A Cure for Loneliness

After recently being widowed, Jillian is deeply depressed and her health declines. When her three out-of-state adult children are alerted, they admit her to the ACE unit and worry that Jillian will resist enrolling in a skilled nursing facility.

An interdisciplinary team of caregivers in Dalton General’s Acute Care for Elders (ACE) unit discusses their newest patient, Jillian.

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The interdisciplinary team of caregivers in the ACE unit determines the best way to address Jillian’s depression.

“We had a tough cookie admitted last night,” Hillary told her fellow nurse Melissa as her shift was coming to a close. “Jillian Jones in room 12A – she’s being really short with everyone, hiding under the covers and refusing to eat.”

“Oh, the nutritionist told me about her,” Melissa replied as she pulled up her chart on the MedCart computer of Dalton General’s ACE unit. “Eighty-nine years old, admitted for depression, urinary incontinence, and persistent coughing. It says hasn’t been eating much or getting out of bed since her husband died.”

Depression and the elderly

Urinary Incontinence Assessment in Older Adults

“When her daughter checked her in, she told me her father died about three months ago,” Hillary said. “Since all of her children are from out of town, they only stayed in town for about a week to mourn with Jillian.”

“It must’ve hard for her after they left her on her own,” Melissa sympathized as she pointed to the screen. “And these lingering urinary tract and upper respiratory infections haven’t helped, I’m sure.”

“No wonder that she’s so irritated and difficult to work with,” Hillary said with a nod. “It’ll be interesting to see what the team says we do with her.”

“I’ll fill you in,” Melissa said.

Later that morning, she attended the ACE unit’s regular interdisciplinary meeting of nurses, doctors, nutritionists, social workers and spiritual counselors.

The geriatric psychiatry ward at Dalton General assessed Jillian the following day. Her sour mood continued, as did her failure to eat a full meal. The nurse who conducted a preliminary screening of Jillian in the geriatric psychiatry ward had Jillian answer all thirteen questions on the Geriatric Depression Scale.

The Geriatric Depression Scale

Jillian scored an eleven on the scale, which is almost always indicative of depression. Given Jillian’s mental and physical condition, the ACE unit’s care giving team determined that she was unable to successfully maintain both her Activities of Daily Living and Instrumental Activities of Daily Living.

Katz ADL Scale and Lawton-Brody IADL Scale

After a few more days in the ACE unit to monitor Jillian’s respiratory and urinary infections, Lyn Benedict, head of the ACE unit, phoned Jillian’s oldest daughter, Terri, to inform her of the team’s decision. They determined it would be in Jillian’s best interest to move to a nursing home with around-the-clock care.

Jillian’s out-of-state adult children ponder how they’ll tell their mother that she should enroll in a skilled nursing facility.

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Terri is concerned about how the transition to a nursing home will affect her mother.

On the way to pick up her little brother and sister from their hotel, Terri pondered the ethical implications of sending their mother to a nursing home. Although she agreed with the ACE unit’s decision, she couldn’t imagine her mother changing her lifestyle without a fight. She wondered at what point a person loses her rights as an individual to choose where and how to live. Terri had researched elder care transitions as soon as Lyn Benedict had called to advise Jillian move to an assisted living facility. She’d brought printouts about Relocation Stress Syndrome to share with her siblings.

Awareness: Relocation Stress Syndrome

“So how’re you handling this, big sis?” Jennifer asked as she settled into the passenger seat of Terri’s rental.

“This isn’t going to be pretty,” Terri replied as she shook her head. Nick, the youngest Jones sibling at 52, squeezed into the backseat.

“You never know,” Nick chimed in, “Maybe all the company at the nursing home will help cheer her up. I just saw a documentary on PBS about getting old and they said some folks thrive once they enroll in a nursing home—especially when their family’s not around.”

Frontline: Living Old – The Importance of Home, Independence, Family

Jennifer cocked her eyebrow, “Sounds too good to be true.”

