Larry
Explain how common skills (e.g. communication and values attitudes and beliefs) can ensure good interprofessional practice for Larry and his wider family.
Communication skills are a vital part of both personal and professional practice (Axtell, 1990; Dimitrius & Mazzarella, 1999). They are necessary in the workplace and in families that function well, but they are also certainly necessary when it comes to how people are treated when they are injured, sick, or unable to care for themselves (Roter, 2001). Because Larry was the primary caregiver to his wife but did not want anyone to know that she was suffering from dementia, he made the problems that he is currently facing more difficult for himself and also for his wife, Jeanie. Larry should have been open and upfront about Jeanie’s problems, so that others would be able to plan for any eventuality. If people who are sole caregivers for ailing family members do not have any kind of backup plans in place, it can make it very difficult for them when they are suddenly unable to care for that ailing family member anymore.
With Larry, the fact that he was active and relatively healthy should not have been the main issue. His age should have overshadowed that and told him that there was a possibility of something happening to him where he would not be able to take care of his wife in the same way that he had in the past. Because he did not consider this possibility or convey it to other people in the family, Jeanie ended up in a nursing home instead of with a family member or close friend who could give her the kind of care that she needed. Larry believed that it was his responsibility to care for his wife, and that is certainly admirable. However, it is unfortunate that he took that so far and that he assumed that he would have to be the only one to care for Jeanie. With her in the nursing home, she is not getting the kind of care that she would be getting from Larry, and he is concerned about her safety, happiness, and security. While this is understandable, it is also likely that Larry feels some semblance of guilt because he is no longer able to care for her.
Sole caregivers need to be brave enough to speak up and say that they need help, or at least to ensure that they have a plan in place for a time when they are no longer able to provide the level of care that they have provided in the past. By suspending their own values and beliefs and instead looking at the needs of the one for whom they care, they are better able to make the right choices for their partner, child, or other family member. Values and beliefs can be quite strong, however – especially in the older generation. Men were expected to care for their wives and their families, and that was simply the way things were done. No outside help was necessary, and it often was not even desired. Because of that, many elderly men today are “stuck” taking care of loved ones. They may care deeply for these people, but they need help and they are not willing to ask for that help.
They become frustrated with themselves for being unable to provide proper care, and they start to feel as though they have failed their spouse or other relative. That is not a good feeling, of course, but the problems could have been mitigated by asking for some help. That does not mean that Larry is to blame for the issues which he is facing. He is a product of society and his generation, and he may simply have never thought much about the possibility that he may not always be able to care for Jeanie properly. Now that he has damaged his ankle and has been in the hospital for several days, he realizes that he left no option for Jeanie other than a nursing home. Family members can take Larry in because he does not require around-the-clock care, but they cannot take in Jeanie because they work full time and she needs more than they can offer to her. If Larry had been upfront about her condition from the beginning, he may have been able to make other arrangements for her and she would not have needed to go to the nursing home.
Larry was also understandably frustrated when he was in the hospital and did not understand why they were keeping him for several days. He may not see himself as frail even though he is advanced in age, and he may not understand why hospital staff did not make much effort to talk to him or to help him address why he was still in the hospital. In other words, Larry may have felt ignored – and he actually may have been ignored to some extent. Unfortunately, the current culture seems very focused on ignoring elderly people and treating them as though they are a burden, they do not matter, or they have nothing else to offer to society. These attitudes are part of society, but that does not make their assumptions true or accurate. Often, elderly people like Larry have much to offer to the other people around them, and they may be loving caregivers for other aging family members, such as Jeanie. Hospital workers do not always realize this.
