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Assisted Living Or Nursing Home?

assistedlivingIt’s the middle-of-the-night phone call we all dread receiving: Dad fell and broke his hip. After a stay at the hospital, which involved surgery, and a stint at the local rehab facility, Dad is sent home. But taking care of him is almost too much for your aging mother, whose health isn’t much better than your father’s. What’s the next step?

The decision to place a loved one in a care facility can easily be one of the hardest decision families will have to make. It is a major life event and trauma for all parties involved. As America’s aging population (there are 40 million people age 65 and older in the United States) continues to increase, more seniors – and their families! – will be faced with the subject of entering an assisted living/nursing home/longterm care facility. Statistics show that 50 percent of the American population will enter a nursing home. Important answers to questions need to be found at the onset of this discussion.

The Advantages Of A Care Facility

The reasons why a person needs a care facility are varied. Sometimes, it’s the circumstances that dictate the decision. For example, a caregiver (in most cases the husband or wife) gets sick and is no longer able to provide care. Or, like in the above example, the care receiver needs more care than can be given at home. This can make the decision a little easier because the situation decides for you. In other instances, the decision is made because the caregiver is burned out, or finances demand that nursing home placement in the only option. A final example may be your family member’s mental condition (Alzheimer’s or dementia) has progressed to the point where he or she exhibits behavioral challenges that can no longer be addressed at home.

When faced with the matter, a family needs to see what type of facility would be best for their family member’s needs. There are obvious differences between assisted living and nursing home facilities. An assisted living falls somewhere between an independent living community and a skilled nursing facility in terms of the level of care provided. Trained staff is on the premises around-the-clock; however, the nursing staff may not be available at all hours. A nursing home or skilled care facility provides care for people who require continual care and have significant deficiencies with the activities of daily living.

Like shopping for a new car or TV, it’s best to shop around for what care facility is best for your family, especially if time is not a factor. Visit multiple facilities and talk to the intake coordinators about what services are provided. Afterward, debrief with the family and discuss the facility and your feelings about the place. Even if circumstances don’t allow you the luxury to check multiple facilities, hospitals have designated and knowledgeable staff on-hand to assist you with the placement process. Physicians, nurses and/or social workers can make recommendations from the hospital, of after a visit to the physician’s office.

Making The Placement Decision

In making the placement decision, there are a few topics to keep in mind. Remember, it’s a balancing act: Caregivers should balance their emotions with objective practical information and always keep in mind what’s best for their family member. Both play a role in when and how the decision is made. Also, and perhaps most importantly, make your placement decision with complete and full information, including medical condition(s) and prognosis, recommendations by the person’s health care professionals, information on the nursing home under consideration and the person’s ability to perform activities of daily living (ADLs), if that’s even an option.

Finances also play a role in this decision. How will the family pay for an assisted living/nursing home/long-term care facility? Dad has a small pension: is that enough to pay the nursing home’s monthly bill? Will Dad have to spend all of his money for this? Is Medicaid even an option? These are questions that need to be seriously asked. A discussion with an attorney, preferably one that specializes in elder law, will help sort out estate planning and see what options like Medicaid are available.

It is easier to make this decision when the whole family is involved, because then it s a joint decision. The earlier in the process that these issues can be discussed, the easier it will be to make the decision when the time comes. It’s better to make a decision when it is not made in crisis mode.

Dealing With Tough Choices

For many of us, moving a relative from home is the last decision we want to make. Too often, caregivers continue to provide care far beyond their physical and emotional capabilities before they even consider long-term placement of their impaired relative. Promises never to put someone in a nursing home may need to be modified because when such promises were made, you didn’t know what the situation would be in the future. The best promise you can make is: “I will do my best to give you the best care I can throughout your illness.” This allows you to make the ‘right’ decision as circumstances dictate.

It is difficult to accept the truth about our own humanness and our own capabilities. It can be hard to admit that we are powerless to make our loved ones feel better or to change the course of the disease. The reality is, no one wants to see a loved one in these situations. It hurts. But the truth is, no matter how much care we provide at home, on our own, or how much of our own lives we neglect, our loved ones will never be the same.

Guilt is the most common emotion when placing a loved one in a care facility. Guilt means you did something wrong. Placement is not wrong, but one of the hardest decisions that one ever has to make. Accept the fact that sometimes people just need a nursing home. They need the care there that a caregiver, alone and unprepared, can’t give 24 hours a day. It takes a lot of courage to make these decisions. If you’re the power of attorney (POA) for a parent, spouse or sibling, remember you were made POA for a reason. That person knows you have his or her best interests in mind, and will carry those wishes and desires out. We can change the guilt to regret by understanding that it is the circumstances of a terrible disease, a difficult care situation, and a need to take care of ourselves as well as our loved ones. With all of these emotions comes grief, the loss of the person who was the loss of what we vowed to do for a loved one, the loss of our role as the primary caregiver.

Moving a relative from his or her home is the last decision we want to make. It is a difficult and oftentimes heartbreaking decision, but one that has to be made. Caregivers have a tendency continue to provide care far beyond their physical and emotional capabilities before they even consider long-term placement options. And who does that help? No one. A key element to remember is planning. Proper planning can help you continue to be there for your loved one, so you can keep providing the love and support he or she needs during the challenges of this new adjustment.