I am following, with interest, the debate on the bill in the House on euthanasia*. Palliative care is a horribly confusing term. As a Hospice Vounteer, everyone has access to the care afford by our volunteers across the province. The discussions is hear are right: we undermanage pain and there are many myths around pain, health care, and its management. In Muskoka, health care is hampered by a lack of health care staff (doctors, nurses, and personal support workers) to maintain adequate standards of care.
Palliative care is a process in the caregiving continuum, it is not a style of care in my mind. There are decisions to be made and no longer are doctors making choices for you.
The goal, for all clients, is to have managed care with treatment goals, treatment options and a plan with eyes wide open. This is what I wrote about in my book, when my father's doctor was inaccessible and unresponsive to our needs for pain management. Many seniors suffer depression - the statistics are clear and predictable, and would be susceptible to choosing death over living.
Picture this scenario...
You walk into your neighbour's house to deliver his Meals on Wheels (MoW), you find him wearing a shirt buttoned with only one button and mismatched at that. He wear a pair of long johns, and old, leather slippers. His wild hair and grey-tinged beard trimmed last week, are in disarray. His face brightens at your arrival, grateful to see another human being in his long, lonely days.
You have brought him his prescriptions that you have picked up from the pharmacist. Last week, there was delivered another bag of drugs. He was most grateful, as he explained that his pain is bad. No one knows his specific health issues, although rumour has it that it involves his prostrate. The bag of drugs isn't the small paper bag with which most of us are familiar. It is a bag the size that would hold a Chinese food order. You check on his dog, who doesn't have food and water. Fortunately, the large bag of dog food, bought by another neighbour, sits open on the floor. Baby has helped himself as needed. This old doggie doesn't have water, though, and you fill the dish.
The Meals on Wheels containers sit in the shed. Dirty, and remaining uncollected by other MoW volunteers who fear the large German Shepherd, a big softy, really, a baby! You take a large garbage bag and fill it with the dirty containers. And you take another. One imagines MoW volunteers dropping the food and running.
Grateful for the attention --both man and dog are happy to see you. You feed the dog the doggie treats you always bring. You've taught this happy-go-lucky beast to 'sit', and sit he does, on command, anxious for the dog biscuit you've brought. That done, greetings and social nicities concluded, the man turns to go back and sit on the couch. As he does so, you notice that his long johns have a spot of feces on it. His arm, still wrapped in the cast he has had for months, he nurtures like you would a kitten or puppy. The last couple of times the neighbours have tried to take him to the city, they were unable to wake him. The cast still has not been removed. There is evidence of alcohol, and either dementia or delirium, it is hard to say which. The conversation remains befuddled, although you sense from both man and dog that they are as desperate for conversation as a man and dog in the desert.
The pet mole they both nurtured has disappeared. So has the baby squirrel. Neighbours have removed boxes of empty beer bottles. They have taken responsibility for him for months, and the burden is great. Bills remain unpaid. The sewer backed up and the church paid for its repair. A doctor at the church checked in on him; congregants concerned are about his welfare.
There was a housekeeper who came daily, but little evidence of her work remains. The poverty and clutter scramble for dominance in the place he calls home. His brother no longer speaks to him. Our beleaguered soul demanded he be cremated when he dies, and his fundamentalist lay preacher brother refuses to deal with this. The man is estranged from his educated children, and the community is unsure that there is any family involvement.
CCAC continues to send a nurse, if the driveway and path are shovelled. Last year, knowing his issues and the informal caregivers who serve his needs as best they can, many with health issues of their own, one went and cleaned his driveway, with help from his four-legged buddy. Most can have a maximum of 15 hours support a week, but one wonders who would be eager to try to serve his needs.
This time, walking into the unlocked home and bringing him his meds, they were promptly handed over to an eager patient. He was sitting on the ratty couch, dog at his side. A shirt on his bony frame, he sat in the cool, dark, dank house and he was bottomless. Almost incoherent, conversation is difficult. He may not have clean clothes, and needs someone to do laundry and keep him on a pain medication schedule. He could be overdosing, he has a history of addictions, and there is no one to keep him in a routine.
Neighbours have effectively stolen his MasterCard, to prevent him form ordering any new beer in and further maxing out another credit card. This is unfair. His bank bills are unpaid. Collection agencies call daily, if not hourly. He has no idea of the time of day. No one to care for him. He needs daily support. And he is entitled to remain within his home, with his precious dog.
What do you do?
You phone the CCAC Care Manager. You let them know his history. Anyone can phone with concerns. They only need the permission of the potential client. Already a client of CCAC, they seem unaware of these issues. No family. An inability to manage his daily needs, he must survive on the MoW delivered thrice weekly. Surely this is not an acceptable way for health care providers to leave him.
Hospice care is an option, if he is able to sign on to the program. They are not just there for those dying, but aging, failing seniors will benefit from care and support. Volunteers provide care and will visit homes receiving mileage for their effort. Yet, he needs a care manager who can ensure that there are people checking in on him regularly; a difficult proposition since many are afraid of the dog and many shudder in the dirt, grime and mess of the place.
The health department could be called. The sewer back up in the spring was followed by a refrigerator that remained unplugged for days. He did not appear to notice, although uneaten MoW deliveries had been placed there by some one.
The police can take responsibility for those who abuse elders. They have specific specialists who deal with those living in poverty and squalor, blissfully unaware of acceptable standards of cleanliness and sanitary conditions. But who is at fault here? No one knows who enters the home. No one can see what his daily life is like. No one seems to care. This is the depth of despair for those who are old and alone.