We have the sweetest patient at our dialysis clinic... an elderly black gentleman who is one of the kindest, most gracious people I have ever had the pleasure of knowing.
His dilemma : Although he is yet mentally extremely sharp, has great wit about him, and quite independant, his doc is now attempting to encourage him to go to a nursing home. He is absolutely heartbroken. He was so downhearted last time.. I have never seen him this way. I was deeply moved and my heart went out to him.
I pulled up a chair and talked with him awhile. He told me how the doc felt he would be better off (as in safer) in a nursing home. He has great difficulty ambulating..actually, he is now wheelchair bound. He is strong, but his legs simply will not cooperate with the rest of his body. He ordered a motorized wheelchair for himself this past Christmas, and was so tickled when he received it ! He told us he would let us nurses use it on the floor during his tx., as he saw how we continuously run our legs off.
I believe the doc has his best interest at heart, for he has fallen a time or two at home, and there is noone close by to tend to him in an emergency.
I went over all possible options with him, everything I could think of. He does have the emergency alert to wear around his neck. He has the "scooter", and he has a aide to come in dailey in the mornings for several hours. I think the doc wants somebody there in the evenings to help get him into bed, and on weekends.
He has not had any luck in finding anyone yet. I spoke with our Social Worker about his concerns, and even asked if he could contact this gentleman's HH socialworker and put their heads together...come up with some kind of a plan.
I know he is devastated and worries about what to do with his home, furnishings,etc. Everything he has worked so hard for all his life. He also watched as one of our other patients ( lovely little lady) ended up in the nursing home, and how she went downhill from there. She wanted nothing more than to return to her home. Her health spiraled down steadily after this. And when medicare ended up taking her home, she gave up. She is now all but gone. She simply quit eating.
I know there's not much I can do... I want to intervene.. offer some tiny ray of hope... think of something.. ANYTHING that might keep him in his beloved home just a few more years. He is SO able in all other ways. I also see that he does NOT want to go and is feling pressured, or that he HAS to do as the doc asks. I assured him that the choice is HIS.
I don't think I could bear to watch him lose his home and independence , go to a nursing home and die of a broken heart. Not when he has so very much life in him as he yet does !
I know this is out of my hands and I feel so very helpless. I feel like I'm letting him down .. almost unworthy. He is one of those rare patients who NEVER complains about ANYTHING.. is always grateful, always kind, always appreciative of any small token of kindness shown to him. AAAAAAARGH !!!
My heart breaks for this fine man, and I don't know how to handle it !
Thanx for letting me unload this heavy burden. Having a hard time with this one.
All Nursing Homes are not bad, it is a very hard situation to give up your own home (I couldn't even imagine) but there are many other people in the same shoes as this man, and often these people form great friendships in the nursing homes and support each other. What about assisted living? There are many great facility's popping up around here to provide this option. Also we have many pts. in the nursing home I work, that bring their motorized w/c's with them. The pts. garden outside, go fishing, sew, we even have computer classes. All done with the help of volunteers. A nursing home is not the end of living. Falling is a serious problem, this could lead to a serious injury. What if he falls in between caregiver visits, hits his head and no one knows it? And much worse if he broke a hip, his situation would go from bad to worse, as hips do not always ill well in the elderly and they often lose more of their independence and mobilty. Just a few thoughts. I am glad there are great nurses out there like you to help bring some caring and compassion into the world.:)
Thanks everyone for your kind and thoughtful replies. I know there's no magic wand, but I was hoping for, and did receive a few other thoughts of what might be helpful in his situation. I will mention these to him and to his social worker.
I have this man as a patient 3x a week, and we have bonded really well. I was the only one he told of his situation. When our DON returns from her vacation, she and I will put our heads together, too. She is a wonderful, caring, compassionate person and I know she'll be more than happy to work on this with me.. and him.
I wish we had the kind of nursing homes you describe. But this is a small, rural area in Appalachia. Forget computer classes, etc. ! We're lucky our patients that DO come in from the local nursing homes here for their tx. are even given breakfast or a bath before they come ! We've had some of our patients sent in nothing more than a flimsy nighty.. no sox or shoes even ! It's pathetic and infuriating ! So there's not much of a good outlook for him if he does have to go. Our patients have to follow special diets, and the nursing homes are aware of what they may and may not eat... IF they even remember to send a snack for our diabetic pts. on dialysis, you can bet that each time it consists of those very foods thay need to avoid !
I do appreciate your responses, and will take action on several of those mentioned. He did tell me today that his HH social worker found someone to come in for an hour and a half on Sat. and Sun.
So that's a start. He said he was breathing a whole lot easier already just knowing this...Now if we could find some one to get him into bed in the evenings, the doc might be willing to hold off awhile.
We'll keep working at it ! Keeping fingers and toes crossed....
The nearest assisted living places are at least an hour or two away... don't know if it's sth. he'd consider or could afford... but will certainly mention it. Will give it all a go, certainly something will work out... must inquire more about what family is available.. I know he had twin sons of which either ONE or possibly BOTH drowned when they were little... never did pry on that one. Too heartbreaking for him. No wife left, don't know about who all is there, but shall ask.
Will keep plugging away and see what develops. Thanx ! :)
You know what...I think your relationship with this gentleman is solid enough that you could do some probbing about his history. And I believe he'd be happy to share about his life with you and his network of friends. Another option for him may be to have someone come in and be a companion to live @ his home. That could be a blessing to someone - as he sounds like he's a pretty nice gentleman. It would be good for both parties. Secondly - I want to compliment you on your approach to nephrology nursing. I place chronic/acute/CAPD/CCPD dialysis nurses all over the country...and you have exactly the right attitude for my clients. Your company is very blessed to have you on board. Thanks for being you! Major thing you have to do is "don't give up." Exhaust every avenue - no matter how silly it might sound...out of that can spring a solution that can work for this gentleman. Give him my best wishes - and I wish you well in coming up with the right solution. All the best! Bobbi Hashem:)
Thank you all, again. You have givien me new hope and motivation to keep pushing.
I often wonder if I care "too much". I don't see the other nurses getting "involved" and wonder if perhaps I should just be "doing my job" like they... but I have this little voice telling me "this IS your job!" And even if it weren't, I would want it to be... not a "job", but sth. I would just do, nurse or not... it comes so naturally for me.
We stay so very busy at our unit, there's not much time to chat with our patients, but I find my heart always looking..scanning the patients.. to pick up on any unspoken needs. Our patients know how busy we are, and often don't speak up and express what's on their mind or in their heart, even though they might want to.. need to.
I wonder if the other nurses assume it is for the social worker to explore or deal with, because they ARE good, caring nurses. But sometimes we have to go that extra mile to get a smile. Or to open that door to possibilities....
sassynurse78
153 Posts
All Nursing Homes are not bad, it is a very hard situation to give up your own home (I couldn't even imagine) but there are many other people in the same shoes as this man, and often these people form great friendships in the nursing homes and support each other. What about assisted living? There are many great facility's popping up around here to provide this option. Also we have many pts. in the nursing home I work, that bring their motorized w/c's with them. The pts. garden outside, go fishing, sew, we even have computer classes. All done with the help of volunteers. A nursing home is not the end of living. Falling is a serious problem, this could lead to a serious injury. What if he falls in between caregiver visits, hits his head and no one knows it? And much worse if he broke a hip, his situation would go from bad to worse, as hips do not always ill well in the elderly and they often lose more of their independence and mobilty. Just a few thoughts. I am glad there are great nurses out there like you to help bring some caring and compassion into the world.:)