Last week there was a 92 year lady on the ward who was unable to stand but wanted to go home where she lived alone. I was requested to do a Guardianship application even though she was cognitively sound. I delayed this because I wanted to see how she would process our conversations about her wishes, which I validated and genuinely sympathised with. I was clear with her about the hospital view of ‘duty of care’ (in the context that they wanted to discharge her).
We understood each others positions and developed an amicable relationship. She appreciated my moral support. Over the period of 10 days she began to participate in physiotherapy. I believe this was a result of my supporting her wish to go home and identifying the need to at least to be able to transfer from her bed to wheel chair to be even vaguely safe.
She did go home. She had a neighbour literally ‘pick her up’. Her Aged Care assessment was for high level care and her care providers said they were unable to provide this, and therefore provided nothing. The Community Nurses, since she is no longer ‘unwell’ said they don’t do ‘welfare’ visits.
For me this is was victory of rule rigidity and risk management over compassion and common sense. It is unlikely she will last long at home before the next crisis, but she needs to go through the process of saying good bye to her home and independence her own way. That’s my view. Since the services who are paid to provide for the aged at home wouldn’t call in and keep an eye on her I enlisted a volunteer church group to do that and to call an ambulance when it becomes necessary. I also notified her GP. I should clarify she lives 45 minutes from me in a different town and shire or I would have done it myself.
There was an article in the Sydney Morning Herald this week about a young indigenous man who died because paramedics wouldn’t attend without police protection. There are times when intelligent flexibility is required; like having the family accompany them and guarantee their safety, or for the Aged Care service to provide surveillance and support whilst being very clear that they do not consider the elderly woman to be safe.