"I Promised My Parents I'd Never Put Them in a Nursing Home"

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Our parents cared for us and now, as they age, it's natural that we want to care for them. At first, we figure we'll stop over at their home and do what they need us to do. That can work for while, when all that's needed is some help with errands, the lawn or fixing a meal now and then. It's kind of a pleasant way to help out and show our love for our parents.

However as care needs increase, we are faced with more decisions. Many of us promised in good faith, back when our parents were healthy, that we wouldn't ever put them in a nursing home. That would be abandoning them. We aim to care for them ourselves until they die.

Admirable thinking. However, as years go by and care needs mount, we find ourselves faced with the fact that we can't raise our families, work our jobs and run to Mom and Dad's condo three times a day.

So, with some guilt, we start looking at other options. For some people, this means having your parents move in with you. If there is enough room so everyone has privacy and the personalities blend, this can work. However, before making such a move, make sure your head is as engaged as your heart. While you are considering this option, you also may want to read "Living With Elderly Parents: Do You Regret the Decision?"

Another option, though there is some guilt attached, is getting some in-home agency help. Why the guilt? Because you are now sharing the caregiving with someone else. Someone who is not a family member. You are hiring help for your parents. That isn't what you had in mind for them, but they are not safe alone all day, and you can't be there all the time. You have to do something.

The same guilty feelings are often attached to adult day care. Adult day care can be a wonderful choice for many seniors, as they get care and supervision, plus peer interaction and activities more stimulating than watching TV all day. But, this too means you are turning over some of the care to strangers. You were going to handle it all yourself. You told them you would. And now? You can't. You need help.

Then the day comes where in-home care can't handle all of their needs. Adult day care can't take care of them. Only one choice remains, and that is a nursing home.

How to Research Nursing Homes to Find The Right One

Cheryl E. Woodson, MD (and caregiving daughter) wrote a wonderful book titled "To Survive Caregiving." One of the most important things Woodson says is that, while you may have to "break your promise" – you know, the one you should never have made – and put your parent in a nursing home, you have still honored the spirit of the promise.

I loved the way she put that. None of us knows the future. Our healthy parents have visions of nursing homes decades ago, and the very idea of living in one is unthinkable to them. You tend to agree. Yet, now the day has come where Mom is incontinent, confused and paranoid. She has wandered away from home twice, and once you had to call the police. Dad had a stroke and needs a lift to get him out of bed and two strong people to get him into his wheelchair. You've run up against a brick wall. There is no choice but a nursing home.

When the guilt starts to overwhelm you, stop it. Adjust your attitude. You have done all you can. You have honored the spirit of your promise. People live longer now, in far worse condition, than they did in the past. You know that both of your parents would be dead, had this been the 1970s. Because of medical advances, their hearts are still ticking. However, they are in such frail health that there is no way you can care for them alone. No one could have foreseen this way back when they were younger and healthy.

There are still some bad nursing homes. So, be proactive and tour the ones in your parent's area long before the need arises. Be realistic but be aware. Find the best one you can. Hang around and you're likely to find family members visiting their loved ones. Ask them what they think of the home.

Elderly Parents in a Nursing Home? You are Still a Caregiver

Then, if it's good, get your parents names on the list. The good homes are often full and hard to get into. You can always say no if they call with a room and you aren't ready. But when you hit that brick wall of reality and know you must, for your elders' safety and your health and sanity, put them in a nursing home, you have done your best. You cared for them in every way possible before turning to this last option. You have found the best home available. Now, you are ready to really share the care.

Even when your elders are in a nursing home, you are still a caregiver. I had a time when I had three people in a home (plus two others in separate apartments) and I was at everyone's place every day. It wasn't a cakewalk, by any means. I was still a caregiver.

If you put your parents in a nursing home, they still need you, the primary caregiver. They need you as an advocate. They need you to put the personal touches on their rooms and to be visible to the home staff and the other residents. They need you to help them settle in and make friends. The best part of this, if you will let the guilt go and think for a moment, is that you now can enjoy them again. You aren't tied to doing everything for them, so when you visit, you can do extra little things. You aren't too worn out to be pleasant. You can surprise them by bringing the children. You can bring their favorite chocolates or wine. You can make this their new home, and be the person who visits, without all of the exhaustion that used to make you crabby. And you can do it without guilt.

Caregivers can be dedicated, but that dedication can turn into martyrdom, and frankly, martyrs aren't good caregivers. Using the help of a good facility, while keeping an eye on things and continuing to care for your elders in this new role, allows you to take off your martyr hat. You can do it without guilt because you have done your best. You are still doing your best. You are providing them with the best care humanly possible. Accept your humanity without guilt. Honor the spirit of your promises by being the best caregiver you can be. Be a caregiver who knows when to say when.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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113 Comments

The Guilt Trap.
It's right there in the middle of the floor. We've all stepped in it. Sometimes we get to step out. Others get trapped there permanently because they don't know what to do about it.

