why do kids refuse to do anything for their parents? why do they feel that it's other people's responsibility to look after the frail elderly women and men that once did everything for them, gave them life, fed them, clothed them and brought them up?
a woman with mild cognitive impairment wants to go home. she is happy to adopt the team's recommendations regarding gaid-aids, home modifications and community services. all she needed was her children to meet her when she got home, make sure there was some food in the fridge until someone from the council could help her do her shopping in a few days' time, and ring her occasionally to make sure she was okay. but even that seemed too much to ask. they wanted us to send her to a nursing home. but why? when we finally got her home, she managed to lock herself out one night, went over to her neighbours for help, who called her son. he rang the ward and wanted us to readmit her. for what? call in a locksmith. call the cops. if all else fails go over yourself and let her in with the spare key. is that so fucking hard?
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why do frail elderly people refuse to do anything for themselves? why do they give up their last shred of independence and dignity so willingly and throw themselves into a cycle of dependence that leads inevitably towards nursing homes?
a previously self-sufficient woman, living alone in her rented flat, walking without gait-aid and independent with her personal activities of daily living, is admitted with osteomyelitis. over the six weeks of inpatient stay for intravenous antibiotics and physical rehabilitation, she becomes fully dependent on nursing staff for personal care and mobility, declines physiotherapy and lies in bed all day, refuses clinical psychology and antidepressants for her anxiety and adjustment disorder despite their overwhelming impact on her level of function, and wants maximal nursing and community assistance for when she goes home. yet when push comes to shove (threatened with delayed discharge or placement into a nursing home), she demonstrates that she can perform at her premorbid level. so why does she insist on playing the sick role?
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why do the frail elderly refuse to accept their declining physical health and diminishing capacity to look after themselves? why do they reject help and insist they return to the same conditions that brough them into hospital in the first place?
a man with urinary retention, faecal incontinence and poor mobility wants to go home. he doesn't understand why these things need to sorted out before he can go home, refuses to participate in therapy and dismisses all of our recommendations as "meddling". he says "i've looked after myself for eighty years and i can still look after myself just fine. i'll know when there is a problem, and until then, i don't see why i have to do anything about it". lack of insight? yes. but then at times he demonstrates an uncanny appreciation of his circumstances: "you have all the tools to rule over my life and i have no control over it. all i can do is be grumpy, and that's exactly what i am". and so there it is: absolute, glorious, undeniable clarity. so how come he still doesn't get it?