Together till the end

The clients of the special-regime home for the elderly struggle with short-term memory problems, as well as many illnesses of the body. But, as head of the home Marie Jurošková says, they are still more than vital. Although their average age is around 80, they still feel an urge to keep themselves busy. “Our generation will probably be a bit different, but these people don’t really know how to relax,” explains Ms Marie. 

The “relaxation room” is not among the most visited in the home, and reportedly, some clients are even afraid to go in there. This shouldn’t come as a surprise since most of them have worked all their lives – in various businesses and factories during the day, and in their own houses and gardens in the evenings. This is Wallachia. 

So, even in a home for the elderly, most of them never idle. They cook and bake, they dry fruits or peel nuts. And they tell each other stories. They return to their youth and reminisce. Unlike their short-term memory, their long-term memory comes back to them in a remarkable way.  

They spend a lot of time outdoors from spring to autumn. They weed raised vegetable or flower beds, they sweep, and they like to sing folk songs with the accordion player. Eighty-three-year-old Mr. Šrámek comes by with his accordion three times a week. 

Before the candle goes out

The fact that the elderly feel at home at the Diaconia in Valašské Meziřící is not just a phrase. Often, they no longer recognise their own children and grandchildren when they come to visit. The only faces they remember easily are those of the nurses and caregivers that they see every day. 

It was precisely the awareness of these "family ties" that led Maria Jurošková and her team to take a bold step: expand the home's services to include palliative care. The home for the elderly is within a stone’s throw of an excellent hospice that is also part of Diaconia. However, a longer-term environment change can be extremely challenging, almost devastating, for people with dementia or Alzheimer’s. Such a demanding change could include a move to a hospice. However, that is a more or less theoretical consideration, because in practice, the clients of the home would usually die in hospital. 

The end of life is sometimes compared to a candle burning out. It is often accompanied by serious health complications, but the home, as a social, not a medical facility, was not legally entitled to address the health complications. “This meant we had to call an ambulance just before the candle would go out,” describes Marie Jurošková. “You take care of somebody for 5, 10, 15 years, and when it is almost over, the person is taken away. You don’t know if they’ll make it through the journey. And if they do, they die in a place where they don’t know anybody,” adds Ms Marie.  

The chance to choose

One of the clients of our home was relatively young, 73 years old. He was a heavy smoker, and as is usual in these cases, the circulation in his legs was collapsing, one leg was dying. There was no way of saving it, the only option was to amputate. If the operation was successful and the patient survived – which was not at all certain with regard to his condition – he would be confined to bed.  

Before the introduction of palliative care at the home in Valašské Meziříčí, this would have been the only possibility. Now, the 73-year-old client had a choice. A doctor with a certificate in palliative medicine, with whom the home is now cooperating, explained the options. The man firmly refused the amputation. This meant that all efforts to save his life were stopped. Now, the only focus was on making sure that the end of his life would be lived well, that the client would be surrounded by the people he knew. His relatives were informed and agreed with the procedure.  

He was receiving analgesics for the pain, the nurses would dress the affected leg on a regular basis. He was spending as much time as possible in the garden in his wheelchair and the caregivers would make sure he felt as good as possible. His greatest joy was tapped beer from the nearby pub. He hadn’t even hoped he would ever be able to taste it again. Then one morning, he did not wake up. “He died of sepsis,” recalls Marie Jurošková. “But he did not suffer, he was happy. He was here with us. If they had amputated the leg, he would have had to stay in bed, he would have had bedsores, you can never prevent that a hundred percent, especially in this condition. So there you have it: which is the better option?”

Easing the pain

When deciding together how to deal with clients' illnesses, it is important to consider the future quality of life in addition to the will of the client and his or her family. 

Palliative care in the home does not mean rejecting hospital care at any cost. It means extending services for those cases where saving a life is no longer meaningful and it makes sense to prepare a dignified farewell in which the family is also included. The patients can be with their loved ones, especially in their final moments, at any time of day or night. The home has adapted its premises to be able to offer this possibility.  

In the spring and autumn, the home holds memorial gatherings for the bereaved with photographs of the deceased. “This is going to sound strange, but I am still going to say it: dying is nice in our home now,” concludes Marie Jurošková. 

Of the 42 clients of the home, six were in palliative care at the time this article was written. Two of them were confined to bed, passing from life naturally. Four were still active. They were receiving analgesics to relieve the pain caused by progressive untreated illness. 

The nursing home staff, especially the caregivers, have had to learn many new skills. Oxygen generators, oxygen goggles, drug dispensers, S.O.S. drugs, heart rate and oxygenation measurements – that is just a sample of what they had to learn when palliative care was being introduced. It was also necessary to employ a physician to draw up a care plan for palliative patients. The whole team at the home had to learn to work with the palliative approach, identify with it and take on the higher level of responsibility that palliative care entails.

As far as client care is concerned, every year, Diaconia votes for the best innovation. Out of 18 entries, the palliative care in the Diaconia Valašské Meziříčí home for the elderly was the winner. 

Adam Šůra