needed. As well, she thought she might be cramped in the private home because she would only be given a two-bedroom apartment.
More and more days passed when she just had to rest. She did not have the energy to go out, but if she did go to get groceries and arranged to have them delivered, she was just too tired the rest of the day. Swimming in the morning meant she had to rest several hours afterward before she had the energy to have someone to tea.
Live-in home care
Then Mrs. Martino got pneumonia. She was hospitalized in a very weak, frail state. When her son visited her in hospital, he found his mother very unhappy with the nursing. On two occasions, he observed one of the nurses abusing his mother by saying, “You don’t need to go to the bathroom again! We just moved you up in bed.” This prompted him to take his mother out of hospital and home to the apartment.
He had a choice: he could move his mother into a nursing facility or organize live-in home help. Having a live-in homemaker cost more than moving into a nursing facility, but he wanted his mother to age in place. So he rented a wheelchair and a commode and hired a live-in homemaker from the same agency to replace the homemaker who came daily. One homemaker lived in for five days, and a second one came on weekends.
Geriatric assessment
Mrs. Martino was deteriorating. She was depressed and she felt useless. She wanted to die. A geriatric assessment team came to the apartment and did an assessment to try to work out what was best for her. The team did assessments, made recommendations, and monitored her progress. Getting her on some antidepressants was their first priority.
(In the United States, health maintenance organizations (HMOS) and the Program for All-Inclusive Care for the Elderly (PACE) have geriatric assessment teams. In Canada, they are usually associated with a hospital and may be funded partly through the hospital and partly through the regional health board. The team, a group of professionals intent on keeping elders out of facilities, usually consists of a geriatrician, a clinical nurse specialist, a physiotherapist, a social worker, and other personnel as needed. Your physician or hospital can refer you for a geriatric assessment.)
Mrs. Martino’s family and friends still visited, but she was very weak and in bed all the time, except to go to the bathroom, which was a great effort. She was too tired to even listen to the talking books, and she was not interested in food at all. The pneumonia got better, but she was still depressed, and life was just too hard. Eventually, the pneumonia returned, and Mrs. Martino died at home in her own bed with the homemaker agency woman in attendance.
Conclusion
If Mrs. Martino had had no financial resources, she may have been eligible for hospice services. These are comprehensive services for terminally ill clients and their families (see Chapter 5). However, she chose to not go into a facility and was wealthy enough to afford the care she needed to die at home. Mrs. Martino was always mentally alert, so she was able to direct her own care and express her own wishes. If she had had some dementia, her choices would have been more limited, and her children would have been more concerned with her safety. Luckily Mrs. Martino never needed any type of special care unit.
Mrs. Martino’s encounters with the health care system were typical of many elders. More than 90 percent of North American elders are living in their own communities, with their families providing most of their care, and formal care as supplement or last resort. This generation tends to be fiercely independent, proud, and private, and it is difficult for them to give up this independence (e.g., by accepting home help and giving up their driver’s licenses).
Mrs. Martino was fortunate that she did not need to access the public health care system much because she had many resources — money and a knowledgeable family. She was grateful that she didn’t have to go through financial-means testing. In fact, she would probably rather have done without than go through that assessment.
Many elders, however, do not have the option of private home care, and they cannot think of anything to do but take themselves to the emergency ward of a nearby acute-care hospital. Elders use acute-care hospitals more than other population groups: they use 48 percent of all patient days in hospitals. Unfortunately, 20 percent of all visits to hospital emergency rooms result from adverse drug reactions among elders.
Mrs. Martino’s encounters with the health system are but one example of how elders cope with their failing bodies near the end of life. The episodes to hospital became more frequent in her last years, and yet the stays were of short duration. Family was used as the first resource, followed by just a cleaning lady, until in the end, Mrs. Martino had 24-hour care. Poor elders without families are the people most at risk for being cared for in nursing homes.
How to Get in Touch with Health Care Services
The American Health Care Association suggests contacting the following resources for getting local information about nursing facilities. To get in touch with any of these health care services, check out the blue pages (government contacts) in your phone book:
• Hospital discharge planner
• Social workers
• Geriatric case manager
• State affiliate of the American Health Care Association
• Local medical society
• Eldercare Locator: Sponsored by the US Administration on Aging, this is a nationwide, toll-free service to help older adults and their caregivers find local services for elders. Call 1-800-677-1116 on weekdays between 9:00 a.m. and 8:00 p.m. est.
• Area Agency on Aging (AOA): This is a federal agency that can provide you with a list of the long-term care choices in your state, including community services.
• Centers for Medicare and Medicaid Services (CMS): Call their 24-hour help line in the blue pages or visit their Web site <www.medicare.gov>.
• State long-term care ombudsman program or health department: The long-term care ombudsman advocates for residents in nursing homes, board and care homes, and assisted-living facilities. They have state and local offices.
• State Health Insurance Assistance program (SHIP): These are state programs that get money from the federal government to give free health insurance counseling and assistance to people with Medicare.
• State Medical Assistance Office: This office gives information about state programs that help pay health and nursing home costs for people with low incomes and limited resources.
• State Survey Agency: This agency helps with questions or complaints about the quality of care and the quality of life in a nursing home.
To get in touch with local health care services in Canada, the health department at City Hall will usually refer you to your local health unit. Or call the local number for Health Canada (check in the federal section of the blue pages). They can tell you about nursing care accessibility across the provinces.
The federal pension department can tell you about the Income Security programs of Human Resources Development Canada and the Canada Pension Plan, including cpp disability and Old Age Security.
Don’t forget to also talk to your minister, priest, rabbi, or other spiritual advisor, as well as friends and neighbors who may have had direct experience using local nursing facilities. Many facilities have individual Web sites,
