When What You Can Do Changes (Part VI)

By: Ann Novick

Published: September 17th, 2008

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The Nursing Home Alternative- Choosing A Facility

It is our fantasy, our illusion, our wishful thinking (supported by the movie industry and our own values) that as we age or become ill, we will be cared for by our ever-smiling and patient spouses and children, surrounded by our loving, laughing, cherubic grandchildren whose sole wish is to hug and kiss us and listen to our stories. Reality for well spouses (who are often caring for aging parents while raising their children alone because they have lost the support of their ill spouses who need their care 24/7) is very different.

Though originally they may have been determined to have the fantasy, after years of dealing with sickness, a well spouse finds himself living in a house, which no longer seems like a home but looks and smells like a hospital. Instead of smiling faces, the house is filled with pain and complaints, hard work and loneliness and an abundance of chronic sadness. The well spouse fights with thoughts of suicide, depression, and anger. His life bares no resemblance to the one of the devoted caregiver on the movie screen.

When he can no longer cope with care giving because of his own advancing age or illness, the well spouse may finally resort to looking into nursing home placement. It is a decision dreaded by everyone, not wanted by the ill spouse or the caregiver. But, often, there is no alternative.
Care facilities often have very different ways of dealing with their residents. It is very important to try and match the facility with the needs and personality your spouse. The better the fit, the easier the adjustment will be. Communication is vital. The facility needs to be told and reminded of what your spouse can do for himself and then they need to detail how they intend to value and encourage that ability.

The larger the facility, the less flexibility it will have in meeting individual needs. A mentally sound but severely physically disabled person will not be able to lead as active a life in a larger facility as a small one. He may be placed on a ward based on his physical inabilities and not his mental aptitude. As a result, he may have no one on his ward with whom he can converse.

If he is used to his independence once his basic needs have been met, and still makes appointments with people outside of the facility or even keeps a job, a large facility will probably not be in his best interest. They will not be able to adjust to his routine but expect him to adjust to their timetable for bathing, dressing etc. Conversely, someone whose mind is failing may find the inflexibility of routine in a larger facility a comfort that gives him a feeling of security and control.

The activities offered in the facility need to support the positive aspects of the resident. Physiotherapy on a volunteer, unsupervised basis is not a fit for someone who needs consistent exercise and or stretching in order to keep muscles from atrophying. That person needs a facility with a resident therapist who monitors his progress. Are the other activities offered mentally challenging enough for someone who can perform cognitively? Does the facility have things like a computer lab, library, social clubs or interest workshops if applicable, so a person can pursue his individual interests?

Is there a desire to cater to your spouses needs or are you expected to cater to the needs of the facility? Some facilities have a smaller permanent resident component within a larger rehab facility. These types of facilities will often have a bigger push toward physical and mental independence than those that are “warehousing” our loved ones. Interview and spend time in the facility you are considering. Drop in unannounced. Speak to family members of the other residents. What do they like and dislike about the care? A good fit makes an easier adjustment for you both.

Can you afford a private or two-bed room? Treatment of your loved one will often depend on the type of room he is in. It is easier for the facility to be flexible about bed times, noise, and even very young visitors if there are no or fewer roommates to disturb.

Meet with your spouse’s caregivers often and remind them of your partner’s strengths − especially after placement. It is often a perception shift when caregivers in a residence have mentally competent people in their care. They sometimes need to be reminded that their clients need to be heard and know what they are talking about. Whatever the strength of your loved one, it needs to be highlighted and capitalized on.

Never forget the power of kindness and courtesy. A box of doughnuts left at the nurse’s station and a thank you card may go a lot farther than constant criticism and snide comments. It is important to remember that you will be leaving at the end of your visit, but your partner will be living there and he or she will deal with any fallout from how you treat the staff − positively, or negatively.

You can contact me at annnovick@hotmail.com.

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When What You Can Do Changes (Part VI)

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