Jun 3, 2013

When Your Loved One Needs to Move to a Nursing Facility but Refuses to Go

“I often work to convince reluctant spouses to change from being a ‘caregiver’ to being a ‘care advocate’. They can still be vigilant to ensure their loved one is receiving care in an appropriate nursing type facility while preserving their own health.”

By Marie Marley
Alzheimer's Reading Room

When Your Loved One Needs to Move to a Nursing Home

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Let’s face it, no one wants to place their loved one with Alzheimer’s in a nursing facility. But sometimes that’s the best (or only) alternative, especially for those in the late-stages of the disease.

It takes a large team to care for people in these stages. They need a doctor on call 24 hours a day. They need a nurse available at all times. They need aides, a social worker, activity professionals, cooks and laundresses.

And they need to be around other people for social stimulation. They need 24/7 supervision and they need to be in a safe, secure environment.

Providing for all these needs can be done but it’s a full-time job. Unfortunately, in many cases the primary caregiver has to work full-time and thus can’t provide adequate care. And sometimes he or she can’t afford in-home caregivers who could make it possible to keep the person at home. Even worse, sometimes other family members refuse to help out.

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People with Alzheimer’s (as well as most people without it) who have a clear and compelling need to be in a long-term care facility typically want to remain in their own homes. Often they are unaware that their condition is such that nursing home placement would be best for them.

Family members are sometimes adamantly opposed to the idea as well. Some view putting their loved one in a facility as virtually a criminal act. Nursing homes have a bad reputation and in many cases deservedly so. But good facilities are out there – you just have to take the time and have the extreme patience to look carefully and look far and wide.

The decision to place a loved one in a care facility can be agonizing, but caregivers need to consider the following: 1) Depending on the circumstances long-term care placement can be the most loving choice for the patient and 2) Caring for the loved one is probably seriously affecting their own physical and mental health and wellbeing. People can’t be good caregivers if they are exhausted and burned out all the time.
“I often work to convince reluctant spouses to change from being a ‘caregiver’ to being a ‘care advocate,’” says William G. Hammond, founder of the Elder and Disability law firm in Overland Park, Kansas. “They can then be vigilant to ensure their loved one is receiving appropriate treatment in the facility while preserving their own health.”
Many patients, however, flat out refuse to go.

In such cases you can try to convince them that it’s best for their own health and well being. If that doesn’t work you may enlist the help of another family member or even the person’s physician or attorney to talk with them.

People with Alzheimer’s will sometimes pay more attention to the advice of a person other than their primary caregiver. You may also obtain the services of a geriatric care manager, who can often guide you through the process.

Another approach is to use what is referred to as “compassionate deception.”

You can convince the person to go for a limited period of time, such as a week. Then you stretch it out to two weeks, then three, and eventually they will probably adjust to being there full time. Loved ones who are significantly impaired may even forget they were supposed to go back home. Or they may not be aware they aren’t at home.

You may also take the person to a facility, saying you’re going to visit someone there or you have dinner reservations there (or some other reason for visiting). Then when you leave don’t take them with you. You will probably feel terribly guilty, but the person will almost certainly adjust.

If none of these suggestions work and you have power of attorney, you may have to enlist the help of law enforcement.

According to Hammond, “You should do this only as a last resort. It’s only for the most severely impaired people and the most dire circumstances – such as if the person becomes a danger to him or herself or others.” Law enforcement typically takes the person to a hospital geriatric psychiatry unit for evaluation and treatment, from where they may be released to a nursing home.

“If all else fails and you don’t have power of attorney,” says Hammond, “you may face costly court action in order to be appointed the person’s guardian or conservator. You can then make all decisions for them about where they will live.”

When you must take a person with dementia to a nursing home against their will and/or go to court to get guardianship, be sure to consult a local elder law attorney for advice because laws vary from state to state. You can call your local bar association to get a referral.

Note: A free 110-page booklet on legal issues related to people with dementia is available on Hammond’s website, www.kcelderlaw.com.
Marie Marley, PhD, is the award award winning author of  Come Back Early Today: A Story of Love, Alzheimer’s and Joy. You can visit Marie’s website at ComeBackEarlyToday.
A similar version of this article appeared on Caregiver.com.

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