GeriPal - Geriatrics and Palliative Care Blog

Tragedies at the end of life come in many shapes and sizes. For Betty, an elderly woman with end stage dementia, the last few years were comprised of minor, daily tragedies, finding herself staring out the window of her locked unit, wondering why she couldn’t get out the door to go for a walk. She would pack her bags with her belongings, excited about a day out with her friends to get coffee at the café and her hair done at the salon, only to find that she needed to stay in the white-walled unit. I remember her confusion and anger as the staff, dressed in white coats and nursing scrubs, would correct her on her age and the fact that the man next to her was indeed her husband. She would spend her days watching television and awaiting her meals and medications without pursuing any of her previous interests like baking and gardening. I wondered if there was a better way to do this, a place where she had a home to call her own and where she could safely and freely wander to the gro…

This is the way it went: a group of familiar faces, some family, some professional care providers, gathered around the man's bedside and talked about his preferences. Aspiration pneumonia or not, he didn't want the feeding tube, and was sick of going to the hospital, so for the next episode of pneumonia, could he please just be treated at home? Notes were made, the decision was repeated aloud to get everyone on the same page, and the preference became the plan. The decision became the default.

This is news because we know the usual defaults in health care run more like this: Panicked relative: "He's getting so sick - shouldn't he be in the hospital?" By-the-book emergency department physician, "Well, I can't send her home like this, can I?" Social worker in hospital, "With so many patient needs, you really ought to consider a nursing home."

Community Life, a Pittsburgh-area provider of comprehensive geriatric care under the Medi…