Of course, we don't always make the right call regarding every circumstance. But we do our best. I'd hazard a guess that the most painful decision for most of us to make is whether or not it's in our loved one's best interests to place him or her in a nursing home. If it is also in our best interest, then the guilt looms even larger.
Patients are supposed to leave the hospital healthier than when they arrived and long-term care is intended to enhance residents’ quality of life through increased care and supervision, but these care settings can also pose some risks. One of the biggest threats lurking in these facilities is Clostridium difficile. This type of bacteria, often referred to as C. difficile or C. diff, can spread easily in these environments and turn into a very serious infection for older individuals and those whose health is already compromised.
Elders can have an especially hard time with the holiday season. While aging and maturity can bring the wisdom of years for many people, there are inevitable losses that come to even the most healthy individuals. Many of these losses are emotional and social in nature. Spouses become ill or die. Other aging relatives and friends become seriously ill, or die. Neighborhoods change, often leaving even those well enough to remain in their own homes feeling friendless and isolated. The holidays can bring this isolation and a feeling of loneliness to a head.
Researchers in the United Kingdom have found that elderly people are more likely to be moved into a care home after spending time with their families over the Christmas holiday than at any other time. The reason? Families who live at a distance tend to spend a longer time with their elders during the holidays. After a few days together, adult children notice issues with their parents’ physical or mental health that may not have been obvious during shorter visits or from telephone conversations. Some of these changes are thought to be due to chronic loneliness which can sometimes be alleviated through more in-home personal care. In other cases, the opportunity to socialize in a care home may be better fit.
Dear Carol: Mom has had dementia for several years. I moved her to my house for about six months but she was extremely unhappy living there. I then moved her back to her home and hired help. That was worse. She wouldn’t get out of bed, she fought the caregivers and she wouldn’t eat. Finally, I gave up and moved her into the memory unit of a nearby assisted living center. Now, she’s up and around every day. She eats well and she is reasonably happy. The problem is that when I visit her she begs me to take her home. The staff has told me that she is doing well and this is just a normal reaction for someone with AD. They said, very kindly, that it may be better if I don’t visit quite so often. I feel guilty if I don’t visit daily but I can see their point. I read your column every week and you advocate visiting our parents often. Is it bad if I cut back and visit just once or twice a week? PR
Family caregivers generally earn their job title in one of two ways. The first is what I call the "sneak up mode." The second is "crisis mode." For me, caregiving began with an elderly neighbor who needed some assistance. This "assistance" turned into a five-year stint of elder care, closely followed by the ever increasing needs of six of my own family members.
Loneliness can be a plague for the elderly and ill. Yet visiting with someone who doesn’t feel well, and may have limited cognition, can be tricky. Some nervousness or reluctance is natural, but a few considerations can help to make things go smoothly.
Dear Carol: My family is having a serious disagreement over signing papers for our mom who has just entered a nursing home. I have Power Of Attorney and am favor of signing a Do Not Resuscitate (DNR) form for Mom. She has always told us she didn’t want to linger when her time came. While she is going into the nursing home for physical, she is showing some signs of early stage dementia so it’s important that we get this done. My brother and sister both think that a DNR is cruel and that it’s like killing Mom. They think that everything should be done to keep her alive as long as possible. Her POA even states that she doesn’t want to be kept alive at all cost. Because of this, I think I can push through the DNR, but I feel bad because my siblings are upset. I know that they don’t want to see Mom suffer unnecessarily but they feel guilty taking this formal step. How do I get through to them that there’s a point where people allowed to go? CD
According to the national Alzheimer’s Association, in 2013, 15.5 million family and friends provided 17.7 billion hours of unpaid care to those with Alzheimer's and other dementias. Also, Alzheimer's and dementia caregivers had $9.3 billion in additional health care costs of their own in the same year. Nearly 60 percent of Alzheimer's and dementia caregivers rate the emotional stress of caregiving as high or very high, and more than one-third report symptoms of depression. Remember, this is just the cost for caregivers.
Dear Carol: I’ve cared for my wife who has dementia for several years but now she’s begun wandering and needs constant supervision. Our kids think that both she and I are both better off if we place her in a nursing home, so we are on two waiting lists. One of the homes that we're considering has a rule that the family isn’t supposed to visit for the first two weeks after the person is admitted, and after that visits should be infrequent. They say that family visits disrupt the routine that they are trying to put into place for the elder and that seeing family members simply confuses them. The other home welcomes visits from the start, saying that while they hope that the family feels comfortable leaving their loved one in their care, they like to have families help with getting the person settled and as comfortable as possible. I hate the idea of leaving my wife in a new place and not being with her to help her settle in, but I want what is best for her. CF