I really need your opinions, please

[Popoki_Nui]

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.

[KnottedYet]

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.

[traveller_62]

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)

[snapdragen]

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.

[SouthernBelle]

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.

[Pax]

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.

[Tuckervill]

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

[annie]

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

[Popoki_Nui]

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.

[mimitabby]

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?

[anakiwa]

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!

[Wahine]

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.

[rocknrollgirl]

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.

[Popoki_Nui]

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??
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.

[Popoki_Nui]

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!
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.