13 Sep 2009
Dear Mary,
This is in response to your recent column about beautician services in nursing homes. I agree that beauticians who visit nursing homes provide an invaluable service. But you dropped the ball in your response to the person asking what you thought about nursing home residents waiting in long lines for these services. It is appalling that frail, elderly or disabled residents have to wait in long lines even missing "nature calls" to the bathroom. Getting hair cuts and other grooming services serves more than an aesthetic function. The failure of the nursing home staff to respect the dignity of their wards and come up with a system of making appointments is inhumane. Any staff member who thinks that watching their at-risk charges wait in long lines is funny ought to be fired.
Dear Reader,
Thank you for writing. Readers are eager to hear a rebuttal from those working in nursing facilities. So if anyone cares to comment, we’re waiting to hear from you.
Dear Mary,
I have an urgent question about my father. He has had Alzheimer’s disease for about 10 years and has lived in assisted living for the last five. He has been in pretty good shape, being able to walk and feed him self and recognize family most of the time. But, over these past few years he has steadily declined. He is now incontinent and losing weight. Although he shows some stubbornness, like sometimes refusing to get out of the car when we go for a ride, he generally functions fairly well. A couple of days ago I got a call that he was lethargic and couldn't walk. He went to the hospital, had a CAT scan and bloodwork, and was sent back because they couldn’t find anything medically wrong. Since this episode he makes odd faces and sounds. At first I thought it was just something he was doing voluntarily, but then I began to see he couldn't control it. Another odd thing is that he keeps his eyes closed most of the time.
He is no longer able to feed himself. Sometimes he will start to open his mouth to eat but then the facial movements begin and prevent him from continuing.
His physician thinks he had a stroke and suggests I call in hospice. I’m concerned that there may be something else going on here. What do you think? Also, what are the pros and cons of hospice care?
Dear Reader,
The rule of thumb when someone with a dementia like Alzheimer’s disease has a sudden change in behavior or function is to rule out a medical cause. Your father certainly could have had a stroke since small ones don’t always show up immediately on CAT scans.
You have two alternatives: Put him through extensive testing or bring Hospice on-board and provide him with comfort care.
You need to think about what your father would want. Testing can be exhaustive and painful, may not be conclusive, and hasten his decline. In the end, he will still have Alzheimer’s disease which is fatal in itself.
Hospice provides “palliative” care to control pain and discomfort. The cons are they will not rush him to the hospital every time a medical problem arises and will not do anything to prevent his timely demise. The pros: They will do everything to prevent any distress and provide the best quality of life possible until the end - and they are there to help the family, too.
It costs nothing to talk, so give them a call and get your questions answered.
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