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Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
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VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
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As a working caregiver here, you don’t have many rights. It would be best to talk to family members, particularly one who has POA, to pass on the comments, and discuss it with them if they are open to it.
There are probably two lines to look at. Is the person you are caring for being kept alive by drugs that prolong life but don’t provide quality? If so, has the option of hospice been discussed? Hospice will aim for quality of life but not to prolong it if the person doesn’t wish it. For many older people blood pressure drugs and cholesterol drugs are the ‘prolongers’, but there may be others.
The other thing to consider is whether the person is depressed and that is the main reason for the wish to die. If so, different medications might help. Most suicide phone lines will also help to talk a person through this. Wishing to die can be ‘a permanent solution to a temporary problem’.
Perhaps your knowledge could be helpful to the family, but it will probably not go down well if you try to talk it through yourself with the person you are caring for. It’s a tricky situation, when you obviously care yourself.
If the client's reasons are blindingly obvious - e.g. pain, loss, grief, new/extreme disability - acknowledge and sympathise.
If the "like this" part is not so obvious, ask gentle questions about what the client is finding difficult. It may be possible to assist a change in perspective.
Widen the discussion and encourage the client to express feelings, which you then acknowledge and validate.
Does this particular client, if you're talking about one in particular, have any realistic prospect of improvements in quality of life?
I'm going to give you a quote from a handbook from the Canadian Nurses Association that I think is somewhat relevant
"If a person in a nurse’s care expresses a wish to die, the nurse should consider it “an opportunity to open a dialogue. Such comments might be transient, the result of a temporary distress or an expression of suffering due to unmet needs”that could be treated or addressed. The role of the nurse is to identify and alleviate the factors prompting such requests, whether these stem from physical symptoms like pain or are related to anxiety or fear. Nurses have an obligation to try to understand the person’s request and to bring in appropriate resources to address unmet needs. Nurses are accountable and responsible for listening to and acknowledging the suffering of every person in their care since failure to do so can increase suffering unnecessarily"
Although this is directed at RN's and NP's I think that front line caregivers are an integral part of the care team and are no doubt the people who know the client's needs better than anyone, if there is an unmet need there should be a process in place to report it.
Are you directly employed by the client? Or by an agency, the family, someone else? Who do you report directly to?
I have reported these sort of comments to my supervisor. Pastoral Care services or Psychology is then usually summoned.
Sometimes it is fear - especially fear of pain. Good hospice care can help tremendously. Sometimes it is grief & counselling helps. There are many reasons.
My brother realistically felt very much this way. He was in Assisted Living, and as a rather Monk-like man, never overly social, he attempted to make the best of it. He oft told me "Like being in the army when I was a young man; I don't like it but I make the best of it". He was well aware of his "probable" early Lewy's Dementia. He knew the long slow slide he faced of nothing but loss, and was fiercely into control, resented the loss of it. Made the best of it. We often talked of his worry and sadness of what was ahead. I think too often we go to the "depression; get them a pill" route. This is reasonable. Are these losses not worth grieving? I think a response of "I wish I could make it better; is there something more you can tell me about what is so hard right now for you?" I agree with those who tell you that this is reportable to the person you are directly responsible to, either his family if they hired you, or your agency manager.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
There are probably two lines to look at. Is the person you are caring for being kept alive by drugs that prolong life but don’t provide quality? If so, has the option of hospice been discussed? Hospice will aim for quality of life but not to prolong it if the person doesn’t wish it. For many older people blood pressure drugs and cholesterol drugs are the ‘prolongers’, but there may be others.
The other thing to consider is whether the person is depressed and that is the main reason for the wish to die. If so, different medications might help. Most suicide phone lines will also help to talk a person through this. Wishing to die can be ‘a permanent solution to a temporary problem’.
Perhaps your knowledge could be helpful to the family, but it will probably not go down well if you try to talk it through yourself with the person you are caring for. It’s a tricky situation, when you obviously care yourself.
If the "like this" part is not so obvious, ask gentle questions about what the client is finding difficult. It may be possible to assist a change in perspective.
Widen the discussion and encourage the client to express feelings, which you then acknowledge and validate.
Does this particular client, if you're talking about one in particular, have any realistic prospect of improvements in quality of life?
"If a person in a nurse’s care expresses a wish to die, the nurse should consider it “an opportunity to open a dialogue. Such comments might be transient, the result of a temporary distress or an expression of suffering due to unmet needs”that could be treated or addressed. The role of the nurse is to identify and alleviate the factors prompting such requests, whether these stem from physical symptoms like pain or are related to anxiety or fear. Nurses have an obligation to try to understand the person’s request and to bring in appropriate resources to address unmet needs. Nurses are accountable and responsible for listening to and acknowledging the suffering of every person in their care since failure to do so can increase suffering unnecessarily"
https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/cna-national-nursing-framework-on-maid.pdf
Although this is directed at RN's and NP's I think that front line caregivers are an integral part of the care team and are no doubt the people who know the client's needs better than anyone, if there is an unmet need there should be a process in place to report it.
I have reported these sort of comments to my supervisor. Pastoral Care services or Psychology is then usually summoned.
Sometimes it is fear - especially fear of pain. Good hospice care can help tremendously. Sometimes it is grief & counselling helps. There are many reasons.
But take it seriously.
People know when they are going to die.
They are tired of suffering. They are ready to leave the misery behind.
In reality, what is there to look forward to?
I suppose you could pass their feelings along to a social worker or clergy if they are religious.