Andreas Laupacis is Editor in Chief of CMAJ.
Some of Canada’s long-term care institutions have been decimated by COVID-19. In one particularly heart wrenching instance, 20 people died in an institution in Bobcaygeon in a matter of days.
Recently a prominent geriatrician recommended that Canadians remove their loved ones from long-term care facilities if they could. Within minutes I was being asked by friends and acquaintances whether I was going to bring my 94 year old mother home.
The answer is no.
To our knowledge, the facility where she lives has no COVID, although I admit I don’t know how forthcoming homes are with this information. She lives in a private room, the care is good, we get regular updates and the institution seems adequately resourced (full disclosure – it is not publicly funded). My mom is living there because, no matter how hard we tried to support her, she just couldn’t manage in her apartment anymore. And it would be almost impossible for us to care for her in our home.
And there is another reason we aren’t taking her home. I know my mom well. I am quite certain that if her dementia miraculously cleared, she would tell us that dying from COVID-19 would not be the worst thing that could happen to her. (Dying with poorly controlled shortness of breath care would be.) She has long said that although she didn’t want to, she was ready to die. Mom might be an asymptomatic carrier. Given the care she requires with dressing and toileting, there is no way she could be physically isolated from us, and I know that she would not want Karen or I to be infected.
So, we are going to leave her where she is.
I worry about the geriatrician’s recommendation in general. An analogy has been made between cruise ships and nursing homes. In both, coronavirus can spread quickly. However, the Canadians who have come back from the ships were placed in strict isolation in hotels and were closely monitored. None of them needed help with dressing and toileting. Most nursing home residents require care that makes physical isolation from family members (who have no personal protective equipment) impossible. At a time when we are desperately trying to limit community spread, this has the potential to do the opposite.
So, I am optimistically hoping that mom doesn’t get infected, and that in many weeks or a few months we’ll be able to take her home for an hour. We’ll be sitting in our backyard and she’ll ask, “What are those animals you sometimes have here called?”
It’s refreshing to hear people talking sensibly, rather than romanticizing and overly emotionalizing issues and decisions. My grandma died a few years ago in an (amazing) nursing home at age 101. I was very sad to lose her – she was a connection to a past generation now gone forever in our family. She was a wonderful person. But she herself was ready to die. It was a tragedy to me, but a mercy to her.
Most people in her NH were the same – the ones that still had enough cognitive function were “ready to go when god takes me” like my grandma. Others were so demented their quality of life was… nil I would say.
My very wise and wonderful and sensible mother-in-law is 85 and still living independently. When she heard about lockdown, and realized it was a threat to her, but not her kids/grandkids/great-grandkids, her view of lockdown was “I’d rather be able to see you all and take the chance. For god’s sake, I’m 85 with bad lungs and heart, I’m not going to be around much longer anyway”. She said she would prefer risking a shorter life by having social contact, as opposed to being locked alone in her condo for months. Analogous to whether to undergo palliative chemo or not – quality vs. quantity of life. The government, by enforcing lockdown for all rather than making it voluntary, has decided for everyone that they have to take chemo.
Thank you for this
good for you .I do think that the funding for the Public Nursing homes is not adequate
and that Public Health has been undermined by the current government but I am on the board of a non profit home and know the amount of care
is being provided …COVID is an unfortunate strain on this sector ..one which I hope can be remedied in time .Thanks for your thoughts