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


Over the course of 15 years, a total of 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 zealous in my attention to the elders who were getting excellent care in the facility. However, there is helpful involvement with your loved ones who live in a facility and there is involvement that borders on, or crosses over into, interference. I like to think I stayed safely on the helpful side of the line. I tended to my elders' specific requests that were beyond what the nursing home could possibly deliver. That, in turn, made my elders easier for the staff to care for.

Over time, I made friends with the staff. I stayed out of their way when they were busy. I didn't take up their time chatting aimlessly. I didn't criticize them if I saw a problem, but asked nicely if we could change what needed changing, and I listened to their explanations. I kept my visits to an hour or so – just long enough to make sure everyone's needs for the day were taken care of. Therefore, my presence seemed welcomed by the staff and certainly was welcomed by my loved ones.

Can families get too involved?

The nursing home staff would occasionally confide in me about families who "took over" the nursing home. The families came on like they owned the facility and their loved one was the only person who mattered. They cornered every staff member they could find and talked to them either with the attitude of a good neighbor who had all the time in the world, or as an adversary who needed constant monitoring. Neither attitude is good.

These visitors spent the day roaming the halls demanding services for their loved ones. I understood that they were anxious for their loved one's benefit, but I had also learned over time about the demands on the nursing home staff. This was a facility with caring staff members who did their best to help every resident. But staff to resident ratio is never what we'd like. Most families would love a one-to-one ratio. However, if that is what you insist on, then the family should hire a private nurse, as no standard nursing home can provide one-to-one service.

It's not the amount of time family members spend, it's what they do

Some elderly spouses of residents spent most of each day at the nursing home. However, most of these people not only helped their own loved one, they volunteered in the dining room or helped push people in their wheelchairs down to meals. They helped residents when it was time for crafts. They visit lonely elders and, in essence, made themselves a valuable part of the daily functioning of the facility. They were also careful not to interfere with what the staff needed to do.

Some facilities want to limit family visits

Lately, I've read several comments on the 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 say that the resident will adjust better if they are left on their own.

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 attitude. Many seniors grow old fearing that they will be "dumped in some warehouse and left to die." To me, knowing that family members care enough to visit often extends the continuity of the life they had before moving to a facility was necessary. I know that the visits from family and friends helped my parents settle in and feel secure. They looked forward to our time with them, and visitors made their days pass more quickly.

No rule applies in all situations, so if a facility does limit visits, ask why. If you trust the facility, you can go along with their wishes for a time. Maybe they have a good reason. And there's rarely a compelling reason that anyone should need to visit daily. But be aware that you have a right as a family member to drop in anytime. I think in most cases it behooves nursing homes to welcome family visits to a point. Transparency is a good thing.

Families who never visit

Then there are the families the facility staff told me about who dropped their elders off and basically forgot about them. If there were facility visits, they were extremely rare. The staff members told me that they saw many of these sad cases. I believe that if nursing home staff had to choose, they'd rather cope with families who over-do visits than see lonely residents with few if any visitors.

Attitude and balance count

As with most things in life, attitude counts. If we treat the staff as good people doing their best for their residents, they may welcome frequent visits. Conversely, if we demand time and attention they don't have, 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 and work out compromises, generally we will be accepted and well liked. If they feel we are judging them as inadequate and we treat them as adversaries, even a weekly visit could be viewed as too much.

The bottom line is that if we maintain a good attitude and use common sense to balance the frequency and length of visits, most facilities should welcome us when we 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.

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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 understand that care facilities are not the answer for everyone, I still have my mother at home with me after all! But if a family feels the need to micro manage every aspect of their loved one's day, if they feel the need to be there from sunrise to sunset every day, I can't help but wonder why they have their family in care at all? I am admittedly a control freak, but if the time comes when I can no longer provide the level of care my mother needs I will trust the staff at the nursing home to look after her. Will they do as good a job as I have? Of course not, because with me she has one on one care. Frequent visits and oversight are necessary, but if the care is so sub standard that you feel the need to always be there I think it is time to find a different care solution.