“Well, all I know is that I’m basically out of vacation days after this week,” Nick said. “Can either of you help her move out and find a realtor to sell the old house?”

“I’ve already called my manager and put in for a leave of absence,” Terri replied curtly. “Wouldn’t want you to go out of you way or anything.”

“Oh, gimme a break!” Nick said with a huff.

“OK, I know we’re all stressed out about this,” Jennifer interjected, craning her head to the backseat, “But if Dad were here, he’d threaten to turn this car around unless you two stop your bickering.”

After a long moment of silence, Terri changed the subject. “So, I’ve been thinking about how we can break the news to mom. I’ve been working a script out in my head.” She sat more upright in her seat. “Something like, ‘I know you’re not going to like this, Mom, but after your UTI is cleared up we think it’d be wise of you to join a nursing home. With the three of us living out of town and dad gone, it simply doesn’t make sense for you to continue staying in this big house with no one to watch out for you.’ What do you think?”

“Why not blame it on the doctors?” Jennifer suggested. “I was thinking we could say, ‘we’ve spoken to the physicians in the ACE unit and they think it would be best if you were enrolled in assisted living so that they can keep an eye on your urinary tract infection to make sure it doesn’t spread to your kidneys.’”

“I don’t know,” Nick piped up. “I think we should just be brutally honest. Just tell her ‘we know you’ve been sad all the time since dad died, living at home is probably keeping you that way, and you ought to go to a nursing home, where you’ll meet a slew of new friends.’”

“I’m not going to go out of my way to break Mom’s heart, Nick,” Terri said as she stopped to take a ticket at the hospital’s parking garage.

A few minutes later, after signing in at the front desk and waiting briefly in the reception area, the three Jones siblings saw their mother emerge from the elevator, being pushed in a wheelchair by one of the ACE unit nurses. Before any of the children could get a word in edgewise, Jillian called out to them from across the room.

“Better sell the car and decide who’s taking the heirloom furniture—doc says I have to check into a nursing home!” she shouted matter-of-factly.

The siblings exchanged quick glances with one another and followed their mother’s lead.

“That old house is falling apart anyway,” Nick said after a beat.

“We’ll find you the best nursing home there is, Mom,” Jennifer assured her as she took over pushing the wheel chair. “Don’t you worry a bit.”

“See,” Nick whispered to Terri as they walked out of the lobby, “I told you there was nothing to worry about.”

Terri couldn’t help letting out a chuckle. “I feel like someone just lifted a thousand pounds from my shoulders,” she whispered back. With that, she knelt down beside her mother and gave her a kiss on the cheek.

Two months after enrolling in the Willow Grove skilled nursing facility, Jillian’s children arrive to throw her a surprise ninetieth birthday party.

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Jillian celebrates her 90th birthday.

With Terri’s assistance, Jillian’s transition to a skilled nursing facility was relatively painless. They were able to sell or give away most of Jillian’s belongings, put the old Jones residence on the market and hunt for the best nursing home in their budget in about one month’s time. After Terri left, Jillian began her new life at Willow Grove eager to fill the void that her husband’s passing had left.

To surprise their mother on her birthday and to see how she was adapting to her new home, the Jones siblings returned to Ohio once again. Terri called ahead to reserve one of the common spaces at Willow Grove and was surprised to learn from the receptionist on the other end of the line that Jillian had already started to make a number of new friends.

After the party, the three Jones siblings headed to their hotel.

“It’s amazing what a difference two months can make,” Terri said. “She went from a total curmudgeon at the ACE unit to a social butterfly at Willow Grove.”

“Well, she wasn’t exactly bouncing off the walls,” Jennifer pointed out, “but at least she’s eating and getting out of bed in the morning.”

“It was great to see her so talkative too,” Nick added. “Do they have her on antidepressants?”

“Nope,” Terri replied, “She’s on twenty-two prescriptions, but none for depression. I guess just having people around again is doing a good job of curing her loneliness.”