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The Nursing Home Decision

Making the nursing home decision for your parent or other loved one can be one of the most emotionally-charged decisions you’ll ever make.

Sometimes there’s guilt on behalf of the family members and caregivers who feel as if they’ve failed their loved one. This is compounded by outsiders who make comments about “dumping” a loved one at nursing home. Worse yet, we hear horror stories in the news about the worst of the worst elder care facilities, where abuse of the residents and theft seem to be the norm.

And yet there comes a time when the family cannot care for their ailing loved one, and they’re running out of options. Children can’t just quit their jobs to care for a parent. Due to financial constraints it’s sometimes hard for a child to move their parents into their household, especially if the parent requires some sort of in-home care from a hired professional.

Even putting financial burdens aside, if the parent requires a lot of care it can be extremely stressful for the family member who takes on the roll of care giver. Indeed, in some cases the loved one may be in such ill physical or mental health that it’s dangerous for them to remain at home.

Naturally this is also very stressful for the loved one, who may dread being put into a nursing home…and yet not want to be a financial or emotional burden to her children. Or perhaps the loved one needs care, but the children are spread all over the country.

In short, trying to come to grips with the nursing home decision can cause depression, anger and despair – for both the family and the loved one. But in many cases when it’s the last resort, it’s a decision that the family and loved one must make sooner or later.

When Should I Consider Putting a Loved One in Nursing Home?

Ideally, the sooner you start a dialogue with the loved one and the rest of the family, the better. Even if the loved one is in perfect health now, it’s better to talk about it sooner rather than later, so that as a family you can make these decisions before you are placed in a position of being forced to make these decisions.

Also, we’ll mention this several times throughout this report – it’s important that your loved one is a part of this decision-making process if he or she is mentally capable. After all, it’s her life. She’s the one that is going to have to adjust to living elsewhere, perhaps giving up a cherished home or possibly even moving away from friends. This is not something that family members should decide and then tell the loved one about. The loved one needs to have just as much say as everyone else.

Most people don’t start considering the nursing home decision until they have to – perhaps the loved one is in the hospital and will require care after leaving, or perhaps the loved one’s mental or physical health is quickly declining.

Making decisions during this time can be extremely stressful for the family. However, if the family has exhausted the other alternatives (such as in home care or assisted living facilities), then making the decision to place a loved one in a nursing home in a sense becomes an “easier” decision because it’s the last resort. Logically you’ll know what decision to make, but the be warned that the emotional impact will still take it’s toll.

What sorts of factors might lead to the family making the nursing home decision? In short, the family can no longer care for the loved one, assisted living facilities do not provide enough care, and the family cannot afford in-home care.

Consider some of these specific scenarios:

* The loved one clearly cannot live alone, perhaps due to factors like decreased mobility, poor self-care, loneliness, needing assistance with taking medication, needing assistance with housekeeping and cooking, etc.

* The loved one’s physical health has declined so much that the family cannot provide the help the loved one needs (e.g., special medical equipment may be needed).

* The loved one is in danger of hurting him or herself if she stays in the home (e.g., frequent falls or dementia).

* The caregiver can no longer meet the physical requirements (e.g., heavy lifting, sleep deprivation, etc).

* The caregiver can no longer deal with the stress of taking care of someone 24/7.

* The caregiver can not meet the overall physical and emotionally overwhelming daily tasks, such as helping with toileting, soiled bedding, etc.

* The loved one is in the hospital, and will be unable to return home to live unassisted.

* Other options have been considered or exhausted, such as in-home care, assisted living facilities, residential care facilities, a family member acting as caregiver, etc.

Making the Decision with Your Loved One

As already mentioned, this is a decision you should make with (not for!), your loved one. While ultimately the loved one may have a hard time accepting the decision, if he or she knows it’s the right one and he or she was involved in the decision-making process, it will be easier for everyone to adapt.

Of course this can be a difficult issue to bring up. That’s why it’s better if you can start discussing this before you actually have to take action. The family and the loved one can decide together at what point in the future a loved one will no longer be able to live alone. For example, you may decide together that Dad can’t live alone any longer if he starts falling. Or you may decide that Mom can’t live alone any longer if she’s having troubles remembering to take her medication.

Perhaps you’ve already reached the point where the decision is inevitable. In this case, be honest and straightforward with your loved one regarding your concerns. For example, “Mom, I’m really concerned about you living alone because________.”

Aside from discussing with your loved one the reasons that he or she can no longer live alone, you’ll want to discuss his or her priorities. Remember, this is going to be a huge transition for your loved one. You can make it easier by taking into consideration what is personally important to him or her.

Consider these sorts of priorities:

* How important is it to live near friends? How about family? Sometimes when family is spread all over the country, to live near the children means leaving friends.

* How important is it to stay in the same community?

* Would the loved one prefer an urban or rural setting?

* How important is keeping a pet?

* How important is it to live near a particular place of worship?

* What sort of help does the loved one need? For example, help taking medications, medical aid, help with personal hygiene, etc.

* What sorts of social activities does the loved one enjoy? For example, if he enjoys bingo is there a bingo hall nearby or does the nursing home provide this activity?

* What sorts of hobbies does the loved one enjoy? For example, if she enjoys gardening, will she be able to keep a few flowers or even a vegetable garden?

