No nursing home promise

Dear Nurse Kris:

My siblings and I live a long distance away from my mom. Seeing her means a full day of flying or driving, time off work, etc. My mom is recently widowed, lives alone in her large home, has Alzheimer's and we worry about her forgetfulness.

She says she's taking her daily medications and eating and showering, but I don't have any way of knowing for sure. We promised her we would never move her to a nursing home. However, when we call, she's forgetful about the day's events, and she's growing lonely. When we visit, once or twice a year, the house is neat and her story sounds good, but still I feel uncomfortable.

I spoke with the government nurse and she recommends we consider placing mom in assisted living. The problem is, we made a promise to her we would never put her in a nursing home.

Mom has always said she would stay in the house until the day she died and she made all of us promise to honour her wishes. Can you make any suggestions?

Thomas- Trying to sort things out from Alberta


Dear Thomas: You are in a tough spot - you are appropriately concerned about your mom and want to do what's best for her, and you want to honour her wishes by keeping her at home.

Basically, there are two main components you'll want to be thinking about - her physical wellness and her mental wellness.

Let's talk about her physical wellness for a moment. Cash-strapped government health authorities often allow workers to come in for short periods of care up to several times per day. These services can include attention to personal hygiene, bathing, grooming, dressing, meal preparation and medication reminders or assistance. They also may book a personal care service for a bath for her, once or twice a week. The costs for this will be based on your mom's income level and the costs could be high. At times, those costs exceed the health authority's grid and the recommendation is the family seek outside private care services.

Your mom may need more "life management" interventions than the health authority can provide. If this is the case, then yes, they will recommend assisted living as a first step.

Once your mom's needs escalate beyond needing two services in the assisted living home, choices will be fewer and a recommendation would be made to place her in residential care (there is no more intermediate care).

In a recent local case, the health authority nurse found that for an elderly couple living at home and needing extensive services, the cost was essentially the same for both the health authority rates and the private agency. However, the difference was that the private care agency could offer more services for the same price.
The private agency service workers could assist the client with paying bills, personal laundry, making breakfast and lunch, going on an outing or to appointments, minor housekeeping, transporting to doctors and other appointments in the caregiver's vehicle - something the health authority care givers were not allowed to do. In this particular case, the couple - who met assisted living criteria - decided to go with the private agency caregivers, because they could do twice as much work for the same price as the health authority was charging.

Let's talk about your mom's mental health. Recent research published in the Archives of Gerontology and Geriatrics shows declining cognitive function is common in 10 per cent of adults aged 65 and older, and in 50 per cent of adults older than 85 there is some form of cognitive impairment.

Many families are concerned about what to do. Essentially, there is no magic bullet for stopping or reversing the disease, but there are medications to slow the disease progression, and there are activities to provide quality interactions with families, support persons, and caregivers. Whether you are a caregiver, family member or friend, these activities should help folks with diminishing cognitive functioning, not only maintain their dignity, but get the most of out every interaction with their loved ones.

Seniors report feeling a sense of accomplishment and were meaningfully engaged for hours - this activity sparked their creativity and imagination, started conversations around reminiscing, and basically prevented boredom from setting in. It enhanced their quality of life.

In short, there is a lot you can do to honour your mom's wishes. It sounds like assisted living is the only option your local health authority can offer, thus if you want to honour your mom's wishes, you'll need to go directly to a private agency. Choose one with registered nurses who can oversee your mom's care. Some private agencies offer 24/7 support hours for families and clients, as well as professional geriatric care management services for folks with dementia.

Good luck, Thomas!

More Ask Nurse Kris articles

About the Author

Kris Stewart is the owner, CEO and Clinical Director of Advanced Home Care Solutions Inc, based in Kelowna. She is a well-known, well respected Registered Nurse with advanced nursing and business degrees; she is also an inveterate health care entrepreneur, establishing health care enterprises in Canada and the USA. She is a sought after public speaker on health care and seniors matters, as well as workplace dynamics, and has won several national awards for her work in health care. She is a distinguished Alumni of Thompson Rivers University. Her professional mandate is to ensure that private health care options remain accessible and affordable for all.

Kris can be reached at:  [email protected]

Advanced Home Care Solutions:  http://www.advancedhomecaresolutions.com/about-kris-stewart


The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

Previous Stories