Thursday, October 29, 2009

'Secure' Health Care

There is a good opinion piece in today's paper concerning the inappropriateness of using security guards as long-term attendants for patients suffering from various forms of dementia.

There is no question that many with Alzheimer's and various other issues are simply confused and wandering the halls of health care institutions. Others become violent.

And it's not like we can them "accountable" for that in some meaningful way - consider how much their world has changed, how confusing and scary that must be and then add in ever-changing caregivers, some always better than others. Consider that someday that could well be you and I.

Even without the issue of violence, the 'wanderers' can pose a huge problem. Both for their own safety (if they happen to wander off the ward) and to the mental health of other patients. We saw that happening during Mom's long hospital ordeal last year.

When Mom was hospitalized and confined to bed by her physical illness, an older gentleman in the room across the hall was a wanderer. He would come and stand in the doorway to Mom's room and talk to her. The problem was that both and he and Mom were subject to dementia. So while what he said probably wasn't making a whole lot of sense, it made even less sense to Mom's fogged mind.

When we returned from a weekend away, I found Mom terrified, refusing to eat or sleep. Between 'the man in the doorway', the nurses in and out of the room and the absence of her main support person (me), those two days became too much for her. It had all meshed into some confused horrifying story in her mind which made her sure that "they" were out to hurt her and her family.

Ironically, it turned out that 'the man in the doorway' was the father of a close friend, who I never even realized was in the hospital. Once we discovered that and told Mom about it, she was fine. Because, as she put it, she "knew the family".

But we also saw hospital rooms with security guards at the door day and night. It definitely made you wonder what was up.

First of all, it can't be an efficient use of resources.

Then there is the question of how much training these officers have. Does it prepare them to safely engage the "60-year-old stroke victim who throws furniture; the psychotic senior who violently strikes everyone, including their own family; or the frail grandmother who screams day and night"?

There's a situation ripe with potential for abuse. Although, in fairness, that's not just an issue for security guards.

And, as noted in the article, the "deterrent factor" offered by a uniformed presence might only serve to make thing worse, especially if paranoia is part of the patient’s illness. The omnipresent security guard, outside the door, only adds to the patient’s isolation, stigmatizes them and their family, and erodes what little dignity the disease has left them.

I can say it no better than the words of John D. Allen (a security professional for more than 20 years; four of those spent supervising the security teams assigned to three Nova Scotia hospitals):

A security officer should never be the primary care plan. It is a clear indication you are not coping.

. . .

Whether their condition is organic, caused by trauma or dementia, brain-injured Nova Scotians deserve the same level of dignity and care we all enjoy, and the need for properly trained health care professionals to deal with their special needs has been clear for some time.

Mahatma Gandhi said, "You can judge a society by how it treats its weakest members" - but the issue, as with everything in health care, is funding.

As we age and face the insidious prospect of our minds turning on us, specially trained orderlies and attendants will become a necessity if we hope to live in a dignified, caring environment.


tam said...

Ohhh MMC......that made me so sad. I remember the whole thing like it was yesterday.

Hope you are doing ok.

Love ya.

MMC said...

Missing you.
It's good to see you back on the blog. Hopefully we will be able to get together the end of the month.

doorkeeper said...

Having worked with these patients, down here, I don't have answers--but I know what we're currently doing is not working. Skilled nursing facilities are not set up for these people--at least not here. In major urban areas, there are sometimes facilities which are devoted solely to them.

But our current laws are just ridiculous in this country, often putting the wanderer in as much danger, or more, because we can't "infringe" on their rights.

It's a really difficult issue. That said, I really enjoyed working with this group of patients.