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Stepping stones in care needs: a nursing home may be necessary

by Carol Bradley Bursack, Editor-in-Chief

Nursing homes are often a necessary step in caring for our elders. For safety and health management, people who live to be very among the very old and frail frequently live in a state that needs professional nursing care. The guilt many adult children feel over placing a parent in a nursing home often reaches back to old promises and old ideas. Yet, sometimes there is no choice. Letting go of guilt is hard, but caregivers need to remember that they will still be part of the care team.

"Promise me you won't ever put me in a nursing home!" Many of us grew up hearing that plea from our grandparents or parents. The instinctive answer, of course, is, "I'd never dream of it. I'll always take care of you."

That was then and this is now. You spent five years running to your parents' home to help out each weekend and spent several evenings with them in the emergency room. Their need for you grew until you had to hire some in-home care. Then your dad died. Your mother stubbornly refuses to move from the too large, outdated home. She falls often, her diabetes is getting to be a critical issue and her memory is failing.

Her living in your home is out of the question. You have growing children, a husband with a crazy schedule and a mortgage on a place that is absolutely not suited for housing an elder. It's difficult to even get your mom into the house for a holiday meal.

Mom's doctor says she needs her diabetes monitored better and she need people around, particular those her own age. But, well, you promised. Welcome to Boomer guilt.

Drop the Guilt: You've Honored the Spirit of Your Promise

A fact of modern life is that many people live longer than they would have a few decades ago, but many of the survivors live in less than ideal health. Modern medicine has brought people a longer life. Your mom wouldn't be alive today if diabetes couldn't be managed as well as it can be now.

The caveat, however, is that many of these survivors, while happy to be alive, need a great deal of assistance to stay that way. What, in the past, was often a year or so of caregiving to one's parents as they declined in health, has become five, ten or more years, much of it spent while caring for growing children and holding down a job.

While you are happy that your parents have lived longer, you have worried a great deal. You took on the extra care they needed out of love. But the time came when you couldn't do it alone anymore. That's when you hired some in-home help for your mom.

Now, even that isn't enough. You will have to listen to the doctor and put Mom in a nursing home. You have toured the homes in your community and one near you is really very good. You approach your mom with much trepidation.

Sigh! She doesn't remember what she had for lunch, but she remembers that you promised you wouldn't put her in a nursing home. Now what?

Talking to Your Elder: You May Need a Third Party

Family dynamics remain as long as family members breathe. This is your mother. You love her and want the best for her. You know that for her health and safety, a nursing home is the answer. But she's your mom and you still want to please her. So, you need a plan.

  • Ask your doctor to back up his words and help you explain to your mom that a nursing home is necessary and will be okay.
  • If your mom has a friend in a local nursing home, it may be worth considering that home for your mom, even if the facility isn't as convenient for you as the one you are considering. Then, that friend could become an ally in convincing your mom that the move is a good thing.
  • Reassure your mom, and yourself, that you will still be her caregiver when she is in the nursing home. You will still be part of the care team. If the nursing home you are considering shuts out family in the care plan, you don't want to go there. But these days, most homes have care plans and families are a part of that. Many have regular care meetings that involve family.
  • Help your mom pick out her favorite objects to take along - photos, art, gifts from loved ones - they all help. If some furniture will fit in the room, let her choose what to take.
  • Take her shopping, if she can do it, to pick out some new clothes and let her tour the home and see the beauty shop and other amenities. Try to make it an adventure if you can.
  • Remain firm, citing the doctor's orders. Our parents' generation usually held doctors in great esteem.
  • Tell her that her safety is very important to you and the rest of the family and that she is no longer safe at home.
  • Don't back down. Reassure. Remind her that she will once again have a chance to make friends. She's likely been quite isolated in her home. She will have peers to talk with and eat with. She will also have meaningful activities.
  • Look for a home that stresses person-centered care and tell her about that. Let her know that these days the person is the focus in good homes, and you've found the best one you have in your area. Most nursing homes are quite different than what she has in mind.
  • Once she is moved, make good on your promise. Be there for her during the transition. Expect some depression and a period of adjustment. But don't show any wavering and don't accept guilt. If she brings up the "promise," you must tell her that such a promise was made out of love, but unwise. You have done all you can to not put her in a nursing home, but life throws us curve balls. We can't foresee the future. Promise or no promise, there really isn't any choice in the matter.

All of what I say is assuming you have good nursing facilities in your area. None are perfect, but most are improving and some are exceptional. You'll need to do the best with what you've got. However, you should be your elder's advocate in any situation. If you have doubts about the quality of the home but it's the only choice at the time, be extra vigilant. Don't be adversarial. That will only cause trouble. But watch the quality of care, and get your mom on a list for another home, just in case. It's no fun to move, but if a home doesn't measure up, that may be your only option.

Life is difficult. I'm not the first, nor will I be the last, to say this. Putting our loved one in a nursing home is hard. However, pressure from families with loved ones in nursing homes has been effective and nursing homes are slowly becoming person-centered care options where we can enroll our parents without guilt. Be a strong and visible part of the care team, and you and your elder should get through the transition reasonably well.