No one looks forward to moving into a nursing home or putting a loved one there. But what to do when Dad is losing an alarming amount of weight because he lives alone and doesn't eat well, or when Mom's deepening depression and forgetfulness make her neglectful of vital medications? A nursing home may truly be the best option.
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You may be able to push back the day of reckoning for months or years. There is likely more support in your community than you suspect. Tap the local Meals on Wheels program to help your father stay well nourished, for instance, or adult day care to take the edge off your mother's depression by connecting her with other people. However, a frail elderly person who may have already fallen and broken a hip or who has been wandering the neighborhood because of progressing dementia must have full-time care.
We have created a four-step tool that first will help you determine whether nursing home care can be put off at least for awhile. Then, if you conclude that a move can no longer be delayed, we will help you find a home that best meets your loved one's needs—human as well as physical and medical. Finally, we will provide tips on how to stand watch so that he or she continues to receive skilled and compassionate care as time passes.
Arrange an evaluation. Your loved one should have a thorough geriatric assessment to evaluate his or her physical and mental status. A geriatrician, or a doctor or nurse practitioner with geriatric training, would be ideal, but such specialists can be challenging to find in some areas. Your mom or dad's primary care physician is another option; phone ahead for reassurance that he or she can do a thorough assessment. The most important element will be your loved one's degree of ability to conduct "activities of daily living"—sufficient upper-body strength to get out of a chair unassisted, adequate dexterity to bring fork to mouth, and enough range of motion to pull on pants or a sweater, for example. Balance will be checked to assess the risk of falls. Memory deficits, signs of depression or anxiety, and indications of dementia and Alzheimer's will be evaluated. Simply identifying all the issues can take a big weight off a worried family's shoulders. "When you frame it by what they need, then you can start putting together a plan," says Cheryl Phillips, chief medical officer and geriatrician for California-based On Lok Inc., which provides long-term care and services for the elderly. If your loved one doesn't have a doctor or the means to get to one, the local Area Agency on Aging may be able to come to the house or to do an initial, if less thorough, assessment over the phone.
Add your own insights. Input from family members should be integrated into the evaluation. The particulars of day-to-day concerns—trouble persuading Mom to take a shower, or her habit of forgetting to turn off the stove—will help guide the assessment, inform the plan of care, and narrow the choices that will have to be made.
Look to your community for help. "If they don't need 24-hour care, many people could avoid a nursing home for one or two years," says Susan Reinhard, AARP senior vice president for public policy. The Area Agency on Aging will have a list of local services, from volunteer groups that arrange rides for older folks to get to doctors' appointments to the businesses that provide in-home nursing care and assisted living facilities. The Eldercare Locator Web page, maintained by the federal government, is a good resource to use as a starting point. You can search for help by ZIP Code.
Consider hiring a professional. Barbara Gortych, a Boston psychologist, recruited a geriatric care manager in Florida near her mother, to help find local resources and assist in care decisions. When Gortych was unable to visit, care manager Stephanie Swerdlow kept her informed about her mother's status and services that were needed. Over the years, she helped Gortych arrange for occasional companion care to help her mother shop for groceries; she helped find a much-loved aide who was with her mother daily, an assisted living facility as dementia set in and, finally, a nursing home when 24-hour care was required. It was Swerdlow, in fact, who alerted Gortych that her mother needed the range of care that only a nursing home could provide. As her mother's mind faltered and her health declined, Swerdlow would make unannounced visits to the nursing home to check on her care. "If something wasn't right, she was the one who had the rapport," says Gortych. She credits Swerdlow with bringing her peace of mind as well as local knowledge.