The Nursing Home Decision

When patients are cared for at home, changes in their condition and their need for increasing degrees of care over time will sometimes lead to the need for a nursing home. Whether or not a family caregiver can manage the patient at home is often determined by the patient’s ability to carry out the regular activities of daily living which include:

  1. bathing;
  2. dressing;
  3. eating;
  4. transferring from chair to bed;
  5. and using the toilet.
If the patient has trouble with the tasks of daily living, full time care such as nursing home care may be necessary. Photo: Jax,

If the patient has trouble with the tasks of daily living, full time care such as nursing home care may be necessary. Photo: Jax,

Once a spouse or elderly parent can no longer do one or more of these tasks for him or herself, constant care may become necessary. Since bathing, transferring and helping a person to the toilet all require lifting or bearing the patient’s weight, elderly spouses often reach a point where they can no longer provide this care by themselves.

Adult day care, provided by many nursing homes, often serves as a good middle ground. Many patients enjoy the stimulation and social interaction of the day care programs, even if they are reluctant at first. They attend during the day and return home at night. In-home health care aids can also keep patients at home longer, but not everyone can afford this help.

If the health and safety of the patient or caregiver is compromised, nursing homes can be the best option. Some families come to appreciate the nursing home once their loved one is placed there because programs in the better homes provide social interaction and stimulating activities for patients, who, when they were home, spent much time in front of the television and sleeping.

Dementia and Mental Status Influences the Nursing Home Decision

Another factor that tends to lead toward institutionalization is the patient’s mental status. The symptoms of disorders like dementia can interfere with the patient’s ability to comply with basic safety considerations and his ability to follow doctor’s and caregiver’s orders. This can make the patient a danger to self and others, requiring a more restrictive setting like a nursing home.

Problems that occur in dementia like sleep disturbances and wandering can disrupt a family to the point that providing care at home is no longer do-able .In addition, a patient who is abusive to the caregiver may need to be placed in a different setting. 

Is Nursing Home Care Over-Utilized?

Until recently, there was a perception in the United States that nursing home care was over-utilized and unnecessarily replacing good, old-fashioned, family members caring for family members.

In recent times, however, there is a widespread recognition of the enormous numbers of those who are caring for parents and loved ones at home. According to a September, 2007 WPBS interview with Dr. John B. Murphy, a specialist in geriatrics and family medicine, for every person in a nursing home in the United States there are three people with similar health issues who are being cared for at home. According to AARP, in 2012, family members caring for loved ones at home are providing the equivalent of two billion dollars worth of services in New York State alone.

Financial Considerations

Financial planning ahead of time is required to pay for nursing home care, as it is not covered by health insurance plans or Medicare and it costs a fortune. Special private insurance policies purchased well in advance of illness known as Long Term Care Insurance are necessary for this type of coverage.

Another option is to protect assets via  various legal planning tools well in advance, and apply for Medicaid to pay for nursing care. Most middle class people would have to spend everything they have for nursing home care, including assets, within a matter of months or a year before their money ran out. Once they have done that they may qualify for Medicaid.

It’s best to make plans well in advance with the advice of an Elder Care Lawyer. Protecting assets offers you more choices for your own care, such as utilizing in-home health aids instead of a nursing home.

Sometimes a hospital stay or additional health crisis will land the patient in a nursing home with no possibility of returning home because of the level of care needed.

Preserving Quality of Life

Whether you are caring for an elderly parent or spouse in his home, your home, or a nursing home, you can help preserve your loved one’s quality of life by ensuring that he receives the best possible care, and by taking opportunities to connect with him in as meaningful a way as possible.

Caring for and doing right by family members doesn’t always mean providing the care yourself. Family members don’t do the surgery if their spouse needs it, they find a qualified surgeon. Nursing home placement doesn’t mean that you are not living up to your responsibilities. Creating and hanging on to moments of closeness can be healing for both caregiver and patient, and can be done regardless of the setting. Families need to look at what is best for both the patient and the caregiver.

Sometimes adult children push one parent into placing the other in a nursing home before the caregiver-spouse is ready to do so. People often experience enormous guilt when placing a spouse in a home and if they are forced to do so before they are ready this can cause a great deal of emotional pain and suffering on the part of the well spouse. Sometimes patience and a more gentle hand, are required in helping with this decision.

This article is for information only and is not meant as a substitute for personal medical or mental health advice.

©Lisa C. DeLuca, all rights reserved.  It is a violation of copyright law to reproduce this work on the web or for profit without written permission from the author. This article was originally published on the web in 2008. Please contact the author with your reprint request.

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