From person to patient…and back

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Three very different ladies, but they have much more in common than a broken hip. Each one will be negotiating a similar journey—from person to patient—and ideally, back again to their former lives. Their ability to weather this transition and support from family and friends will be the key to their post-hospital life. To understand their journeys, imagine a compass. If North is the former life, East is the trauma of the broken hip and the hospital experience. South is the recovery process, and West is the planning and management of the transition back to the starting point, to a life that resembles their old life, or maybe one that’s radically different. Let’s navigate our way through these examples.

Miss Hardcastle was a legend—brisk, active, determined, often rude and fiercely independent in her tidy apartment. When she broke her hip one winter day, neighbours thought they’d never see her again, but no. Within a few weeks she was back to her daily routine with a walker, then a cane and then became unencumbered.

Marion, a local minister’s wife, was the darling of the nursing home. She knew most residents, and within months, had charmed the rest, as well as the staff. One day, she fell while moving from her bed to her lounger. A broken hip! Her hospital stay went well but, six months later, she’s still in the wheelchair and very discouraged.

Alice was another determined lady. Alone in her condo, she refused all offers of help and became a recluse. Nutrition, personal care and social contact all deteriorated until the concierge, alerted by the overflowing mailbox, found her on the floor with a broken hip.

North–Their former lives and who they were

We’ll begin at our Northern points. This will give us an understanding and clues into what’s coming up next. What are the keys to understanding their personalities and interests? What aspects of their former lives were successful, and what needed improvement?

As we have seen, Miss Hardcastle was a self-reliant person. Her personal values were fortitude, determination and “never making a fuss.” She was neither motivated nor interested in other peoples’ opinions. Anytime advice was offered, she considered it through the personal filter of her value and, if it passed her judgment, she followed it to the letter.

Marion was an affiliative person who lived through other peoples’ perception of her. Over her lifetime she had manipulated her family and friends, albeit with great charm, into catering to her every need. When advice was offered that she disagreed with, she expertly deflected it and resisted all attempts to change.

Alice was a former executive secretary who had retired to care for her mother. While she never expressed resentment, she missed the bustle, social contact and responsibility of her job. Increasingly, her sense of self-withdrawal and depression ensured. With no children or close family, she was able to hide her increasing self-neglect. It was here, and then, that Alice went off course. Key elements for success in phases two and three of her recovery were to restore her sense of personal responsibility and encourage her to take ownership of her well-being and place in the community.

East–Their situation and what happened

We now go East to the “acute” phase—the trauma of the injury and the hospital stay. There is no question that an injury, a visit to the emergency department, surgery and a hospital stay are traumatic especially to a vulnerable older person. What are needed for this phase are perspective, focus and the ability to follow direction. Continuity with the former life is important but, as we shall see, can be counterproductive, too.

Miss Hardcastle hated everything  about her hospital experience. She was critical of the staff, hated the hospital food, complained about the nurses and her roommates and refused to wear hospital clothes or consider herself a patient. Her no-fuss attitude put the trauma in perspective—“I’ll be out of here soon enough.” She stayed firmly focused on recovery and getting back home, questioning, but then carefully following, the instructions she was given. In fact, Miss Hardcastle stayed on course, with great success, in this phase. Although she won no popularity contests, she took full ownership of her recovery.

Marion thoroughly enjoyed the hospital experience. Her room resembled a florist’s shop; there were phone calls all morning, visitors all afternoon and very little time for recovery. She was enveloped in love and sympathy from her family and friends, who sent a private care worker to get her ready each morning and escort her to therapy. She opined that much of what the doctor said “didn’t apply to her.”

Surprisingly, Alice also enjoyed being in the hospital. The activity, the regular meals, her roommates’ visitors, the therapy room and the tiny TV all delighted her and reawakened her interest in the outside world. She followed the therapy program carefully and enjoyed walking the halls, the lobby and the gift shop. She even called a few friends, who were happy to visit and reconnect after such a long estrangement.

South–Their rehab process and what was expected

We now go South to the “recovery stage,” which may include a stay in a rehab hospital, therapies delivered in a step-down unit or the outpatient department of the hospital.

Much needed for this phase are continued support, commitment to recovery and the ability to follow direction. In addition, this phase demands discipline, tolerance for discomfort and pain and the courage to persevere.

Miss Hardcastle, predictably, remained critical. She challenged staff, only took the advice that she thought was worthwhile and worked hard despite obvious discomfort. When told she would retain a slight limp she was initially upset, but stayed firmly on course and gained the respect of the rehab team for her determination and courage.

