Readers of this blog may remember that I have been working with a wonderful woman who is now 101 years of age. She is a ‘solo senior or elder orphan’ or simply put, a single woman who never married, never had children and at 101 years of age, has outlived all family and friends. She is remarkable- she does not take any medications and has always followed a simple yet structured routine- always eating the same foods and doing the same things. Every day she walks in her apartment, using the support of a walker and standby assistance from her caregiver. The rest of her day is spent sitting in her reclining chair watching movies or having the paper read to her. Ziggy and I visit her regularly and while she may not remember my name, she certainly knows and loves Ziggy. She has a wonderful trust officer who is her attorney for property and she has been able to have 24 hour awake care for the last several years. Her younger sister was her attorney for personal care and no alternate had been named. Her sister died a few years ago.
About three years ago, she had a fall which resulted in a hospitalization, a referral to palliative care was made and a few months after that, she rallied and was actually discharged from palliative care. Fast forward to a few weeks ago when, while her caregiver was in the kitchen, my client tried to stand up from her chair, she slid down and banged her head on the wall. Her emergency pendant was pressed, and the paramedics were dispatched. Her caregiver called me and I was able to speak with her and tell her that the ambulance had been called so she could be checked out. She was alert and communicative. She was taken to the hospital. After a day in ER and after much poking and prodding, she was admitted. She did not need any stitches and there was no apparent physical, cognitive or functional change in her presentation.
Now here comes the interesting part. In my day to day work world I assume capacity with my clients and always involve them in the decision making as much as they are able. For those that don’t have an attorney appointed, this can become a grey zone. The doctors and I spoke regularly and when they discovered that she did not have an attorney for personal care, they felt that they needed to have someone make a decision on her behalf regarding treatment, feeding and whether she could return home. My client had a DNR order and all plans regarding her desire to remain at home and her wishes on how she wanted to live her life until the end had been discussed and documented the last time palliative care had been involved. While I shared her prior wishes of wanting to be at home, it was not enough.
This is now the Thursday before the long August weekend and the doctors informed me that a referral had been made to the office of the Public Guardian and Trustee. There was no way that I wanted her to remain in the hospital during a long weekend. I called her family doctor (and a big shout out to him) and her former palliative care physician (another big shout out to her) so that they could speak with the attending hospital doctor and advocate for her return home. Remember 24 hour care was already in place for her.
Late Thursday I spoke with the assigned officer from the office of the public guardian and trustee (and a big shout out to her ) as she was able to expedite the file and have her supervisor agree that my client could return home- which was done early Friday morning.
I truly believe that without this intense advocacy my client would have lingered in the hospital and died.
She is now home with a palliative care team and her private caregivers who are able to respect her wishes to die at home. Ziggy and I visited with her and the smile that she had on her face when Ziggy licked her hand was priceless.
I don’t know what will happen tomorrow but for today, she is comfortable and happy to be in her own home.