By Steve Moran
Ageism is a real thing. But so are the ravages of aging. My 91-year-old stepfather — who should be living in senior living but instead lives with me and my wife (that is another story) — is dying, very slowly and very messily. His cognitive capabilities have very slowly but steadily been decreasing, as is true with his stamina.
A few weeks ago we went for a little walk, and after maybe 200 yards, he was done. He is someone who played football for Stanford, and as an adult, golf and tennis for decades. Having to turn around was frustrating for him.
A Messy Journey
A few months ago he went out the front door to mail something, hunt for the cat … something fell and did serious damage with lots of blood to his face, resulting in a trip to the emergency room.
Then a few weeks later he spent several days in the hospital with a UTI. He was really sick and really confused, convinced he was in a hotel and trying to figure out how he was going to pay his bill since he couldn’t find his wallet (I had it safe at home).
In each case I found myself in a role that felt more like parenting than being the adult child of a fully capable adult. Struggling to give him as much control as possible but knowing that he needed help communicating with the medical staff and making decisions.
Once home, his cognitive abilities improved to near where he was prior to the hospitalization.
A few days ago he started coughing, so a friend took him to urgent care. The doctor was young and dismissive. No tests, no imaging. Told him to go home and he would be okay. I guess just an old man worrying unnecessarily.
He came home and went to bed for the next two days. Then he woke up early in the morning feeling terrible. Off to the emergency room. We were very lucky — Sunday morning gave us a nearly empty emergency room, so things moved fast.
I was pretty sure it was pneumonia, and it was, but more than that, congestive heart failure and COVID-19. As I write this article, he is in an isolation room and only sort of understands why.
The Greatest Indignity
Last night at about 10:30 p.m., I got a call from his nurse telling me he would not stay in his isolation room, putting staff, other patients, and visitors at risk for catching COVID. They decided to put him in a Posey vest soft restraint.
By morning they were telling me it was to protect him from falling rather than to keep him from wandering. He hates it. He has been stripped of all control in his life. He is cursing and crying because of the indignity. We have explained it, and he sort of gets it for a little while.
He should not be in restraints, but it is easier for the hospital. It is all about risk mitigation, which is way more important than my stepfather’s dignity and peace. It is the wrong priority. I am fighting to make it better, without much success.
The Big Societal Problem
We have made massive strides keeping physical bodies alive, and at first it seemed wonderful and magical. Who could object to such a thing? But we have not spent very much time talking about the unintended consequences of these “medical miracles.” In truth, relieving his emotional anguish should be the most important thing.
He is going to die. I don’t know if this will be the episode that does it. I hope not, but there will be a last episode, and that last episode should be pain-free, as anxiety-free and stress-free as possible. The hospital and the physicians are failing.
This is worth our industry thinking about. How can we be the antidote to the problem? This becomes a big part of our secret sauce.
Steve, sorry to hear about your stepfather’s situation. I couldn’t agree more, hospitalized seniors have the worst patient outcomes because of age discrimination. The healthcare system can’t keep up with longer life expectancies, so it appears that seniors are not a priority. Families have to be their loved ones’ advocate otherwise they are left alone…& likely to die. I witnessed it firsthand when my 80 y/o father was hospitalized for over 2 mths this past summer following a stroke. After 2wks, he developed delirium & no one was monitoring what he was eating or drinking….lost close to 40lbs & went into acute renal failure. How does that happen in a hospital? This despite us telling staff he was lethargic, not voiding, etc….just fell on deaf ears! We had to get the ombudsman involved due to illegal use of waist restraints on 3 occasions, left unsupervised for hours in only his underwear. Where is the dignity? Staff claimed it was to keep him from pulling out his IV, meanwhile his hands were free. He tried to reach for whatever he could to cut himself out of that belt. Found out later it was because he was wandering into other rooms & staff “didn’t have time to keep getting him back to his room”., this was from a nurse who was arguing with my brother when they wanted to restrain him again. He was denied any proper post stroke rehab because of his age & we were told to place him in LTC. That didn’t sit right with us, so I moved him to a senior living community close to me where he has choices, treated kindly & properly supervised. He’s still traumatized by his hospital stay & it took some time to trust the staff at his new community, but it came. He’s thriving again but it’s a long journey of catch up on rehab he should’ve had months ago. Thank you for your article.
This is such a great article.
I dream of a day when some senior living company will be totally sold out to the customer experience. I fear the problem is that workers always know there is one more or a dozen more things that need to get done. So they do the minimum they care or even ignore what they they perceive to be “not their job” or low priority.
When the customer touch happens it is all about being efficient. Doing the thing that absolutely needs doing then moving on. Maybe the urgency to keep moving is real and maybe it is just programed into the corporate culture and culture we exist in.