Do I Need To Be In A Nursing Home?

No one wants to be in a nursing home. But is there ever a time when I need to consider a nursing home as my best option? Or at least the best options for my family and me?

The nursing home question is one of the hardest any of us will ever address. One of the most knowledgeable dementia care experts in America, Teepa Snow, advocates the following: never promise someone you won’t send them to a nursing home.

Never promise someone you won’t send them to a nursing home.
Teepa Snow

Don’t Dismiss Nursing Home Care

Teepa Snow, a leading expert in dementia care says, “NEVER PROMISE YOU WON’T SEND SOMEONE TO A NURSING HOME.” She wasn’t saying this only applies to distant cousins. She wasn’t saying this only about parents who weren’t nice to their children. She said this in the context of adults, like her own mother. It included children of loving parents. She meant this for siblings of loving siblings. Why would a leading expert in dementia say such a thing?

Nursing Homes Make Sense In Some Circumstances

It’s clear that Teepa Snow has seen and experienced the pain and hardship of what severe forms of dementia do to people and their families. It’s clear that she’s seen it through the eyes of a professional. What she will tell you is that dementia is brain failure. A person in brain failure is no longer the person you once knew. They are not likely to recognize you, think rationally, respond rationally or behave rationally.

Sometimes Nursing Home Care Is The Best Option

The obvious question is, “If I have brain failure, should I be allowed to stay in my home?” Would you allow a blind person to drive on the freeway? How about a drunk person? Would you give a gun to an infant or a person with a psychological disorder? Most people answer no. And people that consider the alternative always add-in, “With supervision, maybe I would.”

Most people with brain failure are not in their homes by themselves. They’re supervised, usually by family members. It’s rare that these family members are trained caregivers. They are not trained to manage a person with brain failure. They do not have the medical, psychological, or social training necessary to appropriately manage a person in this condition. Trying to manage a loved one with severe dementia can have catastrophic consequences for both you and your loved one.

Potential Home Care Problems

Here are some of the consequences of overreaching your abilities:

To The Ager

Creating or failing to recognize conditions that hasten the death of your loved one. The most common missed conditions include:

For You (as caregiver)

Why You May Want To Ask Someone To Never Send You To A Nursing Home

Here are a few thoughts.

Managing My Condition(s)

thought. If I can’t manage myself, and my family members can’t manage me without subjecting themselves and me to harm, why would I say, “I won’t go to a nursing home?”

Does A Caregiver Have The Needed Resources?

This reality begs the other question. Why would someone that loves you, say to you, “Never send me to a nursing home?” Unless the person asking has the $250,000 – $1,000,000 to allow you to turn your home or theirs into a nursing home, they are asking you to make a huge sacrifice.

Someone with severe dementia needs round-the-clock supervision. If they have any additional illnesses, they need care for those illnesses. It’s also likely the person is resistant to help and assistance. Severe dementia patients also struggle, punch, push and yell at their helpers.

Can 24/7 Caregiving Be Revelatory?

There are rare instances when a spouse, sibling, or child dedicates their life to caring for a loved one with severe dementia. It happens. Some even consider it life-altering and revelatory. But this is rare.

Carmen and I never interviewed or spoke with someone where this was the case. In fact, we found the opposite true. When loved ones tried to keep home patients with severe dementia bad things started to happen.

Why Are Nursing Homes So Scary?

We all know why nursing homes are terrifying for many. For many of us our memories or perceptions of nursing homes are terrible. They are places where people are unhappy, where bad smells are present, where sounds of screaming patients echo in the halls and staff are mean to residents. Simply said, bad places. Certainly, places we would never want to be.

If we perceive nursing homes as terrible, why would we ever want to be sent to one? Of course, not all nursing homes are bad places. The reality is almost all nursing homes try to provide decent environments for their residents. Some are amazing places for seniors. Places where seniors get good care, have lots of activities and opportunities for socialization.

When Do Seniors Need Nursing Care?

Determining when a person needs nursing care is not hard. The senior care industry is mature. The industry identifies seniors needing nursing care support by an instrument called Activities of Daily Living (or ADLs). ADLs are the essential and routine aspects of everyday self-care. When you can’t perform them, you need someone else to do them. Sometimes an assisted living facility can provide the needed support, but as a person’s ability to perform ADLs declines dramatically, there is a need for higher levels of care that assisted living facilities cannot provide. This is when nursing care is recommended.

The ADL questionnaire is how the industry assesses a person’s ability to live day-to-day. If you can’t do your ADLs, you are generally considered in need of nursing home level care.

Assessing ADLs

The ADL questionnaire looks at the following areas.

Toileting

Assessment questions separate those that can eat without assistance, those that need some assistance, and those that resist and need .

Eating

Assessment questions distinguish between that can eat on their own, those that need some assistance, those that always need assistance, and those that resist and always needs assistance.

Dressing

Assessment questions separate those that can select, dress and undress on their own; those needing some help dressing or undressing; those that need a lot of assistance; and those that need assistance for everything.

Grooming (e.g., hair, nails, shaving, etc.)

Assessment questions distinguish between those that can groom themselves; those needing help at some tasks; those needing help with all tasks; and those that both resist and need help with everything.

Mobility

Assessment questions distinguish between those that are fully mobile and those that are not. Seniors losing mobility can’t climb stairs; need a cane or walker; can’t get in and out of chairs with some help; or are bedridden.

Bathing

Assessment questions separate those that can bathe or shower on their own; those that can wash face and hands, but need help bathing; those that need assistance with everything; and those that resist and need assistance.

Other Areas Indicating The Need Or Desire For Nursing Care

In addition to the ADLs above, there are other aspects of life many seniors consider critical. When these areas of their life cannot be sustained, they are willing to go to a new home that provides the care they need, or at least a more appropriate environment.

Here are some of these areas:

Ability To Interact With Family

I can behave in ways that don’t involve:

Do Things That Are Critical To My Desire To Stay Independent (Out Of A Nursing Home)

I can engage in my passion(s)

A Technique To Identify When A Nursing Home May Be The Best Option

Carmen and I recommend that seniors create a set of criteria that can be used to determine when it’s time to change homes. All the examples above can be used. Every senior will have their own.

Here are some of the criteria I use when describing to the family when I’m ready for a nursing home.

Other Resources For Determining When I Need To Be In A Nursing Home

See our Section on Senior Housing here.

A great article on when it’s time to seek nursing home care for a loved one is here.