When Grandma/Grandpa Cannot Go Home

I was consulted on an elderly patient who had developed an infection after surgery. The infection required intravenous antibiotic therapy for a long period. The patient required rehabilitation after discharge from the hospital. The intravenous antibiotics were given there. On follow-up in the office three weeks later I determined the patient still needed intravenous antibiotics. This was disheartening news to the three or four family members who came along for the visit because the patient was absolutely miserable in the nursing home and wanted to be home.

Failure to Thrive. The patient wasn’t eating. Didn’t want to engage with others. Just wanted to be home.

So the negotiations begun.

Option 1: Absolutely, take patient home. You, the family, will administer the IV antibiotics with help from nurses who will visit once or twice a week.

Response: Oh no, patient’s spouse has too many health issues, they won’t be able to administer the IV antibiotics.

Option 2: Well, spouse doesn’t have to be the one; one of you can do it.

Response: Oh no, we are all far too busy for that.

Option 3: Well, I can probably make an adjustment to the antibiotic regimen so it would be administered only once a day; so one of you will only have to go out once daily to help your elderly parent/grandparent.

Response: Oh no, we don’t have the time at all.

Option 4: Well, oral antibiotics are not that desirable an option. But if you want patient home no matter the consequences we can consider that. It is not too unreasonable especially as patient has lived a long happy life and with failure to thrive these may be last few months of life.  It might be better to spend that time at home with family happy, and not miserable in a nursing home.

Response: Oh no, no, no, no. We want the IV.

Option 5: I don’t know what to tell you then, have you considered a personal nurse?

Response: Oh no, we don’t have the money.

Blank looks all around.

That was a frustrating experience for everybody. In the end, I had to be the one to banish the patient back to the rehabilitation center to get more intravenous antibiotics and misery. However what got me the most was the refusal or inability of anybody else in the family to step up to the plate and help out. Really? What else is family for?