Saturday, May 4, 2013

Respite Care: Case Study #59 in caregiving

Is it possible to have a good death?
Many clients won't take pain meds
With adequate support, pain relief, home care, house calls and caregiver respite, YES. However, it depends on many other factors, including socioeconomics, mental health, and dysfunctional families all play a role.

There many ways that it can go wrong.

RPNs contradict doctor's orders
An adult son, age 59, comes to the region, from another province, to care for his failing mother. His sisters pay him to do this.

She worked, a waitress, until she was age 63. In 1980 she had bowel cancer. She has aortic stenosis, and wears nitroglycerin patches, although there was an argument about how long it should be on. She is lactose intolerant and eats several tablespoons of soft food a few times a day.

She weighs 60 lbs. and is no longer able to care for herself. The family (two sisters) pay him to live with Mom.

Mom, in her hospital bed, receives Red Cross support every morning. Son/caregiver is unable to change her adult brief, I gagged, too, and he relies on others to do this. Otherwise, he gives her her medications, feeds her, and ensures she is safe. He keeps the two-bedroom
Filth on the wall, nicotine with cat fur attached,
plus more garbage and needle cap.
apartment meticulously. He adores her, and is very affectionate and loving. He is on disability and an addict. I don't think he reports the money they give him to ODSP, the government agency that supports him.

He gets respite from caregiving twice a week, for 4 hours in the afternoon, from two different volunteers.
Due to the nature of the situation, and the weekend service from one volunteer, he has their home phone numbers. He will often phone and request an extra afternoon. When he comes home from his outings, he is either drunk or stoned. He hits on one volunteer, who explains she is happily married.

Portraits of Home Care
This is how PSWs
leave his apartment.
The one volunteer (L), who is a smoker, has permission to smoke in his bedroom. It is government housing and smoking isn't permitted. One day, L was in his room and spotted a half dozen bags of marijuana. He accused his niece of stealing his drugs. His niece was kicked out of the apartment, with great stress all around.

A year ago his niece moved in, daughter of S. She was
This nurse left a needle under the bed
at one client's apartment.
attending school to be a nurse. It didn't go well. She was going to rehabilitation for heroin addiction and is on methadone. She is very kind to her grandmother, lifting her up gently and placing Gramma back onto her bed.
Another sister, E, works shifts and usually visits frequently, especially when her mom needs her brief changed. Both sisters take good care of her, doing her hair, her nails, and tidying her up.

This client was in a retirement home
that told family members they could manage his care.
He was dirty, undiagnosed with pneumonia,
was fed regular institution food after it was pureed by staff.
They did not have enough staff to feed him and called in
CCAC to provide a Bayshore PSW twice a day.
E comes over, feeds her mother, helps her on and off the commode, wiping her clean after a BM. I was holding her up while E worked. It
This is how the nurse fights with a Home Care client,
and often loses. This man didn't belong in his own apartment.
was very difficult.

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