Monthly Archives: January 2013

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Not Dealing with Dementia

 

June and Ward Cleaver (Barbara Billingsley and...

June and Ward Cleaver (Barbara Billingsley and Hugh Beaumont). (Photo credit: Wikipedia)

Television moms and dads are kind, generous, clean, independent, and a source of wisdom. Real life moms and dads can be mean, self-centered, critical, and looking for a handout.  Such is the cards some children are dealt.

 

Dementia

Dementia (Photo credit: Fulla T)

These abusive moms and dads don’t miraculously turn into saints as they age, either. Most of the time the dysfunctional behavior they’ve exhibited worsens, rather than improves, as they age. If they’ve abused drugs, alcohol, or neglected their health, they may get much worse.

 

What to do when bad mom or bad dad (or both) are no longer functioning well at home alone? I don’t mean the not able to shovel out their driveway or lift the air conditioner out of the window type problems. I mean when they think strangers are coming in through the drainpipes and they think one of the intruders stole their gun. That scary not functioning well may be dementia.

 

Dementia is a broad term used to describe difficulties in the areas of language, judgment, behavior, thinking, and memory. Some causes of dementia, such as metabolic disorders and tumors, can be reversed. Other causes of dementia, such as Alzheimer’s disease, can only be slowed down, not cured. Repeat, not cured.  Pay careful attention to the part of the happy pharmaceutical commercials that caution,  “All patients will get worse over time, even if they take wondrous dementia drug.”

 

If you’ve had a great relationship with your parents, filled with mutual respect and assistance, it’s easy to say you’ll do whatever it takes to keep mom and dad safe. Even if it means moving them out of the home they’ve lived in for the last thirty years. Even if it means hiring someone to stay with them so they don’t burn the house down. Even if it means hiding the car or car keys to prevent them from driving to their favorite store that went out of business twenty years ago. Even if it means taking time off from work to accompany them to doctor’s appointments or leaving work early to rush home to deal with emergencies.

 

But if you haven’t had a great relationship with your parent, maybe haven’t even talked to them in five, ten, fifteen, or twenty plus years, what’s your responsibility when the neighbors start calling with their concerns? Do you forget the past and hope they’ll become nice? Put on your martyr uniform and hope for the best? Make an anonymous call to Elder Services and wash your hands of it?

 

There is no easy answer to these questions. Letting your conscience be your guide doesn’t mitigate the guilt that comes with the decision to keep your distance from a demented parent. If you decide to re-engage with the parent, there will still be the resentment that comes with putting your own life on hold to care for a parent who never cared for you. It’s an intensely personal decision that each adult child must wrestle with and decide based on all of the myriad considerations and individual details of their life. If you do decide to ride to the rescue, don’t expect the parent to be grateful for your efforts. Age doesn’t make people any less dick-ish, nor does dementia.

 

As someone who has wrestled with this issue, rest assured I don’t take my abandonment of my parent lightly. There’s a better than average chance that I am the best suited of my siblings for understanding and navigating the complexities of having someone declared incapable of making decisions to pave the way for admission to a nursing home. Not just because I’m a nurse, but also because I’m the oldest. Unfortunately I can’t forget or forgive the toxic parent-child relationship that ultimately ended with my decision to stop speaking to my parent over twenty years ago. I can’t let that go, even though part of me says it’s my duty and part of me feels incredibly guilty that I can’t caretake this person who can no longer caretake themselves.

 

I won’t deny that seeing my parent in their current state, even from a distance without saying a word or them being aware of my presence, breaks my heart. I wish I could find it within myself to soften, bend, and do what some would insist is the right thing. But I can’t.

 

And as much as I salute those who can, I acknowledge that there are those of us who can’t. Age and infirmity doesn’t turn a toxic parent into a saint, it only turns them into a old, sick toxic parent. Don’t judge me for turning my back.  It’s like they say when you fly, if the oxygen mask drops down, you have to put it on yourself before you can help someone else. Unfortunately my parent has demonstrated that they would suck up all the oxygen in my world if they could. As bad as I feel about their condition, I won’t let them.

Day 3: flight to Yazd - inflight safety card

Day 3: flight to Yazd – inflight safety card (Photo credit: birdfarm)

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When Your Employer Won’t Take No For an Answer

English: This is CDC Clinic Chief Nurse Lee An...

