When an elder reaches a certain age, and especially when they need care and move into a retirement home or long-term-care, a difficult conversation needs to happen.
How do you want your story to end?
For some people, this is unemotional writing of a living will, which expresses their wishes. Done, filed, don’t have to think about it until the time it’s needed. For most of us, however, this conversation is wrenching on so many levels. It needs to be a family dialogue, and what family enjoys a friendly fireside chat about the death of a loved one? The process of dying can be equally terrifying, and discussing the details is more than some can handle.
In our facility, we discuss levels of care.
Level one is when the resident is in their last days. Usually, at this point, they have stopped eating and drinking, and the focus is on comfort care. Most times, medications are discontinued except those for pain. Nothing is treated.
Level two involves treatment for infections such as urinary tract infections or pneumonia, but those are done in-house. There is no transfer to hospital for more invasive treatment. The only exception would be a broken limb, which would be treated and then the elder would be sent home.
Level three is as above, but includes transfer to hospital for further treatment, but no CPR.
Level four includes everything, including CPR.
I have this conversation with every family when their loved one is admitted. Most need to take the paper away and think about it, talk together with the elder or reflect on wishes expressed in the past. It’s not easy. I always tell them nothing is set in stone, and the levels are to give us guidance. If the day comes when they receive a call that their mother isn’t doing well, they can change their minds.
“Well, you know, he’s 92. He’s had a good run.”
Many times, as families consider how they want their loved one’s final days to look, age will be mentioned, as if life was some kind of sand in an hourglass. It does run out at some point, but a person’s age should be a tiny part of considering their last days. Well-being, physical state, cognitive status, their wishes…all these are more important than their age.
One of my beloved residents was a few months short of 101. Her sweet disposition and dry sense of humour made her a favourite among all. One day, I heard her coughing, and a few days later, she was a different person. She couldn’t stay awake and could barely hold her head up, she could no longer walk and needed assistance with her meals. Everything inside me screamed, “No!” My heart broke to watch her drooping head and exhausting cough.
Are you nuts? She’s 100. Time to go.
But just a few days before, she was joking, chatting with her tablemates and encouraging her friend to attend an activity. What did her age matter? She had a quality of life.
The cough was treated, and someone sat beside her and helped with her meals. In tiny increments, we saw improvement. It was about this time her doctor came by and said to me, “Look at her. She’s just fading away.” I calmly pointed out to him that her head was no longer drooping and she was more alert. Inside, I was standing on my soapbox and shouting, “She’s not fading away on my watch!”
Another month passed, and minuscule improvements became big changes. She walked to the dining room with her walker instead of using her wheelchair. She ate well, and was able to feed herself at least part of her meal. She was alert, and her low voice enhanced the mealtime conversations. She was back.
On Monday, she turned 101. Instead of a present of flowers or a scarf, she and I made bread together, as she had almost weekly in her apartment before she lost her sight. While it rose, she went to get her hair done, and we took it out of the oven as she and her son enjoyed lunch. As the team crowded around, we took a picture of her with the bread knife posed over the loaf. Her face glowed.
I’m fully aware that the sands in her hourglass are almost gone. This is a reprieve, not a cure. But seeing the joy in her face, I know the quality of life has nothing to do with age.
p.s. I saw that doctor in the hall and pulled out my phone to show him her glowing face with the bread. I wasn’t smug. No, not me.
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Age Is Just A Number