I really need your opinions, please

Please bear with me here. I really need some opinions on how to help a friend.
Brief history: I have a friend Ed who is nearing 80yrs of age, and of First Nations (aboriginal) descent. He is a former eyecare patient of mine; he says I cared for him without the marginalization he received from other healthcare providers, and we got to be fast friends over the last 10 years. I've been a friend, housekeeper, cook, caregiver to him (as a friend, not in any official capacity). I know more about him and his wishes than his family. I am his executrix for his estate when the time comes, but I have no POA. (his sister and sister-in-law are both older and failing physically and mentally, and his nephew takes a kind of hands-off approach to Ed's care)
He called this morning and asked for help. He was feeling very poorly and asked me to get him to a doctor (and this is a man who NEVER asks to see a doctor). I drove into town to his place, and he was a mess. Very ill indeed. I called an ambulance and got him to the hospital, where he remains tonight undergoing tests and all that.

If you're still with me, here is my dilemma: he is past the point where he can adequately care for himself at home. Despite my efforts to clean his home (a small, old trailer), he lives in utter squalor. Despite my cooking for him when I can, his dietary habits are terrible. He lives like a hermit. He has a decent income from his pensions, yet he has always chosen to live like this. Now he will likely need somewhere warm and clean to recuperate, and his home is NOT the place. In fact, nobody should be allowed to live there.
What should I do?? I can bring him to my place and look after him here in the short term, but how can I approach the subject of nursing homes, assisted-living homes, or places like that? He will NOT be happy to have these suggestions brought up. He is 100% mentally, but failing physically, and far too independant to admit it or submit easily to a care facility. His closest kin can't really be of much help, but I can't do much either since I have no POA and am not kin.
Ideas, anyone?
Thanks,
Sherry.

Is there a social worker at the hospital? They have resources to help deal with situations like this. Medical social workers are a great help, my family has turned to them a couple times.

Popoki Nu --

Since he is still on top of things mentally and he trusts you, I think you could approach this by laying out all of the possible options with him but let him make the decision. I think telling him he needs to go into assisted living is probably not the right approach given what you've written about him. But sitting down with him and discussing the facts of his health and going over possible solutions involves him in the process of deciding what to do rather than imposes a solution on him.

One thought is to try and convince him to let a home visit nurse and/or part time house keeper lend him a hand a few days each week so that you can have a break and he can stay in his own house and have some sense of control and normalcy. Is this an option where you are?

If he agrees to consider this option you might need/want to be there for the first couple of times that someone new comes into the house until he has a chance to build a relationship with them as well.

You are a good friend to give so much of yourself and your time to help out. It is a tough situation and my thoughts are with you and with Ed. Good luck.

-traveller (Carol)

Possibly the doctors or a social worker could recommend he look into an assisted living situation? One where he could still be independant, but there would be someone to watch over him if needed.

Don't know if this will help or not, but in my area there are senior apartments that feature cafeterias. Not quite to an assisted living level, but probably much better than his current situation.

Another thing, if he goes to one on a 'temporary' basis, hopefully he will like it enough to stay.

I second the suggestion as to the hospital social worker. My dad had one that was invaluable when he was in decline.

Since you say he is still 100% mentally, then have a heart to heart with him explaining your concerns and possible options. Be very specific about what level of safety net you're willing to provide for him so he has to consider that as well. Once he decides, respect his wishes.

This response comes from 12 years of working with mentally ill homeless people and having to respond to the constant queries "why doesn't someone DO something about this homeless guy??", well the gold standard in MH applies...if they are not at risk of harming themselves or others, then you can't make an adult DO anything.

Major kudos to you for caring about your friend.

I just wanted to say thank you, for making the world a better place.

I agree with most of the advice so far. Definitely get the necessary social agencies involved and see what help they can offer. The idea of assisted living might be much more palatable coming from them. You should also explain to them the exact conditions he is living in so they can get a clear picture. The nephew should definitely be involved as well.

Karen

This is a wonderful thing you are doing, Sherry. There are so many people who don't have the help and friendship that you've shared. You definitely made a difference in his life!

I think you need to talk to him and tell him how much you care about him. You are concerned for his safety and health. With better care, he might not need to go to the hospital again. Bring up as many positives aspects of living with assistance as possible. Hopefully, you'll be surprised and he'll accept what you are saying. And as others have said, do involve any resources available at the hospital to speak with him about his need for better care.

Good luck! Please let us know how it turns out.

annie

Thanks much for your suggestions. It is so difficult. Yes, there are hospital social workers available, as well as community healthcare agencies and so on. I know Ed; if I get an agency or social worker involved, he will feel betrayed. I will have to tiptoe around the edges of this situation until the right opportunity presents itself..
Queen's point about "if they are not at risk of harming themselves or others" is the crux of the matter. How does one know when that line is crossed? Despite Ed's lifestyle and environment, he has never had a sick day in his life until now, and he is happy. ( I visited him in the hospital last night...looks like he just has the flu or possibly pneumonia...like most everyone does this winter around here).

