Friends & Family of Seniors
How Can I Convince a Senior That She Needs to Move Into an Assisted Living Facility for Health & Sanitary Reasons?
It can be very difficult to see a senior not doing well and needing extra help, especially if they are not willing to make a change. The loss of independence and the thought of moving somewhere new can be very difficult. Friends and family need to be as supportive as possible in assisting the senior make any changes to their environment.
It is important for the primary care physician (PCP) to be alerted to your concerns. A visit can be scheduled to have the PCP assess the situation and evaluate if there are any reversible reasons for the decline in health and function. The PCP can also make recommendations regarding future planning or to involve a Clinic Care Coordinator to assist with obtaining resources. If possible, and as long as the patient has given permission, it would be helpful if a family member/advocate is also part of that visit.
An assessment with a Geriatric Nurse Practitioner can be very beneficial. This can be arranged with the senior's PCP.
Sometimes a family meeting with the patient, where concerns are voiced, can be effective. It might be advantageous to visit some of the area facilities to have a sense of what is available.
A few changes in the home may be enough to make the senior safe. This might involve the use of a private pay care provider, such as Heartline and/or Meals On Wheels, to supplement care and increase safety.
Adult Day Services is an option. It is also possible to hire a community case manager to assist with coordinating some of the care aspects. An intake evaluation with Senior and Disabled Services is recommended, as the senior may be eligible for some in-home assistance. If there are real concerns for safety, and the senior is not open to any assistance, Adult Protective Services should be notified.
A discussion with the PCP to request the services of the PCP's Care Coordinator is highly recommended, as they will be able to discuss options with you and patient.
What Should a Hospital Do When a Patient Does Not Have an Advance Directive & the Family Members Disagree About What Should Medically Be Done for Their Loved One?
It is not unusual for family members to disagree on medical decisions when the patient does not have an Advanced Directive, or even more important when the patient has not discussed their feelings and beliefs with them. Staff members, including social workers and chaplains, are available to assist families in coming to agreement. In addition, the PeaceHealth St. Joseph Ethics Committee is available on request to consult with both the family and the professional medical caregivers. The Ethics Committee is not a decision-making body, but it can help the parties develop an ethical framework for making decisions.
In cases where agreement cannot be reached, there is a legal hierarchy of family decision-makers. The law outlines who this would be without an advance directive, and this person would be responsible in the end to reach a conclusion and make a decision consistent with the patient's values. While we prefer that we succeed in helping families come together, having clarity on who the legal decision maker is provides a framework for decision making. This also helps families in extreme conflict to realize that there is a legal framework within which they must work.
Ultimately, the question family members must ask is not "What do we/I think should be done for my family member?" From an ethical perspective the better question is, "What would my family member want done if she could speak for herself?" The answer to this question is more often than not, quite different from the answers given to the first question. This question often prompts a shift in thinking among family members. Conflict is still present, but the focus is on one person's values and feelings: the patient.
What would PeaceHealth suggest? That the caregivers first clarify the question about who the ultimate decision maker is, and second to facilitate discussion about what the patient's wishes would be given the medical condition and prognosis. If conflict proves to be an obstacle, call a chaplain, social worker or request support from the Ethics Committee.