“We can’t deal with this problem here. She needs to go to hospital.”
They are all looking at you. The doctor, the nurses, the care staff, your family. As your mother’s care partner and power of attorney, the next decision is yours.
Maybe she has pneumonia which isn’t responding to the antibiotics she’s been given, and she needs intravenous antibiotics. Maybe the doctor suspects something more sinister like cancer or another disease and further testing can only be done at hospital. Maybe, in spite of constant cajoling, your elder isn’t drinking enough and needs IV fluids to rehydrate. Maybe…
Maybe going to hospital isn’t the correct answer.
Why not?
Here are some possible reasons:
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.
Multiple medical issues make quality of life impossible
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 heal. 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?
Your elder says “No.”
Even though you have power of attorney, you need to listen to your elder’s wishes. Many 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, this should factor into your decision.
Your elder is in the later 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.
There are indications that end-of-life is near
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 further testing reveals serious disease, then what?
If this visit is to investigate a more serious illness, what would you do with the information? If your elder has cancer, would you treat it? If the result of the investigation might be non-invasive treatment leading to quality of life, then that’s a positive factor. But aggressive treatment of disease near the end of life is seldom a desirable choice.
As has been the case many times during your care partner journey, the decision is difficult and not necessarily clear-cut.
All eyes are turned to you.
What is your answer?
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