An article in [last] week’s New York Times entitled Feeding Demented Patients with Dignity suggests that hand feeding dementia patients may be a better option than tube feeding them.
My God, are we really putting feeding tubes in the elderly demented? When did this happen?
During college, I worked as a nurses aide in a nursing home outside Philadelphia. For 20 hours a week (40 hours in the summer) for two years, I cared for patients in all stages of dementia, from the walking confused through to the end stage, stiffened victims confined to wheelchairs or beds. But in all that time, I never, ever saw anyone with a feeding tube.
As an aide, one of my main duties was feeding the patients. Whether it was solid food cut into small pieces,soft food mashed, or pureed food, we fed them. By hand. Three meals a day, seven days a week. What else did they have to do all day and what else was I there for, after all? Mealtimes were our touchstones, and we marked our days by them. It gave us all something to do.
I particularly recall one elderly woman I helped care for one summer almost every day for two weeks. She was at the worst, end stages of dementia. Stiffened with contractures and moaning constantly. When she wasn’t moaning, she spoke her catch phrases — they all seemed to have catch phrases — strings of words spoken over and over, almost like a mantra. Getting her up and dressed every day took two of us at least an hour. Changing her diaper, cleaning her, rubbing lotion into her skin to prevent dryness and breakdown, getting her into a chair, then changing the sheets, adjusting the lambswool mattress cover.
Then I fed her. It took a half hour or more.
I gave her tiny, tiny amounts of food on a spoon — for breakfast, hot cereal and a mashed soft boiled egg. For lunch and dinner, pureed meat , fruit or vegetables. Sometimes she ate eagerly. Sometimes I had to cajole her. Sometimes I got frustrated, or annoyed — I expect, at those times, she was as well. I remember that we were told to try to make sure they got protein in some form — soft boiled eggs were a god send in this regard, because almost every patient ate them well and eagerly. I tried to figure out what foods she liked and focused my efforts on those, but sometimes, she downright refused to eat or spit the food out. So we stopped — until the next meal.
And then, one morning, I came to work to find that she had passed. I have no idea what ultimately caused her death. But until the end, we fed her.
Are you telling me that today, this poor woman would have had a feeding tube because she couldn’t feed herself? And that it would take a social worker to intervene to suggest that perhaps someone might try feeding her by hand instead? Infants can’t feed themselves, but we don’t put feeding tubes in them, do we?
I ask you again — how in God’s name did we come to this?
I know the answer, of course, as do you. It’s because we have shifted the dollars in healthcare away from those who actually provide the care to those who make the diagnostic tests, the drugs and the devices — and the feeding tubes.
Thanks to Info Snacks, which is fast becoming one of my favorite feeds, for pointing me to the NY Times article.
*This blog post was originally published at The Blog that Ate Manhattan*