Joe died a couple of weeks ago, collapsing on the sidewalk on his way back from the barber. Nobody is to blame for Joe’s death. He had advanced Parkinson’s and major cardiac issues. However, I believe his death might have been hastened by a well-meaning policy at the facility to which he’d moved less than six months prior, and I believe there are lessons in his death for all of health care.
Last fall, Joe took a small apartment in one of the best senior living facilities in Chicago, if not the country. It cost big bucks, but Joe could afford it, and given the beautiful amenities, myriad fitness and social activities, and the peace of mind that comes with knowing you can transfer from independent living to assisted living to round-the-clock care as the need arises, he felt it was well worth it.
The staff there are highly qualified, compassionate and dedicated. They’re among the best at what they do. Moreover, they understand the importance of working closely with local hospitals to coordinate their residents’ care — and they understood it long before things like accountable care and bundled payment made it every providers’ priority to work together to strengthen the continuum of care.
In short, it’s an altogether first-rate organization.
This particular policy requires that residents who take meals in the facility’s dining room sit only at tables with other residents. Eating alone is not allowed. The theory is sound: Make sure older individuals who might spend a lot of time by themselves have a chance to converse and socialize. Isolation is a scourge for many senior citizens, and can contribute to depression and other conditions.
Joe took part in many of the facility's activities; he played bridge, he attended talks on history, art and current events. However, his Parkinson’s had progressed to a point where he had trouble cutting food and even holding a fork, and that was a source of deep embarrassment. The one thing he didn’t want to do was to eat in front of others.
And so he didn’t. The last time I saw Joe, he said he no longer went down to the dining room, preferring to eat by himself in his own apartment. He was noticeably thinner, and I should have pressed the issue, to make sure he was, in fact, preparing or ordering regular, nutritious meals.
Now I have to wonder if a policy meant to enhance someone’s well-being actually discouraged this particular person from taking proper care of himself. Did it add to his frailty and make him more vulnerable? And I have to wonder how many other people in senior living or health care facilities are in a similar boat.
There are all kinds of great policies out there that health care professionals use to optimize the lives of people in all sorts of circumstances, and, they do help most people. That’s why we call them best practices. But every individual is different. We need to be alert and flexible enough to adjust even a best practice when it turns out to be a bad practice for someone like Joe.