Aside from being a psychologist in nursing homes, I also had the pleasure of being a caregiver to my own aging parents--as a consumer of the same services I provide, the personal meets the professional. I work both sides of the streets.
My father spent the last years of his life in a nursing home descending into deeper and deeper dementia.
It's time for the quarterly care plan meeting at Dad's nursing home. My father, who has a right to be there, is not there. He wouldn't have a clue. I'm sitting at a table squeezed into an office not meant for conferences, fiddling with my cell phone. My brother, Robert, attends via speakerphone. I chat up a nurse about her golf game. This is the functional equivalent of a parent-teacher conference. We're going over the functional equivalent of a report card.
The golfing nurse--the care plan coordinator--chairs the meeting. Every three months, each of the departments files a report for Dad's chart. Usually the staff moves along the agenda along minus the impediment of family, like my brother and me.
First up, the dietitian. But before she begins, we hear an impediment from Robert on the speaker.
"I was in town from Boston last weekend, and there was a banana on my dad's lunch tray."
Dad's kidney has been slowly failing for most of his adult life--slowly enough so something else will likely kill him first. But bananas and other high potassium foods are poison. He loves bananas.
"Sorry, I'll look into it," says the dietitian.
I'm personally not at the top of the charts when it comes to caregiving time; I'm not spending hours a day or even every week with Dad, but I worry about the bad kidneys of residents whose families never show up.
The doctor never attends care planning. Unlike the nurse, he might be actually golfing. A nurse drones on about Dad's vital signs and the ups and downs of his meds. There's no physical therapist, either. My dad has "plateaued." There is no hope of additional progress for his fractured hips. Medicare won't pay for plateaus. Exercise would still be good for his hips, but he'll have to get someone other than Medicare to pay for him to walk across a plateau. Pushing ninety, he's a Medicare orphan. My brother and I pester the recreational therapist and the social worker about exercise, having the aides walk him. This is when we get the lines about staffing shortages, and how he doesn't want to go on walks, anyway. Neither does he want to go to recreation.
"Forget about his rights and just wheel him down to the damn sing-along!" I implore.
They write that down.
Reminds me of the patient who asked, "Do you write down everything I say?"
"What do you think?" I ask, as I write that down.
For those who remember Lawrence of Arabia, "Everything is written." Maktub in Arabic.
You may think you're in something like a home, but you're a 24/7 patient for the rest of your life. It is written. Maktub.
To mix metaphors. Sysiphus has nothing on me.
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This post was adapted from my forthcoming book, Nasty, Brutish, and Long:Adventures in Old Age and the World of Eldercare (Avery/Penguine, March 2009).