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Give InKind is honored to feature Dr. Sharagim Kemp, M.D. Dr. Kemp specializes in family medicine.
I remember sitting across from my patient of nearly a decade.
“Tom,” I said, “Could you tell me today’s date?”
Tom looked back at me with a blank stare. He replied with confidence.
“June 16, 1954.”
I looked outside at the snow, wishing it was June. But it was January and the year was nearly 60 years after 1954. I shifted my focus to his three grown children in the room who were desperately trying to hold back tears.
Tom and his wife Regina were a wonderful couple. I’d look forward to the freshly-baked cookies they always brought to my office in in a little bag. Even as I gently scolded them about their cholesterol and blood sugars, I knew that I’d be having one of those delicious cookies with my coffee later that afternoon.
Tom’s wife Regina had died tragically in a car accident a couple of years earlier, and Tom had never quite recovered. He still came to see me every three months, but it became clear that his mind was failing him along with his broken heart. That day I asked him the usual questions on the mini mental status exam, questions that were getting harder and harder for him to answer.
That day I realized I’d have to tell Tom’s children that the father that they knew and loved was declining, and that the man who once ran a company would now be unable to use the restroom without getting confused. I would have to tell them that the home he had shared with his wife of 53 years was no longer safe, that he would need to be kept in a place where he could be monitored twenty four hours a day because the family didn’t have the resources to take care of him at home. Tom’s family and his new caretakers would need to help him with this next phase of his life – being admitted into a nursing home facility.
Today this is a common scenario in many physicians’ offices. According to the AARP, in 2010, one in eight adults eighty-five or older resided in nursing homes due to an inability to participate in “activities of daily living.” These are basic activities we take for granted – toileting, eating, walking, being able to move around our homes. In 2012, a total of 1.4 million individuals were living in nursing homes. And even though the elderly were more common in these facilities, younger individuals under 65 who’d suffered traumatic illnesses were also seen.
The cost associated with these facilities is staggering. In 2012, total sending (public, out-of-pocket and other private spending) for long-term care was $219.9 billion, or 9.3% of all U.S. personal health care spending. This is projected to increase to $346 billion in 2040.
With costs of care rising, I’ve found family members of these patients can have just as difficult a time as the individual going to the nursing home. I find myself spending hours reassuring and counseling families through the transition. Many caregivers see this transition as a failure – that they were not able to take care of their loved ones themselves.
In my experience, I’ve found that the families that have an “easier” time with this period of change are ones that follow some of these steps:
Plan ahead – it’s never too soon to meet with an attorney who specializes in estate planning, wills, healthcare proxies, funeral arrangements – these may be morbid discussions, but the best way to take care of those we love most is through preparation.
Make arrangements to meet with the physicians – go to the appointments, get a sense of what is happening, ask questions – if arranged in advance, many physicians will hold family meetings to discuss care.
Utilize local and national resources – many towns have organizations dedicated to helping the elderly and their families – let them guide you through the process of arranging at-home care or nursing home care.
Start looking at facilities early – many facilities are full and some even have waiting lists – it is important to meet with admissions coordinators to discuss the details of having a loved one transferred to a particular facility as soon as possible.
Make sure that, as a caretaker, you’re addressing your own needs too – professionally, emotionally, physically – many caretakers seek counseling for their own issues of depression or anxiety that may have been caused by this new phase. Many employers will even allow for time off work in order to take care of a loved one.
And finally, remember that this is a new phase – not necessarily better or worse, but a new phase. And as with all new things, there will always be a period of adjustment. But in the end, know that what is being done is best for your loved one. Tom has since passed on, but I will never forget the day that the family moved him into the nursing him for his final years. A box of cookies came to the office with a note.
“You thought I forgot everything, huh?”
I smiled, knowing Tom would be okay.
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