Home Is Where The Heart Is
November 8, 2019
By Tammie Guy, ComLink State Manager Care Services.
Once upon a time, in a land far away, people got old and died in the family home. If you were lucky enough that is. The alternative of course, is get old and die in hospital.
When I first moved to the Sunshine Coast back in 1997, I asked many locals about the whale shaped island just off Mudjimba Beach. Everyone seemed to have a different name for this island. It intrigued me. I wanted to know more.
In those days, there was no internet, or if there was, I didn’t know about it, so I relied on the knowledge of the locals. What I was led to believe all those years ago, was, the Island is named “Old Woman Island” and Aboriginal Dreamtime Legend has it that the Aboriginal Men from the local Sunshine Coast area would send their wives out to Old Woman Island when they got old, to die.
Its 2019 now and I’m still none the wiser. I have “googled” the Island and there are a couple of different versions of the Aboriginal Dreamtime story on various web pages. I’m not sure which version is true, but, it has me thinking about our journey to death and how far we have come as a nation when dealing with dying.
When I first became a nurse, in the late 1990’s, I worked in a hospital. The goal was to provide care to patients who were unwell, so they could get better and go home. I enjoyed it, I found it challenging and rewarding at the same time. But I didn’t form any real bonds with the patients, mostly because their length of stay was often very short. Too short to really get to know them. And I didn’t really like that!
So, I made the move to residential care, or a nursing home as it was called back in those days.
I remembered visiting my Nan in a nursing home, something I did quite often because I knew the end was near. I could see her health deteriorating before my very eyes and I wanted to cram in as much time with her as I could. I was on a mission to fill my mind with what would end up being memories for today. Well that’s how it felt at the time, but as I write it down, I think it was probably more about spending time with her simply because I loved her so much.
Apart from the obvious reasons, one thing I loved about my Nan was her stories. I could spend hours listening to her tell tales of her almost 80 years on this planet. She was married to an absolute gentleman, who sadly passed away very suddenly in his early 30’s, and together they had 6 children, one of which was a baby born with a disability.
As a single mum to her own 6 children, my nan also took in other children. She would hear sad stories of neighbourhood kids being abused or mistreated and she offered them a safe place. She never revealed the horrific things some of these kids went through, she didn’t think it was necessary for everyone to know that information. But she would often remark, “if you can help, you should help”.
While there was no formal documentation for taking in extra children, no assessment to make sure you were a suitable carer and no police involvement. It was not unusual for my nan to have an extra 3 or 4 children living with her, on top of her own 6 children.
I don’t imagine there would be many single mums of 6 children, willing to take in a few extra kids these days. But things were different back then. Life was very community minded. Neighbours talked every day, they looked out for each others children, they mowed each others lawns. They were connected to their home and their community!
Very early on in my role at the nursing home, I remember being told by my manager, the Director of Nursing, that residential care is like Gods waiting room! God’s waiting room? Really? That’s how we look at these older people. Tick! Tick! Tick! Waiting for that precious heart to beat its final time? I couldn’t believe what I was hearing.
Unfortunately, that sentiment seemed to be common within the Aged Care industry. Old people who could no longer look after themselves independently, were forced to live in an unfamiliar environment with people they didn’t know, while they queued for the gates of heaven? I struggled deeply. I didn’t know how to nurse to that mind set. After all, I was trained to help improve someone’s poor health and quality of life, not just sit back and accept their decline because of the number of years they have been alive.
Why was that message lost in Aged Care? Why did we as a society adjust our thinking from health improvement to death acceptance, simply because of age?
The difference between me and my nursing home colleagues was immediately noticeable. Not only was I at least 20 years younger than most of the other nurses, I also had a very different approach to caring for the people in the nursing home. I wasn’t the task orientated employee, smashing out the duties as though we had to meet some kind of quota. It took me longer to complete the medication round. It took me longer to feed a resident with dysphagia (swallowing difficulties). It took me longer to change the dressing on a wound. And it frustrated some of my colleagues. But I didn’t care. Because the longer it took me to complete a medication round or feed a resident or change a dressing, meant I was spending more quality time with that particular resident, individually. I wanted to know their life story. I wanted to know what made them happy. I wanted to know how best I could help them and improve their quality of life. After all, that is the core purpose of nursing.
Death was certainly a regular part of nursing in a residential facility. My non-nursey friends would often ask how I handle being surrounded by so much death, how can you stand to see someone die? Well, the answer is very simple. I believe people often choose when they take their last breath, I’ve been part of death enough times to know this to be very real. Some people wait for a special visitor, some wait for a special date, some even wait for a special visitor to leave, but whatever the reason, I believe some people in the final stages of life make a choice when to take their final breath.
With that in mind, having people pass away while I am sitting at their bedside holding their hand is nothing short of a privilege to me. What an honour it was to be there during that final precious moment of life as we know it.
While I found those moments peaceful and somewhat beautiful, it wasn’t perfect. The one thing I found difficult was the dying person wasn’t in their own home, their own bed, surrounded by all their own belongings, connected to their own history. Connected to their own life.
My nan was in a nursing home for 18 months. It was a single room with an ensuite, and a window looking out onto a perfectly manicured lawn. There was a large family photo sitting on a shelf and a TV hanging on a bracket from the ceiling. The walls were empty. The small wardrobe had a few items of clothing, probably enough for a weeks worth.
The furniture was not hers. The curtains were not hers. The bed was not hers. The room was not hers. My nan passed away in that room…. The room that was not hers.
Fast forward to 2019! How things have changed… for the better. Our Government has realised the many benefits of people remaining in their own homes longer. Its all about choices and opportunities. The introduction of Consumer Directed Care, specifically in the Home Care arena, means older people can access the essential care and support they need to remain living in their own homes longer and independently.
Historically, when older people lost some or all of their ability to independently maintain certain activities of their daily life, they would be admitted into “God’s waiting room”. But now, with increased choices and options in Home Care, such services as clinical care, allied health, social support, home modifications, yard maintenance, personal care, domestic care, transport and even palliative care, means older people are avoiding early admission into nursing homes and remaining in their own homes longer.
I think back to the Aboriginal Dreamtime legend of Old Woman Island and the Indigenous women who went to the Island to die. And it means more to me now.
Indigenous Australians have a long standing spiritual connection to the land with a history of living with the land as opposed to living off the land. The difference is significant. But regardless of your spiritual or emotional connection, the point is, it matters. The ladies who went to Old Woman Island to see out their final days of life as we know it, ended their journey spiritually connected to the land they lived with, surrounded by their own unique history.
While “stuff” was not important to my nan, the place where she raised all those children was. Her home was her history. It was where her memories were made, where her children were raised, where her heart belonged.
And, as they say…. home is where the heart is!