The Nursing Home Decision

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The decision to place an elderly parent or spouse in a nursing home involves many factors. Learning about the reasons people end up in nursing homes can help people make an informed decision based on the needs of the patient and caregiver, rather than on guilt.

When patients are cared for at home, changes in their condition and their need for increasing degrees of care over time will often lead to the need for a nursing home. Whether or not a family caregiver can manage the patient at home is often determined by the patient’s ability to carry out the regular activities of daily living which include:

  1. bathing;
  2. dressing;
  3. eating;
  4. transferring from chair to bed;
  5. and using the toilet.

According to a fact sheet by Sheel Pandya for the AARP Public Policy Institute, about 75 percent of all nursing home residents 65 and older required assistance in three or more of these activities of daily living.

Once a spouse or elderly parent can no longer do one or more of these tasks for him or herself, constant care may become necessary. Since bathing, transferring and helping a person to the toilet all require lifting or bearing the patient’s weight, elderly spouses often reach a point where they can no longer provide this care by themselves. If financial resources won’t allow for in-home assistance, a nursing home may be necessary.

Dementia and Mental Status Influences the Nursing Home Decision

Another factor that tends to lead toward institutionalization is the patient’s mental status. According to Pandya, about 42 percent of nursing home residents were diagnosed with dementia, and 12 percent had other psychiatric conditions, such as schizophrenia and mood disorders. The symptoms of these disorders can interfere with the patient’s ability to comply with basic safety considerations and his ability to follow doctor’s and caregiver’s orders. This can make the patient a danger to self and others, requiring a more restrictive setting like a nursing home.

In addition, a patient who is abusive to the caregiver may need to be placed in a different setting.

Is Nursing Home Care Over-Utilized?

Until recently, there was a perception in the United States that nursing home care was over-utilized and unnecessarily replacing good, old-fashioned, family members caring for family members.

In recent times, however, there is a widespread recognition of the enormous numbers of those who are caring for parents and loved ones at home. According to WPBS interview with Dr. John B. Murphy, a specialist in geriatrics and family medicine, for every person in a nursing home in the United States there are three people with similar health issues who are being cared for at home.

Financial Considerations

Many families make as much effort as is humanly possible to care for their loved ones at home. But for those who do not have family, or the financial resources to pay for in-home care, nursing homes sometimes become the only option. Financial and legal planning ahead of time for the possibility of long-term illness can help preserve options.

Sometimes a hospital stay or additional health crisis will land the patient in a nursing home with no possibility of returning home.

Preserving Quality of Life

Whether you are caring for an elderly parent or spouse in his home, your home, or a nursing home, you can help preserve your loved one’s quality of life by ensuring that he receives the best possible care, and by taking opportunities to connect with him in as meaningful a way as possible. Creating and hanging on to moments of closeness can be healing for both caregiver and patient, regardless of the setting.

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