xxAACP Newsletter, Volume 11, Number 4, Autumn 1997
President's Column: Meeting the Needs of the Elderly
What struck me most as I met some of the floor nurses I had known at the nursing home was how fond I had become of the staff and how fascinated I had become with the nursing home as a sociological unit. To be sure, the advances in the neurosciences have enhanced our capacity to be helpful with elderly people as they struggle with physical decline and the impact on their brain function. Treating depression in the elderly is undoubtedly one of the most gratifying jobs for psychiatrists. They improve so much. As a group of patients the elderly are so grateful and respectful of our skills. It is refreshing. Being on a team oriented to talking and listening to old people is a treasure. As one who could have been a history professor instead of going to medical school I often found myself lost and totally absorbed in the stories old people had to tell. What rich and colorful encounters I have had. But my most gratifying moments were with the team we had in our program. The issues I was presented with ran the gamut from primary medical dilemmas, which drew me to active liaisons with primary care physicians, to the practical issues of dealing with the financing and structuring of long term care. I became acutely aware of how our society does not deal wiht the fact of chronic disability and has refused to look at the costs and human issues involved. What irony for me that my family is taking its place with the thousands of families who struggle with the financial and social issues that emerge at the end of life.
But the most fascinating subset of these issues for me have been those which emerge when consulting with chronic care faciliites such as nursing homes. In a society which does not value getting old (a word rarely linked with "wise" anymore, much more likely linked with "dottering") it is not surprising that those who work with the chronically ill and disabled are devalued. Most who work in nursing homes feel this. Many rise above this stigma and are truly angels to those in their care. What has struck me is that under the pressures of intense and difficult work, inadequate resources, unclear administrative directives and poor medical leadership, nursing home staff are particularly vulnerable to becoming embroiled in painful conflicts. The tension in the staff invariably has an indirect impact on the patients. Our patients, those with primary or secondary psychiatric issues, seem particularly vulnerable. How often did our team intervene, when asked to facilitate a hospitalization or add a new medication, by talking to the nurses about changes in staff, conflicts between departments, or new administrative mandates which seemed to "break the camel's back." Cultural misunderstandings seemed to abound as the staff seemed to be a mini United Nations; all races, nationalities and accents. The appreciation of the full array of issues impinging on a patient and their helpers provided for classic opportunities to practice community mental health and for me to function as a true community psychiatrist.
As I dealt with the inadequacies of the nursing home for my father I found that my admiration for the staff and my appreciation of their dilemmas enabled me to be kind to them. I was able to give some perspective on the ordeal to my family so that they could be understanding and see the genuine caring my father had received while in the facility. I found myself actually recalling my days as a psychogerontologist with a bit of nostalgia and a longing to be back in that wonderful and gratifying world.
Charles Huffine
President
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