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kitchenwitch Asked October 2021

When is it time for long-term care, and how do you reconcile that with the Covid risk?

My 78 year old dad lives with severe COPD halfway across the country from me. I always try and see him twice a year, but because of Covid lockdown and travel restrictions, I hadn't seen him for nearly two years. As soon as we were both vaccinated I came for a visit in the summer and to my dismay found him severely malnourished, frail, and barely hanging on. While I planned to be here a couple of weeks, I've stayed for 2 months so far essentially providing round-the-clock care while my partner holds down the fort at home. He's doing a little better; others have commented that he's getting some colour back in his face and has a bit of his old spark back. I can't even quantify how many things I've done since being here to try and help him live more comfortably. Lots of Dr's appointments, a house overhaul, day and nighttime care, searching for and applying to support services, etc. He doesn't qualify for home oxygen at this point and manages his symptoms with a combination of puffers and rest.


He copes okay during the day, but night time he's extremely weak. He has these incidents of breathlessness from getting up to go to the bathroom that I find totally traumatic. (Of course it's worse for him as the one experiencing it.) When they happen I get really clear in my mind that it's time for him to go into long-term care, but at this point that isn't what he wants.


Our most recent plan has been to hire home care to come in in the evenings to cook him dinner, tidy up, and help him get ready for bed. But it's become clear to me that that's not enough and he needs more care. Unfortunately, the local nursing home is in the middle of a Covid outbreak because of an unvaccinated worker (don't even get me started on that), and 5 residents have died. I can't send him there. But my mental health is starting to deteriorate being his 24-hr caregiver, and while he's open to hiring someone, we live in a rural area where there just doesn't seem to be many options so I haven't found an in-home solution yet. Not to mention I have a life and family at home. They are super supportive, but it's hard to be apart. Oh, and I work too. Or at least try to! But it hasn't been happening much lately.


I guess what I'd love to hear about is your experiences with making the decision to move a loved one into long-term care, especially during the pandemic. (He's connected to all kinds of services related to his disease so I don't really need advice on that.) Thank you in advance!

Isthisrealyreal Oct 2021
Kitchen, as others have stated, move him to a facility closer to you.

This will make it easier for you and he will adjust.

Please do not get caught in the senior trap that so many do. You forsake your life to prop his up, so he doesn't have to make changes or do something he doesn't want too.

He needs help and he needs to make changes to get that help. Whether it is comfortable for him or not, because your family matters as much as him and he needs to see that, or not, but he needs to make sacrifices as well.

Find a facility that you are comfortable with, even if you can't see him, he will still have his needs met and have more socialization then being home with 1 caregiver.

Moving my dad into a facility was one of the hardest things I have ever had to do. However, it was the best decision for him. His health improved and he had mates to hang with and talk guy stuff. He didn't want to go but, there wasn't any other solution to meet his care requirements.
kitchenwitch Oct 2021
Thanks so much for sharing your experience and advice, Isthisrealyreal! I appreciate it very much.
sp19690 Oct 2021
The unvaccinated are not causing covid outbreaks. Ask yourself how many people in that nursing home are vaccinated and how many are unvaccinated then do the math on who is really causing these outbreaks. Your father is vaccinated and has about a 2% chance of catching covid especially since he is vaccinated. He is basically dying being by himself as you witnessed when you came to visit. Better he goes into nursing home care to be taken care if then dying at home alone. Unless you want to mive in with him full time or move him into your house. These seniors are more likely to die from being isolated and alone because of the fear of covid then if we just take common sense precautions like boosting their immune systems and washing their hands. Funny i have yet to hear any of these talking heads speak about immune boosting on the TV with all their fear porn.
kitchenwitch Oct 2021
I am zero percent interested in engaging in any discussion about the safety of unvaccinated people. This is a totally inappropriate response. I have not asked for opinions about vaccination. I am a caregiver who believes in vaccination, and in the public health system, who is trying to find the safest option for both myself and my father given the evidence-based limitations of the current situation.

