If you think the end of life is difficult, try compounding it with addiction.
“If you havent been able to face life sober, death is a real challenge,” says Donna Pedroza, LCSW, manager of bereavement and volunteer services for VITAS Innovative Hospice Care®.
Pedroza has worked in a number of poor and violent communities. “The old and the frail are on crack,” she says bluntly. “Dealers focus on senior buildings, and the elderly are seduced with freebies to get them hooked. Dont rule out the frail elderly as having addictions.
“At VITAS,” she adds, “we dont turn anybody away. All VITAS teams are dealing with addiction somewhere.”
“The patients terminal illness might be congestive heart failure. It has nothing to do with his addiction,” explains Mike Moss. Moss has been with VITAS Innovative Hospice Care® of Miami-Dade County for nine months, but as a social worker he has dealt with addiction for 35 years. “We do everything we can to keep that patient comfortable. Well make sure a home health aide comes every three or four days to help him with his personal care. But thats not what he wants; what he wants is his Percocet.”
So the plan of care must reflect the patients drug-seeking behavior. But addiction is multifaceted; for every drug-seeking patient, VITAS teams also care for drug avoiders: recovered addicts who refuse to take medication no matter how much they hurt. The hospice team often must give “permission to die sober,” or assurance that the patient can stay in recovery and still take certain pain medication.
Whether the addict is the patient or a family member, addiction that has affected life will surely affect the end of life. Consider, says Pedroza, the addicts family. “The addict has been in and out of jail, in and out of various programs, in and out of the familys lives, in and out of their pocketbooks. Family dynamics can be ruthless at the end of life.”
When the addict is the family caregiver, “addiction rules the house,” says Pedroza, “and the patient is neglected. She wakes up wet, dehydrated, hungry. Everyone has a right to die with dignity,” Pedroza maintains. “Our job is to put patients and families first, including addicted, chaotic intergenerational families.
“Its hard to deal with,” she says. “We just try to wrap our arms around the caregiver team.”
That team sometimes expands to include “H&I” (hospital and institution) members of Alcoholics Anonymous, who support patients who want to work on recovery issues. But even when the patient is successful, the rewards can be small.
“The typical addict has led an anti-social lifestyle; hes done some jail time,” says Mike Moss. “His drug problem becomes part of the denial process. But maybe he starts to really feel sick. Maybe hes bed bound and off the streets. He goes through withdrawal and we do whatever we can to helpand to set limits.
“My attitude tends to be helpful but not bleeding-heart. His denial breaks down, and I talk about funeral plans, maybe get him some outpatient psychiatric help. In the end, we just hope to help him function better for whatever time he has left.”
But Moss sees positive stories too. He cites a VITAS patient, 80 years old, who is diagnosed with end-stage COPD. He lost his partner of 37 years 12 months ago. “He describes himself as a recovering alcoholic and drug addict for 46 years. He relies on the life skills he learned in Alcoholics Anonymous and Narcotics Anonymous to get him through each day, good or bad.
“Meeting with him,” says Moss, “is inspiring. He still exudes so much hope and optimism.”
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