I am going to do something. Just not sure what, yet. I think I will ask (and strongly suggest) that he comes to my place for a week or so until he gets over whatever it is he has. Meanwhile, I can start planting a few seeds in his mind about his future care, and I can also go clean up his place so it is at least livable. That'll take a week anyway. Then we shall see what happens next.....
Thanks :)

~Sherry.

I correspond with a bunch of cat caretaking people. There was an elderly gentleman who had a dozen or so cats and lived pretty much in squalor like your friend. He had to go into the hospital. While he was gone, a bunch of the cat ladies got together and cleaned his place (they were feeding the cats for him while he was in the hospital. While doing so, they discovered he did not have a bed, had been sleeping on a terrible couch. So they got him a bed too.
On the other hand:
His lifestyle (squalor) is not necessarily something you should change, he's been living like this all his life, so it shouldnt worry you so much, as long as he is eating good (bring him a meal a day?) and staying healthy and warm..
Get him hooked up with the meals on wheels people?

It sounds like you are doing a wonderful job of trying to help Ed.

First- involve the social worker. I don't know how it works in BC, but in this country it's often a standard part of discharge planning (he/she would show up eventually anyway). If Ed doesn't want to talk to them he can always get rid of them. He may be thinking about these things too however, and it's useful for both of you to know what the options are.

Make sure you are clear in your own mind what you are willing/able to offer Ed. If you do decide to take him home, you need to think about what will happen if you don't feel he's ready to go back home at the end of that week. (Again BC may be different, but in this country nursing home placement is a lot easier to accomplish from the hospital than it is from home.) I'm not telling you not to take him, just to make sure that you're sure what you're getting yourself into.

In the end, it's his decision. It may be easier for him to live in squalor than to lose his independence. Making sure he knows he has other options may be all you can do.

Good luck!

PN - it's very good of you to help your friend like this. I have a lot of experience with Frist Nations people and they are a very proud and stoic lot. In the past I have had to discuss many uncomfortable issues with my First Nations patients and I have found that they often respond well to you laying out the facts and letting them think about their options over a night or two.

Usually, I'm discussing problems related to substance abuse with them and ways to deal with it. This is a very different situation, but one of the things I have done inthe past is contact people from the tribe to help. They can often help make suggestions on how to manage these issues in a way that is sensitive to their culture.

Thank you for helping Ed and take care.

I do not have much to add to all of the great advice already give. If it were me in Ed's place, I am sure I would want all the cards out on the table. I think that W adds an additional piece by contacting members of the tribe.

I do want to tell you that I think that it is an amazing thing that you are doing. There are not enough people like you out there.

Just came back from the hospital; Ed is looking and sounding much better, but they are still doing tests as they haven't figured out what happened to him. Ed, being Ed, is all grumpy and twitchy and wanting to be elsewhere.

It turns out someone has already tipped off Social Services to his living conditions. A nurse told me in confidence (since I'm not family); she suspects the ambulance crew did it. It certainly wasn't Ed's nephew. He told me today Ed will be going back home after his release from the hospital, and to more-or-less butt my white trash @$$ out of family affairs. This from a nephew who -although he lives next door to Ed- rarely moves himself to help Ed in any meaningful way. In fact, now when I enter Ed's hospital room and nephew is there, the mood turns downright glacial and I'm totally ignored. By both of them! WTF?? :confused:
Maybe I shouldn't, but I feel a little...hurt. And not quite sure what to do. Guess I'll just hang out around the edges and see what happens next.

But blood definitely is thicker than water.

So....for those who may be wondering: I have Ed here at home after his two-week hospital stay. "Failure to thrive" is the official diagnosis, although he also has some other medical problems consistent with being 80 years of age.
I get to play Mother Hen for the next two or three weeks while we try to sort out a long-term solution for him. We may just buy him a new home -probably a newer mobile home in the same park- and dispose of his creaky old one somehow (four-alarm-fire comes to mind, or something involving a bulldozer or wrecking ball), and arrange for Meals-On-Wheels and regular home care thru the community nursing system. This makes Ed happy happy, since he will have a large measure of independance, but also have his nutritional and medical needs tended to. HE likes the idea of a new mobile; he now realizes his old place is probably beyond repair. Finally! :D
For now, he is eating up my cooking like a starving puppy, putting on weight nicely, and generally feeling friskier and looking better than he has in quite a while.
Things are looking up at this point. Fingers crossed.

well, great news! you sound like a wonderful person!

Popoki..what a nice friend!! Thank you for helping Ed out :)

What a nice lady you are.:)

c

I hope I have a friend as great as you when I'm older. You are a sensational spirit. It makes me cry to read that you care so much.

((((( Popoki ))))) You are wonderful! The world needs more people like you.

