She Had No Family

Thelma was 88 years old, she never married, and had no children. She had outlived her siblings and had no other family, but she did have good friends. She had always lived independently, driving her own car, doing her grocery shopping, and managing her finances. Her mind was sharp, though her body was beginning to slow her down.

A fall had left her with a shoulder injury, and she was referred for home health occupational therapy. I treated her for several weeks, helping with her shoulder pain, and eventually discharged her. A few months later, I received another referral, but this time, Thelma was living in a group home. She had suffered a severe stroke and could no longer live alone.

When I arrived at her bedside, her mind was still sharp. She remembered me and smiled with recognition, happy to see a familiar face. But the stroke had been devastating. She had completely lost use of her left arm and leg and was unable to sit up. Thelma was now bedbound, fully reliant on her caregiver for all aspects of daily life. She could still speak, but she had lost the ability to swallow and required a feeding tube for nutrition.

It was heartbreaking to see such a strong, independent woman rendered so helpless yet fully aware of everything happening around her. I continued weekly therapy sessions, not because she would regain function, her left hand was too damaged, but because she needed the company and the human connection.

The group home was run by Helen, a woman in her mid-60s who provided most of the care for the four residents. Helen prepared meals, changed linens, and bathed the patients. During my visits, she would often hover in Thelma’s room, commenting on every part of the session. It felt like she didn’t want me alone with Thelma. Eventually, I began closing the door to give us privacy, allowing Thelma to open up about how miserable she was living there.

Helen was not kind. She frequently made degrading remarks:

“She needs to be sitting up more.”

“She’s just being lazy.”

“She doesn’t want to try.”

I would calmly explain the medical reality:

“She has lost her core strength and cannot sit up.”

“Her stroke was so severe she can’t even feel her arm to use it.”

Thelma would look at me with tears in her eyes, silently asking, “Do you see how she treats me?”

One day, Thelma confided that every time Helen pushed formula into her feeding tube, she experienced sharp stomach pain. Helen would inject the food quickly, instead of slowly, as proper care requires. When Thelma complained, Helen dismissed her:

“That’s how it’s supposed to be done.”

“I don’t have time to do it that way.”

After just two visits witnessing this abuse, I contacted my supervisor. I knew Thelma needed to be removed from that environment, and I told Thelma I had someone working on it.

The few weeks later, when I called to schedule another visit, the caregiver informed me Thelma was in the hospital.

A call to the home health agency confirmed that Thelma had been rushed to the ER where doctors discovered internal bleeding.

A few days later, my supervisor called to let me know that Thelma had passed away.

Disclaimer: All content is provided for educational and informational purposes only and is based on my personal and professional experience as an occupational therapist. It is not intended as legal, medical, or financial advice. Names and details have been changed to protect privacy.

Thelma’s experience stays close to my heart, even after all these years. It showed me how urgently we all need a plan in place before a crisis; while we still have time to choose someone who will stand by us and shield us from unsafe caregivers when we’re most vulnerable.