Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.

At the beginning of the year, my grandmother found herself in an acute-care hospital, addressing blood clots in her legs and lungs. Having just recovered from COVID-19 at the age of 100, uncertainty loomed over her outcome.

In the past year alone, she’d faced two hospitalizations and, the year before, another. Any of those incidents could have resulted in death, but that hadn’t seemed to be in the cards for Grandma.

Despite numerous conversations, our family consistently opted to continue aggressive treatments in each prior hospitalization rather than transitioning to palliative care. On her 100th birthday, Grandma received over 200 cards from around the world, including a special one from the President and First Lady. At times, it seemed she’d go on forever.

After each hospitalization, Grandma received excellent skilled nursing and therapy, allowing her to return home and live independently. However, over the past year, she began to require more in-home support, and her recovery seemed to take longer. It’s possible she never fully recovered from her previous hospital stay.

When Grandma found herself in the hospital for blood clots, we assumed another temporary stay in skilled nursing for rehabilitation was in order. We meticulously tracked her hospital stay, carefully noted whether she was listed as an inpatient or observation stay, and started looking for the most suitable SNF once her placement was cleared.

My aunt shared that the last nursing home had been satisfactory, but it hadn’t won her affection. She noted that the facility preceding it had been superior, but the travel distance was impractical, and she had heard the facility lost standing after its director of nursing retired. We also considered the SNF next to Grandma’s home, and the conversation continued in this manner.

I promptly initiated a search and reviewed the local SNF’s outcome scores posted on Care Compare. While they exceeded my initial expectations, they still fell short of excellence. I took the time to explain to the family the trade-offs of this SNF compared to others, and as we focused on making a final decision, we realized a particular voice wasn’t being heard — the most crucial voice in this conversation.

You see, Grandma had no intention of entering skilled nursing this time around. She expressed her reluctance toward rehabilitation at home as well. She made it clear that she was done, tired and unwilling to undergo rehab again. Grandma had no regrets or “unfinished business”; she was ready to embrace death. She herself articulated the desire to go home under end-of-life hospice care.  

I am grateful that we were quiet enough, willing enough, and able to hear her clarion cry to honor her wishes. Six days later, my grandmother peacefully passed away in her own bed under the extraordinary care of hospice.

Throughout her life, Grandma never relinquished control of the steering wheel. Despite rarely being dealt a winning hand, her strength and perseverance often led to triumphs.

Grandma, I’m profoundly grateful that we were able to be still and hear you. I’m relieved that we never questioned whether your hands were on the steering wheel of your life. Our healthcare system often struggles to hear the voices of elderly patients. This experience served as a powerful reminder that person-centered care sometimes means simply stopping to listen.

You loved us, and this commitment to protecting our independence and choosing our own destinies was among the many invaluable life lessons you imparted to us. Through the example of your remarkable life, you showed us the significance of family and taught us the essential value of never compromising our integrity. These gifts — and your sassy sense of humor — will forever be your enduring legacy to all of us.

Grandma, your memory will always be a blessing.

Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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