Moving Into a Nursing Home: A Guide for Families
Peter S. Silin, MSW, RSW
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Have you ever had to move to another town? Do you remember what it was like finding a new place, wondering what it would be there, would you find friends, how would you find your way around?
Do you remember, as the move came up, what you felt? Some fear? Some excitement? Sadness at leaving the place where you have been living, maybe leaving things or people behind and wondering if you would see them again. Do you remember thinking about the memories, the events, the life that had gone on where you were? Do you remember leaving the house for the last time; maybe thinking that a part or a time in your life now was over?
Did you once, maybe, when you were a child, have no choice or say about a move when your father got a transfer, or there was a problem in the family. You wondered why you had to move, why you had to leave your friends, why maybe even you had to leave your dog or your cat. Did they surprise you with the move spring it on you so it felt like your world was one of confusion? Maybe you looked for a way out, tried to delay it or find a way around it.
Do you remember what it was like when you got to your new place in your new town? Having to start building a life again, finding your way around, figuring out how people did things, or where they did them? Or who did what if something needed to be done?
If you started in a new job in that new town, do you remember trying to remember all the names of your co-workers, and where everything was? Did you get embarrassed when you did something wrong, or you couldnt remember? Do you remember the anxiety you had, and how you dealt with it? Maybe you got angry, maybe you got frustrated, maybe you tried to hide it. Maybe you got depressed.
Now, imagine you went through all of these events and processes, but you had no choice, and you had no understanding, and no matter how hard you tried, for the life of you, couldnt figure out what was going on. But what you did know is that, you didnt understand, and you didnt choose this.
This is what moving to a nursing home can be like for new residents.
The Caregiver's Role
And then, there is you, the caregiver. I used Nursing Homes: The Familys Journey as the title for my book, because the move to a nursing home doesnt just happen to the resident it is a process that the whole family is involved in. There may be only one of you who is a resident, but in a sense, you are all moving. So while you are paying attention to what moving in is like for the resident, have enough compassion, time, and attention for yourself to understand that you too are going through the move. You too are experiencing loss, change, grief. You too can be going through fear, through the feeling of I dont want this, and why does this have to be, and not having an answer that can ever feel right to you.
The move to a nursing home is more like a journey than an event, for both the resident and the family. By that I mean that the actual admission day is one step in a process. If you think of it like that, you can think of moving in as three steps pre-admission, admission day itself, and post admission adjustment. This will also help you figure out how to face it.
After you have chosen a facility, or even just made the decision that a nursing home is necessary, but before admission, do as much preparation as you can. There is emotional and practical preparation.
For emotional preparation, the prospective resident should be involved in as much of the decision-making as possible. Fear of the unknown can make an admission more difficult. Both the caregiver and resident should be able to spend some time in the facility, with the staff, other residents, and other family members until some kind of comfort is developed. Maybe that means going to activities, having a meal there once a week or a couple of times, going to the family council or family information night meetings, or meeting with the social worker or recreation director before admission. More cognitively aware residents can go to a residents council or be buddied up with a present resident.
It is possible, of course, that the resident is not willing to visit beforehand, or would be extremely agitated, or maybe goes right from hospital to the home. You will have to skip with pre-admission preparation that involves him or her. That still doesnt mean that the admission will necessarily be more difficult. It does mean that the caregiver may have to do more of their own emotional preparation; almost like the less they do, the more you may have to.
Also before admission, become informed. Read as much as you can on the subject and discuss your fears and concerns with others who have gone through the experience before. The related articles and recommended readings at the end of this article will answer many of your questions). My book, Nursing Homes: The Familys Journey explains what will happen and how to be the family member of someone in care. It will teach you about nursing homes and how they function. Read the brochure or handbook from the home. Read the pre admission agreement. Try to have an understanding of what your rights are as regards to nursing homes and care. The more understanding and comfort your have with this process, the more you will feel in control of it. The less you know, the more it is in control of you.
