We have talked about the topic of neglect and bedsores on this blog. We have discussed how a horrifically neglected bedsore is a wound that (when ignored by medical personnel) can progress down to the bone and infect and kill that bone. That is osteomyelitis. The infection can enter the bloodstream, the patient can become septic and die. And that doesn't even begin to discuss the gangrene.
What are we allowing to happen to our vulnerable and elderly?
I understand the topic of nursing home care is very sensitive and personal. The decision to place a loved one in a nursing home is not a decision that any family member or friend makes lightly or without thoughtful consideration. That being said, nursing home placement is not an optimal living arrangement. Hopefully, the placement can be as short as possible and a diligent family member or friend can be present as many hours as possible.
During one of my dad's first hospitalizations at Duke University Hospital, the hospitalist physician and nurses were anxious to have dad placed in a nursing home. The attending hospitalist was so insensitive and told me "you have a life too."
Dad was 4 months status post a completely successful colon cancer resection with very wide clean margins. Dad was just suffering with a difficult urinary tract infection. That was it.
I asked dad's clinic urologist (also from Duke) whether dad should be in a nursing home. I wanted whatever was best for dad.
The urologist first reminded me that in elderly men often the only presenting symptom of a urinary tract infection is altered mental state (confusion).
The urologist (who knew dad better than the hospitalist) told me that if dad went to a nursing home:
- The nursing home staff would be a catheter in dad (because it is easier for the staff);
- Dad's urinary tract infection would continue until it ultimately reached his kidney and that would be the beginning of the end for him;
- I would absolutely need to spend as much time in the nursing home monitoring dad's care as I did in the hospital because dad would receive less care/attention in the nursing home;
- I would need to make sure dad moved every day so that he did not get bedsores or abused.
I chose to take care of my dad at home. It wasn't easy. But the alternative of risking a nursing home placement was not worth it.