Paternalism

I've written here before about dignity being a hot topic among those in the eldercare field. This month, I've been thinking a lot about rights and paternalism. We're working with adults, and they generally retain the rights all adults have: to vote, to make financial decisions, where to live, etc. A few of our residents have court-appointed guardians (family members) because they weren't able to handle those rights anymore. But for the most part, you can't really tell your parents or grandparents what to do unless they're so confused they don't notice you're doing it. We use words like "encourage" and "persuade" and "offer" a lot when talking about getting our residents to bathe, eat, take their meds, etc. Because that's all we really can do. It's easy to think of old people as overgrown children (especially because bald, toothless, and diapered describes babies just as well as very old people). But they're not children, and don't want to be talked to like they are. Usually that makes sense to me, and there aren't many rights that I want to take from the people I care for. The "right" that I have the most difficulty with at my facility, though, is the right to get drunk.

The idea of an elderly alcoholic is a little weird and off putting, probably because you either had one in your family, or because you think old people are unintelligible and clumsy enough sober. I wonder if we know fewer elderly alcoholics because the WWII generation tends to hide it more, or because alcoholics usually die younger?

At any rate, the fancy-shmancy AL facility I work at has a bar, and has a handful of alcoholic residents. This adds up to a lot of falls and a lot of belligerence for staff to handle. We're constantly speculating as to why the bartenders serve as many drinks per resident as they do, but my instinct tells me that they probably want to avoid the ugly scene that happens when you cut a drunk off, so they cave.

This weekend, I had a run-in with one of my drunken "frequent fliers/fallers". While he was still sober before dinner, I took him outside to smoke. Residents who smoke have to turn over their matches, lighters and cigarettes to nursing staff, and we store them where we keep the meds. If they want to go out to smoke, a lucky aide (sarcasm here - I'm a nonsmoker) gets their things and escorts them out, then takes the person inside again and puts their things away. This is because not only is it state law that you cannot smoke in a public building (including bars, even) but we've got a lot of oxygen tanks throughout the building for people who need them to breathe, and those are combustible.

Smoking and drinking go hand in hand, and the last thing we want is our drunk residents trying to smoke in their apartments, setting themselves on fire, and having their oxygen tanks fuel that fire. A lot of people could die that way.

So despite my general non-paternalistic approach, you can probably see why, when Mr.Perma-Rugburn (from drunken falls) whipped out his own lighter, I reached over and snatched it out of his hand. I've learned from past experience that he won't hand them over when asked or told. He was pissed. I was pissed. I labeled it with his name and room number, and stuck it in my supply bag to store with the rest of his smoking paraphernalia in the nurse's station.

And then another employee from a different department spoke up, "But I'm the one that bought it for him". Picture Pollyanna with steam coming out of her ears and red as a tomato. This jackass, also an adult, went and bought lighters for someone who could easily incinerate this building and all the people in it?!?!? I glared and shook my head at this employee, wishing desperately that there weren't uninvolved residents around who don't need to hear me chewing out someone they know and trust.

So what to do now? The next day I put out an APB for that employee, hoping to catch him as he went off shift, but he was too fast for me. Bah.

Later that evening, I was thinking maybe I was overreacting and should pull the stick out and calm down. Until I got a page and went in to see Mr. Rugburn sprawled on his floor once again, drunk as could be, furniture scattered everywhere, insisting that a very pregnant employee should be helping him up and slurring all the while.

This dude, plus the one who is buying lighters and cigarettes for him?

They need a little paternalism. Or a LOT.