The Cycle of Relocation: One Family's Experience With Elder Care

Judith S. Lynch, MS, MA, APRN-BC, FAANP

Disclosures

Topics in Advanced Practice Nursing eJournal. 2006;6(4) 

In This Article

A "Small Fall" and a Trip to the Emergency Department

"Prepare yourself: this is the beginning of the end -- your mother will go through a gradual decline and, most likely, never regain her previous level of function."

(unnamed anesthesiologist, July 6, 2005).

The above sentence, with infinite variations, was repeated many times during the past year as my family attempted to cope with the sudden transition of my mother's health from that of a 91-year-old, independent, New England woman, living by herself and driving her car in a city where there were no family members living, to a dependent ward of the healthcare system. The transition began one day as I listened to my voice mail and heard the small voice of my mother saying that she had suffered a "small fall" and that the "nice men in the ambulance" had taken her to an unspecified emergency department. I stared at my phone, unable to internalize the message for a moment. I was then flooded with terror as I contemplated what she (and we) would have to endure.

My only sibling, a brother 6 years younger, has lived in Texas his entire adult life, and my children were scattered throughout the Northeast. As the nearest relative, her daughter, and the person who was intimately connected with the health system, I realized that this would be a life-altering family and personal event.

I finally located her and was told that no information could be given as she had not yet signed a Health Insurance Portability and Accountability Act (HIPAA) form. This was the first of many frustrations with our healthcare system. I finally succeeded in reaching a nurse at that hospital who was known by a member of our family. She told me that radiology studies revealed a right hip fracture and 2 pelvic fractures: thus began our family's journey through the intricate web known as elder care in America, a journey with many peaks and valleys, and one that resulted in the reshaping of our family structure in ways I could never have foreseen.

Mother's surgery was scheduled for 2:00 pm the following day. I spoke to the orthopaedic surgeon who wished to operate the same night in order to maximize her potential for full recovery. I insisted on a cardiac consultation first, as mother had severe valvular disease with long-term heart failure. I also wanted local anesthesia. I was told that this was an inadequate method of monitoring her vital signs. I conferred with the hospitalist in charge of her care, and we found an intensivist/anesthesiologist who was willing to administer a spinal anesthetic. (Her primary care provider, a geriatric nurse practitioner [GNP], who had cared for her for over 10 years, was not able to follow her in the acute care setting.)

After an echocardiogram and 90 minutes of surgery with a pin placement, she returned to her room asking for her "blush makeup" and a comb. She was in a chair the next morning, in physical therapy the following day, and in a rehabilitation program within 72 hours. Two weeks later, she was sent home with a nursing coordinator and home healthcare services.

Ten days later, she was rehospitalized in heart failure followed by a stay in a skilled nursing facility. With the knowledge of the home failure, we found a respite facility that would provide assisted living services while we tried to make long-term decisions. She later moved permanently into this assisted living facility. She had 2 more hospitalizations within the next 4 months for recurrent heart failure and pneumonia. In total, she went through 10 relocations in the next 9 months.

Why write an article about these events? It is not only my family's journey, but a journey that many of us find ourselves in, either as elders or as children in far-flung places, hoping that our elder relative will escape without entering the long-term healthcare morass. Our family's passage is instructive and paradigmatic in what it helps us understand about the 21st-century American family as well as the healthcare system itself.

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