Is it time to consider a nursing home placement?

PRIME – November 2013 By Victor Acquista, MD Special to PRIME The decision for yourself or a loved one to enter a nursing home can be one of the most difficult and conflicted decisions you or your family can make. I would like to present some of the rational and emotional factors that are often wrapped up in this decision-making. A common situation About 5 percent of seniors reside in long term care facilities at any given time. Approximately one-third of all Americans will require nursing home care at some time in their lives. Sometimes, as a result of a sudden loss of health, such as following a hospitalization or associated with an acute problem such as a hip fracture, nursing home placement is required to address the new health needs and allow more time for recovery. Such short-term nursing home placement is typically recommended by your health care provider when a determination has been made that the care needs cannot be met in the home situation. Although this can be a difficult decision, the temporary nature of this nursing home placement is less emotionally difficult. Making a decision to enter a nursing home, with the anticipation that you or your loved one will likely spend the rest of their life in such a setting is much more difficult. Seeing and meeting needs The main reasons for entering a nursing home are: the need for more skilled care, the health of a caregiver, dementia-related behavior problems, or the need for more assistance. We all have needs. For many of us, there comes a point in our lives where our needs for simple activities of daily living (ADLs) can no longer be met in our normal home situation. ADLs are things such as bathing, grooming, personal hygiene needs, dressing and toileting, eating, transferring and moving about. When we are healthy, we take these things for granted. As our physical and sometimes cognitive health declines, we may require increasing assistance in meeting these needs. As a result, we must depend on others to assist us. In many circumstances, family members and loved ones are able to provide care and meet these needs. In other circumstances, hiring caregivers can provide additional care at home. Sometimes, a change in home setting is required, such as moving in with a family member or to an assisted living environment. When none of these alternatives is available and the person's needs can no longer be met, it's probably time to consider nursing home placement. A difficult adjustment Understand that nursing homes provide both health care and home care, but the kind of home care is likely to be different from what people are accustomed to living in their own home. Choices about what the individual might want to eat today or do today might be limited in a nursing home setting. Personal belongings that surround the person in his or her own home may not be able to accompany them to a nursing home. Dealing with the loss of independence and familiarity can be difficult adjustments. Other losses such as in continuity of relationships, finances, and status can also be difficult to cope with. Often, the decision to enter a nursing home occurs due to death or change in health status of a primary care giver. Given the multitude of losses, grief reactions are common experiences upon entering a nursing home. Emotional responses such as anger, depression, denial, or acting out are sometimes seen as individuals react to this major life event. Handling the adjustment It is important to anticipate some of these possible emotional responses. Often, for individuals with dementia, transition to an unfamiliar environment can be very disruptive and confusing. Again, it is important to anticipate these possibilities. Emotional stressors are common among family members and loved ones. The most frequent response is guilt. Understand that guilt should be confined to actions which are wrong. When life circumstances are such that care needs cannot be met through other alternatives, then nursing home placement; albeit difficult, is the right decision. While rationally many people can support that choice, emotionally they continue to struggle. Frequently, promises about never placing a loved one in a nursing home were made. However, those promises may have been made when circumstances were different. Life frequently gives us challenges – the best decisions are often not easy. Take time to make the choice Change can be hard for everyone. It is advisable to try and visit any nursing home you are considering as a possibility for the individual's – or your own – placement. Try to involve the whole family. Speak with the admissions director or a member of the social services department. They are skilled at helping you address many practical questions about finances and the type of care offered at their nursing home. They are also knowledgeable and have a lot of experience in addressing some of the emotional concerns and conflicts. There are also many good resources on the Internet that can help guide you in your decision making. It is important to get good information and become educated about factors to consider in nursing home placement. It is best to begin thinking and learning about this before you are actually faced with making this major life decision. Stay healthy! – Victor Victor Acquista MD is author of "Pathways To Health: An Integral Guidebook" and a partner in the Collaborative for Community Health in Palmer. For more information on Acquista's book, visit http://pathstohealth.info/