Walter refused what would have been his 9th hospital admission that year.
“You run a great hospital, Doc,” he said to Bruce Leff, “but it’s a lousy hotel.”
It was the ‘80s and Leff, a Johns Hopkins geriatrician who was then a resident, responded by working with his mentors to assemble everything that Walter would need to get hospital care at home, where Walter, in turn, could care for his aging cat.
The effort was beyond arduous but it worked. And since then, Leff has used a photo of Walter (replete with snoozing cat on his lap) to open talks about his “hospital at home” idea.
Hospital at home—a concept catching on across the country and around the world—started by improving care for ONE person.
My ONE—the person whose care I’m working to improve—is my 93-year-old mother.
Who’s your one?
Whether that person is a parent, neighbor, patient, or client, Leff’s story, as described in “Home, Sweet Hospital,” is instructive:
He could at once see the “small stuff” impeding his patients’ health and big picture for improving patient care. Indeed, his noticing “small stuff” is what I think greatly helped him to imagine a program that’s been proven to produce better patient outcomes.
But don’t fret about serving the masses for now, or ever if you don’t want:
Improving care for one person is good and enough.
And if seeing “small stuff” isn’t your strength, ask.
You can start with something along these lines:
What difficulties—big or small—do you have getting through the day?
What things—big or small—do you normally need / wish you could have help with?
Leff, for example, noticed that some patients had difficulties reading prescription bottles.
Your one might have difficulties getting in and out of the shower or getting dressed.
Or finding time to be alone, if your one is a caregiver.
What would make a normal day IDEAL for your one?
Any gains we make are great, but my desire when it comes to care is creating marked improvements for people. And to me, “marked” improvements call for understanding what’s ideal for folks day-to-day and delivering a daily ideal as best as possible.
Having been her live-in caregiver for years, I’m well versed on my mother’s basic needs but initially formed opinions about her preferences in a haze of exhaustion from caring for my father who had dementia and going into lockdown, and all that entailed, days after he died.
Once things calmed down, however, I asked my mother what would make her days ideal. Posed that way, she wasn’t sure, which didn’t altogether surprise me.
I struggled to find the right question until it hit me to ask her for a story:
Tell me about a day that you really enjoyed.
With that, the words flowed and I got the information that I wanted, which happened to match what I thought—my mother enjoyed things like singing, running errands & eating out.
And those are all things that my family and I can make happen.
If your one can’t easily communicate preferences or challenges, ask qualified people for their general insights and first-hand observations, if possible.
And / or learn to read signals yourself.
My father’s speech was unintelligible long before he became non-verbal. Bliss across his face revealed that he loved head massages, but it took attention to read his subtle facial cues, and even body odors, to know when something was off and required a close look.
And it goes without saying that stopping problems from growing is ideal for anyone. But what’s more ideal is helping people to get care with the sprinkles on top.
Next time, I’ll share a simple process to start making that happen for your one, or yourself.
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