collective group should be ashamed of ourselves – myself included. At the same time, until I had the first-hand experience of caring for my parents through hospital visits, I was in fact completely ignorant of the issues. Why is health care not an essential component of our education? It is sometimes surprising how the confluence of life can place new kinds of relevance and motivation directly and unexpectedly in our path. The other principle we should maintain is that the criticism is focused on “the system” that drives it, not a person or individuals within it. For the most part, I found that the employees of a hospital are in many ways its victims as well. The problem is therefore systemic and the system is in fact “broken.”
The treatment—and mismanagement—of Canada’s older citizens represents one of the greatest challenges facing the national health care system. Not only does the greying boomer bulge represent a looming financial crisis, but existing models of care are inadequate, inefficient and frequently dead wrong, say many of those who navigate the system as patients and providers.
- Ken McQueen in Don’t Seniors Deserve Better?
While there is an obvious financial component to this issue, the real issue is how we as a society treat other human beings, in this case the elderly. To describe the existing models of care as “inadequate,” “inefficient” and “frequently dead wrong” is accurate. We do “mismanage” our elderly within the health care system. One of the things that I recall the most is how we, as a family, had to remain constantly vigilant to ensure that our parents received adequate care. And I am not talking about exceptional care; I am referring only to adequate care. I do understand and appreciate that hospital staff are often pushed beyond limits, but if the system is stressing doctors and nurses to this degree, then the system is not working for either patient or health care worker.
A Trip to the Emergency Room: On one occasion my mom was taken to emergency for a second time within a week. The first time she was examined and sent home. Her condition became worse at home and had to be taken back. This time I quickly drove to their house and spoke with the paramedics about her medications. One paramedic gave me a grim look and stated, “You really should have this looked in to.” I staff in emergency about my concerns over the medications. This seemed to fall on deaf ears.
Once again they indicated they were going to send her home until I asked, “So in sending her home, I can assume that you have clearly identified the problem she is having and have resolved it? Please understand that if this is not the case I will be forced to pursue this issue further.” The doctor later reappeared and stated they were admitting my mother. As it turned out, conflicts in the daily barrage of prescription medications were causing her life-threatening problems. At one point during this stay she was given six-hours to live and we were told her kidneys were shutting down. She went through a horrific experience, but eventually recovered and went home once the medications were corrected. She lived several years after this experience.
Today’s frailest patients often suffer from multiple chronic conditions, ingest a mix of drugs and frequently want for medical care until a crisis hits. Once they get to hospital they stay there, tied to machines, consuming high-tech resources to little effect, growing weaker until the dim hope of a nursing home bed is the better of two potential outcomes. A frail, elderly person suffers a five per cent functional decline for every day in hospital, says Nowaczynski.
- Ken McQueen in Don’t Seniors Deserve Better?
This experience revealed two important lessons to me: 1) Doctors may not properly review the prescription medications for conflicts or potential over-doses; 2) Unless I take an aggressive and relentlessly persistent approach in the hospital my parents may not receive basic care. Furthermore, I strongly suspect that doctors have no real understanding of adverse drug interactions – they are simply playing a chemical version of Russian Roulette. I do not mean to say that doctors do not care – this in fact is not my experience once I have their attention – it is to say that their knowledge, especially of the effects of multiple prescription medications, is as the very best extremely weak and frail. Strangely enough, I have yet to see a doctor that has any understanding of natural cures. Why is that?
The Emergence of a Crisis: My father had hip surgery at age 90. His right hip was literally at the point bone against bone, so the pain had become severe. His choice was to use a wheelchair and pain medications, or take a chance on surgery. Being the kind of person he is he opted for the surgery. While the surgery was successful, the physiotherapy was not. Unfortunately, my conclusion is that there simply was not enough time or resources given to him in order for him to recover from the surgery. And it is so very easy to use the excuse, “Well he is ninety years old after all.” Thankfully no one made that comments directly to me, but that line of thinking was very apparent. Just as my mom had been dismissed as having six hours to live, my father’s recovery was dismissed merely because of his age.
On any given day, 7,550 acute-care hospital beds in Canada are filled with people who should be in long-term-care nursing homes or in rehabilitation. Annually, that’s 2.4 million hospital days, at $1,000 each—$2.4 billion a year—spent warehousing elderly people, often to their detriment, while denying space to critically ill patients.
- Ken McQueen in Don’t Seniors Deserve Better?
