One day, when I was a teenager living with my mother, a single parent, she said, “Promise me you will never put me in a nursing home!” She said this immediately after reading a news story about a bad nursing home. I thought she was being a little over dramatic but, of course, made the promise. Mom was about fifty years old and the concept of nursing home care, well it was never going to be. Right? I never expected I would confront the possibility of long term care of any sort.
That memory was brought back to me all too soon when my dear mother, at only fifty-nine, faced a serious health crisis. Unfortunately, or fortunately, depending on your perspective, she passed away before long term care was needed. But, not before some sleepless nights fretting over the promise I made years earlier.
Many people, both those who make such requests and those who might make the promises, find themselves in this kind of conversation. Often, the conversation arises out of a piece of news or expose’ about abuse or a neighbor being taken from his or her home. Sometimes it is born out of fears related to having seen a loved one deteriorate many years earlier.
The person that makes the promise usually does so when both are young and in good health. Both have little idea of how unrealistic or difficult that promise might be to carry out. I believe few who make such a request would if they knew what it might do to their loved one. And, the promising person does not understand the heavy burden he or she is taking on. And I am not talking just about keeping a loved one at home, I am talking about the burden of breaking such a promise when home is just not possible.
For some, continuing to live at home with appropriate care and oversight might be the best choice. They may have adequate resources to pay for care. They may even have long term care insurance that pays for care in the home. They may also be satisfied and comfortable in the home and able to assist with their own care, not wandering or refusing reasonable help.
But for others, the home may be a poor choice and in fact, can be a burden. The frail person may not be able to clean, manage or maintain the home and unable to afford to pay for those services. If the person has dementia she may be paranoid and unwilling to allow helpers even though she needs 24-hour supervision. He may not sleep at night and even wander. One caregiver alone would be unable to provide the amount of around the clock care needed. Before asking someone to make such a promise, or before making one yourself, consider the following.
People often make these kinds of requests and promises based on their current health and mental status with little insight into what the caregiving would look like if there were a dramatic health change. They rarely consider that they too will be aging and could have their own health issues.
Nursing homes have come a long way and the concept of assisted living facilities are fairly new. Because of regulations, lawsuits and business competition, facilities are much better than even a few years ago. Living at home may actually become like living in prison because the person is unable to get out, arrange activities or visit with others. Yet, good facilities can offer transportation, appropriate activities and friends for socializing.
The best indicators of good care are not always staying home but include choosing good facilities and remaining involved. We tell many loved ones that they are still caregivers when their loved one is in a facility, it is just that their job has changed from direct care to overseer and advocate.
Remember, your home is your castle until it is your prison. If you already got that promise, please let your loved one off the hook. If you are thinking about obtaining a promise from someone, please, think twice. Ask yourself whether you really want to put that kind of a burden on your spouse, child or loved one. If you still plan to, consider giving them conditional “outs”, times when they are free to break that promise. You could say something like, “But if you believe it is not realistic or my care is exhausting you, then I would want you to move me to a place that can care for me. But, please stay involved as long as it is realistic for you.”
Consider this carefully before making such a promise. The life care planning services we offer at Hill Law Group are invaluable in helping caregivers navigate the maze of long term care.