Chaplain's Corner

Every day I witness the steady and unnecessarily fast decline of elderly folks who are admitted to acute hospital wards to await placement in Personal Care Homes. On the day I wrote this article there were seventeen men and women in the hospital where I work who had been there anywhere between 40 and 450 days waiting for a personal care home bed to open up.

Many assume, “Well, these folks are in the hospital, they are being fed and receiving nursing care, what is the problem?” Before I started working in health care I drew the same conclusion. However, after fourteen years of seeing the devastating results of this unfortunate necessity, I am moved to encourage you to understand. The elderly awaiting placement in acute care hospitals often experience more rapid cognitive decline and more rapid physical decline. The lack of emotional and appropriate cognitive stimulation often speeds the progression of the symptoms of dementing diseases.

Let me give you just one example. Hank (the name and details have been altered in keeping with PHIA) came into the hospital after a fall at home. He had Alzheimer’s but before the fall he and his wife were managing. One of the characteristics of Hank’s Alzheimer’s was that he incessantly paced around the house. In the hospital this pacing was a problem. In just a few days  a “wander guard” was placed around his wrist and the doors of the ward locked and alarms rang when he got too close to the doors. Before long without sufficient staffing to give Hank the attention he needed, he was placed in a wheelchair with a restraint that wouldn’t allow him to get up. That didn’t work for long so he was put into a broda chair with a pelvic restraint and a lap tray.

From then on, he just sat, sometimes in his room, often in the hall. For a while he asked each visitor for a pocket knife or scissors to cut the restraint. With no one willing to “help” he began trying to wriggle his way out of the restraint and the staff would often find him in all sorts of unnatural contortions from these “escape” attempts. It wasn’t long, his muscles had atrophied and he was no longer able to walk. Without any meaningful stimulation, his once animated, albeit confused, conversation went silent. He simply sat and stared or slept out of boredom or exhaustion from his struggles to break free from the chair.

It became harder and harder to engage him, as he slipped deeper and deeper into this malaise. The number of people visiting him diminished until just his wife and the odd support for her came by. He stopped eating much, lost a lot of weight and became a mere shadow of the person he was (even with Alzheimer’s). Some would simply conclude that his quick decline was simply the natural course of his disease and indeed, part of what I witnessed was related to Alzheimer’s.

But I also know that much of the decline had to do with the fact that an acute care hospital ward just isn’t an appropriate place for a fellow like Hank to live. So what should be done? I don’t know. I have learned over the years that you don’t always have to have a solution to look at a problem. This problem isn’t news to anyone working in a hospital, it is self-evident and many people brighter than I have contemplated solutions, all of which seem just out of reach. But I have also learned staring a problem in the eyes is a necessary part of the process of finding a solution. So, if you have never considered this sad reality stare it in the eyes for a bit. Maybe you will be the one who comes up with a solution?