Marion was shocked to learn, after the fun of her hospital stay, that hard work was expected. Early mornings and long therapy sessions were not popular, and she resisted anything painful or stressful. She was anxious to please the therapists, but that did not extend to working any harder than she needed to—and often got away with doing less.

This is where Marion went off course. Her own personality, as well as friends and family telling her to “take it easy and look after your self,” resulted in a half-hearted effort. Although she was told that the window of opportunity for recovery was limited, she ignored professional advice and set her own pace. Family members told the staff to “leave her alone, she’s 95!” She was not directed into a rehab hospital, but scheduled herself for outpatients’ visits—which were missed and difficult to get to.

Alice surprised everyone by thriving in this phase. She took a particular interest in one therapist—“she’s Irish, like me!” She worked hard and reveled in the therapist’s praise and encouragement. In fact, Alice also went beyond what was expected. Nutrition, activation and social support, as well as being given and responding to a challenge, all conspired to reconnect Alice with many positive elements of her former life.

West–The options for returning home

Now we come to West and planning for return to the community. Yes, life will change; but just how much is a function of the person’s resources, ability to cope with new health status and their ability to accept and embrace change.

This phase requires vision, trust in family, friends and advisors, self-knowledge of what needs to happen going forward, the courage to accept change and the self-confidence to proceed and succeed.

Miss Hardcastle was the first to return to home. Having been told on Day One of her hospital stay that she could never return to her high-rise apartment alone, she was justifiably proud when she pulled her little suitcase outside to hail a cab back. Community services were arranged to call in, several times at first and then weekly after that, but it was clear she was back to fighting form.

Marion was next to be discharged back to her nursing home. She was warned that follow-up therapy at the outpatient department was essential for her to begin weight bearing, and so she could move from her wheelchair to the bed, lounge chair or toilet. Otherwise, full care would be required, including the dreaded adult diapers.

Upon return, her initial high spirits flagged. She complained that she was frustrated with her recovery, but did no therapy at all to become weight bearing. She quickly seemed to forget the commitment or even the need for it, and now requires 24/7 support for most activities. Although back home, Marion has remained a patient.

Alice turned out to be a real success story. Her friends contacted her family, who arranged a move, directly into a retirement home. She was initially enraged at their interference, stayed in her room for a few days, demanded meals on trays and was rude to the staff. Over time, however, the combination of attention from experienced nurses, a solid daily routine, better meals, companionship, physio and daily sit-and-be-fit class transformed her into someone who’d tell anyone she met how lucky she was to live there.


 

How best, then, to help a friend or family member on their journey? Here are some helpful tips:

The “acute” phase:

  • Maintain the elements of their previous life wherever possible, including visits from friends and family. Hire a dedicated care worker if you can to help them in personal activities or take them to therapy sessions.
  • Keep the perspective that, while traumatic, this is a phase that will pass.
  • Reassure them that their care will be professionally handled with your full support.

The “recovery” phase:

  • Listen to the professionals! For example, more therapy is not necessarily better. A treatment plan has to be carefully designed for each person.
  • Help your friend or family member to partner with the rehab team in their recovery
  • Prepare for “tough love,” if it’s required. Coddling your parent does them no favours, and undermines the staff.
  • Draw on past success to help get them motivated—“Dad, you were never a quitter” “Mom, you’ve always been strong for us. You can do it!”

The “return to the community” phase:

  • Do your homework. Work with the discharge planner on options for returning to the community. For example, a short “respite” stay in a retirement home might be a good idea, but make sure you’ve made a short-list and can afford it, before offering it as a suggestion.
  • Manage expectations including yours. Mom may believe she can go home alone. Research and set up supports before discharge. On the other hand, Dad may want to give up and that’s something you have to respect, as hard as it may be.
  • Set them up for success. Create realistic plans for family support: Get advice on what’s available from government healthcare and insurance or veterans plans, what is subsidized and what isn’t and how will you fill in the gaps.

Helping a loved one through an injury, a hospital stay and rehab program requires a delicate balance of analysis, research, encouragement, support and co-operation. But helping a loved one successfully transition from patient back to person is a wonderful gift.

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About Pat M. Irwin

Pat M. Irwin, BA, AICB, CPCA, is President of ElderCareCanada

ElderCareCanada is an advice and action consulting service aimed at ‘adult children’ seeking advice and hands-on help for all aspects of care for aging parents. Toronto-based, its services are available to clients across Canada, as well as internationally.

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