The following real-life story is an example of the needs of one elderly person who was thinking ahead and the steps she took to plan her future well-being followed by a sequence of events of hospital to home management after her planned heart surgery. These responsibilities often fall on the shoulders of a busy family member as primary caregiver, but in this case she had designated her seniors advocate to provide the support because there is no family. The key is to be prepared.
Betty’s Scenario, Planning
Bettyii is a 78-year-old retired legal stenographer who, following her retirement, graduated from a gerontology program and taught tai chi for many years. She lives alone and has no family. Scheduled for heart surgery, she decided to update her will and while meeting with her lawyer she expressed concern about being alone and not having someone to help her when she wanted personal support through illness or the natural aging process. She wanted someone who would take a personal interest and provide some advice and support beyond what the government health system could offer. The lawyer referred her to me.
We completed a two-hour consultation in her home to gather as much history and current information about Betty as possible. Still capable of managing her own affairs, she lives only on CPP and OAS and qualifies for support through the government health authority; however, she has saved to pay for specialized services and support in later life.
While visiting with Betty and listening to her talk about her childhood, illnesses, her marriages, hobbies, careers, political and religious views, financial successes and failures, we gained a great understanding of her values and beliefs, and who she really is now. This information helps provide a clearer picture of how Betty would like to live and be cared for should she become too frail to care for herself. Knowing more about her also allows us to create a shortlist of private or subsidized homes, including care services, for her to consider now rather than having to think of choices and options later on.
All the pertinent information was complied into Betty’s personal booklet to use as a reference for caregivers, nurses and others who may be part of her future support team. This will allow them to identify with her, and help them to see her as an interesting individual rather than a faceless, unacknowledged elderly person, whether she is cared for in her own home or if she becomes a resident in assisted living or long term care.
As Betty was soon going for heart surgery to have a partial bypass and valve replacement, she made BjK Seniors’ Advocate her legal representative for her health and well-being. She asked us to accompany her on the day of her hospital admittance. It was noted by the hospital that we were her legal representative to be contacted should any problems arise, and to be advised as soon as her surgery was complete. She asked that we call her doctor, her lawyer, and a list of her friends and relatives in eastern Canada after the surgery.
We set up a plan where we would be available for her as long as she needed through her recovery. In preparation for her surgery, we suggested to Betty she plan for home care prior to being released from the hospital; but, she had been very impressed with the pre-op planning provided by the heart team so she wanted to wait to hear what the hospital suggested for support following the surgery. We honour our clients’ choices after giving them our professional opinion, and make every effort to provide support as further steps are required later.
Never having had surgery before Betty was apprehensive about managing on her own in her three-story townhouse with no bathroom on the main floor. Also, the nearest store is approximately one mile from her home and she does not drive, complicating her ability to get groceries, and go to follow-up doctor appointments. Her friends are elderly and live in other communities, and she prefers not to have a dependent relationship with her neighbours. She wanted help at home.
We visited with Betty, purchased undergarments for her to provide comfort over her surgical scar, and spent time liaising with the care management leader and nursing staff to get a better understanding of her progress and to prepare for her eventual trip home.
We asked the hospital to set up an assessment with the local health authority to get Betty into the healthcare system to receive home support. At her age and following a serious surgery, she could be at risk; For the elderly the first 72 hours can be the most critical after arriving home from the hospital. Being alone and afraid to navigate stairs could prevent them from go downstairs for meals, or upstairs to use the washroom on time, leading to further complications. The care management leader said Betty did not require support and that an occupational therapist would visit a week after she got home.
After we expressed Betty’s and our concerns about her ability to manage on her own, the care management team did recommend she get equipment from the Red Cross, including a commode for the main floor, two walkers (one for each level in her house), a bench seat for the bathtub, and a sock pull. We asked if the occupational therapist could go to help set up the equipment and ensure Betty was able to manage the stairs, etc., but this was not an option.
