Hello, new health minister. She previously pointed out that we are going to be more elderly on fewer hands. I was quite provoked when she said that, although she is probably right. Several times during a working week, I worry about how we as a society, as a healthcare system, will look after our elderly in the future. Personally, I am unsure whether I will be able to stay in the fantastically important and rewarding care for the elderly as a nursing home doctor when the future looks so bleak. That should worry you. As a full-time nursing home doctor, I know something about where the shoe presses in Norwegian elderly care. Or wait a bit. I may not know it, but I know someone who does. That is what the healthcare worker does inside the shielded ward with a locked door. You know, where the most wandering and outgoing dementia patients live. Where they have their home. The healthcare worker in a sheltered dementia ward actually knows quite a bit about where the shoe presses. She sees the terrified patient in the corner, who has hid behind a potted plant and is having his third panic attack that day. She also sees the tall man at the bottom of the hall who is about to punch his neighbor because he has misunderstood a situation. The only problem is that this health professional is about to follow “Ellinor” to the toilet, and she knows it’s urgent. She can’t let go of “Ellinor’s” hand, because then she falls. It is the same healthcare worker who has not gone to the toilet himself since the shift started and who has not eaten either. Her main goal for the shift is to bring about a peaceful communal meal with the nine troubled, scared, confused, wonderful, unique residents of this ward. But it doesn’t work. Because this department is on fire. The healthcare professional knows well where the shoe presses. Sometimes she manages to document well, or explain to me even better, what happens in the department. She knows she has to, in order to even get me on board with the idea that one of these residents needs sedative medication. I visit once a week. For the healthcare worker, I’m probably just the quick doctor who they never see and who can’t possibly know where the shoe is pressing. She who always leaves the scene. I try to help as best I can. While I disappear after a visit because another department is waiting, or run to something urgent in the middle of a sentence, the healthcare worker cannot leave the scene until the end of the shift. Then she, too, can breathe out, draw air, regain her composure and get out of the closed door to the sheltered ward. So maybe she doesn’t quite know where the shoe presses either? It’s probably she in the corner panicking, him with his fist at the bottom of the hall and she who had to pee so terribly, who really knows where the shoe presses. Who is locked in a chaotic ward and can never leave the scene. The most vulnerable of us. Who cannot write chronicles about their own situation. Who do not get to express what they need. Fortunately, we know what they need. I have read what they need. The healthcare worker knows firsthand what they need. Relatives often know very well what their loved ones need, and thank God for them. Often we, the support system and relatives around the sick or elderly, are in agreement. We work with the same goal: to give the nursing home resident as dignified and good an end to life as possible. We know that our residents should not have antipsychotics that make them walk crooked and can have a heart attack. They don’t need sedatives that make them lethargic. Yes, some people need medication and help, don’t get me wrong. We must have clearer guidelines to avoid doping nursing home patients. Believe me, we work hard every single day to avoid doing just that. Our residents need person-centred care. It helps that we know that he loves to weed the garden with his fist. That we are aware of the traumas she has with panic from her youth. If we are to manage to provide person-centred care to our complex, multi-ill nursing home residents, we need two things; competence and that we are enough people. If we are to manage to look after our residents in a dignified way, avoid both overtreatment and undertreatment, i.e. hit the right level of treatment for the individual, competence and personnel must be in place. Then you can be guided away from hitting. You can be reassured and held around when you panic. And you can be allowed to pee on the toilet and not in your trousers or nappy. Do you know, Minister of Health, that only one person looks after our nearly 30 residents in the sheltered ward at night? Do you know that it is also normal for patients with dementia to have a disrupted circadian rhythm and to be restless at night? Then it is perhaps not so strange that I, as a nursing home doctor, am asked to prescribe sleeping pills. It is challenging to work with people who need health care, when there is such a large discrepancy between what we know they need, and what we are able to give them. Some of the most vulnerable and most complex patients we have in the Norwegian healthcare system deserved better than we are giving them today. In Norwegian nursing homes today, there is understaffing and far too little competence. That is the truth, dear Minister of Health. It already hurts a little every day at work to feel this. That’s why I dread what our care for the elderly will look like in 20 years. We’re probably going to get more elderly, on fewer hands. So what do we do when a department is already on fire? How do you, Minister of Health, want to be looked after if you get old and sick? (news knows the author’s identity. He writes anonymously out of consideration for his patients and their relatives.) Published 04/08/2024, at 21.28
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Elderly care in downhill – Statement
