What's your plan?

This week I received an email from an aunt saying, "People rarely want to leave their homes, though I have known a few people to make the decision to move from home to assisted living of their own volition." She went on to mention two people who had decided to move. I work in a nursing home so most often my patients are facing the question of whether or not they can or should return home. There are more that want to go home when they really shouldn't than those who willingly stay.

No one wants to be in a nursing home even if it is called a care center. One woman I've worked with wants to go home. "I don't want to spend the rest of my life here!" Never mind that she needs two people to help her move from her recliner to her wheelchair. I think she would be happier if she accepted the reality of her physical limitations and was content where she is. Stir in a little dementia and it is hard to reach that state of acceptance. Another friend cared for her mother for a time in her home but there came a point when it was no longer safe to leave her alone for very long. Even after a year in a nursing home her mother still doesn't understand why she can't live at home even though she appears to be quite content where she is.

This week I had a conversation with one of my patients that went something like this. 

Me: What do you do during the day when you are at home?

Pt: I sleep a lot.

Me: Do you help your husband with the cooking?

Pt: Yes, we do that together.

Me: How about the laundry?

Pt: No, that's in the basement and I can't get down there any more.

Me: What did you do for fun?

Pt: (pause) I can't think of anything.

Me: What do you like doing here?

Pt: I like the exercise class, bingo. I've been going to all the activities and I like them.

As a therapist it has been wonderful to see the change in this woman. The first time I worked with her she couldn't hold her eyes open and it took two people to get her to the bathroom. Now her eyes are bright, she greets us with a smile and she just needs some supervision for safety when moving around. The marked improvement has come, in large part, because she has things to do. Sure, she still takes a nap or two during the day, but she isn't sleeping for hours at a time. And now she is talking about going home where it seems she will end up back in the same situation as before without the extra stimulation.

Last week another patient decided that she was going to stay in the nursing home. Could she have made it at home? Yes, she likely would have done fine. Her health has improved and she has family in the area who are helpful. But as she thought of being in that house all by herself, she decided that she would rather stay. Her family and the staff applauded her decision.

When I was a teenager, a woman in my church commented, "It is always better to make a move before you have to." I couldn't agree more. Making the decision to move to a higher level of care is easier when you feel like you are in control of that decision. Of course, life throws some curve balls at us that we don't expect and the move has to be made before we had intended.  But thinking through the different scenarios and talking with your family about different options before you ever expect to need them will likely make the move a whole lot easier -- even when dementia makes it harder to understand why you can't be at home.