BleepingComputer.com: Let them fall down or lock them up where they're safe?

As the old people of my family get even older, I'm getting a good look into the care of old people, the funeral industry, the nursing home industry, Medicaire, hospitals, insurance companies, drug companies, retirement communities. I'm also getting a good look at the inside of the minds of old people, what they want for themselves, what lengths they will go to to try to act fit long after they aren't, what operations help people who are beginning to lose their minds, what pitfalls there are to self-care.

Malnutrition, falls, incontinence, poor memory, poor hearing, loss of sight, arthritis, loss of mobility and drivers lisenses, dependeny, major illnesses, rehabilitation, Veteran's hospitals, emergency rooms, blood pressure machines.

I've been in lengthy discussions with the oldest members of my family to try and understand them and my family has been through lengthy debates, sometimes hostile, about what's best for them. I've taken turns helping to care for them, trying to keep them at home as long as they want to stay there.

When people get old, they start falling down. I didn't know this. There are different reasons for them falling, but one of them is plain and simple, their bodies don't keep up with their minds anymore. They turn too quickly. They overlook a last step because their memory is not as good as it was, because they don't process the information that there's one more step. They don't see as well. They don't pick up their feet. They act as if they were still young and forget that they have limitations they didn't have before.

The ongoing disagreement in my family has been whether to keep them safe, by moving them into a full care situation, or to accept the risk of them falling and allow them to live at home as long as possible.

The industry which cares for old people promotes safety as their primary objective. This is achieved through the restriction of movement, through drugs, and through structured activities. Basically, sleeping is encouraged, sometimes with drugs, electronic surveillance equipment is attached to anyone who might fall to ensure they can never walk again and the days are spent going from meal to meal with sitting hours in front of the television and with small entertainments in between.

When I wander the halls of the nursing home, it's painful to see that the home is gone. The ability to cook is gone. The chance to work in the garden is gone. Privacy is gone. The garage and the tactile sensation of tools is gone. Shopping is gone. A lot is gone.


What do you want for the old people in your family? How do you want them to spend the last years, months, days of their lives? What is the risk/safety factor in your equation?

Zllio

Hi Zillo, in my honest opinion....To instatutionalize most elderly people is to ROB them of their dignity....The aging process steal's enough from them as it is....

These are difficult decisions and there is no one size fits all answer, but I think that the answer has to contain balance; balance between risk and safety and balance between the elder's needs and desires and the needs of the other family members.

A person's health is more than physical well-being. There is mental and emotional well-being as well. Sometimes total physical safety has to take a second seat so that a person's mental and emotional state is sound.

Not everyone has the funds to pay for in-home care, and for one or even two family members to handle the care of another can in the long term create serious health issues for the caregiver. In some cases, care-givers have died before the one they were caring for. Other care-givers have been hospitalized.

Certainly, there are times when there is no choice but to place the elder in a nursing care facility of some sort. I think, however, that many are placed in such when it isn't necessary.

[quote]They don't pick up their feet.[/quote]

It can be difficult for them to do so. In this case, one can reduce the risk of falls by removing things that can be tripped over. Make sure all walkways are clear of debris no matter how thin it is. I've seen folks trip on a sheet of newspaper. Put in grab and support bars. Changes like these are relatively inexpensive and can reduce the risk of falls. It is impossible to eliminate the risk of falls, unless one tied a person down and that would be abuse.

In any case, the elder must be involved in the decision-making process.

On another tack, if possible find out what kind of medical care the elder is receiving. Know what medications the elder is receiving. You might be surprised how much damage a lot of medications can cause. See if the doctor will work WITH you and the elder.

Orange Blossom

I had a Carpet cleaning Company and was contracted to clean a number of these full time care Retirement Villages.
These are places where you would hope your loved ones are well looked after.
Without going into details,it is the last place,I would place my parents.and only when all other options were exhausted.

Nursing Homes are the last resort In My Opinion . They are for when the family cannot meet the needs of the individual be it special medical treatment, or constant 24 hour round the clock supervision. Both of my Great-grandmothers stayed with the family until very near the end, one lasted a few months in a Nursing home, the other lasted only a few weeks but both were very near the end when they went in.

I have thought about web cams as an option. My family was horrified by the idea, but for me, I personally would rather have someone seeing after me in this remote way while I could still live in peace at home and still allow the caregiver the chance to be at peace knowing they have some control and can call a doctor in a hurry if needed. The 24-hour care problem is partly one of interpretation, and disagreement about when that point has been arrived at has led to a lot of conflict within the family.

