Placing a relative in a nursing home may be one of the most difficult decisions a family member can make. Families may be forced to make a sudden nursing home placement because of a drastic change in the person’s health condition, such as following a stroke or major illness. Or the placement may be a planned move that includes the older person in the decision making and selection process.
Families agonize over the decision after the placement is made for weeks, months and sometimes years, asking themselves was it the right decision? The right time? Could they have made it a little longer at home? Acceptance of the placement is eased sometimes if everyone involved feels that it was the last step in a process where many other alternatives were already tried. The family may have provided a high level of care in the home, utilized formal services, or tried residential care arrangements, but the elder still had unmet needs or questionable safety.
The physical and/or emotional health of the caregiver may also have been at risk. Every family has its own threshold at which they feel they can no longer continue to give adequate care. The problems that most frequently lead families to decide on nursing home placement are the ones that require 24-hour care, such as severe memory loss, incontinence, inability to transfer himself or herself, and unsafe behavior such as inability to take medications properly, wandering, or leaving the stove on.
Families feel a wide range of emotions when making this difficult decision. They often feel others will judge them, thinking they have abandoned their loved one. They experience guilt because they may have promised the elder never to place them in a nursing home. They may feel angry that there are no other options. They may experience grief over the physical or mental deterioration of their loved one.
Spouses may feel a sense of loss and depression about being separated from their partner. At a time of such intense change, the caregiver may experience anxiety and confusion. At the time of placement, they are constantly being asked to make unfamiliar and complicated decisions for another person’s well-being. Financial concerns are universal at the time of nursing home placement, and can be another source of anxiety.
There is a myth that families don’t care about their loved ones and “dump” elders into nursing homes because they don’t want to be burdened. Nothing could be further from the truth. Families provide 80 percent of the care required by older adults, and nationally only five percent of people 65+ reside in a long-term care facility.
On the positive side, once the elderly person and their family get through the adjustment phase, the nursing home can be a good experience for both. The caregiver may experience some relief from no longer being solely responsible for meeting their loved one’s multiple needs. They may have their own health needs to attend, which may have been aggravated by the demands of caring for an relative.
The older person may become stronger, healthier and happier with better nutrition, medical attention, exercise, stimulation, and more social opportunities. The older person’s relationship with the family may improve as the day to day caregiving demands decrease.
Caregiving doesn’t end when the older person is in the nursing home, but it changes. Some of the stress of 24-hour caregiving is relieved, but the sense of responsibility does not go away. The quality of care in an institution can never be what it is in a person’s own home. Many caregivers continue to question the placement decision long after their family member is in the home.
Many caregivers visit frequently and provide a good deal of care. Caregiving becomes a partnership between the family and the nursing home staff. Ideally, this partnership can support the caregiver.
Selecting a Nursing Home
If your loved one is not entering a home during a crisis situation, you will have time to research and visit several nursing homes. You can get names of homes from the telephone book, your doctor, or local resources. Your choice of homes may be limited by waiting lists, location, or cost, but carefully exploring the options will allow you to make a wise and informed decision. Make sure you visit the nursing home, and take your loved one with you, if possible. Some things to look for and ask about:
- What levels of care are offered?
- What are the fees and charges?
- Does the home take Medicare and Medicaid?
- Does the home look and smell clean?
- Is the atmosphere pleasant?
- Do you see positive interactions between the staff and residents?
- Is the diet appealing?
- Is there a range of activities?
- Are call lights answered promptly?
- Are there support groups for residents and families?
Spend some time in the facility to get a sense of the atmosphere. Inspection reports are available through the State Health Department.
Once you have chosen the nursing home, make sure that you understand the contract. The home may have policies that their residents must have advanced directives regarding health care decisions, or have someone designated with a durable or health care power of attorney. You may want to consult with an attorney if you have questions about the contract or power of attorney. Every nursing home resident has a “Bill of Rights” that protects their civil rights in the facility.
To contact us here at the Alzheimer’s Care Resource Center
Please call us at (561) 588-4545. Thanks for watching today’s Wednesday Workshop and we’ll see you again next week!