Assessing the Situation and Aging

John is an independent, proud-eighty-year-old man who had nursed his late wife through her long bout with advanced Alzheimer’s disease and kept her at home until the very end. When friends and family wondered how he did it, given his limited mobility due to crippling arthritis, he would say, “I would have it no other way.”

Not only did he insist on doing his own shopping and cooking, he also shopped for neighbors in his apartment building, whom he characterized as the “old folks.” But when John had a stroke which paralyzed his left side, there was no way he could return home from the hospital. John and his three children were told by a hospital representative that they had a week to find a skilled nursing facility for him.

The agonizing decisions which John was facing are the same that numerous older adults and their families will encounter. This is an eventuality that most of us dread and for which few of us plan.

John’s children love their father and want the best for him, and they are deeply troubled by the decisions they must now make. Placing a loved one in a long-term care facility is painful because it forces us to face the irreversible deterioration of someone we love, as well as our inability to care for that person ourselves.

Religious tradition teaches us that we are obligated to honor and revere our parents to ensure that their basic needs are met and that they are treated with dignity and respect. However, we also recognize that we have competing responsibilities, or that there may be very real limits to our ability to provide care directly for aging parents who may have significant physical or mental impairments. Fulfilling our obligations to a loved one sometimes means finding the right person and the right setting to care for them, when we cannot.

The first step before considering long-term care, is to make sure your loved one has been thoroughly assessed for needs, resources and available alternatives. For instance, you may want to have him medically assessed to determine whether the incapacity is likely to be temporary or permanent. You will also want to consider what level of care is needed and in what setting.

The theme is to investigate and then choose a facility, whether it be home-based care, personal care, assisted living or long-term care.

Choosing a nursing home requires that you choose carefully. To start, get referrals from friends, neighbors, or a social worker and once you have identified a few places, you will want to visit them. As you look at a facility, carefully evaluate its physical environment. Look not only for cleanliness, but to what extent it seems “institutional.”

Be alert for what you can discover about the atmosphere and its surroundings. For example: how are residents addressed? Do staff use the term “Pop” for an elderly man instead of his name? Is their privacy with dignity and freedom to move about unhindered?

As you make the decision as to where your loved one will reside, involve everyone who will have to live with the consequences. By that I mean siblings who are geographically distant from you. It is worthwhile to give them information about any and all options and to solicit their input. Remember that the most important person in all of this is the resident who will live there.

It is vital to involve that individual in the decision-making process to the maximum extent possible. If he is not able to visit that facility personally, try to show photos or brochures to him.

As you help the resident move into a care facility, be aware that leaving home involves significant loss, emotionally as well as physically. Allow for a meaningful transition from home to facility to make the moment by letting him supervise those decisions about what to take, what to give away, and to whom things should be given. Make sure your loved one brings treasured mementos with him. Bring objects that reflect something about who he has been.

According to the researchers, Silverstone and Hyman, they state the following in their book You and Your Aging Parent, “Institutionalization, although a tragic step, is not tantamount to dying.”

Here are some final thoughts. Although it is difficult at best, you can help your loved one adjust to care in a facility by visiting regularly, which can boost his spirits, especially if you can find things to do together that he particularly enjoys. You can also help by forging a positive alliance with the facility staff. You can help the staff to appreciate what’s special about this resident by telling them about his past and his accomplishments.

Remember, entering a nursing home does not have to be the “end of the line.”

Victor Frankel, a well-known psychoanalyst, recounts his concentration camp experience in his epic book entitled Man’s Search for Meaning, with the following, “We can find meaning even amid suffering through our deeds, through encounters with others and through growing and changing.”

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