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Avoid the Quantum Leap: Make Informed Decisions Under Pressure

by Terry Lynch, Independent Living Consultant

Terry Lynch owns an independent living consulting business in Racine, Wisconsin. He specializes in assisting frail elders and people with disabilities to remain in their homes. He has served on the Boards of: Elder Care of Dane County, Wisconsin; All Saints Visiting Nurse Association of Racine; and the Wisconsin Association for Persons with Severe Handicaps. He currently is a member of the Executive Council of AARP Wisconsin. Mr. Lynch periodically teaches a course on the psychology of aging in the University of Wisconsin system.


 

Is a Place the Answer?
The emergency room physician looked my mother over, checked her files, then motioned me outside the cubicle. He would run some tests, but then we should discuss the “ultimate resolution of this case. ” That evening, I sat next to my mother as she slept in her hospital bed, and reflected on that chilling discussion in the ER. After seven years of helping her survive medical crises, I was a seasoned veteran when it came to “Quantum Leap ” advice from those who should know better. It always shocked me, nevertheless.

The “ultimate resolution” to Leila Lynch's medical problem was, of course, not a treatment plan, but a place. Not a specific place. Just anywhere called "nursing home." I stifled my reflex response to the physician's suggestion and told him that my mother and I were doing just fine in our current situation. What I expected from him was pain control and a diagnosis that would help get her back on her feet again. He shrugged, said, “OK” and went back to his job. Tests confirmed that my mother had, once again, fractured a vertebra. She was admitted for treatment.

Although I was upset that my mother had to go through this again, we had been here before. She would recover, come back home, and continue the life she loved. What gnawed at me was my conversation with the doctor. My mother’s battle with physical and cognitive disabilities exemplified a familiar national crisis. The ER incident pointed to a more insidious, related crisis that has an enormous impact on many older Americans, their families, their financial resources, and the taxpayer. This is the crisis fueled by service professionals’ uninformed attitudes about aging and older people; and by widespread failure to recognize that small, careful, relatively inexpensive steps often could resolve problems that are being "resolved,” instead, with a devastating Quantum Leap.

Just what is this Quantum Leap? Too often, older people and their families make hasty and drastic decisions in crisis situations because they are not helped to see their options. By Quantum Leap, I refer not only to unnecessary nursing home placements, but also to other, sometimes unwarranted, life-transforming decisions such as elders’ moves to assisted living, or job resignations by family members due to their caregiving burdens.

Families need to understand that many older people can recover from serious illnesses or injuries, if given the opportunity. They must learn much more about the valuable resources around them in their communities and must be taught creative and practical ways to use those resources cost effectively.

Who should be educating our communities on these matters? Regardless of what government does, I believe the Quantum Leap will be curtailed only through the actions of community institutions and businesses. The Quantum Leap for many of our elders occurs at the end of a hospital stay. Most often, it is a permanent move to a nursing home. Many hospitals offer valuable community education programs. They could do much more, however, to educate their communities on ways to keep older people out of the hospital, and, when that is not possible, on ways to help them return home. Patient and family assistance with post-hospitalization options should begin in the ER and continue through discharge. Nursing homes should be educating families on the rehabilitation potential of their older loved ones. Some churches and religious associations provide community education and outreach programs on issues related to aging. Many more must take up the cause.

Businesses are positioned uniquely to reach the majority of family caregivers through their employee assistance programs. It is unquestionably in their best interest to do so. Various national surveys have shown that employed caregiver absences, work interruptions, lost productivity and resignations cost businesses billions of dollars annually.

Conserving The Most Valuable “Community Resource”
What should our community institutions and businesses be teaching families and employed caregivers about avoiding the Quantum Leap? At the core is the question the ER physician should have focused on: what will it take to help this person return to as self-reliant, healthy and vital a state as possible? The doctor looked past the most important community resource in my mother’s case—my mother—to one that did not belong in the equation for Leila Lynch or her son: a place to put her.

Some keys for helping our aging family members stay as active and self-reliant as possible for as long as possible:

• Keep the flame burning!
My mother spent six months in hospitals over the last 10 years of her life. I was constantly amazed at how her desire to return to our front porch and neighbors drove her to get back on her feet again. Never underestimate the power of motivation when you help older people in crisis consider their options.

• Do not make final judgments about a person's rehabilitation potential while that person is in a hospital or nursing home.
No one finds that a hospital is “just like home.” When we reach old age, institutional environments often become extremely disorienting in a short time. My mother’s coping abilities, memory, and motor skills always improved dramatically as soon as she was out of the hospital.

