Systems Imperative - what if families say NO - 2023 08 22

 

Hobson's choice - 

1. : an apparently free choice when there is no real alternative. 

2. : the necessity of accepting one of two or more equally objectionable alternatives.

I have been thinking about family caregiving from a system's perspective and the impossible situation families are put in when one of their family is no longer able to fend for themselves. The family is put in the position of having to make decisions on behalf of their family member to ensure the family member's health and well being. There is no choice in this situation. The family must step in to support their family member. 

The Hobson's choice would be to either step in and support the family member or to step away and not support the family member. Both of these scenarios carry a great weight of responsibility and requirement for internal and external negotiation. We may tell ourselves that we have a choice and it is unthinkable that we would not step in to support our family member, no matter what it takes. We may tell ourselves that we have a choice and it is not possible that we would change our life plans to support our family member.

When I was presented with the 'choice', I fell into the first group. I could not bear the thought that Mom would be put into a long term care facility where her increasing frailty and ill health would mean she was less able to fend for herself in an institutional setting. I could not bear the thought that Mom would have less contact with family because of the impact of Covid on long term care policies for family visitors. I could not bear the thought that Mom, who had spent 40 years in mental health group housing away from her family, would also live out her final years in isolation from a family home.

However, if we look at families on a scale of 1 to 10 - 10 representing families who score highest land in the first group, and 1 representing families who score lowest land in the second group.

What happens to our healthcare system when families who land somewhere in the middle, in the 3 to 8 range, decide they can better survive in the second group rather than the first? What happens to the 627 billion in unpaid family caregiving that is currently bolstering the healthcare system when women start taking the second option, even knowing it will also cost them in terms of anguish, guilt, and possibly remorse?

At present the healthcare system is fraying at the edges of a centrifuge that spins on a central concept of self-destruction. If we don't change the choices women are forced to make, we are not going to improve the destructive impact of family caregiving on families' socio-cultural vulnerabilities.

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