We fail our old people and it's heartbreaking

  1. I recently had a patient who was admitted because a neighbor contacted the police when they realized she was living at home with a few pets in a house with no heat or running water. She's been admitted with a minor medical diagnosis, but it's been passed in report that we're just waiting on long-term care placement for her. She's in her mid 80's, has been living independently for many years, and she's pretty clear that she's going back to her house with her pets, because no one has told her otherwise. I've worked with many dementia patients over the years, even the ones that were pretty sneaky about it, and I honestly didn't see indications of dementia. She had some trouble with phone numbers, and these days no one has a phone book, so she was in the process of tracking some people down to help with the heat and water, according to her, before the neighbor called the police. If we had a system in place where elderly people could live in their home, have someone just check in on them for the basics, and they could retain some independence, that would be so beneficial. Now she'll end up in long-term care, potentially funded by the state depending on her financial situation, and she's one of those people that I'm pretty sure will just will herself to die in an institutional setting. And she's going to be one of the combative aggressive ones, too. That's the report I got from the previous nurse, but it's all about approach with her. If she feels empowered to make decisions, she's fine. As soon as she feels control has been taken away, she digs right in and will get feisty, and I don't really blame her. So what's the worst possible thing we could do for her? Long-term care placement. Breaks my heart to think that she'll never be home with her pets again and all she wanted all night was her dog on her bed. Sometimes I hate getting old.
    Last edit by Brian S. on Jan 19
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    About JBMmom, MSN, RN

    Joined: Jun '09; Posts: 546; Likes: 1,123

    101 Comments

  3. by   llg
    ... which is why we should all be planning for our own retirement. Not just saving money, but really making plans as to where we will live ... who will help us when we need help ... etc. We can't count on "the government" or "society" to make all the arrangements that need to be and provide all the services we would like to have. If left to strangers, our care will be provided in the most cost-effective way possible.

    So if we want things to be a certain way, we need to make arrangments for that. We need to plan for ourselves -- and save the money necessary to cover the costs of the life we want to lead when we are very old.

    I wish the woman in the OP well and hope she can find some happiness regardless of where she goes next.
  4. by   Farawyn
    Adding, Yes.
    We can only do so much, and these seniors often don't have a voice.
    With our current Administration, I fear for the worst.
  5. by   Eleven011
    Isn't there Home Health services or some thing similar where you are? I used to work with people just like the lady you described. Here she would get a nurse visit once a week to help with medicine and check vitals and trim toenails if needed. She would also get an aide 2-3 times a week for help with any personal or household help she needed. So sad to see people forced out of their homes too soon.
  6. by   Farawyn
    Quote from dakotadenise
    Isn't there Home Health services or some thing similar where you are? I used to work with people just like the lady you described. Here she would get a nurse visit once a week to help with medicine and check vitals and trim toenails if needed. She would also get an aide 2-3 times a week for help with any personal or household help she needed. So sad to see people forced out of their homes too soon.
    It is, but what if she has no one else to report the state she's in? Her siblings are dead, she has no children, bla bla bla...quietly living with her cats until it is too late.
  7. by   Eleven011
    Quote from Farawyn
    It is, but what if she has no one else to report the state she's in? Her siblings are dead, she has no children, bla bla bla...quietly living with her cats until it is too late.
    Yes, many times these situations are only caught when things get bad, like the police being called. But I was referring to now that the lady is in the hospital, it seems her only option is the nursing home, when there should be programs like I mentioned available to her to help her safely stay in her home.
  8. by   AceOfHearts<3
    I hugged my dog extra tight today, this makes me so sad. I do agree we need to do better.
  9. by   Susie2310
    Quote from llg
    ... which is why we should all be planning for our own retirement. Not just saving money, but really making plans as to where we will live ... who will help us when we need help ... etc. We can't count on "the government" or "society" to make all the arrangements that need to be and provide all the services we would like to have. If left to strangers, our care will be provided in the most cost-effective way possible.

