Issues of Placing Elder Relatives in a Nursing Home and Possible Solutions

Moving into a nursing home care is arguably the most difficult and stressful decision faced by both the person who is to receive such care and that person's loved ones, for a multitude of reasons. On the one hand, both the academic research and the popular media have created and helped maintain a strongly negative attitude toward institutionalized care of this kind (Ryan & Scullion, 2000a; Nolan & Dellasega, 2000; Ryan & Scullion, 2000b). On the other hand, it goes against the natural progression of a family dynamic where parents take care of children in their young age so children could take care of parents in their old age (Ryan & Scullion, 2000b). Yet a number of life changes make placement of one's parents into a long-term nursing care facility a necessary and often inevitable option, leaving children of such elder adults with an unenviable task of coping with their emotions and concerns. This they predominantly do on their own, without professional help and advice that, unfortunately, is largely unavailable to them (Ryan & Scullion, 2000b). This makes their decision harder, may cause unnecessary and even harmful delays in decision making, and often leads to a deterioration of intra-family relations as family members try to cope with a plethora of negative emotions. Both community nursing professionals and social workers must be aware of such situations and apply their knowledge, efforts, and resources to alleviate the negativity and make the necessary transition smoother and less stressful.

Nursing home placement usually is considered only when the needs of the older person exceed the limits of care that their loved ones can provide at home, generally referred to in academic research as home care (Ryan & Scullion, 2000a; 2000b) or community care (Nolan & Dellasega, 2000). The most commonly cited reasons include a change for the worse in the older relative's condition, wandering, incontinence, inability to be left alone, and aggression on the part of the said relative, caregiver exhaustion, illness of another family member or conflicting family needs, and caregiver's own illness (Ryan & Scullion, 2000b).

Even if such circumstances occur, however, many caregivers insist on continuing to provide home care for their elder relatives, for a number of reasons. Firstly, the image of institutional care is largely negative in the modern Western society in general and in the United States - with its strong ideals of family unity and self-reliance - in particular. This is exacerbated by the fact that information on the basis of which home caregivers can make an educated choice about institutional care available to their elder charges usually is either extremely limited or unavailable altogether (Ryan & Scullion, 2000b). Secondly, individuals with elder parents in need of extensive personal care often feel that by sending their parents to a long-term care institution they are failing their duties as children and destroying the essence of family (Nolan & Dellasega, 2000; Ryan & Scullion, 2000a).

As a result, children with elder parents see 'committing them to a home' as a measure of absolutely last resort, and some hold not to subject their parents to institutional care under any circumstances (Nolan & Dellasega, 2000). This is unfortunate and ultimately dangerous, as maintaining older people in their homes beyond a certain level of frailty might lead to an inferior quality of life when compared to that provided by institutional care (Ryan & Scullion, 2000b). Many researchers cited in Ryan and Scullion (2000b) point at the importance of making decisions about moving an elder parent into a nursing home on the basis of reason than emotion, which not only helps in making the right decision but also in coping with that decision later. It is an unfortunate fact of life, however, that such decisions are not always made in a rational and considered manner.

A number of approaches can be explored to rectify this situation on the part of nursing professionals and social workers. The most essential need among children contemplating placing their elder parents into nursing home care is that for information. This cannot be limited to just the locations of nursing homes in one's area of residence (Ryan & Scullion, 2000b). Detailed information about these facilities must be provided, including the qualifications of the health care personnel working there. It is advisable to allow an individual contemplating placing one's parent in a nursing home to interview one or more staff members of such facilities. Ryan and Scullion (2000a) found that, once experiencing nursing home care through personal observations and conversations with their elder loved ones who received it, people generally expressed a high level of satisfaction with the quality and extent of provided care, at least the medical aspects of it. If they are in possession of such information before their parents enter nursing home care, it might make their decision-making process faster and less stressful.

While the need for a prompt decision on the part of children contemplating sending their parent to a nursing home is often important, particularly if the physical condition of the elder parent is especially bad, it is essential that these individuals do not feel pressured into making a decision quickly. Such pressure generally leads to resentment, isolation, and hostility toward the health care personnel (Ryan & Scullion, 2000b). Patients and the ability to answer relevant questions quickly and comprehensively on the part of health care or social services professionals are key attributes to ensure that the decision is made in the shortest time possible.

Another approach to reducing the individual's anxiety about sending a parent into nursing home care is ensuring that everyone involved participates in the decision and their feelings and opinions are known to one another. It is not unusual for children to insist on continuing home care even if the parent in question desires and is fully prepared to enter a nursing home (Ryan & Scullion, 2000b; Nolan & Dellasega, 2000). Knowing their parent's preference and realizing that no hard feelings are harbored toward them for contemplating such a move can help children with elder parents in making their decision and later coping with it successfully.

Of equal importance is receiving support from every possible source, including health care professionals, social workers, and members of one's own family. Contemplating sending an elder family member into nursing home care is often seen as an embarrassing or sensitive topic the discussion of which should be avoided so as not to generate negative emotions. Instead of helping, this approach makes things worse by making the designated decision makers feel isolated and helpless (Ryan & Scullion, 2000b). The decision in these situations is so momentous and agonizing that nothing short of a 'unified front' can generate in children of elder parents the certainty that they are making the right choice. Nursing professionals and social workers must strive to initiate such discussions to make children of elder parents feel that they are not alone in their decision-making process, which is likely to reduce the feelings of guilt and remorse later on (Nolan & Dellasega, 2000).

Another aspect increasing the reluctance among children of elder parents in such situations is the feeling that they are betraying or abandoning their parents. It is necessary to assure them that their roles do not end with their parents entering a nursing home. In fact, Ryan and Scullion (2000a) found that among adults with elder relatives in nursing home care, the feeling is almost universal on their part, as well as on the part of the nursing personnel working at those facilities, that children continue to play a crucial role in providing social and emotional care to their parents, allowing the nursing personnel to provide an even higher level of technical care. In the assignment's case of a son contemplating sending his mother into nursing home care, he must be assured that, rather than abandoning her, allowing his mother to enter a nursing home would free up the energy and time he otherwise would have to spend on physical care so he could apply it to providing the best possible emotional and social care for his mother.

While keeping in mind the importance of the approaches mentioned in this work, community nursing and social services personnel must be aware of the need to be proactive in applying them in relevant situations. Anticipating the possibility and consequences of sending an elder parent into nursing home care far in advance of the need to do so actually arising is likely to reduce the shock associated with the need to make such a decision and to make the decision itself prompter and considerably less stressful for the involved parties (Nolan & Dellasega, 2000). To ensure this, nurses and social workers must work closely together in serving their local community.

References
Nolan, M., & Dellasega, C. (2000). 'I really feel I've let him down': Supporting family carers during long-term care placement for elders. Journal of Advanced Nursing, 31, 759-767.
Ryan, A. A., & Scullion, H. F. (2000a). Family and staff perceptions of the role of families in nursing homes. Journal of Advanced Nursing, 32, 626-634.
Ryan, A. A., & Scullion, H. F. (2000b). Nursing home placement: An exploration of the experiences of family carers. Journal of Advanced Nursing, 32, 1187-1195.