Margaret Rusnak

Edith* is an 83 year old woman admitted to the hospital for abdominal pain. Upon evaluation, the occupational and physical therapists learned that Edith also presented with balance issues while walking, although Edith claimed that she did not need a walker or other support to get around her home. Edith lives alone with her cat in a home that had 5 steps to enter and her closest family lives more than one hour away. Because of Edith’s risk of falling, the therapists recommended that Edith be discharged to a SNF (skilled nursing facility), where she could receive daily therapy to address increasing her standing tolerance and endurance during functional activities of daily living (ADLs).

But Edith had other plans. Edith refused to even consider going to a SNF. When the healthcare providers couldn’t easily convince Edith to discharge to a SNF, they labeled her as difficult.

However, when I spent a few minutes talking with Edith I discovered that Edith was afraid to go to a SNF because she was afraid of losing her independence. She’d stayed at a long-term care facility previously and she didn’t want “sick people staring at [her]” all day. Plus, she worried about the welfare of her cat, who was her friendly companion. Edith asked about home health services but her insurance wouldn’t cover the 24-hour supervision that the therapists believed Edith needed in order to be safe. Because the only other choice offered to her was untenable, Edith decided to return home upon discharge and take her chances with a potential fall.

She asked me, “Am I being difficult? Why is everyone pushing me to go to a nursing home?”

As an occupational therapy intern at a rural hospital, I saw cases like Edith’s many times. A healthcare provider who was well-intentioned would push an agenda that did not take into account the feelings or needs of the patient. Because the average hospital stay is 1-3 days, the provider needs to accomplish many tasks for patient care and sometimes the task list seemed to be more important than the patient’s understanding of the process.

By taking a few minutes to talk with Edith (and other patients like her), I realized that many of these so-called “difficult” patients were reacting from places of fear or ignorance. A few minutes spent to discuss the medical process with them resulted in allayed fears and informed healthcare consumers. The patients were then more likely to comply with plans of care if they felt that their needs were attended to and that their wishes were respected.

Respecting patients as unique individuals rather than mere to-do items on a task list is a lesson that I will take with me into my professional life and apply to my clinical practice for years to come.

* All patient identifying information has been changed to protect confidentiality.