    So if we want things to be a certain way, we need to make arrangments for that. We need to plan for ourselves -- and save the money necessary to cover the costs of the life we want to lead when we are very old.

    I wish the woman in the OP well and hope she can find some happiness regardless of where she goes next.
    Without actually knowing the details of a person's life it is easy to make assumptions about why they are in their present circumstances.

    Being able to save adequately and plan for one's retirement depends a lot on being fortunate enough to secure decent to well paid jobs during one's working life. There are a multitude of reasons people are often unable to do this; from the cost of a college education, to a lack of employment opportunities because many middle class and working class jobs no longer exist for the most part in this country, to lack of a supportive family background during one's childhood that makes educational and career opportunities possible, to being carers for sick/elderly family members, to being victims of domestic violence, to personal misfortune, and so on. Not everyone is able to access middle class and upper middle class careers, let alone professional careers, and be able to save significantly for retirement and/or receive a good pension, and plan where/how they will spent their latter years, and this is certainly not necessarily due to lack of effort or other personal shortcomings. Many, many people's lives are based on just surviving, and what happens to them in their retirement is left to chance and to the mercy of other people.

    With respect, you have mentioned before that your father was a physician and that you began nursing school after high school (please correct me if I am misremembering); my point in mentioning this is that life and career opportunities were available to you that weren't available to the average person, so it would be reasonable to conclude that your opportunities and ability to save and plan for retirement would be better than the average person.
    Last edit by Susie2310 on Jan 17
  10. by   Munch
    Quote from dakotadenise
    Isn't there Home Health services or some thing similar where you are? I used to work with people just like the lady you described. Here she would get a nurse visit once a week to help with medicine and check vitals and trim toenails if needed. She would also get an aide 2-3 times a week for help with any personal or household help she needed. So sad to see people forced out of their homes too soon.
    I was thinking the same thing. But a lot of times people just don't have the funds to pay for it and insurance depending on the plan at times only wants to pay the absolute minimum. I actually just recently read an article about the home health system and how broken it is. One person in the article elected to work at a coffee shop because that paid more than home health nursing. Its really sad people end up being warehoused until they die. Don't get me wrong plenty of nursing homes are nice places with caring staff but it simply isn't the same as home. I wish we had a better solution for these poor people. I know when my time comes I want to die in my own bed..sadly its not as simple as that for some people but I wish it was.
  11. by   NRSKarenRN
    US needs to expand Program of All-Inclusive Care for the Elderly to ALL states:
    Program of All-Inclusive Care for the Elderly | Medicaid.gov

    The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits . An interdisciplinary team of health professionals provides PACE participants with For most participants, the comprehensive service package enables them to remain in the community rather than receive care in a nursing home. Financing for the program is capped, which allows providers to deliver all services participants need rather than only those reimbursable under Medicare and Medicaid fee-for-service plans. PACE is a program under Medicare, and states can elect to provide PACE services to Medicaid beneficiaries as an optional Medicaid benefit. The PACE program becomes the sole source of Medicaid and Medicare benefits for PACE participants.
    In PA/NJ/DE program is called LIFE (Living Independence for the Elderly)

    LIFE is an option that allows older Pennsylvanians to live independently while receiving services and supports that meet the health and personal needs of the individual.

    Living Independence for the Elderly (LIFE) is a managed care program that provides a comprehensive, all-inclusive package of medical and supportive services to help keep a person living in own home/apt. PA has 35 programs throughout the state. Our health system is largest provider of LIFE care throughout the US. Through this program, my father was able to live at home for 2 1/2 yrs until no longer safe to be alone at night due dementia.

    Services provided in own home or at Adult Daycare Center include:

    Medical Services


    • Primary care and physician specialist services
    • Nursing care
    • Prescribed medications
    • Physical, occupational and speech therapies
    • Dental care
    • Vision care
    • Hearing care
    • Foot care
    • Medical equipment
    • Personal emergency response systems
    • Mental health services
    • Hospital services
    • Nursing home care (if it becomes necessary)


    Support Services

    • Light housekeeping, laundry, cooking and help with bathing and dressing
    • Meal planning and nutrition
    • Spiritual counseling
    • Personal care assistance
    • Medication management meds provided without copay.

