The Nursing Home Decision

Several years ago my father told us that if we ever needed to, we should feel free to put him in a nursing home. At the time it seemed like a strange remark because he was in good health and that was the farthest thing from anyone’s mind. Fortunately, we never needed to make that decision, but in retrospect I realize what an incredibly generous gift he gave us. By giving us this option, my father freed us of any guilt that we might feel if we did have to make that difficult decision. I know that in many families the opposite occurs – offspring are asked to swear that they will never put a parent in a nursing home. Honouring that promise is sometimes difficult, and if the promise cannot be kept, then the offspring has to endure the feelings of guilt about breaking the promise.

The fear of nursing homes is so serious that in Dallas an elderly couple committed suicide to avoid having to go into one. One survey even found that seniors feared nursing homes four times more than they feared death.

So, what is it with nursing homes -why do people fear them so much? Many seniors fear them because they mark an end to their independence. Instead of being in control of his day to day affairs, the senior must now submit to the rules and regulations and schedule of the nursing home. Many seniors also see the nursing home as the final step of their journey to the grave. Seniors and their families may also fear nursing home because they worry about the kind of care that they will receive in the home.

A nursing home may seem like a form of abandonment and it will always be a difficult decision even if the parent agrees as in the case of my dad. However, they do have their advantages. Our lives have changed and the family isn’t what it used to be. Many of us grew up in homes with extended family members and someone was always at home, so keeping an ailing relative at home may have been feasible. Nowadays however, many of our families are scattered and most adults work outside of the home, often coming home only to sleep and refuel for the next day of work. With the best good will in the world, they lack the time and the energy to devote the required attention to the senior.

On the other hand, the senior can be adequately and safely cared for in a nursing setting, and may even be better cared for in a nursing home than if they lived on their own or with family members. The professionals at a nursing home will for example know how to keep them physically active and to stimulate their minds as well as cope with special dietary needs. Secondly, health care has become much more sophisticated and seniors may not be able to manage special health care on their own and even younger family members may not be able to cope. The home setting may also not be appropriate for the type of care that is required of an ailing senior, while a nursing home is already equipped to deal with those special needs.
Finally, our homes are smaller and designed differently. Many of us live in apartments and in town homes with multiple levels and which for example, cannot accommodate wheelchairs nor are otherwise “senior-friendly”. We may have fewer rooms and limited options for expansion even if we wanted to take in elderly family members.

So those are the advantages, but what about the downsides of nursing homes? Who hasn’t heard the horror stories about the neglect or even abuse of seniors? Nursing homes are however like every other facility in modern life – you typically get what you pay for. So, yes there are poorly run, nursing homes. These homes tend to get lots of sensational press coverage and they colour our image of all nursing homes. However on the other end of the spectrum, are very clean and well-managed homes, staffed with caring professionals. Since good news is no news, you probably won’t read about them in the newspaper, but they do exist, and with good research and investigation you can find them. In part two we’ll talk about how to find them, but now is a good time to emphasize the importance of preparing wisely for your retirement years, so that if and when the time comes, you have the resources to pay for a good and reputable nursing/retirement home. If you have seniors in your life, help them to prepare financially. Remember good nursing homes are going to be expensive.

How to ACT when it comes to multi-generational travel

I was recently in Florida and had the opportunity to observe numerous families on vacation. Most were regular nuclear families – mom, dad and children, but there were quite a few multigenerational ones as well. With people living longer and healthier we can expect to see many more families and vacationing as a family is a great opportunity to bond. It can be difficult and stressful as well. A case in point – a friend of mine travelled with her family to a beautiful nature destination. All went well until they travelled to a park which required about a forty minute hike uphill to the ‘must see’ attraction. Everyone agreed that the elderly father shouldn’t take the hike, but then that left him stuck at the bottom for nearly two hours while the rest of the family made the round trip, took pictures and so on. They felt guilty about leaving him, and he was bored and lonely waiting on them.

People who travel with small children usually put a lot of planning into the trip to make sure that it goes well. When it comes to intergenerational travel, the same type of planning is needed. The three step acronym ACT – Anticipate, Communicate and Tolerate will help to make the trip easier and more fun for everyone.

Anticipate– Before booking accommodations, check out the ease of access for the seniors in your family. Obviously if someone is wheelchair bound you want to look for rooms that are designed specifically for them. Many hotels have specially designed disabled friendly rooms with wheel-in showers for example. Even if your seniors are ambulatory you should think about whether a hotel with multiple floors has an elevator to avoid an older person having to struggle up and down flights of stairs with luggage etc. In a resort you may want to request a building that is nearer to the main activity site to reduce the amount of walking. Since these sites can be noisy, ask for a room that is close but not directly above or next to them.

Before going on your trip, spend some time planning activities that are suitable for all generations. For example,a long road trip may be tiring for everyone but torture for an older man with prostate problems because of the need for frequent bathroom breaks. Sitting in a confined space for long periods of time may also be particularly painful or uncomfortable for older persons. For long trips you should consider alternate means of travel for the seniors in your party such as flying or traveling by train. If it must be a road trip, plan frequent breaks for stretching and using the bathroom. Allow extra time for the seniors in the family who may move more slowly or who get flustered when rushed.

At the destination find out about the places you plan to visit. How much walking is involved? How steep are the walking trails? Is the tour/trail wheelchair accessible? Some places may offer go carts so make sure to book those ahead of time. If your seniors can’t handle the whole tour, then plan for where they can wait while the rest of the family continues. Make sure they have reading material, water, snacks etc., and consider calling by cell phone en route so they don’t feel totally cut off and abandoned.

You might also think about splitting up the family for parts of the vacation. Be creative. The choice doesn’t have to be between everyone going to Disneyworld or the grandparents staying behind in their hotel room. Plan ahead to find activities that seniors can do on the days that the younger members of the family might be doing something more strenuous or juvenile. The family can always get together at breakfast and dinner. Choosing a resort that offers amenities and activities rather than a hotel or motel may make staying behind a lot more interesting for seniors.

Communicate – before the trip, spend some time to find out basic information. Many families don’t live together and situations change over time. A parent’s eyesight may have declined or they may tire more easily since you last saw them, so make sure to consult to see how your vacation plans sound to them.

Most seniors don’t want to be a drag and therefore won’t complain if they are feeling tired or ill, and may press on to avoid spoiling everyone’s fun. So rather than asking “mom are you okay?”, keep an attentive eye, and if she looks tired or unwell, take a break and then assess the situation from there.

Sometimes on vacation we go in with our checklists of ‘must-sees’ and ‘must-dos’ and we focus on getting through the list. From time to time check to see that the schedule is working for the entire family. If family members are becoming tired and stressed, it may be time to renegotiate the checklist.

Tolerance – inevitably different age groups will have different stamina levels, values and interests. Even with the best planning and communication, there will be some disagreements and misunderstandings. Taking along a big a helping of tolerance is essential. Rather than focusing on disagreements, try to focus on areas of agreement and build on those. Remind everyone to focus on what’s really important – the family!