Join the journey of a fairly recently graduated MSW social worker, navigating the expanse of hospice social work in the south, the ups and downs of graduate school, LCSW exam stress and excitement, and preparing for a future in macro social work practice

Monday, September 27, 2010

Nursing Home Placements

Since I started working in hospice, my opinion about nursing homes has evolved a bit. I used to think of nursing homes as sad, lonely, pathetic places where people go when no one else wants them. Sort of like an orphanage for the elderly. Surely the only people who were placed in nursing homes were those with no other family. When I started working for hospice, I realized that that is not always the case. Sometimes, nursing homes are wonderful places.

Our hospice is very small and does not have any contracts with nursing homes, so when a patient or family chooses nursing home care, they also choose to revoke hospice (some of our competitors have contracts with the nursing homes our patients typically choose, so they are not without hospice care completely). For our hospice this is unfortunate from a business perspective, but it is obviously better for the patient to be able to get around the clock care needed.

We have had several patients who have not identified a primary care-giver, either because there is none available or because they do not feel they need one. In those situations, when the time comes that the patient is no longer able to care for him/herself at home, part of my responsibility is to help the patient identify an acceptable nursing home placement. I’ve found this to be a difficult task; very few patients admit that they are no longer able to care for themselves, and the notion of having to leave one’s home for the final days or weeks of life is understandably unpleasant. These are the situations I’ve struggled with. What is the best way to help a patient see the writing on the wall? If the patient cannot safely be in their home, how can I explain this to the patient, who came into hospice knowing that the mission of hospice is to help patients remain at home?

A couple of months ago, we had a lovely patient Mrs. G. Mrs. G. is a very sweet lady who somehow managed to capture the heart of everyone who came into her small apartment. She was mostly bed bound, did not have any family in the state, and relied on hospice care and four hours a day personal care from her Medicaid benefits. One day, after her personal care aid left, Mrs. G. decided to make herself some stew. She took her oxygen off, turned her crock-pot on dumped the stew in the pot, turned around to answer the phone, and fell over. Since she had chosen not to wear her lifeline, she had no way of reaching anyone. From 1:00pm until 8:00 the next morning, Mrs. G lay on the floor, a hot crock-pot on the counter 6 feet away from her.

When her personal care aide arrived the next morning, she found Mrs. G on the floor, helped her get up, cleaned, and back into bed, then promptly notified hospice. Mrs. G was adamant that she would not go to a nursing home, but gradually relented when the nurse, the chaplain, and I spoke to her and gently encouraged her to reconsider. Luckily, Adult Protective Services did not have to become involved, and Mrs. G headed off to the nursing home, only a little bit sad. Two days later, I stopped by the nursing home to say hello. Mrs. G was a different woman. Although she was of course still terminally ill, her eyes and her face were so much brighter. She reported more energy, and more happiness, which she attributed to finally receiving the care that she needed. She had lots of positive social interaction with the other people in the nursing home, and she could not remember why she had been so adamant about staying in her apartment.

Experiences like this have helped my opinion on nursing homes to evolve. I know that nursing homes are not without problems, but I love the care they’ve been able to give our former patients. Responsible adults who do not wish or are not able to be the main caregiver to their elderly parents do them a large disservice by keeping them at home without providing the highest quality of care. If being the caregiver is not in the cards, the most responsible choice for the family to make is to work to locate the best possible long-term care facility. And visit regularly, of course.

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