Monday, March 12, 2012

Palliative care in the home or in hospital

cat with her own health issues
This is a huge question for many families. One made, usually, by the patient/care recipient. Unfortunately, it is often a decision made by a care recipient too frail or feeble to make the best decision in the circumstances.

For example, my mother went to the ER the night before she died. She truly thought there was something the doctors could do for her. That morning, when a tumour was encroaching on her lung, she was unable to breathe. I helped her change her adult incontinence product (AIP), and then called the doctor. She wanted him to visit, as she though "Maybe there is something he could do for me."

dangerous amounts of drugs on hand
The doctor made a house call. He and I spoke. He said she is palliative. Finally, a realistic idea. She'd had chemo session #1, into hospital for chemo session #2, when they found a blood clot in her leg with lymphodema. She should not have had chemo. But they listened to her, without me being there to ask the important questions.

Mom was taken home by my brother, where she peacefully passed over on the couch. Fortunately, her cancer was internal. There was no external wound. No infections.

cat hair attached to nicotine film on walls

soiled mattress 3 weeks in hallway
How hospitals allow some clients to go home is beyond me. Surely PHIPA precludes FIPPA, when healthcare professionals are making a decision to allow a patient to go home. Of course, the only person who knows the family well is the family member. They know the conditions the patient will be sent home to. Whether the place is clean or dirty, whether it is a place where less harm will be done.
Yes, many prefer to die at home, but at what cost? Extensive Home Care, with a drain on family members who risk their own healthcare issues.

Our family was fine. Mother had no wounds, no wound care was required, she only needed pills for morphine. She wasn't in extensive pain. She had in Red Cross who cleaned, tidied. I was there to do other ADLs. In many cases a caregiver cannot hope. Support services are worse than ought to be tolerated for those with severe health issues. In many cases they cannot die with dignity.

A risk of re-infection. (My mom had this happen after her second surgery.) Or the risk of open wounds getting flies into it. Maggots crawling across a care recipient's bed isn't a pretty sight for family members.
The lack of care or standards of care for palliative clients is one of the most criminal things I have seen.
We are hiring for-profit agencies, who receive tax dollars, to care for clients in their homes.
Some agencies are non-profit, others are for-profit. While nurses have standards, and training critirea, the College of Nurses Ontario, to watch over them, PSWs do not have the same training, regulation, or body to watch over them.

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