Your loved one lives in a long-term care home of some kind. They have been stable medically for a while, and you are thrilled to see them involved in the life of the home.
Then one day, it happens. They develop pneumonia that doesn’t respond to treatment or a condition that requires intravenous antibiotics. Perhaps the doctor is suspicious that their symptoms may be cancer and wants further investigation. Or because of their dementia, they aren’t drinking enough and are dehydrated.
The doctor says they should go to the hospital. Ultimately, it’s your decision. Going to the hospital will probably prolong their life and may fix the immediate problem. You may find out that cancer is present, intravenous antibiotics might eventually cure pneumonia and your loved one can be rehydrated. Any number of ‘fixes” might be possible, but are they right?
I can hear the voices. “Why wouldn’t you send someone to the hospital when they can be helped?”
Funny you should ask…
Here are some reasons not to go to the hospital:
1. There are no broken bones.
If your elder has fallen and the medical team thinks that it’s likely a bone is broken, send them to hospital. Even if there is a suspicion, you can send them for an x-ray and know what you are dealing with. However, if they are able to walk or move the limb in question, even with some pain (which may be a result of bruising) consider not sending them to hospital. Have the medical team assess them and the physiotherapist look at them and make your best decision.
2. They are dealing with multiple serious medical issues which are affecting their quality of life.
Heart, lungs, kidneys. They are all related, and when they start to deteriorate, it’s a difficult balancing act for doctors to keep people functioning and comfortable. The heart starts to fail and legs swell and eventually weep. A drug is prescribed to remove the excess water, but it’s hard on the kidneys. Perhaps they have diabetes that isn’t well controlled, and skin in their heels and coccyx breaks down and doesn’t heel. It can feel like putting all your fingers in a dyke with multiple leaks. Many of these conditions are painful and uncomfortable, and if you add another serious infection to the mix, is the best decision to go forward and try to cure it?
3. They don’t want to go to the hospital.
Many elders have had at least one recent trip and may have had to go many times. They remember crowded emergency rooms, waiting for hours to be seen, spending the night in the hallway and other horrors of our medical system. Overworked, insufficient staff are a modern reality. If they say they don’t want to go, perhaps you should listen.
4. Your elder is in the late stages of dementia.
There is nothing more frightening and disorienting to a person with dementia than to take them out of their familiar environment to the sterile walls and the cold medical world of a hospital. They don’t understand what is happening, and sometimes they lash out in anger and fear. The medical response to this is to restrain and medicate. There are instances when hospital care is necessary for someone with dementia, but the ramifications need to be closely considered.
5. There are indications that end-of-life is nearing.
We’ve talked about some of the signs of end-of-life. Loss of appetite, difficulty with chewing and swallowing, excessive sleeping and other signs discussed previously, indicate to the medical team and to you that your loved one’s body is shutting down. At this point, do you really want to subject them to a hospital visit?
If they are sick, and you decide not to treat aggressively, what other options are there?
Next week we will discuss, What does “keep comfortable” mean?