Deciding to Use a Nursing Home
by Sheryl Karas M.A.
The decision to place a loved one in a nursing home is always tough. We feel horrified by the options available to us. We feel guilty. We worry that the move will send our loved one into a tailspin. But when caring for a loved one requires more emotional and physical resources than you have available using a facility is sometimes the best decision. The nursing home decision must consider the cost to everyone involved.
I once had a caregiver tell me that she had given up her career to take care of her mother and that in the course of caregiving she had become a virtual prisoner in her house. Her mother could not be left alone and the daughter could not find the paid help she needed. She had lost all her friends because she was never available to see them. She was unable to sleep because her mother would call for help several times a night, and she was losing her hair from worry and stress. There were very few workable options left but the caregiver hung on - until the day she was diagnosed with a serious illness. Her doctor insisted that her mom be placed immediately. All her life the mother had told her daughter "I'll kill myself if you put me in a nursing home," but within a few weeks she adjusted and eventually came to like her new caregivers and friends. My job shifted to consoling the caregiver for not doing it sooner.
The most loving option is to do what people need - not necessarily what they think they want. Keep in mind that placement is not the end of caregiving. The family caregiver can and should play an important role in providing the emotional, spiritual, and advocacy support the placed person needs to weather such a difficult transition in the best way possible. This shift in role begins the moment you start to prepare for making the move.
Preparing for Making the Move
Step 1. Prove the Need. What are the costs involved in keeping the patient at home? Is the patient's safety at risk? Is a single caregiver being expected to meet all the patient's needs at the risk of their own health and well-being? Are there community services or paid services available that are adequate to keep the patient at home? You may need to consult a social worker or other professional who can help you look at your situation objectively. If you are dealing with brain impairment you can call Del Mar Caregiver Resource Center for an assessment by one of their family consultants.
Step 2. Involve the Family. The whole family needs to be in agreement about this decision to avoid situations where a less involved family member second-guesses or undermines the efforts of those who were left to make the choices. Family meetings are hard to arrange when people live out of town or have busy schedules. It can be emotionally difficult to face the fears and guilt and sadness such a choice entails. But for the good of family relations an effort to communicate via telephone or email must be made. Let everyone express their feelings without attack. Decide as a group to put each person's needs ahead of other people's desires and make choices based on what's best for all concerned. Ideally, the patient should be involved in this meeting but when dementia is involved that is not always the most prudent path. Also, if family members have differences of opinion which cannot be easily resolved it can be very helpful to do this kind of preplanning with an objective third party acting as facilitator. Call Del Mar Caregiver Resource Center for suggestions.
Step 3. Talk to the Patient. This has got to be one of the hardest things to do. The ideal situation is to approach the patient with honesty and a clear explanation of the reasons for the decision. If the patient has enough savvy to be able to make rational choices about their future they may actually feel relieved that their needs and their family's needs are being thought about well - especially if they are included in the decision-making process. In any case, the patient needs a chance to express their full feelings. If their response is something like "How could you do this to me?" or "I'd rather die than go to a nursing home" recognize that these are expressions of fear and grief - a natural response which you can respond to with love. "I know how frightening this is - I'll help you make the best of this anyway I can. You won't be left alone." If, however, you respond to these feelings by allowing yourself to be guilt-tripped into making a different choice your patient's fear will be controlling you which is not, in the long run, healthy for either of you. Stay firm. Stay loving. Get help with the feelings that come up by talking to a counselor, a supportive family member or friend.
Step 4. Begin Your Search. Now it's time to visit homes if you haven't already. Get on waiting lists. Talk to your financial and legal advisors. Talk to the Nursing Home Ombudsman Office (429-1913 in Santa Cruz, 688-8833 in San Benito County, 333-1300 in Monterey) to find out what kinds of complaints have been registered (if any) about the homes you are interested in. Take your time. Plan ahead if possible so you don't have to make a swift decision from a limited number of choices. Keep in mind that in Santa Cruz and Monterey Counties there is a shortage of space in local homes and waiting lists are the norm. The wait for MediCal beds is even longer - and there are no MediCal beds outside of skilled nursing facilities. You may need to expand your search to facilities over the hill. Yes, the commute is inconvenient, but the price of keeping your loved one close by may be even higher. Be flexible. Be brave. Let go of finding the perfect situation and you'll get what you need.
Caregiving Articles
A new version of this article can be found in Sheryl’s latest book The Spiritual Journey of Family Caregiving.
Caregiving Articles
© Copyright 2007 Sheryl Karas & Paul Hood