Posts tagged: institutional

When to Seek a Nursing Home

Dr. Holzmacher's Business LogoWhen is it the correct time to seek the assistance of a nursing home?  This is a monumental decision.   An initial hurdle is the public perception of nursing homes.  It is the place to go when one is ready to die.  This remains true for some, but much less than even twenty years ago.  Over half the patients admitted to Florida nursing homes leave in a better condition than when they were admitted.  Increasingly, nursing homes are fulfilling the duties of hospitals.  Most rehabilitation is now conducted in nursing homes, rather than hospitals and free standing rehab centers.  Rehabilitation is a general term for physical, occupational and speech therapy services.  In the state of Florida it would be fair to say that emergencies are evaluated at the hospital, but most of the long-term treatment occurs in the nursing home.

In the most general terms, seek nursing home treatment for a loved one when you are no longer able to care for them at home.  This statement sounds a bit obvious, but it is not obvious in practice.  Most people in the United States wait too long before seeking treatment for a loved one with Alzheimer’s Disease.  I will repeat that statement.  Most people wait too long for nursing home treatment.  This fly’s in the face of world opinion that American’s are quick to institutionalize the elderly.  Over the last twenty years, I have treated hundreds of patients whose only crime was to care for a demented loved one until they were physically and emotionally exhausted.  I have witnessed dozens of families form three shifts to care for an elderly parent twenty four hours a day, seven days a week.

An especially poignant example is a family aftercare group.  A woman tearfully described the guilt she experienced placing her mother in the nursing home.  She had cared for her severely demented mother for nearly twenty years; seriously impacting her marriage and career.  Like so many, she found herself in the unpleasant and awkward position of changing her mother’s dirty diapers.  At the time of her mother’s admission, she was over one hundred years old, and required total care for bathing, dressing and toileting.  Her tears became torrential when others in the group reflected the depth of her devotion and sacrifice.  The situation was not unusual, it was the support she received from peers of her own age that etched the story into memory.

Another misconception is that demented elderly patients will decline rapidly in the nursing home.  It is may be awkward for family members to admit their loved one has mentally and physically improved in the nursing home.  It is easier to coordinate physician care in the nursing home.  On an outpatient basis, physicians rarely have a coordinated picture of the total clinical situation.  Said another way, Dr. A may unfortunately not be aware of what Dr. B has prescribed.  Dr. B may not be aware there is a Dr. A. .  In the nursing home, there is a master medication record, and this record is often reviewed by pharmacists to catch possible drug interactions-or just plain errors.  The nearly universal lack of coordinated outpatient care leads to many preventable iatrogenic hospital and nursing home admissions.  A potentially positive aspect of nursing home care is the increased socialization.  So many widowed and single elderly become extremely isolated, and this lack of socialization may be destructive to their mental and emotional functioning.  Family members are often surprised to the degree their loved one’s spirits have brightened in the nursing home.

A general rule of caring for a loved one is to not exhaust yourself in the process.  Once exhausted, a caretaker is largely worthless to the patient and themselves.  You will not be doing anyone a favor by working yourself to death.  Do not be deceived that nursing home placement is a sign of personal failure, or that keeping a loved one in their home will slow the disease.  Consider adult day care if you are becoming exhausted caring for a person with a progressive dementia.  Once the loved one experiences falls, becomes aggressive or escapes from the home, have them evaluated as soon as possible.  Please visit local nursing homes and develop a relationship with the ones that appear most promising.  Do not wait to evaluate institutions until the patient has an emergency-typically a fall.  Please listen to close others who tell you to lighten the workload.  We only know ourselves through the eyes of others.  A happy nursing home visitor will likely do more for the patient’s spirits than a depleted caretaker cleaning another diaper.

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