During my first job, in an SNF, I was taken aback by the diffuculty of discharge planning and family meetings. Family members were reluctant to accept that their loved ones needed more help. Patients were unprepared for the reality that a time would come (had come) when they would be unable to care for themselves independently.
During this time I was thankful to come across the book, A Bittersweet Season, by Jane Gross. Ms. Gross is a NYTimes columnist who writes deftly of her personal journey with her mother's physical decline, which began with trips to the ER and ended in a nursing home stay. The book balances personal insight into the role reversal of children caring for their parents with helpful information and statistics on national healthcare delivery.
I found the book informative and challenging. I would recommend it to anyone who works with elderly clients.
"Until she reached the nursing home, no doctor or other medical professional ever asked her for her goals of care. Did she want to live as long as possible? Or was day-to-day quality of life, independence, and level of functioning more important than longevity? In the same vein, no medical professional ever suggested or assembled a family meeting on this subject, even though Michael and I would surely have a role in how she met those goals."