Today, I took one of my clients from the state hospital to a nursing home, as this has become his least restrictive setting. He cannot function in the community whatsoever; he would only last a week in the community before decompensating enough to need hospitalization again. Even in the group home run by my agency, where our team was with him constantly, he only lasted a few weeks at most, and was a behavioral nightmare the whole time. He does fantastically in the state hospital setting, and thus it was time for a behavioral unit of a nursing home. I advocated for this extensively and it finally was able to happen. (It is a very, very frustrating, slow, and difficult process to get someone into a nursing home, and worse still to find one that will take a client like him. Somewhere in the ballpark of forty said no when they saw his paperwork, across three different counties. We had to go to a fourth county even further away to find one that would take him.)
It’s hard to put a client in a nursing home, as that’s it. Their needs are all being met by the nursing home, so we close the client and move on. To a lot of our clients, we’re all the family they’ve got. I brought this client by the office so he could say goodbye to everybody and everyone was crying. I was in the car with him for a total of two hours going from place to place, and at one point, he said, “It feels like you’re throwing me away.”
My heart broke.
I am so scared that someday I will be like him, so very sick, no family, only a guardian making choices for me that I wouldn’t make myself, shuttled from hospital to group home to hospital again, and finally dumped in a nursing home and abandoned. I tried to tell him we weren’t throwing him away, but it was hollow, really. We will all miss him, (and I’m sure his constant phone calls will not stop until they pry the phone out of his cold, dead hands.) We were his family, and we had to make the tough call of having him put on a locked behavioral unit of a hospital an hour away from anything he’s familiar with. And what’s worse is, we won’t go visit him, because ethically we can’t. Once we close his case, he sort of ceases to exist, from a legal and ethical standpoint. At least family will come see you on holidays most of the time.
I’m terrified of winding up like him, staring out the window of a locked door and surrounded by strangers, all very sick people, watching my case manager walk away forever.
I cried the whole way home.