Home Care Now: I Don’t Need it.
Home Care Later: I’m on the Floor; Now What?
When families get together for the holidays, you might hear stories about the time mom fell and had to get the neighbor to help her up or when she went to the doctor and he told her she needed home care, which made her upset. In person she tells you, “There’s nothing wrong with me; I can handle my own life.” You go over to pick mom up for dinner and notice stacks of unpaid bills jammed in a drawer, and there are full vials of pills in the kitchen that have long expired with conflicting directions on when/if they should be taken. This is especially a red flag since the #1 cause of death after a hospitalization is due to medication not taken as directed. You may notice that mom’s hygiene is not what it once was: her hair appears greasy and unwashed, and her fingernails are long and dirty. The house reeks of urine, from the upholstered chair mom likes to sit in to a closet full of saturated adult diapers crammed away under the bathroom sink. On further inspection, you notice that the dog appears underfed, the cat’s hair is falling out, and there’s no fresh water or food for them anywhere. You open the refrigerator and find last year’s leftovers from dinner right where you left them. If even one of these conditions has you nodding in agreement, it’s time to explore home care options for your mom.
When this subject first presents itself, many adult children react like the children of alcoholics: “I cannot say anything to mom because she’ll get mad at me. If I tell her what I’m seeing, she may never talk to me again. And if I keep it up and continue to point out her problems, she may cut me out of the will.” Contrary to what you may think, this is the point where you must take the bull by the horns and tell mom what the problems are while knowing there is help available. Remember, these living conditions will only get worse. She will either end up falling and breaking a hip, becoming hospitalized, or worse, due to medication mismanagement or starving to death waiting for someone to find her on the floor. Now is the time to make a plan, get information about home care companies and make a list of their pros and cons.
Home care is something of an old concept made new. In the Charles Dickens’ novel Martin Chuzzlewit, the unscrupulous and alcoholic nurse, Sarah Gamp, became the stereotype for the itinerate midwife/hospice nurse who attended needy families at the most critical and life-changing times: birth and death. Indeed, such a poor representative of the nursing profession led to changes in this relatively new field, most notably by Florence Nightingale and the Victorian medical reform movement.
Historically, home care nurses were necessary for new mothers and babies, as well as working families that contracted infectious diseases. Up until the 1930s these were the most critical patients, at which point chronic degenerative diseases became the primary cause of patient mortality, and the majority of these cases were dealt with in a hospital setting. In the late 1950s hospital costs began to rise, and multiple nurses’ organizations started to bring home care back to the forefront.
The old adage “home is where the heart is” applies nowhere better than to positive patient outcomes, as opposed to the sterile environment of a hospital or skilled nursing facility. Home care is generally preferred when it comes to end-of-life matters, as well as patients with disabilities or those recuperating from surgery. A little help can go a long way to ensure the patient remains safe in the home, no matter the medical issue involved. Home care may be considered if the patient needs pain management, assistance with bathing, activities of daily living, light housekeeping or range of motion therapies. Indeed, home care may be the deciding factor for maintaining an independent lifestyle.
Just remember that home care, like religion, age and politics, is often ignored as a subject in polite company. However, continued denial about the state of a loved one’s health will only cause more upset and guilt when the time comes for action to be taken. Get information ahead of time, understand what your needs may be and make a plan of action. Consider disease conditions and how they may change and the resulting physical limitations so that when that time comes, you have a definite course of action. Work with a home care agency that will make a preadmission assessment and give you more insight and possible referral ideas when that eventuality. Take the time to do your homework so when a crisis occurs, you’re not caught off-guard and working in panic mode, rather than from a calm, well-considered perspective.
