How to Cope with a Difficult Decision

At Fundamental, one thing we understand all too well is how difficult it is to come to the decision that the person you love is ready for a long-term care facility. Awakening to this emotionally difficult realization is but the first of many steps, that, taken together, will guide you to a better way of caring for—and therefore loving—your aging family member.

"Where Do I Begin?"

Begin as early as possible, maybe even before you need to. This is very difficult and may sound and feel discomforting, but it will help you later when the emotions that surround every decision feel overwhelming, as there are also practical matters to consider.

It is not always the case, but it is not uncommon to encounter waiting lists at some facilities. If you start looking at and assessing the differences between facilities early on, this will not be an issue for you. You’ll also have the opportunity to learn where your parent or spouse in need is most comfortable living.

Know What You Need

How is your family member doing when it comes to mobility? Can he or she get around with little or no assistance? What about nutrition, dressing, hygiene and toileting? Can he or she be responsible for taking medications reliably? What is her mental status? Is he more forgetful than usual? Is her speech impaired? Is her behavior unpredictable?

His or her ability to perform activities of daily living (ADLs) as well as interact with others is crucial to determining the level of care he or she will need.

Take Notes

Observe every everything and write it down. Often, families entering this stage of life feel overwhelmed by the details. Writing them down will help you stay organized and stay focused. Here’s what you’ll need to look for:

First of all, emotions count. Keep track of yours and those of your loved one’s. Take note also of memory loss, falls or other injuries, as well as any type of functional decline. For instance, is your father losing his sense of smell, taste, vision or hearing? Are his cognitive abilities waning? Does he have a harder time recalling names or events? By keeping a journal and marking down the dates of your entries you will be able to track important changes over time.

Deciding What to Do

Togetherness is important in a decision as big as this one. Everyone in the family should have a say and be heard, however the final say belongs to your aging loved one — so long as he or she has the cognitive ability to do so.

Preparing Your Loved One:
The Most Difficult, Loving Talk You’ll Ever Have

If you think it’s going to be difficult to tell your parent or spouse that it’s time he or she went into a nursing home, imagine how he or she will feel upon hearing it. If things go well, your aging loved one will recognize their need for outside help and accept what you have to say. But the emotions that surround aging are complicated. Your loved one may feel that you are abandoning him, that you don’t love her anymore or that she’s a burden. Be prepared for an angry reaction.

Use these tips to help navigate the emotional waters that surround this difficult, but essential time.

To begin, when you speak about your loved one’s care understand that he very likely is afraid of his own decline and uncertain about what the future holds. Ask him what he hears you saying. Let him know you understand and respect his feelings. Reassure him of your love and make sure he knows you’ll be there for him emotionally, but draw a distinction between the love you share and the professional medical care he needs. Then move into the more pragmatic parts of the topic.

Find out what personal possessions he would like to bring along with him. A few small possessions will give him peace of mind and a feeling of control. But there won’t be much in the way of personal space, so help him minimize the number and size of what he brings.

Keep talking, especially as you get closer to the big day. Communication is vital. It eliminates surprises. It keeps everyone focused. And it will go a long way to managing the anxiety that everyone in your family is sure to be feeling.

Finally, recognize that even the best-laid plans don’t mean that it will be easy. Your loved one may still flat out refuse to go. In this event, be sure that he can speak with his physician to determine what other options—if any—exist, such as home health care. Your physician will help you work your way through all these issues. Among the toughest issues to deal with, however, will be your own emotions.

For many individuals, the hardest act to perform is leaving the nursing home after dropping your loved one off, not just physically, but emotionally. It may seem at this time that a storm of feelings is swirling about you, not the least of which is guilt. It’s easy to feel lost.

Here are a few guides for understanding your own feelings:

These feelings are not only complex, they’ve been building for quite some time.
These feelings are heavy, and they exact an emotional toll. The trouble many family caregivers have once their loved one is actually admitted into a nursing home is feeling as though a huge burden has been lifted—and then feeling guilty about thinking that way. For one thing, it doesn’t make you a bad person. Chances are you’ve been shouldering a bigger responsibility than anyone would be able to sustain long term. It’s natural to admit you feel some relief. Secondly, you can feel relief and still love your aging parent or spouse. They are not mutually exclusive feelings in this case.
Don’t be afraid to ask for help, both from within your family and from a support group alike.
Keep your perspective. This will be a trying time. Set aside some time for yourself to do things that take your mind off this difficulty.
Learn to let go—even if just a little.
Make time to tend to your own health. Exercise, eat well, sleep. You’ll need to keep your energy up.

Embracing Your New Role

The change that’s about to take place in your relationship is significant, and likely it will have a few bumps in the road that are uncomfortable, however with love and persistence you can work through them. Here are a few insights into the things you may need to be prepared to take on:

Happily, you can return to being your loved one’s son, daughter or spouse instead of caregiver. This will be a welcome change for both of you.
Be an advocate for your family member so that the physicians, nurses and other professional caregivers understand what your loved one’s needs and wishes are. But remember that these people are here to help; avoid being adversarial.
Make sure your parent or spouse’s finances are in order. You very likely will need to become the manager of his or her financial affairs.
Help her through her transition. Remember, this is an enormous emotional change. Not only will she be living in a group setting, but she may even have a roommate for the first time. Not to mention the fact that her lifestyle will change dramatically.
Reassure your loved one that she made the right decision and that things will get easier. This is also a message that you will want to take to heart yourself.
Visit. Your presence will bring a smile to family member’s face. And it will make you feel good too.