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When It's Time for a Nursing Home

Caregivers often feel an emotional mix of relief and guilt, reassurance and anxiety

When a Nursing Home Is Necessary

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The potential need for 24-hour supervision is something caregiving families should discuss.

En español | When the phone call finally came, I gasped in shock. It was a social worker from the nursing home where my mother had been on a waiting list for admission for a year and a half. The social worker said the words that I'd both yearned for and dreaded: "We have a bed for your mother. Can she move in tomorrow?"


I knew it was time. During the previous nine months, my mother had been hospitalized three times for confusion, as well as for injuries from falls. It was clear to me she was no longer safe living alone in her apartment.

For reasons of privacy and incompatibility, neither of us had wanted to live together (plus, the stairways in my home made her moving in near impossible). Instead, we scraped together the funds to hire home health aides to be with her for seven hours a day. But that still left 17 hours when disaster could and did still occur. I never stopped worrying — whether I was by her side, at work or on the basketball court. Would the aides show up? (Not always.) Would my mother fall even when an aide was present? (Yes.) Was I being a good son? (Each subsequent fall made me more doubtful.)

A bed in a facility with 24-hour supervision would ensure greater safety, but also less freedom for her and more guilt for me. Would my mother feel like I was dumping her there? Fortunately, she didn't see it that way. That night, when I offered her the choice of moving into the nursing home or staying in her apartment, she quickly opted to move.

Many family caregivers anguish over nursing home placement. Some regard it as a failure of will or effort to honor a parent's wishes to stay at home until the end. Others see it as the ultimate loving and responsible act when safety becomes paramount. Some hold both views and feel powerfully conflicted. Here are ideas for dealing with the many emotions that arise around this difficult family decision:

Don't make promises you can't — and shouldn't — keep. I've heard many caregivers say they won't even consider a nursing home for a parent. This sounds noble but could have untoward consequences. If the parent should have a sudden downturn — for example, a broken hip or stroke — then the family is caught unprepared when the hospital staff insists the parent can't return home and needs a nursing home facility. To prevent this, I suggest that caregiving families plan for all contingencies, including the potential need for 24-hour supervision some day. Ideally, parent and adult child should visit local nursing homes, weigh options and indicate preferences before an emergency requires a rushed decision.

Your job is to provide the right care — but not always in the form a parent wants. The "right care at the right time" is always open to debate. It shouldn't, however, be solely defined by a parent's unchanging wishes in what are usually fluid situations. A "right" plan should meet a parent's needs now and in the future, while taking into account the needs and capabilities of other family members. If the care that best meets that formula is nursing home placement, then that is the prudent choice for everyone.

Expect a cascade of emotions. When my mother agreed to go to the nursing home, I felt a palpable rush of relief mixed with onerous guilt that I somehow hadn't been able to do more to prevent this move. And I felt deep sadness. It was awful that my mother had deteriorated to the point that 24-hour care was crucial. Then, like her, I began worrying about what nursing home living would actually be like. These feelings were very strong and uncomfortable, but normal.

Caregiving changes but continues. In the last few months, my mother has been adjusting to her new living situation and so have I. I no longer pick her up off the carpeting or sit with her in the emergency room, but I make sure her nursing home room is clean, her nurse's aides are responsive to her and that she is reasonably content. And I still live by the same imperative I have for five years: to help my mother live as fully and safely as possible as she gets older.

Barry J. Jacobs, a clinical psychologist and family therapist, is a member of the AARP Caregiving Advisory Panel.


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