Try to have a good understanding of the costs and payments that you will run into. Understand the differences between Medicare, Medicaid, and private insurance funding. There may be an explanation of costs and extras in the admission agreement, but make sure. If you have hired an elder lawyer or geriatric care manager, dont hesitate to ask for explanations.
If there are several family members who are involved in the caregiving, it might be wise to have at least an informal meeting as the process is unfolding, so that everyone is caught up and on the same footing. Be prepared for the fact that not everyone will handle this process emotionally in the same way, even if you are all agreed that it is necessary. If there are divisive issues about money or care, you may have to get professionals involved to protect you and your loved one.
Understand and be prepared for the anxiety, and confusion and other feelings that will arise, both on the part of the caregiver and care receiver when the time of the actual move has arrived. Many caregivers, even if they have been prepared, still feel a sense of panic. That is why you make plans, even do a dry run or two in your head. It is harder to think rationally when you are nervous and stressed. Although you may not feel these emotions, if you are prepared for them, at least they wont hit your from nowhere. Maybe you will need someone to call who can be your support or guide. Maybe the home has someone who can act as a buddy to you even before the actual admission and while you are doing the move. Also, understand that things will become easier, after you have had time to catch your breath a few weeks after admission.
Many caregivers, but not all, have the additional feelings of guilt and anger. These are powerful and sometimes overwhelming emotions. You do not have to be helpless with them. Reminding yourself why you are doing this. Accept the fact that sometimes people just need a nursing home. They need the care there that a caregiver, alone and unprepared, cannot give twenty four hours a day. Review what you have been though and what you are going through. Write it down, talk to a friend, or other people who have been through this. Dont get trapped with these feelings in your head try to listen to what others tell you.
The day of admission can be filled with forms, interviews, and tasks. If you can fill out some of these forms, and do some of the tasks beforehand, it will be easier. That is one of the reasons for pre-admission meetings. On admission day, give yourself enough time to do whatever comes up, and be prepared to stay for the day. Find out from the home what that day will be like, and what you are required and allowed to do.
Also review with the staff what kind of care you have been providing, and how you do it; what works, and doesnt work. You can even write down some of the specifics. Let them know what you expect from them. Ask them how they expect things will be done. This is the beginning of a care plan the guide that tells the staff what kind of problems a resident has and what kind of help, medications, therapy, etc, they need. If the home is a government-funded program, the care plan must be initially done within about a week of admission.
Remember, no matter how good a home is, the care is not individual, and it will not be the way you did it. There will be more than one person looking after you and your relative. This can make communication and systems difficult to manage. One of the tasks you will face is figuring out the system and how it works. If you cannot eventually allow this to be so, you are setting yourself, your loved one, and the home up for failure. You must become a partner in your loved ones care. Some responsibilities must be ceded to the staff. Your greatest responsibility is to continue to stay involved, to visit, and to actively work to enhance your loved ones quality of life.
Nobody has to do this process alone. There is always help available to you. There are often support groups in the nursing home, through groups like the Alzheimer Society (in Canada) or the Alzheimers Association (in the US), Children of Aging Parents, your friends, your pastor, and others. There is also professional help such as geriatric care managers, whose job it is to help you and the prospective resident find a good home, and monitor the admission. There are social workers, psychologists, and other counselors who specialize in grief, loss, and transitions.
Online support groups serve as an important venue for gathering information, sharing experiences, and finding understanding and camaraderie.
Do you remember what it was like six months or a year after you had made the move, even if you didnt want to? At some point, even without your noticing it, you knew your way around. There were familiar places and people. You knew where to go to solve problems, and you werent getting lost anymore. When you looked back on the day that you moved, and the feelings you had about moving, they were a memory, maybe still strong, but easier to deal with. Remember this, when you think about moving into a nursing home. Things may not be good or great (or maybe they are wonderful) but you will get through the move.
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