My client whom I will call “Marie” for the purposes of this story, was a 71 year old woman who had serious respiratory issues. Until recently, Marie lived at home with her mother. They had spent their entire lives together. A sudden illness caused Marie’s mother to be hospitalized and subsequently sent to a nursing home for rehabilitation. When it became apparent that my client’s mother was not going to recover, Marie brought her home and arranged for hospice services. There, my client Marie, a 70-something senior, continued to help tend to her mom, who eventually passed away.
As I had been hired by Marie previously, I was recently contacted by her trust officer, and was informed that Marie had been ill. It was requested that I act as her geriatric care manager. I went to the hospital in order to assess her situation. At that point in time, the trust officer knew very little about Marie’s physical condition.
When I arrived at the hospital, I was very surprised at how much Marie had deteriorated. She had been a feisty, quick witted woman. Despite her breathing issues, she had always been a fighter as evidenced by her devotion to her mother. At first, Marie didn’t recognize me because she was taking medications. Then in a matter of a few minutes, she confessed to me that the combination of taking care of her mother and the breathing issues landed her in the hospital, then in a rehab. community for respiratory therapy, then back in the hospital again. She said, “Andrea, I am convinced that taking care of my mother worsened my health. But, I loved her, and I would never change what I did. But, now that she is gone, I really have nothing to live for.” The hospital’s plan was to send Marie home with hospice care. She told me she was impressed with the hospice team that had taken care of her mom, and wanted the same people to take care of her.
When I reported to the Trust Officer that the hospital planned to place Marie on hospice, the officer was flabbergasted because she didn’t know that Marie’s condition was failing. I suggested that I work with Marie’s Power Of Attorney For Healthcare, who also happened to be the pastor of Marie’s church.
One of several serious concerns I had were (1) Why were both Marie and the hospital perhaps “giving up” so quickly; and (2) how would Marie fare at home, since hospice care would not be full time? I would need to hire a non-medical home care agency to help out between intermittent hospice visits. And since such non-medical agency personnel may not be able to lift Marie (on a “one-person” basis) as a patient, but only assist with transfers (say to or from a toilet or wheelchair), it might require a 2 person assist. That could have cost somewhere in the ball park of $480 per day. This is one reason why Marie’s pastor/POA and I pushed very hard for rehab. for Marie. We were not about to give up on a woman who never gave up on her older, frailer mother.
In a subsequent conversation that included me, the pastor, and my client, Marie asked why everyone had given up on her? After all, several years ago, Marie had been given a prognosis of only six months to live. Several years later, she was still alive. The pastor and I agreed that we would push to get Marie more respiratory, physical, and occupational therapy so that she would at least have time to get her affairs in order, a request she made to both of us more than once.
Our next move was to meet with a hospice nurse who explained to us what hospice would pay for under Medicare if my client went home. She also had the option to move to a hospice in one of their “approved long-term care communities.” However, Medicare would not pay for rehabilitation and hospice at the same time. The end result of our meeting was that the hospice nurse convinced Marie’s doctor to approve more rehab. I immediately found a rehab. community that could handle Marie’s complex respiratory issues. The day before the transfer to the rehab. community, Marie was feeding herself and transferring with some help. She was enthused about the prospect of getting more therapy.
Very recently when I visited Marie, she told me she felt weak. She told me she fed herself but didn’t have enough of an appetite to finish everything. She said the community staff had been responsive to her needs, but that she felt she was ready to go to God. She prayed out loud very fervently for 45 minutes, asking God to please come and take her. She also thanked God and asked for blessings upon those who had taken care of her, and she specifically named me and the pastor.
While Marie was deep in prayer, a nurse entered the room without knocking (a nursing home standard of etiquette). She stoically informed her that due to the complexity of the breathing issues, they had done all they could for her, and that hospice should be her next serious consideration. To put it mildly, this professional’s bedside manner left a lot to be desired. I saw the disappointment on Marie’s face.
There was to be a meeting the next morning to decide what the next step would be, but I was informed that Marie passed away, or should I say was taken home shortly after midnight.