At a retirement community, one man I spoke with said he had the towel racks replaced with support bars, because when he slipped, he grabbed for the towels and the towel rack came away with them. This seemed so sensible, I wondered why no one had thought of it before.

In having a chance to observe a nursing home at work while one of our old people was recovering from two brain operations (due to internal bleeding from falls), I got to see the mechanics of nursing homes. They are a huge network of teams. There are the ones who are in charge of the medicines. This is a definite full-time job. There are those who are in charge of rehab. There are the dieticians who have to keep track of what each inmate/patient can eat. There are the cleaning crews. There are the administration. There's the building and maintenance staff. There are the nurses and usually one doctor. There are the hair-dressers and the barber. There is the activities coordinator. Part of this staff is around-the-clock, so three 8-hour shifts. A single nursing home employs a huge number of people. While Medicare is motivated to keep people in their homes as long as possible, the nursing homes are motivated to keep all the beds filled.

I also learned that there is a financial power of attorney which is different from a medical power of attorney. There are also different state-by-state laws on Do Not Resuscitate statements, what form is accepted, what color the form is (this was important - that it be bright yellow), what constitutes a situation of do not resuscitate. In all of these different kinds of paper work and systems, the decisions still come down to what the family agrees to and primarily what the one with power of attorney decides. As long as the person who has signed the do-not-resuscitate form is mentally competent, he or she can unsign it at any time. Medical power-of-attorney is only valid once two doctors have declared the person incompetent.

There are so many big issues and big decisions.

Being a person in there fifties and having a few health problems I personally would be horrified to go into a nursing home in later life.I accept in some cases it is necessary but to me I would think thats the end of my freedom.Elderly people can manage with support in most cases.I think if families keep in touch and visit elderly relatives regularly,one for companionship as loneliness can be hard for older people and two to satisfy yourself that they are coping.Both my parents died at home and I think that is what they both wanted.My father could hardly do nothing for himself as he had been run over 6 months previously.But we all as a family pulled together to help out.Carers need support to and it should be a shared responsibility and not for one to carry.

Zllio spend a little time thinking on how you would want to be treated when you get old/older.

[quote name='Layback Bear' post='1198236' date='Mar 29 2009, 09:04 AM']Zllio spend a little time thinking on how you would want to be treated when you get old/older.[/quote]

Hi Layback Bear,

I think I've been pretty clear about where I stand. I want them to stay at home as long as possible. And that's what I would want for myself if the conditions don't improve.

This is a great topic for discussion. And a tough one too. (Since I am American, my views are limited to that experience).

A few years ago my grandmother broke her hip and after surgery she was sent to a nursing home for rehab. She just didn't make it after that. We all learned a lot in just a few weeks--but you know, I don't think any of us has made any changes based on what we learned!

She had been living in an "assisted living" place, with the lowest level of assistance--basically one room with a bar sink and private bathroom in a place that took care of the 3 meals a day and had a barber and hairdresser and some activities. I think this idea is okay and as we all get older maybe we will get better about how we set these places up and can make them a little nicer.

The nursing home, on the other hand, was just frightening; and this one was a pretty nice, fairly new facility. Like Zllio mentioned, the whole cadre of professionals to handle each and every facet from medication to physical therapy. But the people there just wanting some attention--it is really hard to ignore someone who just wants to talk when it is taking all you have to deal with your own loved one. And while I was there during lunch one day a diabetic lady came really close to going into a diabetic coma even though there were half a dozen nurses in the room!

My aunt is an MD who works pediatrics in a hospital. She once said she would probably take the "Lee Vining" approach to care as she aged. Lee Vining is a tiny town in California with basically no facilites or services. So I guess she is in the "let them fall down" camp--when it comes to herself. (My grandmother was her mother).

The other thought I had recently was, so we think we know what is best for our elders as they become frail--but how are we going to act when we get there? I can't see myself behaving any differently--wanting to stay in my own home, trying to hide any frailities (like passing out behind the wheel), and not becoming overly depressed from the lack of interaction and the loss of abilities.

I am probably in the "let them fall down" camp. I think the web camera thing is brilliant--and why not? People have web cams up on coffee pots for goodness sake. Hopefully, both technology and geriatrics will come up with some better solutions. Like smaller nursing facilities that are basically real homes in real neighborhoods. Speaking of homes, we were actually discussing the other day how regular home building doesn't build wheelchair friendly when it would really be pretty easy to do. Make standard doors wider and so forth.

