As part of our service we often counsel families regarding this tough decision. As mom or dad completes a stay at a rehab facility, do they return back to the home or condo where they live independently, engaging in home care, or is it time to make the move to a retirement community that offers continuum of care, be it assisted living or full nursing?
Since each case / person is unique, it is not possible to generalize, so I thought I would retrace the steps that we just went through with my father-in-law because it is a good case study that included many of the variables in play.
Marion’s dad spent 60 days in rehab after becoming very weak due to a progression of setbacks that resulted in a hospital stay. He is 93. He was eager to get back to his condo, but his progress was slow in the rehab facility and we were worried he would need 24 / 7 care. The rehab discharge personnel recommended full nursing, or at minimum, assisted living.
Our philosophy regarding this decision places emphasis on our parent’s wishes (as opposed to what is best for the kids, stay tuned, that is a topic all by itself!), tempered by the following salient variables; their cognition, financial considerations, the family’s availability, quality of home care services available.
In dad’s case, he was firm about going back to the condo, and while he can be forgetful, he is mentally intact. He does have a long term care policy that would pay for a move into full nursing care, but he also has the financial means that allow him other options. As far as the budget between bringing in home care (in the end, we figured he would need 9 hours a day, 7 days a week of home care) or moving into assisted living, they both would cost about the same amount. No matter what move we made, Marion would be his advocate / family caregiver, so she was already on board to support him. Therefore we opted to bring him back to the condo and set him up with a very qualified home care agency we happen to know!
End of story? Hardly. One of my favorite sayings for family caregivers regarding our role in assisting our parents as they navigate through the aging maze is that this is a marathon, not a sprint. The job really never ends (until…), it just takes on new dimensions with the passage of time.
Dad’s condo was no longer the quiet, private place it once was. He now had our caregivers there to help him first thing in the morning till after lunch and back in the late afternoon to help with dinner and to get back to bed. He was not happy about his loss of privacy and it was pretty tense for two weeks before he got to know and trust each of our caregivers and then things settled down.
As for the family caregiver, the first two weeks were also very challenging for Marion. She had to set up a very complicated plan of care for her dad. He is diabetic and was recently diagnosed with CHF (Congestive Heart Failure), so we had to create and maintain a strict low sodium diet (thank you Mary!) and make new adjustments to his growing medication schedule. Marion had to then train each caregiver on the specifics of administering the plan, all while dealing with her dad’s stress. Oh, and the rest of her life? Me? Her friends? The annuals in all the flats in the back yard? We were all “on hold” till things settled down! Sound familiar to any of you family caregivers out there?!
It’s a marathon folks. Steady as she goes, deep breaths, hydrate, could be a downhill around the corner, or an uphill. But you are doing God’s work, for which there is neither a time clock, nor a paycheck. And the marathon only ends when God decides to take over as the family caregiver. Not to worry though, He does a pretty good job! J
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