The elderly with nowhere to go

 Christmas should be a joyous occasion when friends and family meet up in celebration, but for the handful of elderly patients stuck at the Cayman Islands hospital with nowhere to go and no one to take care of them at home, Christmas will be the loneliest time of the year.    Some elderly patients have been at the hospital for six or seven months, and some patients die in the hospital still waiting to go home.

“The patient is crying ‘I want to go home’ and the patient dies with us,” says chief nursing officer Hazel Brown.

There are a number of reasons why patients are unable to go home, says Brown. Some patients need modifications to the home to be safe environments. Sometimes the patient needs a skilled caregiver at home. However, if the family does not have resources to pay for a caregiver or make the necessary modifications then it might not be safe to send the patient home.

But then there are the families that appear to have the means; the family may even be living in the patient’s home, their largest asset. But for a range of complicated social and family reasons, they do not take responsibility when the patient is ready to be discharged, explains Brown. Some of it is child upbringing; some of it is the grown children can’t seem to cooperate with each other on what to do with the elderly patients.

Abuse or neglect by the family might also be an issue of why the patient can’t be sent home, acknowledged Brown.

Sometimes it is as simple as a single mother in low paying jobs struggling to feed her family, and she does not have the time or the funds to bring the elderly parent home.

Just a couple of decades ago, more women stayed at home and took care of elderly family members, with more women going outside the home to work, this is not happening as much.

“After the patient passes away, then the kids come crying by their bedside. It is heart-rending. People have contributed to society all their lives and they have raised large families.”

However this is not a new issue that has just come, says Brown. “This has been a problem as far back as I know,” she says

While the hospital does not specifically track the number of patients that stay in the hospital because there is nowhere for them to go, many stay there for six or seven months at a time. There are five elderly patients in limbo at the Cayman Islands Hospital right now, says Brown.

“We rarely go beyond six patients. At one time we had seven. Sometimes we have had as few as two patients,” says Brown.

With the economy in a slump, and tightening government finances, it doesn’t look like a problem that is going to go away.

“I hope it doesn’t get much worse. People are afraid of getting old; afraid their kids are going to abandon them,” says Brown.

No place for long-term elderly
Hospitals are not places   set up to look after elderly patients long-term. They don’t get the exercise they should, they don’t get physical or occupational therapy as they should, and they are more or less confined to their beds.  Left in the hospital for months, elderly patients have fragile immunity systems. And with micro-organisms floating around, many patients end up getting new infections and go downhill from there. As well as the physical complications, there are the social implications, that    they don’t feel connected to the family or the community, says Brown.

Few options for elderly care
the elderly person is indigent, the hospital tries to coordinate with Child and Family Services to place them in one of two residential homes, East End Cottage and Golden Age Home, both operated by the government in Grand Cayman. This is a good option for the elderly patient if they cannot go home, because it is a residential facility that is set up to provide medical care and social activities in a home-like facility, explains Dawn Rankine of Child and Family Services.

The homes are set up so there are plenty of social activities: going to church; outings to the beach; games and sing-a-longs; arts and crafts. They help keep the elderly person’s mind stimulated and feel connected to the community.

But with only 16 beds in Grand Cayman, these homes are almost always full.

The only other facility in Grand Cayman that can accommodate elderly patients is The Pines, a private home for seniors operated as a non-profit organisation. With charges of $3,100 for a regular patient per month, it is a costly option by government’s standards. The monthly charge goes up to $6,500 if the patient needs a high level of nursing care. So Family Services tries to use The Pines sparingly, says Rankine.

Currently it is unknown how much it costs to take care of elderly patients, says Rankine. The department is starting the process of doing a cost analysis.

Whether or not there is a significant cost differential between government residential homes or The Pines, Child and Family Services is paying for 24 patients at the $3,100 monthly rate at The Pines according to the home’s manager Sue Nicholson.

Currently, the Golden Age Home in West Bay is being renovated and expanded. When the expansion is completed on the Golden Age Home, it will increase its capacity from 10 to 20 people, says Rankine.  That means the capacity for government-owned homes will be 26 beds in Grand Cayman.

The situation in Cayman Brac is also tight. Before Hurricane Paloma, its residential home had two wings that could accommodate 30 beds. But after Paloma destroyed the older part of the facility, it can only house 18 patients. That facility is also at full capacity.

As senior citizens are the fastest growing population, there will continue to be a shortage of facilities to look after aging parents who can’t live at home.

Lack of visiting
Many elderly people housed in government residential homes are regularly visited by their families, but many families don’t visit their elderly parents in the home for six or more months, says Rankine.

“If they feel neglected by the family, they get depressed,” says Rankine. “They feel sad. They feel alone. They feel abandoned. It affects their physical situation. They don’t eat.”

And even if they feel lonely, the elderly will often make excuses for their children.

“It’s human nature and the nature of a mother’s forgiveness,” says Rankine.

She recalls one elderly person who felt bad when her friend at the home got a phone call from a relative and she had not heard from anyone. So Rankine arranged for the elderly lady to get a phone call from one of the staff.

When the elderly lady got off the phone, she was sitting up straighter, saying ‘I got a call too,’ says Rankine.

“You try to circumvent that as much as possible, but you can’t substitute for their family.”

Christmas at the hospital
For the elderly patients in limbo at the hospital, the church groups help distract them from their worries. Christmas carolling by the National Choir also helps. But they can’t make up for not being at home with their families.