Does Your Relative Need a Nursing Home?

One size doesn't fit all when it comes to eldercare

By Lisa M. Petsche

For a printer-friendly version, please click here. | Help?

The average age at admission of nursing home residents is 82 years. Two-thirds are admitted from a hospital or another facility, while the rest are admitted from home. Of those who come from home, approximately 60 percent have been living with family members.

The most common medical diagnosis of people admitted to nursing homes is stroke. This is followed by Alzheimer’s disease, hip fracture, heart or circulatory condition other than stroke, and non-Alzheimer’s dementia.

If you are caring for a frail relative, you may reach a point where you wonder if his or her needs would be better met in a nursing facility.

Before you consider this route, though, be sure you have explored what's available in terms of community support services. These might include: in-home programs that provide medical care, personal care or various kinds of therapeutic services, such as physical therapy and social work; adult day programs; meal programs; recreation programs; friendly visiting services; respite programs; and home adaptation subsidies or grants. Caregiver support groups can also be beneficial, especially if you're feeling stressed or isolated.

If your relative has become deconditioned due to increasing immobility, discuss with his or her family doctor whether referral to an inpatient or outpatient rehabilitation program might be appropriate. This can increase the person’s independence, but first it must be determined if there is potential for improvement. Your relative must also have a certain level of mental functioning in order to be able to concentrate on tasks, follow instructions and retain new information.

To find out what's available in your community for frail seniors and their caregivers, contact the local Area Agency on Aging. Another resource is the local chapter of the group that's specific to your relative's diagnosis, such as the Alzheimer's Association or Parkinson Foundation.

Even if community resources are in place, however, the time may come when they are no longer enough.

The following are the most common reasons for admission to a nursing home.

Care Receiver Issues

• Need for assistance with activities of daily living (ADLs)--include bathing, dressing, grooming, toileting, feeding--because of physical or mental limitations.
• Incontinence of bladder and/or bowel.
• Need for assistance with transferring from one surface to another—for example, from bed to chair or wheelchair.
• Need for skilled nursing beyond what community home care services can provide---for instance, if there are pressure sores or other wounds that require frequent dressing changes and ongoing assessment.
• Need for close medical monitoring and frequent intervention due to fluctuating medical status–for example, recurrent bladder or chest infections.
• Health problems associated with poor nutrition, such as dehydration or slow healing of wounds.
• Safety concerns, such as falls or accidents with appliances or cigarettes.
• Behavioral concerns, most commonly wandering away from home and getting lost, suspiciousness, refusal of care or medications and verbal or physical aggression.

Caregiver Issues

• Chronic sleep deprivation owing to regular provision of care or need for supervision during the night.
• Physical health concerns: chronic exhaustion; stress-related conditions such as ulcers, insomnia or frequent infections; chronic health conditions—such as arthritis--that limit the ability to provide hands-on care; or injury sustained during care.
• Mental health concerns, namely ongoing anxiety, fear, sadness or anger, which may be indicative of clinical depression.
• Inability to meet co-existing obligations, such as to an employer or other family members.
• A major life crisis such as marital separation or illness of another close relative.
  

Other Issues

• Inability to afford the cost of needed in-home help, medical supplies and equipment, or home renovations.
• Family conflict regarding caregiving issues

A Personal Decision

It's important to keep in mind that the decision to place a relative in a care facility is a personal one. That is, what one caregiver might consider manageable, another might not. Your ability to cope with the demands of caregiving depends on numerous factors, including your relationship history with your relative, your personality and coping style, your lifestyle, and the amount of practical assistance and emotional support available to you.

If you're finding it difficult to meet your relative's needs, consult with a hospital or community social worker or contact your local office on aging.

Lisa M. Petsche is a medical social worker and a freelance writer specializing in health and elder care issues.