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It’s important for him to know and be reassured that your caregiving will continue in his new setting. Assure him that you’ll be his advocate, companion, and cheerleader. And know that your health and well being matter too
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I'm adding what you wrote in your profile because it is important info:

"74 yo caregiver for husband who was in an accident 2 years ago and fractured his neck. Is now paralyzed and needs total care. Having problems keeping caregivers at a rate we can afford and one who will do a bowel program. Children all work so I get little help from them. They want me to be the decision maker to put him in a nursing home but I feel guilty about putting someone I have been happily married to for 58 years in a nursing home. I am exhausted mentally and physically."

I'm very sorry you're having to make this decision -- you've been doing your best for him. I'm assuming he'd be assessed for LTC. Your state's Medicaid would cover it, so I think your next move is to talk to either an elder lawyer/estate planner and/or Medicaid Planner since he is still "young" and could require many more years of care.

You will need to have any discussion with him with all the facts on hand, especially financial ones. Maybe the financial facts will make the decision for you. Or, you yourself can consider downsizing into a care community (in IL section) so that you'd be on campus with him and demonstrate that you're not abandoning him. It's a practical matter. You're in a difficult situation and I'm not making flippant suggestions, but I think you need to consider all sorts of ideas. Bless you for sticking by him. I wish you rest and peace in the near future.
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Does your husband want & expect you to take total care of him indefinitely? Is he okay with you doing so, at your age, until you can't move anymore and need care yourself? After 58 years of marriage, I would think he'd be against you killing yourself on his behalf! If you haven't had a talk about the future, now is the time to do so. 74 years old is not the time to be 24/7 caregiving for someone who's fully incapacitated, which is why you don't see 74 year old nurses or CNAs working in nursing homes.

Speak to DH in a loving manner about how you simply can't do this anymore, period. You're not 'abandoning' him by placing him in a SNF; you're actually placing him in capable hands where TEAMS of people can look after his needs 24/7 which is a much more realistic and safe approach than you doing the job yourself. You can go visit him daily and take on the role of his wife again instead of his full time caregiver who's at the end of her rope now, and rightly so.

I'm sorry you're in such a difficult position in the first place. Wishing you the best of luck with this conversation and prayers that he is in agreement with the logical choice to be placed in a SNF, where he belongs.
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I would lovingly say, "How do I tell my husband of 58 years, who has needed total care for two years, that I can't do it anymore and it's time for a nursing home?"

If there's any significant pushback, I'd also point out that there's a reason you don't see 74-year-old caregivers in nursing homes -- the job is too much.

I don't know the state of your marriage, but perhaps the last thing your husband wants is for you to suffer and he might be more amenable to the suggestion than you think. If you've been married that long (you were married at 16??), I completely understand your feelings of guilt, but in reality, you're confusing caring FOR someone with caring ABOUT someone. You care enough ABOUT him to know you can no longer care FOR him. By placing him where he can receive consistent quality care, you are caring for him by caring about him. Nothing will change about how much you love him once he's been placed.

Make the decision, and at least ask your children that they be supportive of that decision.
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I’d suggest you go to see the doctor yourself, and tell the doctor what you’ve told us. Then tell your husband that the doctor has told you that if you don’t move him to somewhere he can get 24 hour care from three shifts of people, you will die before he does. He will then have no support left at all.

It’s true, it takes the ‘decision blame’ off you, and it helps your husband think of both of your needs together.
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