One of the things Larry could have used while he was in the hospital was an advocate. This would have been someone who was younger than Larry, who was preferably a family member, and who would have “gone to bat” for Larry and made an effort to talk with the hospital staff and find out what the issue was. Why was Larry not being released? The case study, however, does not say anything about this kind of person being in Larry’s life, and it does not mention family members coming to visit him at all. It seems quite possible that communication breakdowns and other problems have become so prevalent for Larry and his family that they are not close like they once were. That would be something to consider, because Larry may have isolated himself in caring for Jeanie. Even though he was a frequent visitor to football games in his area, that does not mean he went with other people in his family. Does Larry have friends, or has he pushed them away as he has gotten older and Jeanie’s health has started to fail?
These are the kinds of issues that are faced by many elderly people in society today, because they are unsure as to how they can reconnect with others in their family unit without being a burden to those people. They may also have trouble with friendships, because their friends are dying off, moving away to be cared for by relatives, or going to nursing homes. It is highly likely that Larry did not realize how much isolation he has created for himself and Jeanie, and it is also quite possible that Jeanie was unable to stop it from taking place as her condition advanced and she became less certain about reality. Dementia can be a very hard diagnosis to accept, and it is often worse for the family who surrounds that person than it actually is for the person who is diagnosed with it. Did Larry get any kind of professional or therapeutic help to deal with his feelings about his wife’s condition? Does he talk to anyone at all about the problems and the struggles and the fear with which he is dealing? From the information in the case, it appears that Larry has not addressed the issue with anyone, which could be harming him emotionally.
Elderly people need social networks that are made up of family members and friends who care about them. Despite that, many of them begin to isolate themselves because they have to care for an ailing spouse and/or they do not want to “burden” their other family members – such as siblings or children. For these elderly people, there can be a serious dilemma when something goes wrong with their health or with the health of the person for whom they are caring. They may not be clear on how they are going to continue with their caregiving, and they may find that there is not really anyone who can help them because they failed to mention to other people that they needed any kind of help at all – or that they might need help in the future if they are not able to care for someone else.
Another issue that makes things all the more frustrating for Larry is that the staff at the nursing home does not seem committed to attempting to help Jeanie stay healthy, clean, and well-fed. They let her wear other people’s clothing, do not provide her with privacy, and do not interact with her when they feed her or help her to do something such as bathing or changing clothing. Larry, understandably, feels bad for his wife. He goes to see her each day, and has started to bring her food from home and help her eat. He wants to see her in the morning, but is only allowed to do so in the afternoon, and has been yelled at because he was “there too much.” Naturally, he simply wants what is best for his wife – and that is not what Jeanie is receiving when it comes to care at this particular nursing home. Again, Larry needs an advocate. There are plenty of good nursing homes, but there are also bad ones where the residents are poorly cared for and not treated well.
In order for Jeanie to get the proper care, she may need to be moved to a different nursing home – but there could be factors that would stop this from taking place. If Larry cannot have her moved, he needs to find a way to get answers to why he is not permitted to visit in the afternoon and why Jeanie is not getting the standard of care that he feels is adequate and appropriate for her condition. Because he is being ignored, it is time for him to communicate his concerns to his family. He must allow someone to help him, for the sake of his wife and her treatment. If he continues to hold only to societal values that require him to handle everything because he is the provider for his wife, he will be doing her a disservice. It is a very important part of communication to know when to ask for help. Many elderly men struggle with this, but Jeanie’s future may depend on it.
Question 2: Explain how frameworks (e.g. professional codes of conduct, legislation and structures of organisations) can influence interprofessional practice when caring for Larry and his wider family.
Larry and his societal beliefs and values are not the only issues at work here, however. The way organizations such as hospitals and nursing homes are operated can also have a lot to do with how a person handles a life-changing event such as a health scare or a loved one going to a nursing home. Legislation, codes of conduct, and the organizational structure of medical care businesses all play a strong role in how people who utilize those businesses are treated (Guerrero, et al., 1999; Knapp & Hall, 1996; Leathers, 1996; Lieberman, 1999). This can certainly vary from one business to the next, but it is going to be similar overall because of the laws, rules, and regulations that govern medicine. In a large organization such as a hospital, an elderly man with an injured ankle is not something that warrants a lot of scrutiny. Larry is just a number to them, really, and is not seen as having much to offer when it comes to studying a rare condition or interacting with a person who is similar or who has a lot of things in common with the staff.
