Our hospice works with many senior patients, a population that is very interested in self-reliance. Our hospice also serves Appalachian counties in Kentucky, where self-reliance is prized and closely guarded.
And our hospice–Hospice Care Plus–is also very committed to honoring the values, wishes and needs of our patients & families. Yet, what are we to do when honoring a patient’s bucket-list wish for independence causes some safety concerns?
What if you were an 89 year-old woman who had lived on her family farm her entire life? You have no running water, so you haul it every day from the creek. You also lug coal in a bucket from the storage room to the stove, because a coal stove is your only heat source. You’ve raised a large family, who are all far away. Your husband has been gone for many years. You’ve grown and canned your own food all your life. You’re proud of being a strong, self-reliant, independent woman who has kept the family home and farm, even if it’s lacking in modern amenities and comforts.
This 89-year-old woman, Mrs. Brown (name changed), was a patient of ours, and our responsibility is to make quality of life as good as it can be—as defined by the patient and family. In this case, the patient defined quality as being self-reliant, independent, and never taking handouts from anyone. Her bucket-list wish, simply put, was to stay right where she was until her last breath.
We were challenged by her case. She was so admirable, yet the hospice team had concerns about her safety. The combination of her illness, age, and poor eyesight made it very hard to manage the coal stove. After the first couple of visits, the staff began to notice burns on her dressing gown. We were concerned that she would be seriously burned, or worse. The lack of running water also raised questions about how we could provide care in the home without risking infection.
Mrs. Brown was known and loved in her town, so there was no shortage of offers to have her move in with others. But it was out of the question. She insisted on paying her own way and living completely independently. Anything else was impossible in her mind. Anytime we broached the subject, she made it clear we weren’t to do so again.
Our care team had to be creative. We reached out, had conversations, made suggestions. After a few days, we had a deal we could offer Mrs. Brown—one that would allow her to remain independent, but give her the safe environment she needed in her last months. It would still be up to her, of course, and we were more than a little nervous about introducing the idea.
We told her about a local gentleman who had a property that he only occasionally used. It was fully furnished, but sitting empty. He worked with the team to offer Mrs. Brown a job: if she would temporarily move to his house and work as the caretaker of the home, he would pay her in room and board. She would not have to give up her farm and home—just leave it for a while to do a job that a friend needed.
To our great relief, Mrs. Brown agreed. In fact, she was thrilled. She was actually honored to be offered a job (“at my age!,” she said to us). She felt she was still paying her own way in life, which was so essential to her. She also confessed that it was “heaven” to have gas heat and running water.
Now, we have to be honest. The local gentleman—our partner in this deal—did not need a caretaker. He was just another community member who was worried about Mrs. Brown, but who knew what her independence meant to her. He fabricated the need for a caretaker so she could live out her days according to her one bucket-list wish: to live completely independently until her last moment.
Thanks to a creative staff and the wonderful communities in which we live and work, we were able to honor a patient’s bucket-list wish for self-reliance without compromising safety or the quality of care. Mrs. Brown wouldn’t have it any other way. And neither would we.