Services for Elders and Their Families
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The Nursing Home Decision: Tips for making the ‘right’ decision.

Entering a Nursing Home can be a difficult decision for everyone concerned. Let’s face it, no one really looks forward to moving into a Nursing Facility. In all my years working, I don’t think I have ever heard anyone say, “Oh goody, I finally get to go to an Old Age Home!” However, there are circumstances that warrant a move to so that an elder can get the care and support that they need, both physically and emotionally. Planning can make both the move and the transition, easier for the elder and the family.

Confront your own feelings.
The Caregiver can experience many feelings when making a decision to move an elder. The caregiver may feel that they are letting the elder down or deserting someone that they should be able to care for themselves. Thus, it is important to not make promises that may be impossible to keep. It is not wise to promise anyone that you would never place them in a Nursing Home. If you ever find yourself in this situation, simply promise the elder that you will do whatever is best for them.

Placement Assistance from the hospital.
Sometimes it is easier for the Caregiver to move an elder into a nursing home from a hospital stay. There are a variety of support services available in this situation, that are not otherwise accessible when making the move from the community. If the elder is in a hospital setting, your most valuable resource is the hospital social worker or case manager.

When patients are in the hospital, they are assigned a Case Manager for appropriate discharge planning. It is important for family members to meet with the Case Manager as earlier as possible. You may want to call a family conference and ask the Case Manager to meet with the elder, Caregivers, and interested family members to discuss all possible options. If nursing home placement is decided upon, the Caregivers may need to time to consult an attorney, complete paperwork, and check out various facilities.

Making the or later?
Some families have the opportunity, due to family and community support, to postpone the decision process for a time. When choosing an appropriate time for moving, and if a progressive disease such as Alzheimer’s Disease is the diagnosis, there are two options. The first is choosing not to move the elder into a skilled nursing facility until the last minute. The delay allows the elder to enjoy familiar surroundings, spend more time with family, and perhaps take care of personal business, until they are no longer able.

The second option encourages the elder to move into a facility while they still are able to be active and have their cognitive faculties. Moving into a facility early can be beneficial in several ways. First, the staff and employees who work with the elder, both formally and informally, will learn the elder and their eccentricities, while the elder still has the ability. In addition, the elder will be able to experience more fully, the facility, activities, fellow residents, and get to know employees and caregivers, while they are able. Whatever you decide, choose a facility that is easily accessible to the family members that are most involved.

Gather information.
The decision to place an elder is a difficult one -- and is even more difficult when it is unplanned and made in a hurry. It is important that the adult child feel comfortable with the decision. There are many tools that can help a Caregiver decide when the time is right for long term placement. It is important to have all of the available information; talk to the elders’ physician to gather prognosis and illness information. Talk with hospital social workers to gather their feedback about the elder, as well as insight about the various placement options.

Obtain information from other professionals working with your elder such as physical therapists, home nurses, and nursing assistants. If your place of employment has an ElderCare information and referral source and/or and Employee Assistance Program, now may be a good time to give them a call. They may be able to offer assistance in finding out what the various choices are, as well as offer counseling and support for you as an employee.

Stay involved in the care.
One of the things I like to tell Caregivers, is that the decision to place an elder in a Nursing Home is not an all or nothing decision. If an elder moves into a facility, family members can still assist the elder in many tasks including: personal care, bathing, feeding, and taking care of daily tasks. In fact, it is beneficial for the elder if the family continues to provide hands-on care. It allows the elder to feel connected to the Caregiver, and encourages continuity of care.

Accept what is.
Don’t expect from the elder what they cannot do. If your elder was never a joiner in group activities previously, they probably won’t start now. I sometimes hear caregivers say, “If only she would...she would be so happy”. One of the simplest things to do, yet somehow the most difficult, is to keep our expectations in check. Keep your expectations realistic.

Make your own choices.
There will always be those who will tell you what they think you should do. If all sources point to a particular decision, and you are not comfortable with it, then act on what your heart tells you. As was stated earlier, there are many tools that can help you decide, but the final decision must lie with you and your family members. In a nut shell; talk to many sources - pray about your choices - and then do what you think is right. If you follow this rule of thumb, you and your elder will stand a better chance at a successful placement, when the time is right.


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