May 10, 2012, 11:04 AM
Post #1 of 1
By Dr. Michael Gordon
Where to Live is Not Always an Easy Decision
Caring families usually want the best for their loved ones. Sometimes, in the quest to provide what is thought to be the best and safest care, we may forget that the person we care about has to be part of the decision-making process. The assumption is often made by family members, that if there is any degree of cognitive impairment and if there has been a serious fall, the best solution is a “protective environment” which often gets translated into a retirement home or nursing home depending on the loved one’s level of function.
I periodically see situations in which there is a conflict between siblings as to what is “best” for their parent. Sometimes the siblings believe that their solution is the best one and the parent rejects their recommendations with the resulting family conflict. It is easy to forget that decisions related to where one should live cannot be based solely on issues of safety. Sometimes the solution deemed appropriate by the children results in great consternation in the parent.
I witnessed such a situation some time ago. A daughter came with her mother for a follow up visit pursuant to findings of mild cognitive impairment and a history of repeated falls. At the time of the previous visit, the cause of the falls appeared to have been addressed at the time of a visit to an emergency department, when an adverse reaction to medications being used for high blood pressure resulted in a combination of excessive fall in blood pressure, when standing, and excessive slowness of the heart. The mother at the time was already on a medication used for cognitive impairment which alone could also cause a slowing of the heart.
At the time of the initial visit, her blood pressure and heart rate were controlled, and her mild cognitive impairment was to the degree that she would be necessarily considered unsafe. She had not had any further falls since the change in medication. At the time she was living with the daughter who accompanied her who was quite happy to have her at her house even though during the day she was alone. The mother had an emergency alarm system which she knew how to use. The plan at the time was for her to not return to her own apartment because it was not clear how safe she would be even with some help. She and her daughter seemed happy with the current arrangement.
Following the fall the patients two other children, were adamant that she needed to move into a retirement home and an emergency admission was arranged for a reputable one. Following three days the patient begged the daughter with whom she was now living to take her out. She explained to me that she did not “like living with so many people around” and she did not like “eating in a dining room with others”. While discussing this almost traumatic experience at the home she said quietly, “I would prefer to return to my own apartment, but if that is not possible I am quite happy to live with my daughter, as long as she is willing to have me. I feel safe and everything I need is on one floor and I wear that bracelet all the time which I know that I can push if I have a problem.”
I suggested to the daughter that she and her siblings arrange to meet with our social worker to help explore the process of such a decision so that her mother’s wishes became the proper and central focus of this decision-making process.
Adapted from Solutions Magazine Winter 2012 edition.
Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto.
Dr. Gordon is the author of the engaging memoir Brooklyn Beginnings: A Geriatrician's Odyssey, published by I-Universe.
Brooklyn Beginnings is available in bookstores and online at: Indigo-Chapters, Amazon.ca, Amazon.com, Barnes and Noble and I-Universe
Moments That Matter: Cases in Ethical Eldercare: A Guide for Family Members, is available online at Amazon.ca.
His latest release is Late-Stage Dementia: providing comfort, compassion and care. It is available at Amazon and Indigo.
Visit Dr. Michael Gordon's website.
(This post was edited by MGordon_MD on May 10, 2012, 2:30 PM)