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The Nursing Home Dilemma: Should We, or Shouldn't We?

Posted Nov 03 2008 9:02pm

For as far back as I can remember I have heard elderly and not-so-elderly relatives try to elicit promises from family members that a nursing home will not be in their future. Guilt is a powerful tool and there are those who are extraordinarily adept at using it. Promises made under duress by a child in her/his thirties can be hard to keep when the same child is in her/his sixties or seventies, perhaps having experienced any number of health issues during that thirty or forty year gap.

I doubt anyone has ever said with great excitement and cheerful anticipation, “I can’t wait until the day I move into a nursing home!” None of us likes to think of ourselves as incapacitated but the reality is that some of us will find ourselves in just such a situation, needing more care than our families can provide at home.

It’s important to remember that the vast majority of long-term care facilities are not the dens of horror that our imaginations might conjure up. I am from a large family and through the years I’ve had a close association with a number of assisted living and skilled nursing facilities. My experience and observation in those situations has been that the caregivers take tremendous pride in the care of their patients on every level. It is natural to be wary when faced with such a change in our lives but being unnecessarily fearful is a detriment to finding the best solution for everyone involved.

I am reminded of an elderly couple, 78 and 80 years of age, living in their own home. Their three adult children, all with jobs and families, lived nearby. The elderly woman was diagnosed with Alzheimer’s, prompting a family meeting to discuss arrangements for her care. The decision was made that the husband would care for his wife at home, with the daughter who lived nearest volunteering to stay overnight several times each week to allow her father a restful night’s sleep.

As the mother’s health declined, so did the elderly man’s ability to care for his wife. She wasn’t being bathed regularly, she wore dirty clothes and a lack of oral hygiene caused her to lose several teeth. Her weight dropped from 120 to 98 pounds. Enrolling her in an adult day activity program and hiring home care aides helped for awhile until she fell and broke her hip.

The husband, a diabetic himself, stayed by her side during the resulting hospitalization and subsequent stay in rehab. He slept poorly in the bed provided for him in his wife’s room, lost 12 pounds and looked shockingly gaunt to his children. Not long after his wife’s discharge to their home, he fell and broke his wrist while responding to her call for help. The family decided that placement in an assisted living facility was necessary.

She adjusted well to her new living situation, regained the weight she’d lost and her husband, who visited her daily, reported that his health and feeling of wellbeing also improved due to being on a schedule that enabled him to better control his blood sugar.

How can we argue with such success? My mother is 85 and, to her credit, has not asked her children to care for her only at home, no matter the circumstances. I have just one child and asking the same of her would be a tremendous responsibility for her and, in my opinion, unconscionably selfish of me. We certainly should do the very best for our family members for as long as we can, but accept that sometimes that includes turning over the care to those better equipped to deliver it.

This is a complicated and emotional topic. I know that many of you have had to deal with it in some way and would appreciate hearing your stories and opinions.

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