Saturday, May 23, 2009

seniors and pain, caregivers and medical decisions

Interesting Toronto Star item:

HealthZone.ca - Your health - Law turns deaf ear when elderly beg ... A lawyer-member of the Human Rights Tribunal, Handelman says Ontario's Health Care Consent Act is clear: Except in an emergency, there is no treatment without consent. When the patient is not capable, the substitute decision maker consents – or not – to treatment

I found that in Long-Term Care (LTC) this is not an issue. Emergency rooms are reluctant to accept LTC residents. For that reason, many LTC homes require that residents, or Alternate Decision Makers, sign a form indicating the level of response to a resident.
Home Care is not necessarily an easier situation, but it does make life much more comfortable for the patient. You have many more choices and options.

For example, when my late father entered the home, we knew he was palliative. We had a DNR order, to not resuscitate. There are several levels of orders like this. You can choose to DNR, and not send the resident to the hospital (with long waiting times in emergency), or within the LTC the client can receive any medications s/he needs. If you are there, and you are vigilant, you can advocate for them.

So often you see families making all sorts of incredible things happen to try and prolong a life that is less than comfortable. Caregivers know their loved ones/clients, yet health care professionals need to recognize that end-of-life and palliative care require different treatment options from no treatment, to utilising the full resources of the LTC and the nurse on duty.

For some, not eating is a crisis, yet at end-of-life your systems are shutting down, like the slowing down of a clock. One's body cannot process food. For those with pneumonia, to give IV fluids means that they are fighting with more fluids in their lungs. To feed by tube similarly weighs down a body that is preparing to shut down. We really must respect the patient, and
many are simply not hungry yet we force them to eat.

My
father was in pain and we had great difficulty accessing a physician. The nurses are the only contact, and the physicians are too busy to return calls, or go to the LTC home. Pain control, if it is neglected, is a form of elder abuse, in my mind. Seniors with dementia are unable to process 'pain' as an abstract concept. When asked, they cannot understand your request.

Care of terminally ill attacked: The standard of care of the terminally ill in the NHS in England has been criticised by MPs. Palliative care is becoming more complex, yet we are not giving any more training in geriatrics to those caring for palliative clients.

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