* What is the loved one’s financial situation? If you are seeking assistance such as Medicaid, you must fall within their guidelines.

This is not an exhaustive list. Talk to your loved one to see what they need in a particular nursing home setting.

What to do When a Loved One Rejects the Decision

When my grandfather’s hearing deteriorated to the point that he couldn’t hear you unless you practically shouted at him, the family told him he needed to get a hearing aid.

“I’ve heard enough in my lifetime!” he snapped. And that ended the conversation each time someone brought it up

All of this stubborn refusal over a small device – I can’t imagine what the conversation would have been like had he ever needed to go into a nursing home.

Many people as they get older start to contemplate what might happen if they can no longer live independently. Chances are, while they may know that moving to a nursing home is a distinct possibility (and for some it’s even inevitable), they probably don’t want to do this until the absolute last possible moment.

As such, it’s easy to go into denial.

If you’re an elderly person who’s starting to fall down, and as a result your kids are worried about you living alone, it’s easy to be in denial. You can say to yourself and the worried kids that you’re falling down because you’re just a bit clumsy. Or maybe it was your fault that you didn’t see the rug was bunched up. Or maybe it was just that darn cat.

Many adults spend a lifetime caring for others and being “useful” in society. They held down jobs, they raised kids, they took care of their spouses. They felt useful and needed. They felt like they had a purpose.

Then suddenly one day the kids are grown and have left the house. They retire and don’t have a job any more. It almost seems as if no one needs them.

For many this is ok. But then perhaps gradually they realize that they are moving into a position of needing someone else. Instead of being the independent one who took care of everyone else, they are now the dependent one who needs to depend on others for their well-being. Whether it’s something like help walking to help eating to dressing or even toileting, it can be a humbling and sometimes embarrassing experience to have to ask for help.

As such, it’s very easy to go into denial about needing this help. No one wants to admit that they need to depend on others for day-to-day tasks like grocery shopping and food preparation, eating, dressing, bathing, taking medications, and everything else.

Imagine if you were in this position of declining health. You wouldn’t want to admit to yourself either that you may no longer be able to take care of yourself. Admitting it means admitting you need help. And if needing helps involves the possibility of going into a nursing home, you’d probably refuse this sort of “help” for as long as possible.

Likewise, your parent or other loved one may be refusing your help. When you open the dialogue regarding what will happen when they get older, they may outright (and understandably) reject the nursing home idea. It’s a hard thing to think about for your loved one when they still live independently – they hope that the day never comes.

However, for some that day will come. Financially, emotionally or physically the family can’t take care of the loved one, and the loved one can’t live alone. If you approach your loved one with your concerns and start talking about a nursing home, your loved one may argue with you and outright refuse to go into a nursing home.

Naturally of course most people would be hesitant and know it’s going to be life-changing – but there are those who aren’t just hesitant, they refuse. Of course your loved one should have a say about where he or she lives. But if a nursing home is the only option left and your loved one is refusing, what do you do?

First off, you need to discover why your loved one is rejecting the idea.

Is he or she:

* Concerned about the cost?

* Worried about his or her house and belongings?

* Worried about leaving friends and family?

* Feeling like going to a nursing home makes him/her a 'welfare/charity' case?

* Feeling like a nursing home is where you 'dump' people?

* In denial or refusing to admit he/she has a problem and needs help?

* Feeling like the whole procedure (from paperwork to moving) is overwhelming?

* Upset about having to give up a pet?

* Upset about having to give up certain freedoms?

* Have other preconceived notions about a nursing home facility being where people 'fade away'?

These are just a few reasons and perceptions, but it certainly isn’t an exhaustive list.

Your task is to figure out why your loved one is refusing help, and what perceptions he or she has about a nursing home. Only then can you begin to address these concerns.

For example, if your loved one is worried about the cost, you can discuss the many alternatives out there like long term care insurance and Medicare.

If your loved one is worried about leaving friends and family behind, assure her that you will visit often – and that you will choose a nursing home that is close to her current community so that it’s easy for other friends and family to come visit.

This is one reason why it’s good to start the dialogue before you actually need to take action. It gives your loved one (and you) time to contemplate and begin to accept the idea.

It’s also easier if you can avoid a nursing home until it’s the last resort. That way you’re only making small changes gradually, which gives your loved one time to accept the fact that they aren’t as independent as they’d like to be.

For example, perhaps you take advantage of community services like Meals on Wheels when you become concerned about your loved one’s ability to cook. Then later on you may add another service, such as you dropping by weekly to clean and do laundry. Perhaps the loved one will eventually move in with you, or go to an assisted living facility where they’ll receive help with things like cooking and cleaning.

In short, you take it one step at a time so as not to overwhelm your loved one.

Try to avoid placing 'blame' on the loved one (for example, by saying things like, 'you can’t even cook for yourself any more!'). Instead, focus the conversation on you (for example, 'I’m concerned that you’re not ________.').

As mentioned before, give your loved one as much input as possible. The more in-control they feel regarding these decisions, the better they’ll adapt.

Finally, make sure your loved one knows that nothing is permanent. Ask them to 'try it out' for a few weeks or a month before making a final decision. That way they won’t feel as trapped into any decisions that you make with them regarding their care.


Please click on List of Nursing Home Details to read about many different aspects of Choosing the right Nursing Home for your relative.