How Involved Should Families Be When Elders Live in a Facility?


Over the course of 15 years, five of my elderly loved ones lived, for various spans of time, in a nearby nursing home. I visited them nearly every day. Some would say I was over attentive, since my elders were getting excellent care in the facility. But I tended to their specific requests that were beyond what the staff could possibly deliver, which made my elders easier for the professionals to care for.

Striking a careful balance is crucial when it comes to visits and family involvement at a long-term care facility. There is helpful participation with your loved one, and then there is involvement that borders on, or crosses over into, interference.

Can Families Get Too Involved?

I like to think that I stayed safely on the helpful side of this line. Over time, I made friends with the staff. I stayed out of their way when they were busy and refrained from taking up their time with small talk. I didn’t criticize them if I saw a problem. Instead, I asked nicely if we could make some adjustments and I listened to their suggestions and explanations. I kept my visits to an hour or so, which was just long enough to visit with each elder and make sure their needs for the day were taken care of. My presence was welcome by elders and staff alike.

However, employees would occasionally confide in me about families who “took over” during their visits to the nursing home. These visitors acted as if they owned the facility and their loved ones were the only residents who mattered. They cornered every staff member they could find and talked to them either as if they were a good neighbor who had all the time in the world or an adversary who needed constant monitoring. Neither attitude is good.

Advocacy vs. Entitlement

Family caregivers naturally advocate for their loved ones’ wellbeing, and this is entirely necessary, especially for seniors who cannot fully understand or participate in their own care. However, there is a point where some family members take this responsibility to an unrealistic level.

We all want the people we love to receive the best care possible. Most families are keen on a one-to-one staff-to-resident ratio, but that is not what nursing homes and assisted living facilities provide. The nurses would tell me about visitors who spent the day roaming the halls and demanding services for their elders. I understood that they were anxious for their loved ones, but I had also learned over time about the heavy demands that are placed on nurses, CNAs and aides who work in this industry.

This facility happened to employ caring staff members who strove to provide quality care for every resident. Families must remember that other residents live there and have care needs that are sometimes more urgent than your loved one’s. Hiring a nurse or professional caregiver privately is the only way to obtain the one-on-one care that so many families seem to expect.

How You Use the Time Is More Important Than the Length of Your Visits

Over the years, I noticed that some residents’ spouses spent most of each day at the nursing home. You might think that having a few visitors constantly lingering would be a nuisance for staff members, but in this case, it was quite the opposite. Most of these people not only helped their significant others, but they also volunteered in the dining room or pushed others in their wheelchairs down to meals. They helped residents when it was time for crafts. They took it upon themselves to visit lonely residents and, in essence, made themselves a valuable part of the daily functioning of the facility. Most importantly, throughout all of this, they were also careful not to interfere with what the staff needed to do.

Placing a loved one in a nursing home minimizes a caregiver’s hands-on responsibilities, but in no way does that mean they are over. Seniors still need an advocate to make sure they are receiving quality care. They need visits from family to feel loved and important, and occasionally, they will need a hand when it comes to cleaning up an accident, eating a meal, and obtaining the personal items they want and need. The lesson here is that the most successful caregivers treat the nursing home as a respected ally rather than a threat and do what they can to enhance their loved ones’ experiences there.

Some Facilities Suggest Limiting Family Visits

I’ve read several comments on the Caregiver Forum about facilities that want to restrict visits from family members. The staff members in these facilities claim it’s hard on the resident to have their loved ones come and go. They initially recommend not visiting for a few weeks to help the senior adjust.

I’m not saying there aren’t elders for whom this may be the right approach. However, for most elders, I have a hard time accepting this recommendation. Many seniors fear that they will be “dumped in some facility and forgotten.” Knowing that family members care enough to visit often extends the continuity of the life they had before moving to a facility became necessary. I know that regular visits from family and friends helped my parents settle in and feel secure. They looked forward to our time together, and visitors made their days more eventful.

