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Caregivers: is it time for a nursing home?

by Isabel Fawcett's Needs Assessment and connections to skilled long-term care, respite and various elder agencies are a resource caregivers can take to the bank. Chronic illnesses in elders may lead to irreversible health decline. Caregivers ultimately face major decisions about when, or whether, to obtain outside caregiving help for their elders. If or when that day comes for me, agencies on will be my Plan B.

I suspect that each caregiver has some informal means to determine when, or whether, to place an elder in a nursing home. Nursing home placement decisions are a moving target.

My own gauge of nursing home placement for my loved one(s) is tied to observable cognitive and physical health triggers or events, including:

1. Memory lapses and mild cognitive impairment are not important to me as nursing home placement indicators. If Mom forgets that her beloved mother died 52 years ago, it makes me sad for her. I can live with it. I would rather Mom remain in-home with familiar routines, faces and sounds for as long as I am able to do the honors.

There is a lot I forget. I understand lapses in memory, confusion and embarrassment. It is never lost on me that when I cannot remember where I put something Mom tells me where she last saw it. She also recalls whether she may have moved it to avoid me losing it. If memory lapses were the sole factor someone may want to advise Mom to place me in a nursing home.

2. Familiar routines help elders feel less anxious and more in control. Morning, bedtime, and other routines are created by elders and caregivers. Continuity of care is fairly uneventful unlike shift rotations and high staff turnover in nursing homes.

3. Memory lapses with extreme glucose fluctuations notwithstanding, Mom's deductive reasoning is impressive. Her deductive logic tells me all I need to know about nursing home placement decisions.

Knowledge is Elder Power

Never underestimate the knowledge of elders. Having lived full, and often highly productive lives, our elders have acquired advanced knowledge, wisdom and skills. Not unlike the rest of us, periodically elders also make considerable leaps of logic. Historically, I have been amused by Mom's leaps of logic.

Leap of Diabetic Logic (One)

1. While I was hospitalized as a diabetic, the hospital gave me a cup of ice cream after dinner. (True)
2. There is ice cream in your refrigerator.
3. I am still a diabetic who needs hospital-endorsed ice cream after dinner.

Leap of Glucose Logic (Two)
1. Diabetics' bodies need sugar to function. (True)
2. There are sources of food with regular sugar in your kitchen to counter my unexpected low blood sugars.
3. I am a diabetic in need of sugar to stabilize my glucose levels-- now.

Both leaps of logic above manifested in Mom's younger, not older years, so there can be no blaming advanced age in either instance.

Deductive Reasoning

Deductive reasoning marries cause and effect, starting with a general or larger premise, then working its way down to particulars

Leaps of logic aside, Mom's deductive reasoning in increasing sugar intake by circumventing caregiver police is remarkable. I still laugh at one memory of my watching television as I ate cookies from a box.

Mom's glucose level that day was under control. I occasionally reward her self-discipline with a scoop of ice cream. Whenever I do, I use the opportunity to congratulate her on her glucose readings over a period of days and let her know why her glucose trends occasionally allow her moderate treats.

Mom ate the scoop of ice cream while she paced in the kitchen. I thought nothing of her pacing while eating until she approached me at the sofa. She smiled, establishing superb eye contact and hummed as she handed me a bracelet I had not seen in awhile. I thought she may have found my bracelet and wanted me to put it away for safekeeping.

As I reached to take my bracelet from Mom's hand, she simultaneously lunged forward, grabbed the box of cookies away from my side, and ran as fast as she could. (What mobility impairment? Cookies and ice cream are inseparable.)

She couldn't stop laughing.

"Aha! I know you like jewelry. The only way I could get you to release those cookies was to hand you jewelry," Mom said, still laughing. Although I was not the least bit amused, Mom's laughter is contagious. I joined the laughter at my expense. Elder, one; caregiver police, zero.

Mom is in control of her home environment. Her deductive reasoning remains visible. She derives correct outcomes. Unless her health further declines home is where she has fun. Laughter is good medicine for both caregivers and elders. If I ever find that my informal "litmus test" no longer meets my mother's long-term care needs, and/or if Mom needs skilled nursing care and round-the-clock supervision, it is reassuring to know that I can look to and agency providers in their database to lead my mother to her next level of eldercare.

My carer's heart and preferences notwithstanding, www.eldercarelink.comis an angel on my caregiver's shoulder and journey. is priceless.