Is It Safe?

Hoffman

It won’t be the first thing hospice asks you, but it’s important.

“Is it safe?”

The above was not a query from hospice, but the riveting question posed in the 1976 film Marathon Man. During a grim, crucial scene, Laurence Olivier’s menacing character demanded—as he wielded dental equipment in the worst way—to know if his scheme could be safely accomplished.

Dustin Hoffman’s “innocent man” paid an excruciating price for every hesitation, every uncertainty.

I sometimes thought of the Olivier-Hoffman confrontation when one of the hospice’s social workers announced a patient’s house was “safe.” During the discussion about a new patient entering hospice care, the “safe question” must be asked and answered.

Which is to say . . .

Are there are any weapons in the home?

Based on 2017 statistics, 55% of the almost 1,500,000 Medicare-connected hospice patients in the United States were treated at their place of residence by hospice staff. Residence includes nursing homes, residential facilities, and all of those in their “home sweet homes.” (Those not in private residences were served in a hospice-owned facility or acute care hospital.)

According to a 2017 Pew Research study, 42% of American households have at least one person who owns a gun. Various research projects have concluded there are likely 300,000,000 guns in the United States—which means there is nearly one firearm for every man, woman and child. Pew’s report states this modern truth about firearms: “Americans have a deep history and a complex relationship with guns. A point of pride for some and a source of fear for others, guns continue to ignite sharp debates in our society.”

Obviously, many hospice staff will be welcomed into private homes. Equally obviously, the staff never knows by simply glancing around if this household has or does not have firearms. The hospice where I worked (and I suspect this is the case with all hospices) requested that either guns are removed from the home or that they are clearly locked and . . . safe.

A hospice agency might not care for a patient without this reassurance.

Since many don’t own guns, the hospice question will be easily addressed by them. For gun owners, the majority quickly comply. A daughter takes her father’s shooting range pistol to her place. The family already has the weapons in a secure cabinet or vault designed for firearms. The spouse purchases a simple locking mechanism for the hunting rifle and stores the ammunition in a separate location. Complying with hospice’s request is cheap and uncomplicated.

Only a very few hospice patients or families disagree when the gun question was asked.

The resistance is rarely a second amendment debate (the right to keep and bear arms), but more of a you-can’t-tell-me-what-to-do cry for independence. Along with the other emotions individuals and families experience when entering hospice, they don’t want to lose control of the significant, or insignificant, parts of their once normal life.

Why does hospice ask the question?

  • We want the patient to be safe and not have a gun to use for suicide or threats.
  • We want the family to be safe and not have to worry about any accident.
  • We want the visiting medical staff to be safe, not threatened by a frightened patient or a random bullet from an accident or suicide attempt.

Whether suicidal, homicidal, or accidental, guns represent a different threat than other weapons (scissors, knives, the Marathon Man’s dental tools, shovels, etc.) in the home. Once a bullet leaves the barrel, it can easily penetrate walls, windows, and flesh. Bullets can strike objects across the street or many blocks away. A bullet from a .22 rifle travels upwards of a mile. A shot from a .38 pistol will traverse the length of two football fields in less than a second.

  • But nothing bad will ever happen!
  • The patient is bedbound and can’t go to the bathroom by herself.
  • The patient is medicated and barely communicates.
  • Cancer wrecked his body and he can’t even eat unless someone feeds him.

All true, and not true.

Back in the 1990s, I worked as a hospice chaplain. We had a bedbound patient. Each day revealed his slow, sad decline. One of our support staff—she helped families with housework—routinely arrived at the patient’s home when most of the family was resting. It was a time when the patient usually took an afternoon nap. Soon after she entered the house, a gun was fired. The patient had managed to leave his bed, crawl to his closet, and find the gun that everyone claimed had been removed.

A suicide.

It was terrible, messy, horrific death. All suicides shatter more than one life; the patient’s family would struggle with anguished questions and a sense of failure for the remainder of their lives. I recall, in the late afternoon after the bullet was fired, sitting with my hospice colleague, comforting her, reassuring her that none of what had happened was her fault. She too was a victim of his suicide.

Whatever position we take on guns and gun violence, the annual statistic that always troubles me involves suicide. Of all the thousands of deaths by a firearm in 2017, 60% were suicide. I have no idea how many of those bullets may have been fired during hospice care, but one would be too many.

Is your house safe?

It’s an essential question asked by hospice. It’s not a political question. It’s not a gun control question. It’s not a second amendment debate. It is, like so much of what hospice tries to do as they enter into a home, an effort to make sure everyone is well cared for and that everyone is safe.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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