Consider this — by the year 2030, nearly one quarter of the population in the United States will be age 65 or older. Presently, those over age 85 are the fastest growing segment within our society.
As the population continues maturing into the years of late life, assistance with housing, finances and activities of daily living (i.e. bathing, dressing, feeding, taking medications) will increasingly become the major factor which will define and shape our elders’ residential future.
There are a variety of community-based options such as respite care, Meals On Wheels, companion service, adult day care and transportation services which enable elders to remain in their own home for a long time. Adult children and other family members are also instrumental in extending an older loved one’s residence in her/his home.
When is it the “right time,” therefore, to consider placement in a residential care setting such as an assisted living facility or a nursing home? Of all the decisions with which families are faced, this one is perhaps the most difficult. It requires what many have called “tough love.” It is quite normal and understandable that families will waiver in this decision since love, commitment, fear and guilt all contribute to the difficulty of evaluating the situation and determining the right time and the appropriate care setting for their elder loved one.
The answer will likely be different for each family. And, since there are no textbook rules to follow, it will be the reality of day-to-day life with your loved one which will indicate when the “right time” for placement has come.
It is important to recognize, however, that there are a wide range of circumstances which typically convince families that placement in a residential care setting is a good decision. Among those often cited are: chronic incontinence, frequent falls, getting lost, failure to self-medicate properly and poor nutritional status. Another circumstance which often contributes to choosing placement is the limited social stimulation and lack of physical activity their elder relative is experiencing at home. Though any one or combination of these may have presented occasionally, it is when they persist and push family members beyond their physical and emotional limits that keeping prior commitments to mother or father is seen as no longer feasible. Coming to the realization that our time, energy and patience are not boundless is certainly not an indication of failure.
Nursing home placement, of course, is most often the right decision in response to an acute change in your loved one’s physical and/or mental functioning. It is helpful to remember that recognizing placement in a residential care facility as the right decision represents what Duke University professor Lisa Gwyther, calls, “another step in the caregiving process,” an indication that everything possible has been done “to maintain the safety and quality of life” of the family’s loved one but that it is now “time to turn that responsibility over to a professional team.”
Bill Cave is director of Social Services for Lebanon Valley Brethren Home in Palmyra, Pa., and serves on the Older Adult Ministry Cabinet of ABC.