This does not mean that Larry has no value, but only that a hospital is not going to see Larry as a person as much as his family or friends will, since he will only be at the hospital a short time and the job of that hospital is to treat Larry so that he is able to heal up correctly and go on about his life. Unfortunately, many hospitals do not really provide their patients with much information as to why they are doing things a particular way. Larry may not understand why he was kept several days, or why the hospital felt the need to put him into the older adult ward for a week. The staff was concerned about his mobility, but also about his overall condition. This may indicate that the staff is overzealous in attempting to get money from Larry’s insurance company, but it could just as easily indicate that Larry is not taking care of himself properly since he has to take care of Jeanie. If that is the case, Larry may need more care than he realizes and may not, in fact, be able to care for himself and Jeanie in the way he needs to or assumes that he can. This could be detrimental to the health of both Larry and Jeanie, and should be addressed.
However, explaining this to Larry would have been the right choice for the hospital. It is important that people who are hospitalized are treated with dignity, and that they understand their condition and why they are being kept – especially for nearly a week. Even though it would have been better for Larry to have an advocate who could help him communicate with the hospital staff, it is still important that the staff recognize that Larry is a human being and that he had questions which were being ignored and not being answered. A few minutes spent with Larry would have eased his mind and ensured that he knew why he was being kept at the hospital for several days. He would have felt better about the issue overall, and he would have felt more valued at a human being. Often, that is all people need.
When it comes to the nursing home, the same ideas that are seen at the hospital often prevail. In other words, Larry would have to consider how to get through the bureaucracy when he needed answers, and he would have to determine who to talk to and how to reach that person. That can be a lot for an elderly, injured man who is just worried about his wife to handle. Without an advocate to fight for him and demand answers, Larry most likely feels lost and ignored by the nursing home staff. He does not feel as though his wife is being treated properly, and he is not treated well when he goes to visit her. Those are both problems that should be addressed. Fortunately for Larry – and anyone else experiencing that kind of problem – there are people with whom he can talk. Nursing homes must meet specific requirements for care. If the home in which Jeanie is housed is not meeting those requirements, Larry can do something about it.
One of the ways in which a nursing home can avoid problems with visitors and similar issues is to be clear on what to expect right from the beginning. The nursing home may be too understaffed to pay close attention to whether a resident is wearing someone else’s clothing, for example. However, whether that is acceptable is up for debate. Also, the nursing home should consider the issue of visitors. Are there clear, posted visiting hours in which Larry can come and see Jeanie? If not, that should be corrected or the staff should be quite and not tell Larry he is “there too much” or that he should not come in the morning when Jeanie is more apt to recognize him. Many problems that come about between patients, family members, and staff at medical facilities simply come from a lack of communication. If rules and regulations are clearly communicated, there are fewer problems and misunderstandings that must be addressed (Axtell, 1990; Guerrero, et al., 1999; Roter, 2001).
Sometimes, problems come about not from anything that is directly problematic, but from issues that have not been handled correctly or from a general apathetic attitude and lack of empathy. These may also be issues at the nursing home in which Jeanie is housed, and understaffing and overwork problems may be concerns. Finding out if these kinds of issues are really problems should not fall to Larry, however. There are guidelines and laws that have to be followed, and there are patient advocates who work at medical facilities. If Larry is willing to open up to his family and to the staff at the nursing home about his concerns, he may get more answers and be able to address the worries that he has about Jeanie’s care. He may also want to look into some other kind of care arrangement for both himself and Jeanie, so that they do not have to be apart. The nursing home has not been helpful with that, but that does not mean they would not be if it was asked.
