The family physician Martin De La Boissière believes that the loneliness is what is most troubling in this time for the families of residents of NURSING homes and mainly for those whose life is shortened quickly by the COVID-19.
April 25, 2020 4: 00
CHSLD rhymes with solitude, believes Dr. Martin Of La Boissière
Loneliness is part of the reality of NURSING. The COVID-19 has only exacerbated this reality, while families are kept out of the end of life of a parent. This separation, which is justified by good medical reasons, however, has a perverse effect because it generates anxiety within families that have walked to the end of life of the elder, believes dr. Martin De La Boissiere.
The latter knows what he is talking about when he addresses the crisis in NURSING that is hitting some regions of Quebec. As a family doctor in the sector of Dolbeau-Mistassini, since the beginning of his career, he has known for a long time NURSING homes in addition to offering a benefit in the palliative care at Home Colombe-Veilleux. Finally, his mother is a resident of the CHSLD de Roberval.
“The solitude, it is always what is most difficult in a CHSLD. I have many stories where a person is deceased in the company of an old nurse and an old doctor like me. There are also residents that steps made at a very advanced age to which all members of the family are deceased. I remember a very elderly patient whose niece distant deals, ” insists the doctor to illustrate a reality that is part of the landscape in a normal period. The staff of the CHSLD and the doctors must cope with it and, in some way, become the family of these elders.
NURSING homes have become places where older people come to the last phase of their life. Martin Of La Boissière speaks of the last stage ” before the big trip “. Therefore, an environment where the person will live on average 18 to 24 months. There are in these institutions a medical practice very soft, which is to ensure the best possible quality of life for the person and not the healing.
“When a person is admitted, we proceed to its evaluation in the company of the team. It is often in the presence of patients with cognitive problems. The journey (emotional) is so much more for families. We allow really to the resident to walk towards the moments of the end-of-life, comfort care, palliative care, and it’s part of our daily lives, ” says the doctor.
Death is a reality well integrated into the life of a CHSLD, with which the staff and the doctors have learned to combine. No one is surprised when the deaths occur fairly regularly, as reminded by the doctor. “You lose one or two per month. At times it may be two or three weeks without a death, and it accompanies them in there. “
Even in NURSING homes where the coronavirus is not entered, the COVID-19 has fundamentally altered this environment, which allows people very ill to die in dignity.
“The COVID-19, what it does, it is that we can do more to support people. They are alone. Loved ones are no longer there. For good reasons, we told the families to stay outside. They are no longer there, the loved ones remain at home, and they become anxious. From what I understand, the testimonies, there is not so much of loved ones who are going to accompany in the last moments. “
Martin De La Boissière is a family doctor.
The ministry has agreed to put in place a protocol that allows the humanitarian visits in NURSING homes for the last hours of a resident. The directive states 24 hours before the death. However, the family doctor understands very well that it can happen that the staff of a hotel is not able to properly judge the time to live of a person. “Myself, I was wrong on one out of three times. And the COVID-19, from what we hear, it’s pretty fast. “
A portrait that changes
In NURSING homes where the coronavirus is not present, the elderly can always benefit from the presence of people they know or, at least, who know. Who know their habits and their behavior. The portrait is changing rapidly in places where the disease has spread and it is a situation of loneliness that the doctor has difficulty to accept, but against which there is nothing to do in the midst of a pandemic.
It comes to submit the hypothesis that the families don’t really have a fear that a parent grabs the COVID-19 and die of the disease as it could die after a fall, a bad case of the flu or another situation that leads to the end-of-life. “I think that the families fear that their loved ones will die in solitude. “
Because when the staff is sick, there is a turnover rate. “As a result, even the staff close to these people, who knows them well, knows their habits, is no longer there. Suddenly, you have an epidemic of death that comes without that there has been preparation and this is what I find most sad in this story. “
At the same time, the closure of the CHSLD enacted to protect the elderly has also put an end to a number of activities which could be used to brighten up a bit life in this environment. The doctor, who had stopped the visits because of the pandemic, is part of those who contribute to this animation. He happens to walk in the corridor with a resident. We asked him to sing The Mouse Green.
Levels of care
The ministry of Health and social Services had expected that there might be problems in NURSING homes. The doctors in the practice had received the directive to update, for April 2, the levels of care for each resident under their responsibility. A request that has not traumatized Martin De La Boissière, to which it is a normal step in the context of its regular work.
“We assessed the situation and decided with two families to move from level 3 to level 4. It makes me laugh when I read in the media that we will not be able to transport the elderly from NURSING homes to intensive care. In my customer to me, there is no patient that we will transport to the intensive care unit. “
The doctor, however, has taken advantage of this revision of the medical records in the company of the families to be able to discuss the situation. He also took the opportunity to address the issue of end of life care with some people.
“When the guy was 81 years old and is at the CHSLD, and that his wife was 79 years old and she is still at home, but that she may be ill, I brought the topic if ever this situation arose. “
Martin Of La Boissière has all the same wanted to be reassuring. The LTCU is a medium of life which has all the medication needed for the doctor to be sure that a person will finish his days without suffering. There is also a system in place before the pandemic, which allows the staff of CHSLD reach a doctor 24 hours per day, including weekends.