Stories and thoughts about family and life

The Nursing Home

on November 16, 2013

I remember I was about 15 when my grandmother was placed in a nursing home. I didn’t dislike the place–they were very nice to her and she seemed okay. My younger sister and I would go visit her throughout our high school years on days I would drive to school. Sometimes we would take her things. Sometimes we would just say hello. It became harder and harder to endure the visits as she never seemed to recognize me, and she got to where she seldom recognized my sister. She passed away a couple of years after I had moved away, but I suppose she probably was in the nursing home about 10 years.

I remember the facility being clean, but still having a distinctive smell. Most of the patrons would be lined up and down the hallway, or possibly in the dayroom in their wheelchairs. My grandmother was hardly ever one of those people. She usually was in her room, mostly in bed. In the beginning, she would try to interact with us and she seemed happy to see us. At the end, she would mostly just lie in the bed and stare at us. For two teenage girls, you can imagine how awkward the whole situation was.

I haven’t really thought about Grandma and that little nursing home in a number of years. I guess it was one of those memories I was rather happy to move to the back of my mind. As the events of my own life have unfolded the past couple of months, I have found myself faced with the same decisions which likely were also draining for my parents all those years ago.

As you read in my previous post, my father-in-law has had some medical issues, which have necessitated us finding alternative care for my mother-in-law. This whole thing has been quite the revelation from us, from learning of medical issues he never wanted us to know, to realizing that our concerns over their abilities to care for themselves a year ago were quite well founded. A year ago, when we moved them to an independent living facility, we had several discussions over whether my mother-in-law could, in fact, live independently. We all knew she couldn’t, deep down. But it was breaking my father-in-law’s heart to think of separating them, so we went along with it all. It didn’t take too long into that first year to see that she was wearing on him pretty heavily. Some of that is the suspected Alzheimer’s/Dementia we believe she likely has, and some of that is the custom he has set in place of meeting her every need. She has become heavily reliant on that–to the point that he was literally doing everything for her, including feeding her most days. She was capable of doing some of these things, but sometimes arguing with her isn’t worth it and I think that’s ultimately where he found himself.

We had just had the conversation with my husband’s sister about whether we needed to consider another level of living for her (or perhaps for them both), when Paul’s medication situation arose and, well, kind of pushed us along the nursing home path. When it became apparent Paul was going to be in the hospital for a bit, we had to face reality. Louis and I have children, as does my sister-in-law (Kathryn) and her husband. I have my own business (which requires me to travel regularly), Louis is working on development with me, and Kathryn is a successful veterinarian in a thriving practice about four hour’s drive from here. Kathryn was able to stay the first week Paul was in the hospital, but we realized very quickly that my mother-in-law could not be left alone. Between racing back and forth to the hospital, the family was constantly working to have evaluations performed to see about assistance in the meantime for my mother-in-law. By the time the second evaluation had been performed we realized our original suspicions were true and we began the search for a nursing home.

We knew they would want to be together, and we knew now that Paul would not be able to live independently when he was released. We knew he would require intensive therapy, and that she could also benefit from some of that. In a nursing home setting we would be able to ensure they were receiving those services and not have to be there for each one. It seemed like a no-brainer. In the meantime we had secured 24-hour in-home assistance for Helen, and had been fortunate to find one of the lesser expensive places in town, but as I wrote the first check for over $2500 for a mere week, we realized we needed to get them situated, and quickly.

My husband and I each made a list of the facilities in the area we liked, based on ratings and feedback we found online. I then ensured each of those met our minimum qualifications, which had to include a Medicaid option, for when the money is gone. We spent the afternoon every day touring and visiting with each place and finding out about waiting lists, activities, transportation and the like. Since we wanted his parents to be able to share a room, that presented a significant problem. Most places would eventually be able to accommodate that, but not immediately. We knew his mother would not tolerate a roommate other than Paul, and that information quickly brought us down to two nursing homes. We were lucky that the nicer of the two actually had ONE two person room completely available, so I acted quickly and began the application process to hold the room.

Let me take a moment to encourage you to keep good, well-organized records and to possibly go ahead and begin keeping a dialogue with your children about your situation so they can help you when this moment occurs. This will be important because much of the information in a nursing home application (or in this one, anyway) was not information we had readily available. Trying to gather said information with a mother-in-law who claims no one tells her any details of their lives anymore and a father-in-law in CCU and then heavily medicated in rehab becomes a bit of a challenge. It was almost serendipitous that I had been responsible for their bills and business needs when Paul was so sick a couple of years ago and I knew what insurance policies I was paying for them. The rest was digging through their file cabinet and sorting through hundreds of pieces of paper. Even when I thought it was all finished, my husband and I uncovered a couple of additional things when searching for something else a day or two ago. Thankfully, the nursing home sees this stuff regularly, too, and they were very patient with us.

