I am doing my FW at a SNF. One of my clients has a wife that is always there when my OT and I go in for a session. The very first time I was there, she let us have it as soon as we went into her husband's room. She complained about everything that happened the night before that we had no part of. She was in tears, and although I felt sorry for her, I wondered why we were getting all this dumped on us. He had breakfast already, so there was an opportunity to voice her opinion to whoever brought that in, or maybe she just complained to everybody. The gentleman was a very quiet, pleasant soul.
The second time I accompanied my OT into this room, the wife appeared to be pleasant. However, before we could even make it back down to the therapy room, she had already called to complain. You see, we were trying to work on his ADLs so that he could return home, and his wife wanted us to work on shaving and brushing his teeth, so we did. Her complaint was that he didn't need someone standing over him watching him brush his teeth, but w/o us, he would have never completed the task.
After that, the OT sat down with the wife to complete new goals. This time she wanted him to get stronger, so yesterday we t/f him to his w/c and he used the hand cycle to increase his endurance. While this was occurring she told us how unhappy she was with certain shifts but if they left, it would probably be the same anywhere else. She actually smiled one time when she was reminiscing about a trip her and her husband took.
This woman stays at this facility with her husband pretty much all the time. It's not a very big room, and she even sleeps there, in a chair. Her husband is a sweet old man and doesn't seem to pay her much attention either way. My OT said she has been known to leave with her husband in the middle of the night because she wasn't happy with the way something transpired. I can't imagine that being a safe situation for her or him.
I believe her continued stay in that cramped little room is wearing on her mental status. She told us that she can't sleep well there either, so she is most likely sleep deprived, too.
According to our textbook there are many stressors in the aging adults life including: loss of careers or their home, sickness, wondering how to pay for everything, the aging body in itself, and just not having the energy needed to perform the most basic tasks is enough in itself to warrant psychosocial problems. I'm sure this patient's wife has come to the realization that her husband is never going to be "normal" again and is most likely going to just get worse, and she needs to vent and let someone have it. So, we listen and do whatever we can to help ease her pain. The facility has a contract with a psychologist. I think she should probably schedule an appointment. After all, our textbook says, depression is the most common psychiatric dx in the elderly.
My client's wife eventually wants to take him home, so I have included a link to a great website with some very helpful suggestions on how to care for the elderly. I think she needs to pay close attention to numbers 4 & 5. She needs to learn how to trust others with her husband so that she can have a break before she drives herself "crazy" trying to do everything. This is a classic example of why socialization is so important, because everyone gets a little stir crazy without it!
I think it is great when family members are involved in therapy. I feel that far too often family members are not involved at all. However, I think you are right in saying that your client's wife realizing that her husband may "never be normal again" is causing frustration and anxiety for her.
ReplyDeleteI wonder if they have any children or close friends who can help. Or is there someone at the facility that she feels closer to or able to talk to (patient advocate??) Most hospitals have pt. advocate not too sure about rehab or SNFs.
ReplyDeleteI run into this very often at my SNF. There are family members who are there every single day who think they are doing the best thing for their loved one, but in some of the situations I have been in at my SNF they are doing more harm. The actual patient feels added stress and can not focus on their recovery, the family member often has an unrealistic view of what their family member will be able to SAFELY complete, and the family member interfers with other patients in rehab. My solution is to get SW involved to address certain issues, incorporate the family member into the treatment session especially if they are going to be home alone with my patient so that it is not a shock once they get home, and introduce the family member to the activities director to help encourage the family member to participate in things that bring them joy or help with expanding a social circle to have others to talk to about anything.
ReplyDeleteI ran into a similar problems at my fieldwork site. . .An elderly lady had torn a tendon in her leg and had surgery to repair it. This made her unable to bear weight through this leg. Her OLDER husband who was in not so great shape himself was there with her all the time.
ReplyDeleteDuring the first treatment session he told us how his wife had fallen in the kitchen floor and hurt her leg. What shocked me was when he said he had to leave her there for 4 days (he brought her a blanket and pillow at night) before he called anyone to help. He was very stubburn and thought that he could help her. On the first day he tried to help her up and ended up hurting his back too. Back to rehab now. . . so here is this older lady in her w/c with her leg propped up and needs help putting on her socks and shoes. What does he do? Gets down on the floor to help, and now can't get up, but in the process of trying to stand up, pushes down on her injured knee to try to pull himself up.!! Oh my. It's the pyschosocial aspects of eldery minds that doesn't want to give up to the fact that they need help, (from someone else) at this point in their lives. It must be hard to give that up and a difficult decision, so I guess they just hang on as long as they can!