Yes You Can!
I can’t! We just can’t!
by Sue Collins, RN, and co-author of OK Now What? A Caregiver's Guide to What Matters
The last four years of my hospice career, I performed Medicare and insurance eligibility reviews for patient referrals. These were received mostly from hospitals, though occasionally from physicians or family or friends. Once I determined that the diagnosis met the requirements of Medicare or commercial insurance, I called the family to explore their understanding about their loved one's situation. The families of patients who have already had a cancer diagnosis, or declining cardiac, respiratory or kidney disease were a bit more prepared for the news about the new milestone their loved one had reached. But the families of a newly diagnosed person were always blindsided. They weren't prepared for the new reality, and their potential part in that reality. The notion of caring for a loved one who has reached a new level of need can be overwhelming, yet the need for assisted care is urgent.
There is an exploration: Can't they stay in the hospital? (The short answer is No. Hospitals actively work to free up their beds and to discharge patients as quickly as possible).
My friends have had bad experiences with nursing homes, and they are afraid of them. We understand. Not all care facilities are created equal.
What about your house or another family member's house? I can't! We can’t! We all work. I have no more time or energy or room! I care for grandchildren (or spouse, parent, grandparent) already.
Take heart. There is potentially another solution. If the patient owns their home, a possible solution would be to have them return home and ask a relative – perhaps the adult child of a relative or a trusted friend looking for income – to become the caregiver.
If the patient has any assets, use those to pay the caregiver, if not perhaps borrow against the house. This solution avoids paying for rent at a facility, removes the guilt and shame one may feel in placing a loved one in a facility – especially of the person has previously expressed fear or loathing of that possibility – and keeps the loved on in their own home, their place of comfort and security. It can also alleviate the daily anxieties about the care the loved one is receiving.
Will it be exactly what everyone would want? Perhaps not. But will it be a possible solution to a situation that is (in reality) finite.
If the patient does not own a house, try the same strategy in the home of the next of kin, adult children, or siblings. Perhaps there can be a rotation of caregivers and/or locations. Obviously, there is much to consider.
BUT, what is the immediate take-away? Be prepared. Instead of panicking when the hospital physician informs you the loved one should not be left alone (or that it's time to consider hospice), have a plan. Even if it's a fluid, a not-completely-in-place plan. Consider it mental health insurance so there are things already decided when a crisis hits.
Start having discussions with your family now for the mental health of all involved by giving you a little time to get your mind around the potential situation. Early family discussions give everyone an opportunity to create a workable scenario. As time goes on, what may seem impossible now, could be an opportunity for a family member in the future when needed. Instead of I can’t, we just can’t, with a plan yes you can with much less stress in the process. This is particularly important when family members are scattered across the county.
Sue Collins was a hospice nurse for 38 years.