Deciding on Long-Term Care

"Gramps is getting worse as he gets older and I'm finding it increasingly more difficult to take care of him in my home. When should a nursing home for him be considered?”

The decision to place a family member in a facility is never easy. A decision like this is one the family should make together after consulting doctors, therapists, and lawyers. In some cases, the decision to place an ailing family member in long term care is easy and everyone agrees. In other cases, it is more complicated. No matter what the case though, the whole family should be involved.

Who decides?
The final decision on where the family member will go should ultimately be made by the family members who provide the most care. It is these people who are shouldering most of the responsibilities such as feeding, dressing, personal hygiene, and recreation. These caregivers will also have the most accurate assessment of the person’s abilities and the changes (positive and negative) in these abilities over time. While all voices in the family should definitely be heard, the day-to-day caregiver is the one who will know if they can continue to provide the necessary level of care. Their final decision should be respected and followed.

Factors involved in the decision making process
Deciding when a family member is in need of long-term care depends on several things. The severity of the stroke and the resulting disabilities are a big indicator of whether or not long-term care is needed. The understanding that caregiving can get more difficult as the family member gets older is equally important. So is the family’s willingness and ability to care for the ailing family member. Finally, the family’s beliefs about long-term care facilities may also play a role.

Many African-Americans do not wish to be placed in long-term care facilities, and see being placed in one as a single step from death. Once you are in a facility the only way for you to leave is to die. That is how many older African-Americans feel about nursing homes. Many will do anything and everything to stay in their homes or that of a family member. The caregivers of these people will also do everything in their power to keep them out of long-term care facilities.

Options
There are other alternatives to think about. Most of these require the movement of the loved one from the home to another facility. If this is not an option for you and your family, there are other options that allow the ailing family member to remain home. Home health agencies offer in-home nursing and patient care. An agency like this may also offer assistance with finding a home-helper. Home-helpers are people who come into the home and perform minor housework such as laundry, cooking, and dressing. There are also elder sitters; people who stay with your loved one until you return from work or some other activity. Another option is senior day facilities (adult day care), where the family member is taken to a senior center with a qualified staff to take care of them during the day. Respite care is another option where a qualified person comes into your home to stay with the ailing family member while you and your family leave. A respite person may come into your home for two or three days at a time. There is a cost associated with all these alternatives, but in many cases there is financial help and community programs for those that need it.

Links for More Information

Eldercare Locater: from the U.S. Administration on Aging
Provides an information and referral service for finding eldercare facilities.

Fact Sheet: Assisted Living and Supportive Housing
From the Family Caregiver Alliance comes this well-designed and thorough guide on alternatives to long-term care facilities.

National Center for Assisted Living
This site provides information on choosing appropriate assisted living care for older adults. The information included in this page explains the ins and outs of assisted care. There is also a worksheet to help estimate the level of care needed and possible cost associated with care.

Centers for Medicaid and Medicare Services
Alternatives to nursing home care: this site provides information about choices in long-term care that Medicaid and Medicare may cover.

Centers for Medicaid and Medicare Services: Care planner
An interactive site that will create a report on housing options for your family member. The report will explain how well your family member may do at each facility, based upon information you provide. This report will also provide information and links to other programs to help make long-term care issues easier.

Medlineplus: Nursing Home Information
A complete list of sites that can be accessed to find information on cost, payment, types, and issues concerning long-term care placement.