• Remember this: not all “Alzheimer’s” is Alzheimer’s.
My mother was diagnosed with Alzheimer's disease by her physician in 1985. In a panic, I started looking at nursing homes. I was advised by a colleague to do nothing without a second opinion. Additional testing at a geriatric assessment clinic indicated she did not have Alzheimer's disease. It was likely that her memory loss resulted, instead, from small strokes. She was put on medication to improve her blood circulation. Her memory loss plateaued, and she was able to remain in her home until her death in 1995.

Families should know that significant memory loss and confusion are not normal aspects of aging, and that they should have any memory disorder diagnosed by physicians trained to work with older patients. Some memory disorders, which mimic Alzheimer’s disease, can be treated.

• Never accept “old” as an explanation for anything!
Various other problems often explained with: “She/he is old. You have to expect these things” can often be treated, if there is appropriate effort to diagnose them. For instance, it is not “natural” for people to become withdrawn as they age. Depression, which is usually treatable, can be the cause of this behavior change. Medication side effects can cause falls, incontinence and many other correctable problems which precipitate unfortunate decisions. In my mother’s last years, we avoided many medical crises through quarterly blood tests and semi-annual visits to her doctor.

• Use familiar skills on new problems.
Even when older people and families in crisis are not derailed by misguided views on aging and are informed about important services, such as those provided by home care agencies, they frequently are not given the critical missing piece. They are not taught that the answers to many of their problems can be found in their own common sense and in their families and neighborhoods. They need to be reminded that the same problem-solving and networking strategies that have served them in other aspects of their lives will often work surprisingly well when it comes to figuring out “what to do about mom” (or dad). For instance, low- and middle- income families are unable to afford more than a few-hours a week from home health agencies.

I found competent, less costly in-home help for my mother from self-employed aides and from neighborhood homemakers who wanted part-time work. Some of our neighbors brought us meals and volunteered time with my mother. In many communities, families can receive invaluable assistance from community resources such as support groups, respite volunteers, home chore services, and nutrition programs, if they are assisted to use them effectively.

• Learn to live with acceptable risk: Edna's “case study.”
My mother’s friend, Edna called to ask a favor. Edna was 90 and had been single and independent all her life. She had lived in the same, comfortable second floor flat for 20 years. Edna was frail, almost completely blind, and had heart disease. The favor: Edna wanted me to help her move to “a suitable care home.” I immediately thought of what places might be “suitable.” Then I made one innocent comment that changed the focus of our conversation, and caused me to think more about “when it’s time to move.” I told Edna I could imagine that she was finding it dangerous to navigate around her apartment because of her vision problems. Edna replied: “Oh my, no! I have been able to get around here in the dark for years.” I was surprised at her answer, and decided to take the questions further down line:

• Climbing the stairs was getting too difficult? “No, I have the railing to hang onto. And that’s the only good exercise I get.”
Was she feeling isolated and lonely? No, her gentleman friend down the street was still driving her around town occasionally, and her downstairs neighbors were good to her.
Was she afraid at night because of her heart condition? “Not at all. I have my neighbors, and I have my hospital emergency button to push if I need help.”


I told Edna I was confused. What kind of help did she need that required a move? She said she was having trouble seeing well enough to prepare meals and pay her bills. Sometimes it was difficult to get out for groceries. I told her those problems could be handled without having to leave her home. Edna exclaimed, “I was hoping you would say that! I love it here. But my friends say I need to leave my apartment. They are worried about me.”

With a few small steps, I was able to help Edna remain at home. I contacted a wonderful self-employed home health aide nicknamed “Betty Crocker” for her legendary cooking skills. Betty spent eight hours a week with Edna for the next two years. She prepared meals and froze them in microwave-ready containers. Betty managed Edna’s checkbook and took her shopping. Sometimes they went out to lunch. Several times Edna’s heart condition sent her to the hospital. Each time she returned to her home—and to Betty Crocker. When she needed more help, Betty either provided it or found it for her. They became good friends.

This system worked until Edna’s heart condition worsened. She spent her last few years with her niece who lived in Florida. Before she moved, Betty brought Edna to say goodbye to my mother and me. As she left, Edna told me “Thank you for everything you did for me.” It is ironic that what I did took much less time than it would have to help her find a “suitable” new residence. It was what any of us can do, once we are helped to recognize misguided advice, apply our everyday problem-solving skills, and use creatively the resources that are all around us in our communities.

Little things can mean a lot when it comes to avoiding the Quantum Leap.