By Brian Hennon
Hanging on the wall of the personal care home was a white board with several columns of information. It’s a familiar sight in most facilities.
In one column there were room numbers and next to the room number was the name of a hospice agency providing care for the resident who lived in that room. There were no less than five different hospice agencies on that board.
The next column was another list of room numbers with the name of the home health or therapy group seeing the resident.
Then there was the column marked “hospital” with several room numbers underneath indicating who was currently out of the building at a local hospital.
A final column simply said “at risk” with about eight or nine room numbers.
I asked about the first column. Personal Care Homes don’t usually have that many hospice agencies in their building because it’s a recipe for confusion.
Case in point, a few years ago I received a call from an angry executive director asking why my hospice agency didn’t show up to pronounce a patient who had passed away. When I looked up the patient’s name on our Electronic Medical Records system, they were nowhere to be found.
Turns out the patient was being cared for by a different hospice, but in the heat of the moment, the overnight staff got things confused and called the wrong one.
Back to the white board...
I asked how they got so many different hospice agencies in their building and she said, “they went to the hospital and the hospital sent them back with those hospices.”
There was frustration in her voice as she shared that information. She didn’t want that many different hospice agencies in her building, but even more importantly, she was frustrated that so many elderly residents had to endure an unnecessary, and even harmful, trip to the hospital.
That’s when we moved on to the “at-risk” column. Each room number represented a person, advanced in age, with some form of chronic, life-limiting illness. In most of those cases, those people had already been in the hospital and they were only getting worse.
The falls were increasing.
The symptoms were worsening.
The dementia was progressing.
The hospitalizations weren’t helping.
In an article published by the Mayo Clinic, Dr. Allyson Palmer illustrated why hospitalizations may not be beneficial, particularly for older adults.
“Older adults may also have functional impairments that are preexisting, such as mobility limitations or cognitive impairment that could increase their vulnerability to hospital-acquired complications.” (Mayo Clinic Press Editors, 2025).
It’s counterintuitive in our treat-at-all-costs healthcare system, but the reality is, hospitalizations are not always in the best interest of those with declining health.
Sometimes they just make things worse.
Worse still, many times repeated hospitalizations hasten someone’s decline rather than slowing that decline.
So, how do we know when to stop calling 911?
What do we look for when making that decision for someone we love?
The best way to answer that is by sharing two illustrations.
First, meet Dave.
Dave had been receiving treatment for lung cancer for about a year.
Chemotherapy...radiation...immunotherapy...proton therapy...
While receiving those treatments he had been in the hospital three times. Dave was 5’ 10” and two years prior, he was 175lbs, but now he weighed 105lbs and had to punch about seven more holes in his belt to keep his pants up.
He couldn’t eat, sleep and he was in constant pain. Even worse, with every new treatment, he got sicker and with every hospitalization he grew weaker. He had bruises all over his body and now had a wound developing on his sacrum due to lying in a hospital bet so long.
Now, meet Edith.
Edith was diagnosed with cognitive impairment when she was 80. It started with some mild forgetfulness, but quickly progressed and she ended up in the hospital after she was found wandering in the neighborhood, looking for her childhood home.
While in the hospital Edith became agitated and angry, lashing out and throwing food. Her children blamed her behaviors on medication and asked the doctor to try something different.
Unfortunately the new medication came with new side-effects which extended Edith’s stay in the hospital another three days.
While there she became even more confused and because of being in her hospital bed so long, she lost the ability to walk independently, and now her family had to find her placement because she wasn’t safe at home.
They found a nice, clean personal care home and moved Edith into a private room. She hated it and began to scream for them to take her home. Edith even called the police one night claiming to be kidnapped.
One night she fell while trying to transfer from her wheelchair to the toilet and the facility staff sent her to the hospital even though there were no visible injuries.
Edith was wheeled into the Emergency Room at 4 a.m. and she laid in the bed for two hours before being whisked into another room for an x-ray...and then another for a CT scan...and yet one more for an echocardiogram.
She was surrounded by people she didn’t know, in rooms she didn’t recognize, being peppered with questions she couldn’t answer. She was terrified.
When she returned to her new home in the facility the staff immediately noticed she was now weaker and more confused.
These are just two examples, but there are so many more.
My aim with this article isn’t to talk anyone out of treatment that may be beneficial. If there is a good chance for healing or recovery, then by all means, please pursue that treatment.
But, please remember this: the hospital is not the answer for everything. Sometimes it just leads to more questions.
If your loved one is in a facility and on that white board in the “at-risk” column, please consider whether another hospitalization will increase their quality of life or decrease that quality.
Will one more trip in an ambulance make things better or worse?
These aren’t easy decisions, especially when someone we love is involved and sometimes it helps to talk them through.
If that’s you and I can help, please head over to my contact page and send me a message.