As home care providers, we know the benefits of aging in place—familiar surroundings and food, the proximity of neighbors and friends, one's own bed, and of course the affection and companionship of beloved pets. But, there comes a time when home is no longer a viable option—a time when around-the-clock care is needed, but this level of care is beyond the resources of most people. How do you know when it is time to move in the direction of transitioning your patients to a skilled nursing facility or nursing home?
A common scenario involves past promises made to mom or dad by their adult children that they will never place them in a nursing home. Then reality sets in. The adult children may work full time and are likely raising children or even grandchildren. Mom or dad have had falls, increasing memory problems, and are becoming socially isolated because of loss of peers and the inability to drive. Guilt and anxiety may prevent some caregivers from accepting the need for a higher level of care. I remember more than one patient I cared for over the years who were no longer safe living in the home. They were sometimes bedbound and left alone for parts of the day because the family caregiver had other obligations. Although you can understand the competing priorities these caregivers face, you know it is unsafe to leave an immobile person alone in the home.
The website verywellhealth (2018) describes the following signs that might indicate the possible need for nursing home placement:
- The caregiver has sustained a back or other injury while caring for the patient
- Patients with dementia start to exhibit anger or paranoia
- Patients with dementia start wandering
- The caregiver is showing signs of burnout or their health is declining
- The caregiver is facing illness or surgery
- Other options have been tried but are not meeting the needs of the patient or caregiver
- The patient's or caregiver's primary care provider suggests that it is time to consider nursing home placement
What can you do? First provide emotional support to both the caregiver and patient. This is a very difficult time for both. Let the caregiver off the hook for promises made in the past, and understand they are likely experiencing the seesaw emotions of both relief and guilt. Encourage caregivers to start visiting nursing homes and to start talking to acquaintances who have “been there done that.” It is always good to have more than one opinion, so consult physical or occupational therapy, and of course social work. A united front may give the caregiver the courage to take the next step. Finally, don't see this as a failure, on your part or the part of the caregiver. There often comes a time when safety becomes the priority.