By Marie Marley
Virtually no one wants to either live in a nursing home or place a loved one in such a facility. However, according to Linda Breytspraak, Center on Aging Studies, University of Missouri-Kansas City, “Today, people over the age of 65 have about a one-in-four chance of spending time in a nursing home.”
Most elderly people who have a clear and compelling need to be in a long-term care facility desperately want to remain in their own homes. They want to be in a familiar setting and be close to their family members.
Family members are often adamantly opposed to the idea as well, even when a nursing home is clearly what is needed. It may be that a spouse previously promised to never put them in a nursing home. It could also be that a child made the same promise to a parent. In many cases, it’s even more difficult because a loved one’s objections usually make the family member(s) feel guilty about the very idea of institutionalizing them.
The decision to place a loved one can be agonizing, but caregivers need to consider the following:
Long-term care placement can be the most loving choice when absolutely needed to ensure the person receives all the necessary care, is around others for social stimulation, and is in a safe environment.
Their promises (if any) were made years earlier when no one could have foreseen the current conditions that are urgently requiring the kind of care that a nursing home provides.
Caring for a loved one is probably seriously affecting their own physical and mental health and wellbeing. No one can be a good caregiver if they are exhausted and burned out all the time.
“I often work to convince reluctant spouses to change from being a ‘caregiver’ to being a ‘care advocate,’” says William G. Hammond, founder of the Elder and Disability law firm in Overland Park, Kansas. “They can then be vigilant to ensure their loved one is receiving appropriate treatment in the facility while preserving their own health.”
Many people, however, flat out refuse to go. In such cases, you can try to convince them that it’s best for their own health and wellbeing. If that doesn’t work, you may enlist the help of another family member or even the person’s physician to talk with them. People will sometimes pay more attention to the advice of someone other than the primary caregiver. However, if the person is mentally competent and continues refusing, there may be very little you can do about it unless their health is in imminent danger.
If your loved one has dementia and is resisting placement, it can be more complicated, but there are several strategies you can use. First of all, try those listed above for loved ones who don’t have dementia. You may also obtain the services of a geriatric care manager, who can often guide you through the process.
Another approach is to use what is referred to as “compassionate deception.” You can convince the person to go for a limited period of time, such as a week. Then you stretch it out to two weeks, then three, and eventually they will probably adjust to being there full time. If a loved one is significantly impaired, he or she may even forget they were supposed to go back home. Or they may not be aware they aren’t at home.
You may also make arrangements for a facility to allow you to take the person there, saying you’re going to visit someone there or you have dinner reservations there (or some other reason for visiting). Then when you leave, don’t take them with you. You will probably feel terribly guilty, but the person will almost certainly adjust. This may take a few days or, in rare cases, a few weeks, but your loved one will probably come to know the facility as ‘home,’ and they are not likely to remain angry with you.
If none of the above suggestions work and you have power of attorney, you may have to enlist the help of law enforcement. According to Hammond, “You should do this only as a last resort. It’s only for the most severely impaired people and the most dire circumstances – such as if the person becomes a danger to him or herself or others.” Law enforcement typically takes the person to a hospital geriatric psychiatry unit for evaluation and treatment, from where they may be released to a nursing home.
“If all else fails and you don’t have power of attorney,” says Hammond, “you may face costly and potentially embarrassing court action in order to be appointed the person’s guardian or conservator. You can then make all decisions for them about where they will live.”
When you must take a demented person against their will and/or go to court to get guardianship, however, consult a local elder law attorney for advice because laws vary from state to state. You can call your local bar association to get a referral.