The Case for Home

Home Sweet Home! We all put our hearts into our home. The elderly are no different! The first thing my mother told me (as a young girl) was she never wants to live in a nursing home. She told me

• she worked for many years
  
• finally lives in her dream home
  
• she wants to leave this earth living in this home

With those thoughts in mind, she will stay in her home. Mom would benefit from the socialization she might get in a nursing home. However, she does not wish to be around others.
So far, so good! I have fought tooth and nail to keep her in her home.
My dad feels sort of the same. However, I think men do not get quite as attached to a home as women. He seems to be happy as long as he has CNN and his office!
The case for parents staying in their home once they are not able to do for themselves is a hard one. I think this is a personal choice, depending on the persons' situation both financial and medically.

• I feel blessed to have the financial capability to hire caregivers, providing appropriate care in my parents home.
  
• Both parents have Alzheimers, however, they are now pretty compliant with what I ask of them
• I feel blessed we have a good medical team as well as legal team to guide me through.

My parents have friends who come over, bringing lunch, talking to them taking into consideration their physical and emotional conditions.
I do question what quality of life is this? However, I would not want to leave my home when I am in this situation. I, too, worked hard for my home, putting my heart and soul into the creation I call home.
So, which is it? Nursing Home or Home?

Why a Nursing Home?

Nursing Homes are meant to accommodate those who can not afford appropriate care in their home. My mother can afford to hire caregivers to come into her home and take care of her. Therefore, my feeling is she should remain in her home.
While the care is more expensive every time I hire, I still remember mom stressing to me she does not want to go to a nursing home. I am really not sure what will happen once the care requires skilled nursing around the clock. This is something I assess each week.
The positive aspect of a nursing home is the following:

• Socialization
• 24 hour care
• Therapies will be provided as ordered by a doctor
• Meals prepared with a dietitian supervising
• Multidisciplinary team

Sounds good so far...............the above is from my experiences with mom being in a skilled nursing facility until a doctor releases her.
Socialization
Mom is at the point where she does not want to go outside the house. Her friends are sweet about trying to include her when they have luncheons or get togethers. However, we have people who also discriminate against her due to her disabilities. They will not include her in any functions, telling me she is "not normal". Therefore, her socialization is minimal at this time.The day programs in town are scarce due to her need for someone to transfer her. She is now what is considered a total transfer.
24 Hour Care
I hire caregivers to provide 24 hour care at her house. At first, she was the only person needing help. However, both parents are in need of help. At a nursing home, it is imperative the resident has his/her own care. Otherwise, due to under staffing, your family member will not get the attention they need at all times.
When mom was at a skilled nursing facility, she was found under her wheel chair. I called nursing to alert them. She was left alone in the bathroom, on the toilet, and fell every time. She fell more than 5 times in one month. That is not right.
Therapies provided
I can say this is a true positive when at a nursing home. However, it depends on the resident. Some just don't want to participate. Most of the time, the therapist is over booked and will pass this resident up.
There is also out patient therapy covered by Medicare. Mom seems to like this better, even though she will balk about going!
Meals
The caregivers will cook, as well as report to me what my parents do and don't like. I do the shopping online. Nursing home food appears to be institutional. This is because most homes are owned by big corporations. The food is good, however. There is variety.
Multidisciplinary Teams
The nursing home does provide reviews at which time they will allow family to participate. This is when each team member will report the progress or decline of a resident and set goals. Family members are able to actively participate.
We have a team approach at our house. I consult with the doctors, nurses, pharmacists, and caregivers working with my parents.
There is alot more to this complex situation. I learn new things as time goes on. Some nursing homes have different areas to house residents. Some specialize in one group, such as Alzheimers patients. When deciding on providing caregivers at home or placing your family member in a facility try to be objective and take their wants into consideration. Sometime, the decision is obvious, sometime it is not. So, Nursing Home or Home?

Nursing Home or Home?

This journey started around 10 years ago. My mother got sick first, falling at her door while home alone. My dad was out of town. I was home, 100 miles away. Luckily, I had children who lived close to where my mom lived. They found her. What a shock, to find ones grandmother on the floor of her house. I was called to come to the hospital, by my daughter. This was the beginning to the Nursing Home or Home question. Luckily, I discussed things like this with my mother.
For years after this, she fell. My father refused to let anyone take care of her. He could do this himself. He would call me all times of the night, "Mom fell and I can't get her up, will you come in?" My husband and I would come in to find mom on the floor. Let me explain.......my dad was athletic at the time, as well as a real go getter. He felt his wife was his responsibility, they didn't need help. This was the beginning to the journey from hell.
After a few years, dad started falling. He would be playing tennis and would fall on the court. He was smart, though. I asked him one time if he won many games. His reply was "Of course, do you think I am going to play against those who can beat me?" One day he came home bleeding. He tried to hide it, but was not able to since he was leaving a trail of blood. We fixed his leg and his arm for him, wiping away blood, noticing his onion thin skin. He was embarassed about this. We talked to him about our concerns regarding his continuing tennis. He is a stubborn man!! He did continue until falling was a regular part of his game. He ceased playing tennis !!
During the above period, mom was in and out of the hospital. She would fall, and have small strokes. The medical team at the hospital would remember her last visit, encouraging me to place her in a nursing home unless my dad would agree to help in the house. I would find help, and he would fire help. This went on for a few years. There were alot of tears on my part, seeing this happening. You are never prepared for this!
After mom had her colonoscopy in 2001, we discovered she had cancer of the colon. Surgery was imperative. Mom was a trooper! She tried to comply with the therapies after the surgery, but was not able to. She was in pain. Alot of pain. The medical team encouraged me to place her in a nursing home. I would refuse. I would find help at the house. This time, I explained to the help if dad tried to fire them, they were to call me. He did try to fire them. I was alerted, after the fact. He would only keep one lady, said the rest slept.
We finally discussed his allowing someone to come to the house during the night to help with mom. He said "when we are sick, we will consider it"
My dad started to get worse, wasn't going to play tennis, and other things. He didn't say anything to anyone, just would not go. He was starting to go to meetings about Alzheimers Disease, on the pretense that mom has the disease. He also started taking mother to many doctors, for the same thing. She was getting medications from all the doctors, who were treating the same symptoms. The doctors all thought they were the only ones treating the symptom. Then, dad started to play doctor with mom. He would put her on a medication then take her off of the medication. He doubled doses, and tripled doses. I would find out once she was taken to the hospital.
Finally, my daughter found a doctor who specializes in Geriatrics. Geriatricians are wonderful! They did a complete workup both physically and mentally on mom. At this time, we made the decision to make this moms primary physician. Funny thing is, dad had Durable Power of Attorney, and would do what we told him to do.
Now, he is also losing his short term memory. Dad hired anyone who came to the door. We had girls who stole from them, used credit cards to pay bills, and other things.
After a ring was stolen, causing my mom to have a major stroke, I took over the household. I encouraged them to put me as Durable Power of Attorney, which they did. I ended up with Medical Power of Attorney, HIPPA, and the Living Will. I was aware of the responsibility I was asking for.
During this period, my brothers decided they were going to place my parents in a nursing home. I have been fighting this battle for about 2 years now.
This blog will cover my experiences with different issues related to caring for parents. Nursing Home or Home?