I have a  woman in her 90s in hospital who I am expected to do a guardianship application for. She is very intelligent and cognitively above average, can actually do that counting backward by 7s thing! She lives in a nearby regional centre and wants to go home there. She is however de-conditioned and can’t stand. She has the idea in her mind that she just needs rest and after that it is mind over matter. I have delayed the Guardianship application – for which I will be challenged, to give us time to talk it through and process it and to see if she can accept that she is no longer capable of living independently (alone) at home, or if we can come up with another option than a  high care facility. To have any chance of going home she would need to go to rehab which she is declining at present. Our physios on the ward don’t have the equipment to work with her  in her present condition so she would need to go to larger facility. It takes 2 or 3 people to move her. She has a lot of pain in her legs. She wants to go home, she doesn’t care if she dies, she says, ‘ I’m 92′. She is not worried about being unsafe she says’ I’m unsafe here’ (she had a heart incident on the ward).

I have informed her about the hospital ‘duty of care’ attitude and the fact that they will take it to the tribunal if necessary. But of course that just upsets her and makes her cross – she says they have no right and I’m inclined to agree, hence my delaying tactics.

The main pressure to process the guardianship is from the Aged Care case manager, an RN, who just sees it as a matter of fact. The lady has no family in Australia and won’t countenance any attempt to contact those she does have, and says her friends have all died. One neighbour has helped but they don’t really like each other. She’s on the aged pension.

My decision so far is to plod along with my relationship with her and see what if any movement we can get, or further information (difficult as she prefers to talk about her life and past – was an alternative healer in Sydney). For me this situation raises issues about the right to self determination, respecting her wishes, the rush and push to move people out of the hospital, and the pressure on workers to be ‘provider driven’ rather than operate within professional values and ethical systems.