A crisis of monumental proportions had now revealed itself. Dad could not return to his home. He was the sole provider for my mother who could not live at home without him (she had been “temporarily” placed into a nursing home while my father was in hospital, under the assumption she would be returning home once he recovered). My parents’ lives, in a brief moment, had irreversibly been turned upside down. The ideal of living independently together had suddenly and permanently ended for them (see Points of No Return: On the Loss of My Parents – 3) I still feel the shock of this – my mother and father together for nearly seventy years now may not be able to live together, and potentially die apart from one another. It was true, their ability to live independently was erased, but the options we faced were deeply unsettling and revealed a faceless and inhumane aspect of our health care system known as “long-term care homes.”
The aggressive use of technology and specialists can literally be overkill. “The frail elderly need something completely different,” says Sloan. “The analogy is a Formula One racing car trying to pull a freight train,” he says. “It’s just the wrong job for a wonderfully sophisticated thing.” In hospital, the frail lose all control, he says. “They need to be allowed to make decisions about what’s going to happen to them as their inevitable decline occurs.”
- Ken McQueen in Don’t Seniors Deserve Better?
Aging with Dignity: Dr. Sloan’s comment is one we should all pay attention to: “They (the elderly) need to be allowed to make decisions about what’s going to happen to them as their inevitable decline occurs.” The loss of control in the twilight hours of our life generates a significant amount of anxiety and fear. As we grow older we simply and inevitably become less and less independent. That is, we have to rely on receiving help from those around us. We all need to take the time with the elderly to ensure that they are, to the fullest extent possible, included in any decision-making process that affects their life. It almost seems absurd to have to point this out, but as absurd as it is it needs to be stated.
On my visits to my parents in the finals months of their lives, I was often greeted by levels of anxiety that were entirely unexpected. The anxiety usually originated in some form of loss of control over their lives. The nature of the anxiety ranged from a relatively simple incident to a significant issue that had to be dealt with immediately. In both of my parents, levels of internal anxiety steadily increased. Perhaps as we come to the full realization that our days on this planet are rapidly become less and less, a certain increase in anxiety would be perfectly normal. However, the levels of anxiety I witnessed were often too intense to be considered normal. Life had been becoming increasingly terrifying.
We enter this world with no control or decision-making power, but we should say good-bye to the world having the comfort of knowing that we were fully involved in the final choices of our life. This is not always possible. Both of my parents had varying degrees of dementia that quite obviously began to have more intense affects in their final months. Sometimes it became hard to know what they were imagining versus what actually happened. At the same time, every effort should be made to include them in for as long as possible. Eventually there may in fact come a day when inclusion is no longer possible.
In a hospital every patient appears to be an opportunity to perform some kind of test. While this is an essential function for critical care, I agree that it is “the wrong job for a wonderfully sophisticated thing.” Eventually even both my parents shuddered at the thought of more tests and certainly in their final months wanted nothing to do with them. They had also become exhausted from the barrage of prescription medications they took three times a day, and I suspect just wanted to be able to spend their remaining time with us free of them. Of course, that is not possible as the effects of taking them off medication could in itself be fatal. But I sensed they just wanted some time free from all the medical interventions they had experienced.
The very thing that had perhaps extended their lives past expectations, was now something they wished to escape even for a short time.
An Opportunity to Rebuild: I always feel a little out of sorts when writing material that is clearly on the attack. Perhaps the grieving process is still causing me to perceive these issues with a greater intensity then I might. However, emotional intensity aside, there are issues we need to resolve. This is not an issue of specific people or groups of people doing bad work – it is an issue of a larger system impairing our ability to provide quality care for seniors. And there are people trying to repair the system:
Then there’s Dr. Samir Sinha, the dynamic new director of geriatrics at Mount Sinai in Toronto, who approaches eldercare with evangelical zeal. The hospital board gave him a mandate to do what’s best for its older patients, to make geriatrics a core priority, to have an integrated team deal with every aspect of their hospital stay—and, where possible, to meet their needs as outpatients or at home. “Our goal,” says Sinha, “is that people in the community never have to come visit our hospital.”
- Ken McQueen in Don’t Seniors Deserve Better?
Having an integrated team that is focused on every aspect of a hospital stay could be very beneficial. During my parents stay in the hospital, it was never really clear from one moment to the next, who I should speak to get information. In fact, there was no one single individual that seemed to be the keeper of the information, except the doctor who was usually unavailable for discussion. This lack of a central team is a source of anxiety for patients and family alike.
Quality care for elderly means that we assist them in dying with dignity and respect; quality care is not something purely physical. The World Health Organization wisely defines health as “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” If we are to provide “health care” then we must care for the complete state of physical, mental and social well-being.
We cannot continue to treat the elderly in the same manner we treat our planet; nor can we continue to treat the planet in the way we do. Neither practice is sustainable. Neither practice is honourable. I can say from personal experience, it is time for a new vision and a new model.