    Transportation is provided to daycare centers and to medical appointments.

    There are income levels under Medicare/Medicaid programs with private pay option available.

    Find a PACE Program in Your Neighborhood | National PACE .
    Last edit by NRSKarenRN on Jan 17
  12. by   brandy1017
    Quote from llg
    ... which is why we should all be planning for our own retirement. Not just saving money, but really making plans as to where we will live ... who will help us when we need help ... etc. We can't count on "the government" or "society" to make all the arrangements that need to be and provide all the services we would like to have. If left to strangers, our care will be provided in the most cost-effective way possible.

    So if we want things to be a certain way, we need to make arrangments for that. We need to plan for ourselves -- and save the money necessary to cover the costs of the life we want to lead when we are very old.

    I wish the woman in the OP well and hope she can find some happiness regardless of where she goes next.
    In an ideal world we'd pay for long term care insurance or even better we'd live in a country that provides long term care. But hell our country doesn't even provide national healthcare. Funny Trump bashed poor countries and the richest country in the world won't take care of it's own people, something the rest of the world has figured out. We are more like a third world country with respect to the lack of benefits and the miserly minimum wage!

    As for long term care I think only people making 6 figure salaries could reasonably afford LTC insurance. The rest of us would be throwing money away only to find out in the end we could no longer afford the premiums or the company would go out of business. This has already happened.

    So sure one can plan but there is no guarantee things will work out!
  13. by   NurseCard
    Commenting without reading the other posts... but if she is completely alert and
    oriented, no mental deficit, competent to make her own decisions... she can
    do whatever she wants. She can go back to her home without heat and
    water and live with her pets as long as she pleases. She doesn't have
    to go to long term care. It doesn't even matter if she can barely get
    herself around.... she can do what she wants if she's competent.

    It can be sad and frustrating when someone who is competent,
    refuses to leave that type of situation. I've had home health patients
    who could not care for themselves, did not have adequate care,
    but were alert and oriented and competent to make their
    own decisions and refused to leave their homes and that
    situation.
  14. by   Susie2310
    Quote from NRSKarenRN
    US needs to expand Program of All-Inclusive Care for the Elderly to ALL states:
    Program of All-Inclusive Care for the Elderly | Medicaid.gov



    In PA/NJ/DE program is called LIFE (Living Independence for the Elderly)

    LIFE is an option that allows older Pennsylvanians to live independently while receiving services and supports that meet the health and personal needs of the individual.

    Living Independence for the Elderly (LIFE) is a managed care program that provides a comprehensive, all-inclusive package of medical and supportive services to help keep a person living in own home/apt. PA has 35 programs throughout the state. Our health system is largest provider of LIFE care throughout the US. Through this program, my father was able to live at home for 2 1/2 yrs until no longer safe to be alone at night due dementia.

    Services provided in own home or at Adult Daycare Center include:

    Medical Services


    • Primary care and physician specialist services
    • Nursing care
    • Prescribed medications
    • Physical, occupational and speech therapies
    • Dental care
    • Vision care
    • Hearing care
    • Foot care
    • Medical equipment
    • Personal emergency response systems
    • Mental health services
    • Hospital services
    • Nursing home care (if it becomes necessary)


    Support Services

    • Light housekeeping, laundry, cooking and help with bathing and dressing
    • Meal planning and nutrition
    • Spiritual counseling
    • Personal care assistance
    • Medication management meds provided without copay.

    Transportation is provided to daycare centers and to medical appointments.

    There are income levels under Medicare/Medicaid programs with private pay option available.

    Find a PACE Program in Your Neighborhood | National PACE .
    This is terrific, and I couldn't agree more that this program should be expanded to all states. It's great that your father was able to benefit from it.

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