Planning For Long-Term Care

Why is discussing long-term care with my parent so hard?

It is very hard to discuss long-term care with parents, because, what it means is they are giving up some of their independence and they are going to be transitioning from an independent community setting, maybe a house where they have lived for the last forty years and moving to a place where they are going to be increasingly dependent on others. They may not be able to drive anymore and it is traumatic, it is traumatic for everybody but especially for them. It is just a tough conversation, it is the kind of conversation that at certain times, you will just get a "We're not talking about that, it is not happening, I flat out refuse", and yet sometimes their safety is at risk and so it is just the kind of thing that you need to insist upon.

What can I say when my parents want me to promise they'll never be 'placed' in a nursing home?

If your parents tell you, "No matter what happens, promise me you'll never put me in a nursing home", you cannot make that promise. You just need to tell your parents, "That is not a promise I can make". I will do everything I can within reason to keep you in a home setting as long as you can, but there are things that we can't foresee. I don't want to make a promise that I might have to go back on someday and then spend the rest of my life feeling guilty about because you, Mom or Dad, had to spend your last six months in a nursing facility. Because your care and needs were far beyond what I could provide at home or any of the grandkids or anyone could provide at home. So don't fall for that and whatever you do, don't make your kids make that promise to you. It's a truly unkind and toxic thing to do.

What if I can't provide the long-term care my parents need?

If you're a care giver and you've been caring for your elderly parent, parents at home or in their own home and you're starting to burn out, you're in good company. That's a very common situation and probably more common when there's dementia involved, because that's exceedingly stressful. I would say, if you wind up having some kind of break down or if you get to the point where you're so irritable that you just snap or do unkind things to your parents, that is no longer being helpful to them, and so sometimes the sad reality is that we cannot care for our parents in a home setting. Before you get to the point of just having a break down or having some bad outcome happen, start thinking about long-term care. There are other options. There's also, day care, and adult day care. There are a whole lot of other resources that are available. But just don't let it get to the point where you're really at the end of your rope. It's a very difficult task to care for parents at home.

Why does the thought of my parent in a long-term care facility make me feel so guilty?

The picture that Americans have in their mind of the nursing home is not a pleasant place. When you think, I have to put my parents in one of those places, number one you think, "well, we are warehousing them, we are just waiting for them to die." At some level this may be true, but they are not terrible places. Sometimes that is just the reality. People have their own lives, they are not able to devote their entire life to taking care of their parents, as much as they might like to do that. Also, people feel guilty because they feel that they are failing, that they are not able to do what is expected. That still happens in many other cultures as far as caring for your parents. I think our parents took care of us when we were little and we feel like we owe them. Of course, we do owe them, but there is a limit as to how much can be done.