It wasn\u2019t the Thanksgiving holiday any of us had expected.<\/p>\n

Two weeks before, my 94-year-old father-in-law, Melvin Zax, suffered a stroke after receiving dialysis and was rushed to a hospital near his residence in western New York.<\/p>\n

There, he underwent a series of tests over the course of several days. With each test, Mel became more agitated. His hearing aids weren\u2019t working right, and he didn\u2019t understand what was happening.<\/p>\n

Amid the hubbub of a busy hospital, Mel wasn\u2019t sleeping at night. He became delirious, a frightening and all-too-common experience for older adults who are hospitalized.<\/p>\n

For two days, Mel was housed in the emergency department; the hospital had no regular rooms available. Similar scenarios are playing out across the country, as hospitals stagger under a surge in respiratory illnesses and covid-19-fueled cases alongside acute staffing shortages. Older Americans are at particular risk: About 1 in 5 emergency department visits<\/a> are made by people 60 and older.<\/p>\n

An ongoing crisis in long-term care options has contributed to the bottleneck. Some seniors are occupying hospital rooms longer than necessary because there\u2019s no place else for them to go. Many nursing homes and home care agencies aren\u2019t accepting new patients because they simply don\u2019t have enough workers.<\/p>\n

Staffing issues at my father-in-law\u2019s hospital were apparent. My husband, who was at a conference in Montreal when his dad was first hospitalized, called repeatedly but couldn\u2019t get through to a nurse or a doctor for hours. As far as we knew, Mel\u2019s stroke was tended to promptly, but the lack of clear communication left us with lingering doubts. How often did nurses check on him in the subsequent hours and days? How were decisions about testing made, and what consideration was given to Mel\u2019s advanced age?<\/p>\n

Mel was a distinguished psychologist who\u2019d worked part time until age 90 and remained mentally sharp. But he\u2019d had diabetes for decades and since September 2020 had been getting dialysis three times a week, a grueling therapy for kidney failure. \u201cI\u2019m a wreck,\u201d he would tell my husband over the phone after returning from a session.<\/p>\n

I\u2019d written about dialysis for the elderly<\/a>, and I knew the statistics: Patients 85 and older live, on average, two years after beginning treatment. Mel had already beaten the odds by surviving 26 months. Did the hospital staff realize how frail he was and adjust their treatment and testing regimens accordingly?<\/p>\n

\u201cAsk for a geriatrician consultation,\u201d I advised my husband, who has legal and medical power of attorney for his father and was now at his side.<\/p>\n

I worried that nothing being done at the hospital \u2014 electrocardiograms, CT scans, an attempted MRI scan (Mel couldn\u2019t tolerate that), an order to wear a heart monitor \u2014 would change Mel\u2019s prospects. And he was increasingly agitated, groaning and throwing his arms out in seeming distress.<\/p>\n

Some of what hospital doctors suggested simply didn\u2019t make sense. Mel had been taken off statins for high cholesterol in the past year; a hospital physician put him back on the medication, citing the risk of another stroke. Was there any chance it would really make a difference? (Statin therapy is not recommended<\/a> for people near the end of life.)<\/p>\n

Six days after his stroke, Mel was discharged to the nursing home where he\u2019d been living for four months following a previous hospitalization. It\u2019s part of a well-run senior living complex with a top-notch geriatrician who oversees medical care.<\/p>\n

That geriatrician was the first to acknowledge that Mel might be dying. Gently, he told my husband that Mel had been depleted by all the interventions he\u2019d received in the hospital and recommended that dialysis be stopped. Compassionately, he explained that Mel would probably pass within a week or two of ending the therapy.<\/p>\n

Mel was barely conscious and unable to express what he wanted at this critical juncture. But my husband knew the ferocity of his father\u2019s desire to live. \u201cLet\u2019s try one more session of dialysis and see what happens,\u201d he told the doctor.<\/p>\n

It didn\u2019t work: Mel\u2019s circulatory system was too compromised for dialysis to proceed. Over the next few days, Mel\u2019s six grandchildren and three sons and their wives traveled to be at his side.<\/p>\n

My husband realized it was time to arrange hospice care, and a social worker met with us to describe what that would entail. An aide would visit Mel several times a week, she explained, but that would take a few days to set up because of staffing issues. Meanwhile, a nurse would visit in the following days and we could call the hospice 24\/7 for help.<\/p>\n