We fail our old people and it's heartbreaking

[JBMmom]

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.

[lifelearningrn, BSN, RN]

Elderly care as a massive, for profit racket that is only going to get worse as it drains the boomers of every penny they have. Then the poor folks are going to be kicked to the curb, left for the states and Medicaid to foot the bill. Sad but that's the state of affairs in elder care.

[llg, PhD, RN]

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.

I didn't mean to imply that everyone had the same opportunities. I simply meant that all of us need to do the best we can to plan and make arrangements for ourselves -- before we become too frail and incapacitated to care for ourselves. Most of the readers on allnurses are nurses -- people who have jobs and who are in a position to make some plans, even if they are not luxurious.

And as for you assuming that because my background was not impoverished that I have no understanding or sympathy for those who were not so fortunate ... that's unfair.

[llg, PhD, RN]

Not only is LTC insurance not affordable, you usually can't even get it, unless you are in perfect health.

I get it through my employer and get a group plan rate of $33 per month, with NO health requirements. (I signed up when I was about 48 years old). I don't consider that cheap, but it is not outrageous. We should work to get more employers to offer this type of insurance so that more people can get group rates at an affordable price.

[Emergent, RN]

I think this is a result of several factors:

1) People are living longer.

2) Women, formerly mainly homemakers and caregivers, have been driven by economics and/or increase opportunity, into the paid workforce.

3) Breakdown of the family and age-old values of honoring our mother and father.

4) Smaller families.

I daresay, from my observations, in the Mexican-American population that I work with a lot, the elderly are doted on. The families stick together and have a great sense of responsibility toward one another.

[hppygr8ful, ASN, RN, EMT-I]

I get it through my employer and get a group plan rate of $33 per month, with NO health requirements. (I signed up when I was about 48 years old). I don't consider that cheap, but it is not outrageous. We should work to get more employers to offer this type of insurance so that more people can get group rates at an affordable price.

The cost for this insurance is just over a dollar a day - of one Vente latte a week from Starbucks. Completely doable!

Hppy

[Susie2310]

And as for you assuming that because my background was not impoverished that I have no understanding or sympathy for those who were not so fortunate ... that's unfair.

I was responding to your post, and from your words I did not discern understanding or sympathy for the lady you referred to who was mentioned in the OP.

[Daisy Joyce]

I've worked with wealthy elderly and poor elderly.

The rich elderly have it way better (and water is wet!). There are some really great LTC facilities out there, but you have to fork out the big bucks --usually the people who live there were wealthy their entire lives, then chose high paying professions or rich husbands. Of course, they will say "but I worked hard to get where I am now. I deserve pleasant surroundings.

So lately I've been asking myself this--at the beginning of one's career--should you choose meaningful work or high paying work? My social-worker friends will never get to live in one of these nice nursing homes. Nor that SAHM whose husband never rose higher in the ranks of the corporation than middle management. Nor the teachers or cops or nurses.

And anybody in the creative world. Nope.

My kids are discerning careers right now. I don't know what to tell them.

[Ruby Vee, BSN]

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.

I can see how lack of heat and hot water would be seen as evidence of some BIG PROBLEM by many, but there are those of us who manage just fine without it. I grew up on my great grandfather's farm in rural Wisconsin with no heat or hot water. No electricity, either. We had a wood stove, and water got plenty warm in the tea kettle.

My retirement plan involves living on a sailboat without central heat or hot water. I have a kerosene heater, gas lamps, and the water gets plenty warm in the tea kettle on the propane stove. If the lady is aware of the problem and is coping, working on fixing it and is alert and oriented, I fail to see the reason for her to go to a nursing home.

[llg, PhD, RN]

I've worked with wealthy elderly and poor elderly.

The rich elderly have it way better (and water is wet!). There are some really great LTC facilities out there, but you have to fork out the big bucks --usually the people who live there were wealthy their entire lives, then chose high paying professions or rich husbands. Of course, they will say "but I worked hard to get where I am now. I deserve pleasant surroundings.

So lately I've been asking myself this--at the beginning of one's career--should you choose meaningful work or high paying work? My social-worker friends will never get to live in one of these nice nursing homes. Nor that SAHM whose husband never rose higher in the ranks of the corporation than middle management. Nor the teachers or cops or nurses.

And anybody in the creative world. Nope.

My kids are discerning careers right now. I don't know what to tell them.

Actually, there are some very nice retirement communities (and LTC's) that are well within the budget of teachers, nurses, etc. My sister worked as a public school teacher in a small town - and retired at the age of 53 with a nice pension. She and her retired school teacher/administrator live in such a place. I will live there too in a few years. That place is crawling with retired middle-class people.

For someone with a middle class job (such as teachers and nurses), you just need to make a few sacrifices when you are young -- not a have a ton of kids -- and save a little each week for your whole life. Participate fully in your employer's retirement plan and get every dollar in there that you can get.

You also need to chose jobs that pay reasonably well and not choose careers & jobs that don't. Don't take a lot of time off to stay home with the kids if you do have some -- unless you have the financial means to do so without sacrificing your retirement, etc. If you "live for today and let tomorrow take care of itself, " you probably won't have very much tomorrow. Even if you won't be able to save a lot, save a little. It adds up.

Yes, there are some people who have hardships in their lives that they can't overcome. But most middle-class people could do a lot better at saving than they actually do. Those that do a good job will have more and better options to choose from.

Maybe the elderly woman in the OP will get her act together and demonstrate that she is not a danger to herself or her pets -- and be allowed to return home. That would be great -- for a while. But eventually, she is probably going to need to find some help from somewhere -- either a home health service or LTC. Let's hope the professionals invovled in her case can find something that will keep both her and her pets safe.

[llg, PhD, RN]

I was responding to your post, and from your words I did not discern understanding or sympathy for the lady you referred to who was mentioned in the OP.

Maybe you should have asked for clarification before assuming the worst of me on such little information.

[Susie2310]

Maybe you should have asked for clarification before assuming the worst of me on such little information.

Re-reading your post again that I replied to, my response to you would still have been the same. As I read your post you didn't sound compassionate towards or understanding of the lady. You made suggestions based on the lady's unfortunate situation that other people take heed and save and plan for their retirements. I don't know you personally, and all I can respond to are your words written as posted.

[Nursingsince2019]

This subject breaks my heart but is so important to discuss. Thanks for the thread.