English: This is CDC Clinic Chief Nurse Lee Ann Jean-Louis extracting Influenza Virus Vaccine, Fluzone® from a 5 ml. vial. (Photo credit: Wikipedia) You go, girl!

The recent firing of 8 healthcare workers who refused to get a flu vaccination at Goshen Hospital in Indiana is not surprising. As influenza season kicks into hyper-drive, hospitals unleash the latest public relations strategy in making patients believe they are safer – mandatory flu vaccination for healthcare workers. The reasoning is that hospital inpatients are already vulnerable to infection and preventing healthcare workers from infecting them, because the healthcare worker has immunity due to the flu vaccine,  will save lives.  This mindset has a few flaws.

First, the flu vaccine is not 100% effective. That’s not to say I don’t get one myself, but, as the Centers for Disease Control (CDC) website points out:

“The effectiveness of influenza vaccines varies from season to season, and depends upon a number of factors. One factor is how well the vaccine strains match the viruses that actually circulate during the season. In addition, vaccine effectiveness is affected by the recipient’s age, immunocompetence, and previous exposure to influenza viruses.”

No 100% guarantee there.  In fact the CDC notes,  “Recent RCTs (Randomized Control Trials) of inactivated influenza vaccine among adults under 65 years of age have estimated 50-70% efficacy during seasons in which the vaccines’ influenza A strains were well-matched to circulating influenza A viruses,” “a study of Dutch community dwelling people aged 60 years of age and older reported a vaccine efficacy of 58%” and “study among 92 healthy adults aged 18–41 years, the efficacy of inactivated and live attenuated influenza vaccines in preventing laboratory-confirmed influenza was 71% and 85%, respectively.”

With the average age of registered nurses at 46 and doctors at 51, I’d guess the vaccination effectiveness is in the 50-70% range. Oh, and did I mention if you’re going to get immunity,  it can take up to 2 weeks after the shot to get immunity?

Even if it did confer immunity to 100% of the healthcare workers who received it, they are not the only carriers of influenza. Since the infected are able to infect others one day BEFORE getting symptoms and up to seven days AFTER getting sick, think of all of the other traffic in a hospital including visitors, admitted patients, and vendors. Are they all vaccinated against flu? Who knows. Can hospitals require them to receive vaccination? I’m guessing the answer is no. This means in a perfect world, with every healthcare worker not only immunized but also immune, there would still be potential flu carriers wandering the halls every single day. Since the flu can be spread to others up to six feet away, a vendor or visitor at the nurses station can infect a patient who is walking nearby for physical therapy. Unless hospitals go into lock-down at the start of flu season, a strategy of mandatory vaccination leaves plenty of room for infection.

Forcing people to get immunized for flu or lose their job is easy. In my book, proving that it is the best and most effective option to save patient lives is a little bit harder. Having worked in a number of healthcare institutions, I know most healthcare workers work sick for a number of reasons including managers who penalize them and co-workers who resent working short-handed. I also know that hand hygiene, considered the baseline measure to prevent the spread of disease, is nowhere near 100% in organizations. Instead of picking the low hanging fruit of vaccination, organizations should look toward preventing all healthcare acquired infections. I’d love to see someone fired for not washing their hands.

Instead, Goshen Hospital fires 8 out of 1300 people who refuse vaccination. It makes me wonder about the 1292 workers who didn’t get the vaccination, but were allowed to keep their job. Maybe the excuse was they don’t provide direct patient care. Maybe the hospital couldn’t take the financial hit of losing certain positions, such as doctors, surgeons, and top administrators.  Firing front line staff, such as nurses, therapists, housekeepers and food service workers,  has always been easier than the politics of firing the rainmakers of healthcare.

Perhaps this is just the first salvo organizations will fire in the crusade to show their commitment to patient safety. Imagine a hospital website proclaiming, “100% flu vaccination rate” instead of “71% rate of compliance with washing hands between patients.”  The illusion of safety provided by mandatory immunization shouldn’t be confused with the reality of 1.7 million hospital-acquired infections and 99,000 associated deaths each year.

For now, firing a few employees for show will have to do. I know I feel safer.

Fired red stamp

Fired red stamp (Photo credit: Wikipedia)

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