When it comes to elderly individuals who have been married for more than 60 years like Larry and Jeanie, just being apart from one another can be very difficult. All too often, that is overlooked by hospitals and nursing homes. If Larry was assigned an advocate or other individual from the hospital or the nursing home – or even from an outside agency – getting answers and determining what to do next would be easier. This kind of service may be available to Larry, but it is highly possible that he is not aware of that fact and that no one else is going to suggest it to him. They are either too busy, do not want to “butt in,” or would rather Larry just went away and stopped bothering them. They fail to realize, quite often, how significant it is to spend 60+ years of one’s life with a singular person and then not have that person there and not be able to care for that person properly. Seeing his wife neglected and mistreated (at least in his own way of thinking) is not what Larry had expected in his later years. In some ways, this may be worse to him than losing her altogether.
However, instead of demanding answers and rallying his family to do the same, he simply comes to the nursing home when he’s told he can and brings food to give to Jeanie so he can help her eat. This is not the ideal scenario, because it is only a temporary fix. It is not something that will correct the larger problem of the way Larry feels she is being treated, but he still appears to believe that he is supposed to take care of her and that asking for help in order to do so would not be acceptable. That is unfortunate for Larry because it is such a source of frustration, and it is unfortunate for Jeanie, because her condition has left her unable to think for herself and be her own advocate for the kind of care she really needs. It would be best if nursing homes and hospitals had stronger policies on really helping their elderly patients and their families, but many of them do not.
That leaves Larry and people like him floundering because their entire world has been turned upside down and they are not sure what they need to do next in order to fix the issues which they are now facing. If no one will give them answers or at least point them in the right direction, they may eventually give up – and that is not good for them or for the loved ones for whom they are attempting to advocate. Overall, some of the medical businesses that are designed to help others are inefficient in various ways and do not always do a proper job of caring for the patients with which they have been entrusted. People can fall through the cracks, and some are basically ignored because (like Jeanie) they have dementia. Often, it is thought that these kinds of people do not need any interaction, because they will not remember it later anyway. While it may be true that they will not remember it at a later date, they are still human beings and they deserve the dignity of being treated as such.
Ultimately, that is all Larry wants for his wife – for her to be treated as though she matters and as though she is still a valuable human being. Medical institutions that fail to treat patients and their families as though they have value should be avoided, if at all possible, so that experiences like the one Jeanie is having are not repeated. While it is true that Larry should be more communicative with his family – and quite possibly with others, too – it is also true that medical institutions should make more of an effort to explain issues to people, so that they understand what rules are in place and why those rules are so very important to the proper operation of the facility. If Larry’s concerns were addressed or even listened to, he would likely feel much better about the circumstances in which he finds himself and his wife, and that could make a significant difference in his health and happiness. It could even affect his longevity.
References
Axtell, R.E. (1990). Gestures: The Do’s and Taboos of Hosting International Visitors. New York: John Wiley and Sons.
Dimitrius, J. & Mazzarella, M. (1999). Reading People: How to Understand People and Predict Their Behavior-Anytime, Anyplace. New York: Ballantine Books.
Gilsdorf, J.W. (1997). Metacommunication Effects on International Business Negotiating in China. Business Communication Quarterly. v. 60, 20-37.
Guerrero, L.K. et al. (1999). The Nonverbal Communication Reader: Classic and Conteporary Readings. New York: Waveland Press.
Knapp, M.L. & Hall, J.A. (1996). Nonverbal Communication in Human Interaction. New York: Hbj College & School Div.
Leathers, D.G. (1996). Successful Nonverbal Communication: Principles and Applications. New York: Allyn & Bacon.
Lieberman, D.J. (1999). Never Be Lied to Again: How to Get the Truth in 5 Minutes or Less in Any Conversation or Situation. New York: Griffin Trade Paperback.
Roter, D.L. (2001). How Effective Is Your Nonverbal Communication? In Conversations in Care (chap. 2). New York: Wiley & Sons.
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