Just before Betty was to undergo a partial bypass and valve replacement to her heart, she arranged for Seniors’Advocate.ca to be her representative. She asked me to accompany her on the day of her hospital admittance and it was noted by the hospital that I should be contacted should any problems arise and that I had to be advised as soon as her surgery was complete. She wanted me to call her doctor, her lawyer, and a list of her friends and relatives in eastern Canada after the surgery.
In preparation for her surgery, I suggested to Betty that she plan for support at home before going into the hospital; but, she wanted to wait to hear what the hospital suggested for support following the surgery. I honour my clients’ choices after giving them my professional opinion, and make every effort to provide the supports as required later. Many of the steps described below should have been set up in advance making the whole process easier but families or seniors are often unaware of their limitations.
After surgery I visited with Betty, then liaised with the care management leader and nursing staff to get a better understanding of her progress and to prepare for her eventual trip home.
For the elderly the first 72 hours can be the most critical after arriving home from the hospital. The care management leader said Betty did not require support and that an occupational therapist would visit a week after she got home. Being alone and afraid to navigate stairs could prevent Betty from going downstairs for meals, or upstairs to get to the washroom on time, leading to further complications. Here is a case where Betty was unable to articulate this to the CML.
After I described Betty’s home situation, the care management team then agreed she needed supportive equipment and recommended she get equipment from the Red Cross, including a commode for the main floor, two walkers (one for each level in her house) and a bench seat for the bathtub.
Betty was very apprehensive about the stairs and with no home support in place yet or occupational therapist to provide support I had my work was cut out for me. Hospitals generally are not able to give a concise notice of discharge, which also meant arranging private care needs at the last minute. In this case I asked the hospital to fax a requisition to the Red Cross to have the equipment ready for pick up by Betty’s GP (a wonderful doctor) had offered to pick up the equipment until we discovered the address we were given was outdated; the new location was well out of the doctor’s way. I made arrangements with the care company to provide an able-bodied caregiver to pick up and install the equipment for us.
I had also asked the hospital to fax the prescriptions to the drugstore to save time so that Betty would not have to wait long in the car while I picked them up on our way home.
The First 72 Hours can be a difficult time for the frail elderly after leaving the hospital. Here is a detailed sequence of responsibilities that unfolded as we got Betty safely settled at home. The process may very well be different for each client, depending on his or her needs, but the goal is to make the transition home as seamless and effortless as possible and in this case Betty was able to rest easy.
Betty and I went through the hospital discharge process with the care management leader, and I gave her a ride home, although the hospital would have arranged transportation to get her there.
- Before leaving the hospital, I had made calls to arrange for a private care company to meet us at Betty’s home.
- On the 45-minute drive home we stopped to pick up the supply of medications, which were not ready although the drugstore had been given several hours’ notice.
- The care company arrived shortly after us, completed their assessment installed the equipment and reviewed management of the stairs, using the commode, getting in and out of bed, using the raised toilet seat, and managing the tub bench.
- We arranged for care aides to come in twice a day: first thing in the morning to help Betty bathe, dress, navigate the stairs, have a meal and take her medications, and do some light cleaning and laundry (located in the basement); and again in the evening to help with dinner, manage the stairs, and prepare for bed.
- After the assessments were completed and while the care aide was preparing dinner for Betty, I made a trip back to the drugstore to pick up medications and a few groceries to last for the week.
- The drugstore had a standing order for a specific style of lid for her medications, to open the bottles more easily and they had neglected to use on this occasion, so it meant a third trip back to the drugstore in the morning.
- The care company prefers the staff not to have keys to the clients’ homes. This would prove to be a challenge for Betty in the morning, because she was in her bedroom upstairs and afraid to leave the door unlocked for the care givers. As her private advocate, she had given me a key, so I came back the next morning to let the care aide into the house.
- Phone calls were made to secure a locksmith as quickly as possible to deliver and install a lockbox for easier entry for support staff coming into Betty’s house. He wasn’t able to come until later the next day
- A drain under the kitchen sink had sprung a leak so I made calls to find a plumber to fix this and also install a shower hose which I had purchased .
- Phone calls to Lifeline to arrange registration and installation of their phone equipment. First appointment available in two weeks.
- The occupational therapist arrived as scheduled one week after Betty’s return home, reviewed the equipment, and assessed Betty’s ability to manage the stairs, her balance and her gait, among other things. She came back a few weeks later to do a secondary review, confirming great progress, which left Betty with more confidence.
- Two weeks after Betty’s return home I picked up backordered medication and stayed with her while Lifeline set up service.
Within seven weeks after coming home from surgery, she felt she could manage with less care and later able to stop the care altogether. I gave her phone numbers for grocery shopping by phone and driving services, should she not be able to use public transport as she has done in the past. I also suggested she change her drugstore to one that delivers medication and is more reliable with standing requests.
Sometimes the lines of a personal advocate become blurred. Going the extra mile to make things happen is all part of the vocation. The “extras,” such as making personal phone calls for the client, calling their financial planners, banks and lawyers sometimes being a delivery service, shopping for things such as shower hoses, managing their daily finances, navigating the health care system is all part of securing the quality of life for the elderly. Whether they are alone or their family is committed to being involved, the client’s quality of life and well-being is priority. Yes, there is a cost for a personal seniors’ advocate’s services, it is in line with other services and well worth the peace of mind.
These services are offered to enhance the continuum of care provided by the government health authority and hospitals. The broad knowledge, tactical planning, follow through, accountability and communication and relationship skills and personal knowledge offered by a private Seniors’ Advocate working in harmony with the other professionals definitely helps smooth the way for the senior who is adjusting to a new lifestyle and needing hands-on support.
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Barbara J Kirby‘s strong belief in respect for our elders, honoring their life experiences and treating them with dignity is her driving force. As a working professional with a business background she learned to navigate the cumbersome health care system while managing her elderly parents complex care over the period of 15 years. Barbara Kirby is the founder of www.seniorsadvocate.ca