Mrs. Martino liked eating with other people and enjoyed the good nutritious meals. When she couldn’t take the elder minibus, she took a taxi. Luckily, because her physician had assessed her unable to take public transport, she qualified for taxi savers and paid only half the cost of the taxi fare.
Private home support
Mrs. Martino still swam every nice day and had visitors. With the help of her son, they found a suitable cleaning person and he and his family had her over for dinner once or twice a week. During this year, she had another congestive heart failure attack. Luckily, her apartment neighbor heard her cries and called 911. She was taken to the hospital to be stabilized for a few days, then returned home.
After the heart attack, Mrs. Martino became weaker and needed more help. Her son called a private agency to hire a homemaker to supervise the bath and make two meals daily. The homemaker also did the shopping.
Mrs. Martino was not pleased with the arrangement because she still did not like to have strangers in her apartment. She resisted any formal help and felt that her son could give her all the help she needed. Her son felt otherwise. He explained to his mother that he wanted to be a son, not a caregiver, and he felt that having to do the cleaning, grocery shopping, and preparing meals when he came to visit cut down on their time together.
After a time, Mrs. Martino came to know and trust the homemaker, and the agency assured the son that the same person would be there daily. Mrs. Martino hated paying so much for help, but luckily the private home support agency was cheaper than the government agency through the regional health board.
Environmental support facilities
As Mrs. Martino became frailer, she needed to make environmental changes to her apartment to make things easy and safe. Getting in and out of the tub was a problem, so grab bars and a hand-held shower were installed in the bath to make it safer. Her son looked at the apartment to see how barrier free it was. With a few exceptions, it was almost barrier free: the step-off platform on the balcony and the sliding door tracks to the balcony were not recessed. Her son installed a sloping cover on the raised door tracks to make the balcony accessible, and a small ramp on the raised step-off platform of the balcony allowed her to water her plants.
If the hall furniture was removed, it was wide enough for a wheelchair or walker. Neither the kitchen nor bathrooms were designed to accommodate a wheelchair. However, the master bathroom had room to transfer from a wheelchair to the toilet.
Private personal care homes
In her 87th year, Mrs. Martino was having a difficult time. She hated not being able to see, she was tired all the time, and if she did any kind of activity, she was short of breath.
She looked into a private personal care home nearby where she had some friends. Personal care homes are private, nongovernment-supported institutions of more than three people that provide some nursing care to clients (usually less than a half-hour per client per day). Because the facilities are private, they are usually fairly expensive.
This private facility had independent living with congregate meals. Mrs. Martino thought it would be nice to have her meals provided and a place to entertain. If she got sick, she would receive 24-hour nursing care in a special area until she got better. Unfortunately, if she deteriorated until she could not walk and was assessed at an extended care level (see Chapter 3), she would be transferred out of the facility. This meant that she would not be able to age in place.
This private home called Mrs. Martino on a number of occasions to say a room was available, but she always declined in the end. A move was just too much trouble, and her son kept assuring her that meals could be provided or whatever help she needed. As well, she thought she might be cramped in the private home because she would only be given a two-bedroom apartment.
More and more days passed when she just had to rest. She did not have the energy to go out, but if she did go to get groceries and arranged to have them delivered, she was just too tired the rest of the day. Swimming in the morning meant she had to rest several hours afterward before she had the energy to have someone to tea.
Live-in home care
Then Mrs. Martino got pneumonia. She was hospitalized in a very weak, frail state. When her son visited her in hospital, he found his mother very unhappy with the nursing. On two occasions, he observed one of the nurses abusing his mother by saying, “You don’t need to go to the bathroom again! We just moved you up in bed.” This prompted him to take his mother out of hospital and home to the apartment.
He had a choice: he could move his mother into a nursing facility or organize live-in home help. Having a live-in homemaker cost more than moving into a nursing facility, but he wanted his mother to age in place. So he rented a wheelchair and a commode and hired a live-in homemaker from the same agency to replace the homemaker who came daily. One homemaker lived in for five days, and a second one came on weekends.
Geriatric assessment
Mrs. Martino was deteriorating. She was depressed and she felt useless. She wanted to die. A geriatric assessment team came to the apartment and did an assessment to try to work out what was best for her. The team did assessments, made recommendations, and monitored her progress. Getting her on some antidepressants was their first priority.
(In the United States, health maintenance organizations (HMOS) and the Program for All-Inclusive Care for the Elderly (PACE) have geriatric assessment teams. In Canada, they are usually associated with a hospital and may be funded partly through the hospital and partly through the regional health board. The team, a group of professionals intent on keeping elders out of facilities, usually consists of a geriatrician, a clinical nurse specialist, a physiotherapist, a social worker, and other personnel as needed. Your physician or hospital can refer you for a geriatric assessment.)
Mrs. Martino’s family and friends still visited, but she was very weak and in bed all the time, except to go to the bathroom, which was a great effort. She was too tired to even listen to the talking books, and she was not interested in food at all. The pneumonia got better, but she was still depressed, and life was just too hard. Eventually, the pneumonia returned, and Mrs. Martino died at home in her own bed with the homemaker agency woman in attendance.
Conclusion
If Mrs. Martino had had no financial resources, she may have been eligible for hospice services. These are comprehensive services for terminally ill clients and their families (see Chapter 5). However, she chose to not go into a facility and was wealthy enough to afford the care she needed to die at home. Mrs. Martino was always mentally alert, so she was able to direct her own care and express her own wishes. If she had had some dementia, her choices would have been more limited, and her children would have been more concerned with her safety. Luckily Mrs. Martino never needed any type of special care unit.
Mrs. Martino’s encounters with the health care system were typical of many elders. More than 90 percent of North American elders are living in their own communities, with their families providing most of their care, and formal care as supplement or last resort. This generation tends to be fiercely independent, proud, and private, and it is difficult for them to give up this independence (e.g., by accepting home help and giving up their driver’s licenses).
Mrs. Martino was fortunate that she did not need to access the public health care system much because she had many resources — money and a knowledgeable family. She was grateful that she didn’t have to go through financial-means testing. In fact, she would probably rather have done without than go through that assessment.
Many elders, however, do not have the option of private home care, and they cannot think of anything to do but take themselves to the emergency ward of a nearby acute-care hospital. Elders use acute-care hospitals more than other population groups: they use 48 percent of all patient days