Advance Directives – Entry 1

Dear Diary:

This morning while making rounds, I ran into Hattie’s daughter Carol.  Unfortunately, since Hattie came to live here things haven’t gone so well for her. She had increased lethargy and confusion related to antipsychotic drug use. She fell, broke her hip and needed to be hospitalized. After returning to River View, she experienced quite a bit of pain after her hip surgery and then she developed a catheter-acquired urinary tract infection that almost landed her back in the hospital.  Carol told me she’s relieved that despite some worsening dementia, Hattie seems to be getting back to “her old self.” Carol is pleased that her mom is participating in activities she’s always liked to do—cooking, knitting, and going to church. She’s even getting involved in the quilting club that meets at one of our neighborhoods on Tuesdays.

Apparently Carol, Hattie, and the rest of her family have been having some end-of-life conversations, as they’ve been observing what she’s been through in the past few months. They all agree that at this point they are more concerned about Hattie’s quality of life, rather than the length of her life. She’s suffered a lot in the last few months, and Hattie has told her family that she doesn’t want to go through that again. She says she’s ready to die and doesn’t want to be sent back to the hospital.  She’s adjusted to her new home here and would prefer to stay and remain comfortable where people know her and her routines. With that in mind, Carol has asked me to note in her mom’s chart that as long as we are able to keep her comfortable here at River View, she should stay here rather than being transferred her to the hospital.

I talked with Anna, one of Hattie’s nurses, and she’s working with Carol to update Hattie’s advanced directives. Made me think that we need to make sure we are regularly having these kinds of conversations with all of the residents and their families. How can we make sure this happens?

Signed, Donna

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