“I Promised My Parents I'd Never Put Them in a Nursing Home”

Caregiving is a job that is full of ups and downs. Many of us take on this role out of love and concern, but as care needs increase, the pressure ramps up and we are faced with increasingly difficult care decisions. One of the most heart-wrenching choices a family caregiver must make is whether to place a loved one in a nursing home.

Unrealistic Promises Complicate Caregiving

Back when our loved ones were younger and healthier, many of us promised in good faith that we would never put them in a nursing home. Doing so would be unthinkable—like abandoning them in their time of need. So, we naively pledge to care for them ourselves until the very end. We assure them that they’ll be able to live out their remaining years at home with family tending to their needs.

This is admirable yet unrealistic thinking. Recent research shows that the average duration of caregiving is a whopping 4.5 years. As time goes by and our loved ones’ care needs mount, we find ourselves spread thinner and thinner. Eventually, we are forced to admit that we can’t raise our families, work our jobs, care for ourselves and provide full-time hands-on care over the long term. So, we regretfully start looking into other options. They need more care than we can singlehandedly provide, so we start by making some kind of change to their care plan such as hiring in-home care or enrolling them in adult daycare.

There are plenty of benefits to home care and adult day programs. Seniors get the care, supervision and social interaction they need to thrive. The activity programming is far more stimulating than can be provided at home, and you get some valuable respite time away from caregiving. Yet this care doesn’t completely halt a senior’s decline. Unfortunately, the day comes when in-home care and adult day care either can’t meet all their needs or the cost of such assistance becomes unaffordable. At that point, only one choice remains a nursing home.

Ditch the Guilt about Senior Care Decisions

Cheryl E. Woodson, MD, a geriatrician, family caregiver to her mother with Alzheimer’s, and author of To Survive Caregiving: A Daughter’s Experience, A Doctor’s Advice on Finding Hope, Help and Health, says that you can still honor the spirit of your promise even if you have to break it.

None of us knows what the future holds. Our parents cling to visions of the crowded, smelly nursing homes that existed decades ago before regulations were put in place to protect residents and employees. The very idea of moving to a nursing home is unthinkable to them, but the truth is that these long-term care facilities have made leaps and bounds since most people last visited one—younger generations included.

Despite these improvements, caregivers still tend to feel that living in one isn’t ideal. We all want to remain in our own homes, living independently or at least with the help of those we love and are comfortable with. But swearing off nursing homes altogether usually happens when we’re still relatively new to caregiving, our loved ones are still healthy and the possibility of such a decision is far off.

Years later when the unthinkable happens and your parent or spouse requires skilled nursing care and/or around-the-clock supervision, this promise can come back to haunt you. Whether your loved one is laying on the guilt or the blame is largely self-imposed, there’s no point in letting it get to you. You can’t change the level of care they require, and you can’t singlehandedly meet these needs. Trying to keep a senior at home is commendable, but at some point, this becomes unsafe and unsustainable for both of you. One person attempting to do the same job as an entire nursing home can be detrimental to your loved one’s health and is a guaranteed recipe for caregiver burnout.

Placing a senior in a nursing home can feel like a monumental failure, but this isn’t the case. Adjusting your attitude can help you realize that you are actually fulfilling the underlying commitment you made to your loved one. When you boil it down, you vowed to ensure they receive the best possible care in a comfortable setting. If you have researched alternatives to the placement and still decided that a nursing home is the only viable option, then ditch the guilt. You have done all you can. You have honored the spirit of your promise and are making a difficult decision to ensure your loved one is properly cared for. That’s exactly what being a good caregiver is all about.

Finding the Right Nursing Home Can Make the Decision Easier

Doing your due diligence when researching and selecting a nursing home will give you some peace of mind. If your loved one is capable of participating in this process, encourage them to do so.

Long-term care facilities have improved over the decades, but not all nursing homes are equal. So, learn about what to look for in a facility, its staff, and the services it offers. Tour prospective providers a few times each, ideally before an immediate need arises. The more time you have to make a decision, the less stressful it will be, and the more thoroughly you can vet these places.

Keep in mind that demand is high for some facilities and there are often waiting lists for admission. If you find a nursing home that is warm, inviting, clean, and staffed by friendly, attentive employees, you’ll feel much more confident in your decision and comfortable with moving your loved one in.

Caregiving Doesn’t End After Nursing Home Placement

One common misconception about moving seniors to a long-term care facility is that their family members just dust off their hands and no longer function as caregivers. While that may be a possibility for some who go no-contact, most simply take on a different role in their loved one's care.

There are still responsibilities to see to, like visits, laundry, shopping for personal care items, managing finances, etc. But the biggest change is that caregivers are no longer responsible for assisting with time-consuming activities of daily living (ADLs) like bathing, dressing, and toileting. Family members can actually enjoy spending quality time with their loved ones rather than focusing solely on meeting their needs. Visiting caregivers are less likely to be so worn out that they’re unpleasant to be around.

The biggest responsibility you will take on after putting a parent in a nursing home is serving as their advocate. They need you to put personal touches on their room and be visible to the staff and other residents. They need you to help them settle in and get their bearings. They need you to ensure they’re getting quality care and that they’re mentally and physically healthy. Most of all, they need you to help make this place their new home and be the person who visits without all the pressure and exhaustion of handling daily care tasks.

Caregivers are a dedicated bunch, but that dedication can get carried away and turn into martyrdom. Frankly, martyrs aren’t good caregivers. There is nothing “bad” or “wrong” with placing a parent in a nursing home if it is in their best interest and your own.

Accepting the help of a good facility while keeping an eye on things and continuing to care for your elder in this new role allows you to take off your martyr hat and stop running yourself ragged. You can do it without guilt because you have done your best. You are still doing your best. Just because someone else is responsible for your loved one’s care doesn’t mean it is automatically substandard. Accept your humanity without shame. Honor the spirit of your promises by being the best caregiver you can be. Be a caregiver who knows when to say when.

Bruce Webb is a Senior Real Estate Specialist (SRES) and has an extensive network of senior-related referrals.

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