I am only guessing, but I think elders get better care and respect in cultures that still have the idea of extended family that are really close and maybe even a few generations still live with each other. My family is both small and scattered all over the place; I do assume I will have to make changes in my own life to care for my mother as she ages though (unless my brother and his family move back to where she lives or she moves in with them--but I am also hoping it is another 15-20 years before I have to worry about it).

ransom

Hi ransompendragon,

Thanks for your great response. All of the experiences you get when you spend much time with people who are getting into really old age and increasing infirmities starts the brain cells working. You asked why it isn't standard to simply put in the wide doors that accomodate wheel chairs and why aren't ramps standardly put in for homes? My own thoughts went into the more exotic why aren't there easy access sunken baths with good grab bars for the steps and a place to sit in the bath? Bathing becomes troublesome for older people, so it needs to become a place that is fun and relaxing, and not a confrontation with growing inabilities. It seems like it can't be too difficult to have a bathing experience with an unexpectedly nice environment, a setting that makes someone want to sit there for awhile, the kind of removable shower head that gets the water into the right places, warm towels, warm floors. Since bathing becomes a primary issue for older people, just as baby periphenalia becomes an enormous part of the baby experience - changing tables, wheelie buggies, gates, disposable diapers, carriers - why not put more investment into these areas that matter for the one who's gotten old?

Also, what about letting them fall? Is there such a thing as a jump suit that breaks a fall? The concept has surely been applied for stunt people, so it must be possible to make some adaptations for older people who are particularly at risk, like those with Parkinsons.

And what about just plain ugly functional and embarassing? I think there's a huge market for elder care design, making it elegant or pretty or something less than a medicinal necessity. The experience of getting old is certainly one of the important parts of life, and unlike the baby who's 2 months old, surrounded with teddies and with balloons on its nappies, old people are conscious of their environment and their appearance and I don't think much care has been given to appearances and acceptance of old age and its inevitability and working with it as something other than it being a mistake of nature.

Zllio

HI Zillo
I've got to say that i like the way that you think!!!

unfortunately right now i have to sit on the side lines and watch a tragedy play out in my own family
with this issue....one of my parent's was placed in a nursing home after the death of my other parent. the sibling that did this has very effectively tied my hands....
where it up to me my parent wouldn't be in such an awful place....my parent has had staph infection's twice...
my sibling has paid more attention to getting our parent sedatives then getting our parent into a healthy enviroment.....our parent has cancer and won't be with us much longer....i think that our parent's last day's should have been spent in the comfort of their own home....with dignity....all of the thanges that you mentioned would have been possible!!!...but like i said my hands have been tied.....
i sincerely hope that all of the thanges that you have mentioned will be of help to someone who's facing this issue with an ageing parent

@MissPlaced this is totally off topic. I go to a lot of dirt track races around here, and one of my favorite drivers has a car called Miss Behavin'. It has a pretty snazzy paint job, and the guy is pretty good. Anyway, your alias reminded me of that.

@groovicus, , ther for just a minute i thought you was gona tell me that i was Miss Behavin....

i never have to go lookin for trouble, it usually knows right where i am.....

now i return you to the topic at hand....

Zillo, i haven't been exactly sitting on the side lines, i've done my homework... i just can't use my homework...
nursing Homes are well known for the spread of Staph infection's(mrsa)
the health problems that attack elderly people are hard enough on the body, but when you add the constant
attack's of MRSA,it weaken's the body further, making it almost impossible for the body to repel their health problem's.... as i'm sure you can tell i'm NOT a fan of nursing homes at all.. our elderly deserve sooo much better!!!
to those that might be faced with this issue i would suggest that you avoid nursing homes at all cost!!
BUT that's just my opinion....
as i used to tell my parent that passed away...i didn't jump up outta my crib an ask how much did that cost?? and then in my best george lopez voice say I GOT THIS!!!

My mother lived with me for her last 6 years. The final 2, totally bedridden. I do not work, therefore I took care of her during the daytime, plus my 2 daughters were a phone call away
My mother in law now lives with me and I will do the same for her as my wife did for my mother

You mention quality of life, in our case you can see the difference. When she lived by herself, she refused to eat right, got confused with her pills and generally got depressed
Now she's up every morning, eats right, plays with her great-grandkids
Her doctors said we have added years to her life