No one rule applies in all situations, though, so if a facility does limit visits, ask why. For example, a move can be very stressful and confusing for a person with dementia. The memory care facility may recommend waiting a week or two until visiting to help them adjust to their new surroundings with minimal distractions and reminders of home. If you trust the facility, you can go along with their wishes for a time, but be aware that you have the right as a family member to drop in at any time. If they are discouraging visits for other reasons, it could be a red flag. In most cases, it behooves nursing homes to welcome family visits. Transparency is a good thing.

Achieving the Balance

Treat the staff as good people doing their best for their residents. If we demand time they don’t have and attention they cannot provide, they are bound to resent us. The same goes for complaints. If we approach the staff as though we know they want the best for their residents, it will be easier to work together and devise solutions—especially ones they feel compelled to see through. If they feel we are judging them as inadequate and treating them as adversaries, staff are not likely to go the extra mile for you or your loved one.

The bottom line is that if you maintain a good attitude, keep your expectations realistic, and use common sense to balance the frequency and length of your visits, most facilities should welcome you when you stop by to see a loved one.

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.

Minding Our Elders

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This article has some good points, but, as with most aspects of caregiving, this is a no win situation. Some facilities are better than others and if you are unfortunate to get into one of those less better ones, then you can't win. If you don't visit frequently your family member may be neglected. If you do visit and do things staff are supposed to do but are not and don't complain, then staff take advantage of you and come to expect you to do it. If you do complain, sometimes even in the nicest way (as described in the article) staff will resent you anyway. I may sound jaded but this comes from dealing with many hospitals, rehabs, nursing homes, assisted living facilities. You can have great staff members and then a few bad apples. I have witnessed medications mistakes, other patients falling out of bed and being ignored, coming in on several mornings and finding a confused woman trying to get into my mother's bed (and no staff around), another place, a strong younger (60's ) man was found by me nude in the bed next to my mother. And even after I complained, he was permitted to roam and I had to barricaid my mother's door until I had the state investigate. Residents not getting the proper meals for their restricted diet or no meals at all, residents who could not eat by themselves not having anyone helping them. Residents begging for someone to help them go to the bathroom. I don't post this to upset anyone with a family member in a facility where they can't visit. My other suggestion is to help your family member settle in. Stay as much as you feel necessary and as long as you want until the staff gets to know them, their needs and their routines, listen and observe quietly to what's going on with other patients/residents without family or other visitors. And I would be wary, unless you agree this is best due to the mental state of your family member and your relationship, of any facilitiy that tells you not to visit. Thank them for trying to relieve your burden but tell them in order to have peace of mind and it has nothing to do with them, you want to keep involved in your family member's care. Even in the best facilities it does't hurt to have an extra pair of eyes or two. Yes staff are overworked in some places but that's when you really need to pay attention. We all make mistakes but we need to try to do the best we can and if that means having to listen to a concerned family member who is upset, without taking it personally, then maybe facilities need to start training their staff to do. And my final suggestion if you are visiting and you see neglect or abuse of another resident, please anonymously report it to the elder abuse line in your state. that person may not have anyone else watching out for them.
If I did not visit twice a week, my parents would look like street urchins. I have to be their voices because my dad will not stick up for himself and my mother is in memory care with late stage Alzheimer's. The staff sees me coming and they all take off. They do not want to hear my wrath when my parents are being neglected. I go immediately to the director of each area involved and get things taken care of. I have gotten ombudsman involved once so they all know I mean business. I praise the staff when they do their job. I know to get things done I have to be respectful to them but if they do not follow through, I take action. Be sure to be advocates for your parent(s). They are the only parents you will ever have and they would do the same for you.
I felt bad for my mother when my older half sister and half brother put her into a nursing home with promises that they would come take her home with them on weekends which seldom happened. I lived 4 hours away and worked 6 days on and 2 days off at a State Hospital. I went to see her when ever I got a weekend off and take her out to eat. It was kind of strange as I was the child she said she never wanted and yet I was the only one of 7 that was making an effort to see her as often as I could. I guess maybe I was still looking for her approval/ acceptance. The children she favored the most were the ones that really let her down, big time. Human nature is kind of strange.