It's really important to understand that caregiving is not guilt-free, even when you do everything perfectly. Absence of guilt is not sign of success. Feelings of guilt are not a sign of failure. It's a trap. Be ready for it.

Don't be misled to think the feelings of a caregiver are as simple as feeling guilty or good. It's not black & white like that. It's very, very complicated.
We misname this complex hairball of simultaneous and conflicting feelings guilt, out of a lack of better names or understanding.

Guilt is fine if you did something illegal or morally wrong. Guilt is not appropriate when you are simply doing the best you can under the circumstances. There are no caregiver bonus points to the one dying with the most guilt.

We are all human beings, not super machines that suddenly have training and knowledge to take care of a frail old person. We don't live in The Matrix, where you can sit connected to a computer and have new ability downloaded into your head. But we act like that is the case for family & friends who take on caregiving.

Overnight, we are supposed to be an RN, personal attendant, nutritionist, activity director, psychiatric nurse, janitor, cook, and driver. Financial manager, estate & probate expert, real estate savvy, and familiar with the ins & outs of Medical Assistance and the VA. If you can't do any of that, or aren't very good at it, then you're supposed to feel guilty. Seriously?

I reject that nonsense. I didn't make my mother old, nor did I give her mental illness, or dementia. I'm doing the best I can, and if anybody out there wants to criticize me, without stepping in to help or pay, kindly stuff it.

What I do feel is a lot of fear. Fear of the unknown. Fear of failing. I'm going to screw up by paying the wrong thing in the wrong order, and just make a mess out of it.

Resentment. The opportunity cost for this experience for me and my family has been very, very high. I only get one life to live too, and when my mother was this age, she was not doing parental caregiving at all. Both her parents had relatively fast declines & deaths. It did not go on for decades, as dementia care tends to. She did not have her hands full with a diabetic, kidney & liver impaired psychiatric patient who also developed dementia.

Frustration. Everything is so confoundedly hard because mom would not plan ahead. She had almost nothing in place to allow me to do her caregiving in the first place. Her home, her finances, her stuff, her health, her everything have all been one giant hot mess after the next. So much money has been spent on doing things so I can take care of her, that could have gone directly to care. E.g. attorney & court fees.

Disappointment. The current state of things and the fact there is no recovery means the end of any opportunity for do-overs. We are not going to see those Christmas lights, eat at that restaurant, or shop that store. I am never going to hear "I'm sorry" for the years of bad stuff. There will not be happy family memories around the dinner table, close moments with grand kids. That ship has sailed and is not coming back. We were robbed before we even began.

So, to anybody who wants to heap guilt or blame, tsk their tongue at me, shake their head, or whisper about me, go ahead. That doesn't mean I will accept it, let it affect me, or change anything about what I'm having to do to follow the laws & rules, make sure mom is safe, clean, fed, & properly medicated. And if you can do better, by all means, let me know ASAP so I can get the guardianship & POA documents changed!

My beloved Dad went to Heaven on September 16.

He'd been in the hospital since late July, and at first was going to be moved to a wonderful private VA Medical Foster Home for necessary 24/7 care. This was his physician's strong recommendation because we could not offer the comprehensive supervision that he desperately needed while living in our home. Dad's bank account could not accommodate home health aides and nurses, as he gave his entire life savings and material assets to his son.

Both employed full-time, neither my husband nor I could afford any "leave of absence" luxuries. We're saving for our OWN retirement, paying a mortgage, etc., and financing our own health care. We're also contributing to SS (hoping it's still available in 3 decades).

We don't have children, but even if we did, we would by all means take responsibility for our sunset years, and if need be, live in a care facility ourselves.

I never made such a promise to my Dad, because I knew it was downright unrealistic and completely out of our financial scope. He and his sisters had placed their own mother in a care center after having tried to look after her in their own homes for many years.

Dad never made it to the medical foster home, as he declined in the hospital and went right into Hospice toward late August. The entire ordeal was heart-wrenching, and there were very few choices available to us. Thank God for the VA because without it, Dad would have been in a Medicaid nursing home and hospice.

I will mourn Dad's loss the rest of my life. But I will entertain not one IOTA of guilt because I did everything I could for him, in good faith, with a devoted daughter's love.

For anyone to imply that outsourcing a parent's care is callous is in ITSELF quite callous. My hat's off to those who are able to make this happen, but the rest of us are not quite as fortunate in logistical or financial means.
I believe that home is best too... but today, since 2, my Mom has refused to take her meds and she has cried and yelled at me telling me, that I don't love her and I don't want her around. I have not been able to get her to eat... She is not at peace and is not happy. If my Mom did not have AZ, then yes, my Mom would be able to live happily and peacefully at home with me.. If you haven't lived in my shoes, don't criticize me and what I have to do. I never planned on placing my Mom in assisted living, but the AZ was never expected either.