Hurray for winning at least a couple of little battles. Ed is truly lucky to have you with him. I hope things keep going well and that you will soon have him in his new mobile with the help that he needs from healthcare.

Popoki...Faced this with my parents a three years ago. They are now in "assisted living"...and doing well.

We eased them there:

• first, we acknowledged the problem (making it seem like it was about "US" not them...you know..."we are unable to be on call 24 hours a day and it concerns us that something might happen while we're not there."
• second, "let's go check it out together. Give it a try for 30 days, if you don't like it, then we'll try something different. We won't sell your house"
• finally, bring familiar things into the facility. We used their own furniture, etc.

After a couple of weeks, they found a routine, saw the benefits, and after a few months, they were ready to sell their house and belongings.

Today, they're happy and glad they moved. The strange thing is that to this day (they're approaching 80), they believe that everyone there is old and infirm and that they 'don't belong with these old folks'. In reality, they are the most infirm ones there.

It's wonderful that you care...he is a blessed man.

Quote:

---

Originally Posted by anakiwa

In the end, it's his decision. It may be easier for him to live in squalor than to lose his independence. Making sure he knows he has other options may be all you can do.

---

Ya know...I think this is exactly how this situation is going to play out.

Things are not going as well as I had hoped. We have taken all the kind suggestions from this thread, as well as all the many options the Community Care program here offers, and presented them to Ed for his consideration. He has rejected every one. Nothing the community nurses, social workers, or home support workers have suggested has had any effect either. The only real success I've had is to get him to agree to have his bank pay his household bills directly from his bank account; at least now we know his lights, heat, and phone will not be disconnected because he has forgotten to pay (which happens with greater frequency lately). None of his friends, nor his nephew, has stepped up to repair his trailer, or help find him a newer one.

It is clear now that he simply cannot care for himself in any meaningful way, and utterly unable or unwilling to accept that fact. I can understand that...it can't be easy for him. I think assisted living would be the best solution for him, but that isn't going to happen anytime soon. I'm still trying to get him to agree to Meals-On-Wheels, and occasional visits by a nurse, as well as my usual visits/meals/cleaning, at his place.

Sooo...I think he is going to have to go back to living as he was before, alone and in squalor, until he comes to the same conclusion the rest of us have. I just hope he makes that realization before it's too late.

Gee...that was a bit of a ramble. Sorry....frustration. Thanks again for all your suggestions, I really appreciate them. I'll probably post one last update later this week when Ed is scheduled to return home.

~Sherry.

We had an older homeless woman here in town who refused ANY offer of help for years and years, she eventually declined to the point where she met the criteria for involuntary placement into an assisted living facility. She was angry and miserable for the first month but eventually realized that the comforts of having good food and a clean warm bed were kinda nice, she started to enjoy her new place and remained there happily until she passed away three years later. Hopefully your friend will be able to find such a placement when he's no longer judged capable of self-care.

Well...Ed is back at his place after two weeks in the hospital, and two more weeks recuperating here at my place. On the down side, no one did anything to clean or repair his trailer in his absence as they had committed to :mad: , but on the up side he is looking and feeling 100% better than he has in a long time. We've got him set up with Meals-On-Wheels, and twice-weekly homecare support. I've stocked his freezer with frozen meals, ready to heat 'n eat, and laid in enough Ensure supplement drink, V8 juice, fruit, bread, and other staples to keep him going for a couple of weeks. I can stop by 3-4 times per week to check on him, and we're just going to go ahead and hire someone to clean and repair his place. Screw the relatives...they're useless.
Guess that's it for now. I think he will be ok.

Well, his situation is better than it was, thanks to you. You've certainly done a lot for this man and I hope that your plans for meals on wheels and homecare work.

You have a big heart. The world needs more people like you.

Just thought I'd post a couple of updates for those who were following this thread. Gosh, it seems ages since I've been on TE.

My friend Ed is settled back at his trailer, and doing pretty well all things considered. We've got it cleaned and fixed up as good as possible. Meals-On-Wheels delivers a hot meal every day, and I keep his fridge stocked with easy-to-heat meals, veggies, milk, juice, etc. He's eating well and feeling quite good.

Then we lost a very dear family friend on the mainland. It was sudden, and SO and I had to scramble to make the wake. It was a boisterous event as good wakes should be-- as he would have liked--, but still very sad to have lost a friend who lived so large.

And not long after that, MIL passed away suddenly in the nursing home where she was living after her stroke. I guess it was inevitable, but it wasn't imminent. A very big shock, as you might imagine. Life can be so fickle.
And so it goes.

~Sherry.

I do beleive that when your time comes to leave this earth, you will have achieved Nirvana.

I wish I had a neighbor like you, my house badly needs painting and I have two eggs and some milk in the fridge. I have no job yet but I do have a bike!

Keep us posted on the saga of Ed. We care too.