The PDF which includes endnotes and footnotes in which this article appears can be found in Bifocal Vol. 45 Issue5.
Transitioning an older adult from their home to a skilled nursing facility or a memory care unit can be extremely difficult for the older adult, their family, and their caregivers. It can be especially hard to know when the right time is to transition an older adult, and how to talk about it with them.
Consider this hypothetical: an older woman, living about two hours away from her children and grandchildren has started to develop dementia. She had a stroke and a few falls, and her old two-story house is not safe for her to live in anymore. Her children also start to notice changes in her mood as her dementia worsens; she wanders and starts to be paranoid of her daughter. Of her five children, two live in the area and three live in different states. The children do not get along most of the time, and they disagree about her care. On top of it all, their mother’s physical health is rapidly declining due to a recent cancer diagnosis, and it has been suggested by her physician that she needs placement in a 24-hour skilled care facility. The search for a nursing facility to meet her needs within the budget is daunting, uncomfortable, and tiresome for family members. The decision to move her into a memory care unit is an extremely difficult one as her savings were rapidly draining and her children fought for every penny Medicare and Medicaid would give them. After two years in the memory care facility, she transitioned to hospice for “comfort-measures-only” end of life care, and she passed away peacefully on the night of her oldest granddaughter’s high school graduation.
The key issues in this hypothetical are emotional (confusion, mistrust, desire for the older adult to be well cared for, stress, sadness, guilt), physical (treatment, declining health), mental (dementia diagnosis), financial (daily battles with Medicare, Medicaid, and private insurance to finance her treatment). This scenario, which many caregivers of older adults can relate to, shows that there are no easy answers to these issues. This article will provide recommendations for family members and caregivers going through similar situations, although every individual situation is unique, and what may work in one situation is not guaranteed to work in another.
The reasons why an older adult may need placement in a nursing facility are numerous, and as seen in the hypothetical above, the older adult needed memory care, cancer treatment, and assistance with dressing, bathing, and eating. There could be dozens of reasons an older adult might benefit from additional care. One of the biggest issues families and caregivers face in this process is knowing when is the right time to move the older adult, and how to tell the individual they can no longer live on their own.