Anyway, the paper trail is intense. The nursing home has to prove all kinds of things about their coverage and abilities and medical situation, and you have to document every potential contact who might serve in case of emergency, every insurance policy they have which might be responsible, funeral arrangements, medical history, even down to which church they attend and what their hobbies might be. After the first set of applications was approved, we had to do a second set to actually admit them both. Since my husband is power of attorney for them, he had to sign many of the documents to finish the process and is the primary decision-maker on many of the “business” decisions. He must have signed his name 50 times that last morning we were turning in documents.

Let me tell you, nothing quite prepares you for the response of your relative when presented with the reality of being moved to a nursing home. Despite telling my mother-in-law for two weeks that this is what was happening, and seeing her react in a positive way when we showed her the room, she still completely fell apart when we got in the car to go back and pick up things to move her. She felt we had surprised her, and she began with a number of things that displeased her about the facility and the room especially. She was fearful we were going to make her sit in a wheelchair in the hall and visit with all the other people, and that she wouldn’t get to watch TV anymore (despite us promising her we were installing her TV that very evening). My husband handled the whole thing beautifully, and with a reality and grace I couldn’t seem to muster. She had been telling us for a couple of days that she didn’t realize that Paul was as “disabled” as he is. She just thought he was spending a few extra days in the hospital and would soon be home to take care of her again. At first, everyone just brushed past that and let her talk. We finally had to remind her that he had nearly died, and that the hospital kept warning Kathryn not to leave town for fear that we were at the end. When we finally had that conversation with her at lunch that day, she seemed to get it. It’s hard to engage in those conversations. I don’t like to lie, and would prefer to just have the conversation straight on, but sometimes with her we have found that she doesn’t always understand what she’s saying, and it’s rather like having a conversation with a kid. You nod politely and engage, but you don’t really argue the details. Although Louis remained the same emotionally throughout the lunch and that afternoon, I vacillated between being anxious about something I might have overlooked or that I could have done a better job to irritated that she knew this was all coming and was potentially hoping a last-minute pity party might “save” her.

That’s the hard part of dealing with someone who has a mental incapacity. It’s hard to differentiate between what’s really incapacity and what’s just an attempt to get attention or sway things their direction. My mother-in-law and I have gotten along over the years, but it has been pretty tense a few times, and the worst of those have been when we’ve tried to push her into something she wasn’t ready emotionally to do, such as leaving their house and moving to the apartment where they’d spent the past year. Now she loves the apartment and can’t imagine leaving, and we’re doing it to her all over again. I get it–I really do, and it’s something we had to do, but we also had to try to get her to see the big picture. We took her to lunch to try to re-focus her for a bit and so we could talk about what to take to her new home. I texted my sister-in-law about our situation, and she did her best to lighten the mood for me through her texts. In the end, though, my mother-in-law alternated between crying jags and questions about things we were surprised she had even noticed during our tour of the facility.

We had a few minor situations during the packing process at the apartment. She was upset she couldn’t take her curio cabinet (about 7 feet tall and 18 inches or so across, made of glass and backlit with all her collectibles). She was also upset that I told her she wouldn’t have a refrigerator in her room. We were doing our best to figure out how to accommodate her lift chair, Paul’s recliner, a computer table, and a decent-sized TV. I know, I’m a bit ambitious. That’s a lot to fit into about 275 feet, but I wanted to make it as much like home as possible and try to ease the transition. Anyway, after I got her to understand that she wasn’t allowed a refrigerator (not mention where to put it!), she began taking trash bags and just filling them with stuff. I’m honestly not sure what all ended up over there that first night, except I did see her grab four separate boxes of Kleenex, and when I was putting things away in her room I found two empty jewelry boxes, and all her makeup (which she rarely wears anymore). For me, it would have been Chapstick–I’m addicted to that stuff!

The move-in for her actually went more easily than I anticipated. The nurse on duty was exceptionally sweet and helped Louis re-arrange the beds and offered his input about how we could actually make the furniture fit. They had flatbed carts available for family members to use and the CNA on duty even put together dinner for Helen, despite the fact that we had technically missed dinner rounds. We were very quickly impressed and felt good about the location we had chosen. Paul was relocated the second day, and it helped Helen when Louis said that we moved her ahead of him so she would be situated and could help him settle in. Who knows how this is all going to go, but at least we feel like things are moving in a forward direction for the first time in a month. Now we have to clean out their apartment and relocate all their belongings to my house. That’s the easy part, though, believe it or not. Knowing that they’re somewhere safe and well-cared for was a complicated undertaking. It’s given me a whole new perspective on the relationship I need to have with my kids and with their future spouses. I hope to never need a nursing home, but if I do, I hope that my kids put the kind of effort and love into the whole experience that we’ve tried to do for this set of parents.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: