Elderspeak and Emergency Rooms
This blog's focus is First Do No Harm. Seems reasonable enough. Yet, in the past several weeks, the tsunami of harm impacting elders living at home is simply mind boggling. The financial environment this past year is having an horrific impact on the elderly, cost of food doubled, cost of gas and oil and propane doubled, health care premiums, for those borrowing from retirement accounts to pay for current living expenses, many of these accounts have values that have fallen below levels that will recover in their remain lifetime, falling into bankruptcy up almost 500% for elderly.
Many elderly in the past several years, took out equity loans to pay for health and living expenses, and refinanced their homes ... on balloon mortgages.poof - foreclosure looms large for many ... with their children, in the same boat, unable to rescue them
If that isn't enough, when folks do seek help - they often find it demeaning, frustrating, depressing and simply give up. We have two recent studies that confirm several concerns reported here on this blog :ElderSpeak & Emergency Rooms -Not surprisingly they are closely related.
It's all about elder caregivers (family and professional alike) intention, actions & investment in relationships - a frequent topic here. In the case of ElderSpeak, which is adult to elderly conversation that is patronizing condescending, blaming, dismissive - and ultimately abusive; and which only serves to engender fear, shame, and push-back isolation.
There are now measurable negative impacts on outcomes and mortality when we treat elderly like children, in our intention, control and conversations - when we talk with fake familiarity to elderly as baby, honey, sweetie, and dearie ... while not engaging active supportive and safe listening -for them.
Which leads us to Emergency Rooms. Recent data suggests that a huge majority of elderly to not follow through with their home care orders and medications after discharge from the emergency room visits. Why is that not surprising? Elderly Patients in ER's are under terrific stress, often sitting passively for hours (worried about how to pay, will they hospitalize me, will they send me to a nursing home? We print discharge orders too small for poorly sighted elderly to read, We fail to engage or retain a caregiver (family, home health aide or VNA to assist in proper follow-through).
And we talk to elderly patients and parents like children - forgetting short term memory loss, and processing them -matriculating them back back into their homes rather than graduating them with appropriate with the tools and knowledge they need to manage their care ... because we don't engage then in the conversation -
instead, we talk in the third person to the family member who drove then to the hospital and the patient is presumed to be deaf. (Daily followup phone callbacks with simple discharge orders in large print are very helpful.
What is the outcome? You know the answer, depression, suicide, reduced mortality, reduced cooperation, compliance and increased isolation.
Look at the 90 year old woman who shot herself as they were foreclosing on her house. After all of the publicity, the bank forgave her mortgage... How Sweet of Them.
Yea Right! How scummy can you get. You only do the right thing when the searchlight is on you and you look really stupid. Yet this pattern, of "I'll do what I want - until I'm caught" (like the CNA who verbally abused a patient beside me - at 2:30 in the morning) is endemic is elder care.
Why not engage in a real conversation with real respect, real active listening, and turn caregiving into a dynamic partnership ... and not a cattle processing center.
The excuse that there is no time to do it right - is nonsense. If we took the time ... the data says - our elder caregiving costs would drop, lives would be lived, and care givers and elderly wuold have a lot more joy in their engagement ... in the quality of their lives.
So why don't more banks forgive elder mortgages or renegotiate terms ... it would be cheaper than a 700 billion dollar bailout. Perhaps we are approaching a new vision of elderly care and civility - in which we don't blame and punish the victim.
Strong message to follow...
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