Avoiding hospitalization

The latest edition of Care ADvantage, the magazine put out by the Alzheimer's Foundation of America, had an article about trying to prevent hospitalizations for individuals with Alzheimer's and how to make the best if someone does go to the hospital.  I saw first hand this week another aspect of what happens when someone with dementia goes to the hospital.

One of the residents at the assisted living went to the hospital about a month ago.  It was not a preventable situation.  While in the hospital, she did not get up and walk.  So after addressing the issue that sent her to the hospital, she needed a rehab stay at a skilled nursing facility because she had lost so much strength and ability to walk on her own.  So off she goes for the famous 21 day stay at rehab.  I understand why it happens, yet that doesn't make it any easier to watch.  While at both the hospital and rehab, she was restricted from walking except when there was a staff member to walk with her.  Because of her dementia, she was not one to use the nurse call system when she needed to go to the bathroom.  So if she didn't call, they didn't walk her to the bathroom.  She walked during the physical therapy sessions, but that was about it.    And I firmly believe the old saying, if you don't use it, you lose it.  And she did.

The staff at the skilled nursing facility told the family that her inability to walk now (when she was slow, but able before going to the hospital and the reason for the hospitalization had nothing to do with her walking) and the fact she was not feeding herself was because the dementia had advanced.  Now I can't see into her brain so I can't say it wasn't.  I just think it was more a function of how the system is set up that isn't beneficial for people with dementia.  First of all, I don't like to just write a decline off to dementia progressing.  I think that can be an easy explanation for people to fall back on.  Secondly, I have worked in a skilled nursing facility and I know with the pace there, it can be much more efficient to just do things for a resident, feed them, wheel the wheel chair to the bathroom, or just change pads if they don't make it to the bathroom.  And I'm not against facility care.  I know there is a need for it and I know there are lots of facilities out there that are really trying to do the best job they can.

So when I went to evaluate her for coming back to assisted living, she was not in any shape to come back.  We are lucky in assisted living because even though we see our residents decline and need a higher level of care, we don't watch them deteriorate to the extent I did when I worked in a skilled facility.  That doesn't mean it isn't hard to see.  Not only was it hard for me to watch while she ate when fed, but not on her own, but I could see the future for my own mother as well.  It used to be when I first started in long term care, I accepted people where they were at the time and it was okay.  I hadn't known them in the younger days as young wives and husbands, parents, grandparents.  All I knew was how they presented at that time.  Now as a family member myself, I understand how hard it is to watch the person you once knew disappear.  And just as hard is the saying good bye to the family member that has become a part of your family as well.  Giving the daughter a hug, her looking you in the eye and you both know this move out of the assisted living is the beginning of the end.

I do love my job and I love being able to help residents and family members.  And I guess if I really didn't care, then it wouldn't be so hard to watch a resident decline or have to say good bye to a family member.  I just pray this experience helps me to be a better person, to be a better care-giver, to help families more and to be better at caring for my own mother.