Ramanujam was  a feisty, independent-minded, and solitary 92 -year-old man who, after a fall and many complications, had been living in various ‘care homes’ for more than three years. He never stayed in any place more than four months and Janakiraman, his eldest son lost count of it. Fed up of the incompetent and substandard ‘Care Homes,” one day he decided he wanted to go back home. A widower with three children, Ramanujam felt a longing for his house, his neighbours, and the street where he lived. For all practical purposes, he is bed ridden and need help get up and sit. But remarkably sharp with no decline in his faculties he still thinks he’s perfect to ‘age in place.’ Ever since he moved out of the house three years back has been occupied by his 68 year old elder son who himself is a widower. Ramanujam’s new found  desire became a bone of contention between the brothers. Younger son, Balaraman who lives in Connecticut, wanted to oblige but Janakiraman is hell bent not to bring him back. 

Many nursing home residents would like to go home but few have both the financial and physical ability to actually make that return journey. Although Ramanujam was determined, no one really believed that it would be possible for him to return to the community after being in a ‘old age home’ for so long. And Ramanujam had no idea of how logistically difficult it would be to accomplish his wish. He kept saying that all he needed was to die in his house, even though he was bed-ridden and his house had nine steps up from the street to the front door and two stories above that.

Problem Areas Identified

• Ramanujam unhappy because of the poor care he received.
• Highly improbable desire to ‘age in place’, because of the logistical issues.
• Elder son’s hesitation to bring back father has many valid points.
• Difference of opinion between brothers have grown  to animosity.

How We Helped

At first Ramanujam  was suspicious and sent our councillor away. We made a strong connection with Ramanujam with frequent visits.  Over the time they worked together, Ramanujam  and the councillor developed a trusting relationship that allowed Ramanujam to accept some help. No doubt, Ramanujam was stubborn and not easily convincible. Our elder care councillor’s made frequent visits to him to win over his confidence and were able to understand what he really wants. We helped him to make a choice and opt for the right care setting. 

After gaining his confidence, Ramanujam opened up and spoke to us and we felt bad as he was never given appropriate compassionate care. It was always dispassionate and sub standard. This inferior care  made him dislike institutional living. Dispassionate care givers making insolent comments while changing his diapers, bathing him and care givers hated asking for help in between while they are hanging on their favourite TV shows. Most times he missed his timely medications.  Worst was the care, he developed decubitus ulcers on his back as a result of inferior care meted out to him.  

Our investigation revealed that all the earlier care facilities, where he was admitted have no in house care takers  and it is the family who has to appoint a private caregiver. In turn, management  has no control over them resulting in poor co-ordination. Since care givers come from an independent agency where care facility has no checks on their competency or the tasks they performed for the residents. There was a huge quality deficit in terms of care extended to Mr. Ramamnujam.  Every time he raises a complaint, his carers branded him as a ‘difficult’  client and disappears without notice. Many a time  he is left want of care until the next one is arranged by the agency. In the bargain he had to change 8 care givers in a matter of 2 years, resulting in trial and error on him and he ended up in diminished quality of health. 

As per our our suggestion, Ramanujam was shifted to a new place. Ramanujam was closely monitored at the new care facility. His care goals were set, primary concern was to get his bedsores healed and stabilise his nutrition and electrolytes as well as upkeep of his hygiene and promote mobility. We participated with Ramanujam’s new care home to draw a detailed care plan. His health condition was assessed fortnightly and the same was reported to his both sons. His health drastically improved and from being completely bed ridden he started sitting on wheel chair and move around.  We were able to derive a win-win situation for patient and his both sons.