When is it time to move into a nursing home?
By Kevin McClintock Specialty Publications

There just isn't a published "How To" book on sale inside book stores that detail the exact moment when a loved one should enter a care facility or nursing home, or how a loved one should even go about handling this often delicate and emotional situation.

That was the summation of elder advocacy coordinator Carolyn McLaren, who spends the bulk of her working hours inside dozens of nursing homes, speaking to both the home's residents and their visiting loved ones.

"It's a real challenge," McLaren said of this uniquely uncomfortable situation. In fact, she said, such decisions are oftentimes described as some of the most difficult a person will ever have to make, where one can spend weeks agonizing over the various pros and cons.

McLaren said a family who works together as a whole to help keep an ailing loved one inside his or her home for as long as possible is probably the best way, since loved ones are comforted by familiarity and daily routines.

This appears to be a nationwide trend.

According to the National Association of Area Agencies on Aging, more than 85 percent of seniors, 80 years and older, living in America today, are still residing inside their homes. Most are on their own and, though heavily-supported by family members, are doing just fine.

On the other hand, a loved one's physical or mental deterioration can often push a family's collective stamina to the breaking point.

According to the National Center for Health Statistics, more than 1.6 million Americans live inside nursing homes.

It's usually when a person begins showing alarming lapses in judgement, either due to old age or Alzheimer's, that the subject of a "nursing home" is first brought up in conversation., McLaren said.

"It could be a family that has been taking care of a loved one that needs the care, and the family members are so burned out that they are losing their tempers, or they're exhausted, or they're becoming ill themselves - this is when they need to look very seriously at getting some help," she said, such as Hospice care, where people come into the home for visits or stay permanently to take care of household chores, fix meals and ensure the proper dosage of medications are taken.

"And if they can't afford the care inside their home, and most can't because it's so expensive, they then need to look seriously at a facility of some type, a skilled facility perhaps, or a resident care facility."

Spring River Christian Village is an example of a growing trend in the nursing home industry, where one facility under one roof offers independent living, congregate living, residential care, intermediate nursing care and skilled nursing care. The concept is called "continuum care." Think of this new breed of facilities as the "Wal- Mart" of the healthcare industry. Independent living offers the most freedoms for an individual, including single or double apartments with community meals and social services nearby.

Assisted Living is a type of facility offering private rooms, shared meals in a dining room but 24-hour supervision and assistance. A Board and Care Home is a private home/facility offering room and board, help with daily activities and minimal nursing services. Nursing homes provide 24-hour care.

Once a decision to place a loved one into a home is made, McLaren said it's extremely vital for family members to hold a family council, making sure to include the ailing loved one.

She admits it's one of the most difficult decisions in the world to make. "But when you don't keep the person you're going to place into a nursing home informed, you'll discover it will make them much more angry; that they've been betrayed or... dumped on."

While a majority of families have no intention of "dumping" their mother or father inside a facility (dumping is the industry word for family members to leave family members on nursing home doorsteps with a note pinned to their coats, much like a litter of newborn puppies), and have every intention of seeing them on a daily basis, "But because (he or she) wasn't included in the decision-making process, they don't feel like they have had a part in any of the choices that directly involve them," McLaren said.

So what should family members do if a mother, father or grandparents say, "No way"?

"That happens," McLaren admits. "I don't have any real good answers... except the family has to be really honest."

If the loved one's refusals continue, there really isn't much family members can do about it. In this case, "You'll have to determine if the person is competent to make (that type of decision) on their own."

Family members can only force a loved senior into a home if a son or daughter has guardianship or power of attorney.

In most cases, after initial refusal, the stayat home senior will experience some type of accident that will scare them into sensibility. It may be leaving the stove on. Or leaving the front door open in the dead of winter. Or locking themselves outside their house. "They usually agree after they've had a 'Help, I've fallen and I can't get up' moment," McLaren said.

Most sons and daughters are wracked with guilt when forced to move a parent from their home. Such decisions, not surprisingly, is often delayed because of these feelings. But those feelings aren't healthy, she said.

"A lot of people promise (loved ones) they won't place them inside a nursing home, and in my opinion that's just a bad promise, because there is a point where there is simply no other choice - whether it be a fall or a broken hip, a person can no longer get out of bed or they have no clue as to what's going on around them," McLaren said.

Sadly, siblings often disagree, sometimes violently, over a decision to move a loved one. This can cause a great deal of tension among family members, McLaren said. At the first sign of trouble, she recommends bringing in a third neutral party, maybe a social worker, who will look at the situation without prejudice.

McLaren said it's important for family members to remember moving a loved one into a nursing home is one of the most difficult decisions in life. The more love and TLC that can be shared with the loved one moving, the easier the transition will ultimately be.

"Seniors still have a lot to contribute to our society," said Bart Davis, administrator to a 91- room skilled nursing home. Seniors, he continued, "would give you the shirts off their backs if they could, even if that's all they have. That's why we treat our residents here with the utmost respect and dignity they deserve."