With no home support or occupational therapist, our work was cut out for us. Hospitals generally do not give advance notice of discharge, which also meant making arrangements at the last-minute for private care and for someone to pickup the Red Cross equipment.
The hospital completed a requisition and faxed it to the Red Cross to have the equipment ready for pick up. Betty’s GP (a wonderful doctor) had offered to pick up the equipment until we discovered the location information we were given was outdated; the Red Cross office had moved and the new location was well out of the doctor’s way. We switched to plan B calling the care company we had made arrangements with, asking if they were able to provide an able-bodied male caregiver to pickup and install the equipment for us.
We 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 picking them up on our way home.
The First 72 Hours
Here is the 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 for them.
- Betty asked we sit with her during the hospital discharge process with the case management leader, and then give her a ride home, although the hospital would have arranged transportation to get home
- We made calls to arrange for a private care company to meet us at Betty’s home on the same day of her discharge.
- 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 the assessment and reviewed with Betty, 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, a trip was made back to the drugstore to pickup medications and a few groceries to last for the week.
- The care company prefers the staff not 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. As her personal advocate she had given us a key, to come back the next morning to let the care aide into the house.
- The drugstore had a standing order for a specific style of lid for her medications, which they neglected to use on this occasion, so it meant another trip back to the drugstore in the morning.
The following arrangements were completed from the office
- Phone calls 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.
- Phone calls to Lifeline to arrange registration and installation of Lifeline phone equipment.
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, giving Betty more confidence.
Two weeks after Betty’s return home we picked up backordered medications and stayed with her while Lifeline set up service. A drain under the kitchen sink had sprung a leak,we arranged for a plumber to arrive while there have the new shower hose, we had purchased on Betty’s behalf installed.
Some of the care aides provided extra services and drove Betty to her follow-up appointments and did some grocery shopping. Within seven or eight weeks after coming home from surgery, she cut back her care to three days a week in the morning and alternate three days in the evenings, with Sunday to herself. She has appreciated the care and service they have provided immensely while she was in recovery and she has many compliments for the staff. As her recovery continues, she will reduce these services further. We have given 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. We 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, sometimes being a delivery service, shopping for things such as shower hoses, or even having to step on a toe or two when 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 seniors services and well worth the peace of mind.
These services are offered to enhance the continuum of care provided by the government health authority. As a large organization they can only do so much, and a personal seniors’ advocate working with them in harmony definitely helps smooth the way for the senior who is adjusting to a new lifestyle and needing hands-on support.
We attended Betty’s two-month, follow-up doctor’s appointment with her and she is recovering nicely. She has been grateful for the planning, management and support and knows we will be there for her when she needs her personal seniors’ advocate in the future.
She can choose to continue with check-in calls, and she has asked we help her look for rental suites when she sells her home and after that again when she considers assisted living. Our view is she would do well to move into assisted living next rather than moving to a rental property; however, as her personal advocate we are mindful of her right to personal choice and will not interfere, but will make her aware of options and be available for her when needed.
Following that, should she go into long-term care she has requested a monthly plan take effect. We will visit at least four times a month as monitor and liaison, ensuring she is well treated and cared for and to resolve any issues the long-term-care staff have which might make caring for her difficult. This may include hiring extra care or a companion for her.
Betty’s key contacts such as investment advisor, doctor, etc. all have our name and contact information on their records. Any one of them can contact us as her personal advocate. Our goal is that she remains safe, happy, and confident in her choices for the future, and reassured that there is someone to look out for her well-being and best interests.
i Statistics Canada, Report on the Demographic Situation in Canada 2005 and 2006
ii The client’s name and location have been changed to ensure privacy, but the services provided took place as described.
If you would like to use this article in your Newsletter, E-zine, or on your Website it must be used in its entirety, including the title, by-line and copyright notice and the following paragraph with a live link back to our website www.seniorsadvocate.ca
BjKSeniors Advocate and can be contacted by emaiing firstname.lastname@example.org ©2011