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cwillie Oct 2021
I think in the long run choosing a facility that is close to you is better than choosing something farther away, your ability to make impromptu visits really does make a difference in what you see and hear about what is going on in a facility (not to mention a shorter commute is just easier on you!).
My experiences are all pre pandemic (thank god) but my mom spent some time in an interim facility while we waited for a bed to become available in the NH in my town - since he is still mostly able to function independently perhaps look at an independent living or assisted living facility in a safer area with an eye to moving him closer as his needs increase.
kitchenwitch Oct 2021
Thank you, cwillie! I appreciate your input.
Windyridge Oct 2021
Kitchen, would it be possible to move dad near you? I would advise against trying to up root you and/or you family to move near him. You have to have a life too. We can be good caregivers without going down with the ship.

I did long distance caregiving for years for both parents eventually moving dad across three states after mom died so he was near me. He was in a nice place and eventually adjusted well. He got in before the covid outbreak but they were still in lockdown when he died last year.

Sorry I can’t advise you on getting and elder in care during covid precautions but I know facilities will still accept new residents. My dads place did during the scariest period. They had very good and effective protocols.

I haven’t been active on this forum for awhile but in the past posted and discussed my situation here and got loads of good advice and support along with some nutty stuff here and there. Just ignore and move on.

Good luck to you.
kitchenwitch Oct 2021
Thanks Windyridge. I'm very sorry for your losses. I'm so glad to hear your dad adjusted well to living in a care facility.

I appreciate your advice! I will definitely ignore and move on from now on. :)

As for moving...my home is about 2000km away from his, and I think even traveling there would be too taxing on him, so I don't think it's an option at this point (but a good idea overall). I think you're right that uprooting us, at least permanently, wouldn't be the right thing to do either. I think temporary longish stays are going to be what makes most sense once we can find either a live-in caregiver or a care facility that is safe.

Thanks so much for sharing your input.
MaryNTN Oct 2021
Are there more options closer to you? In the long run, if you will be his responsible person, being close will be so much easier. Rural vs. suburban area realities is why I moved my mom from a very rural area closer to me. Started off as a vacation, but I had her just look at an assisted living near me, and she agreed to move. Best decision ever. She has gone from independent living to assisted to LTC while here. I have been able to advocate for her, insure that she has good care, and drop in without major travel ordeals.

Sierramuse8 Oct 2021
People are not getting covid from the unvaccinated. Most that are getting it are fully vaccinated. The shots do not stop or prevent covid.
cwillie Oct 2021
People can choose to risk their own personal safety but those who work up close and personal for prolonged periods of time with vulnerable people need to be held to a higher standard than the general public. And sadly in my experience those who refuse vaccination are often also not taking any precautions in the rest of their lives either. Vaccines don't stop all covid infections but they do stop many, and they do stop most severe infections and deaths. But it's also true that even those fully vaccinated need to continue to be on their guard to prevent spreading disease needlessly.
Taarna Oct 2021
Please bring him home with you - temporarily. Work to find an assisted living residence near you so you can pop in to visit more easily. I know that it would be quite the process to get him new doctors and prescriptions and services transferred over, but he will probably do much better if he is closer so you can monitor his health frequently.

Bridger46146 Oct 2021
My uncle is in a nursing home. All employees are vaccinated. Residents were vaccinated last year. Each resident can have two essential visitors/caregivers. I signed for him to get vaccination. They have not had a Covid case in over a year.
They wear masks and have hand sanitizers dispensers at every door. If working directly with a resident aides nurses wear disposable gowns and gloves.

I thought he would do terrible living there. He had always been on a large farm and always outdoors. But he has made friends with sever male residents. Reacquainted with two ladies he went to high school with. Before my accident I checked on him every day. My husband, sons and DIL's visit now. One of my sons has become very close to him. He stops in almost everyday and takes him a kids size milkshake from Dairy Queen. That's been a favorite for years.

We take him back to the family farm every couple of weeks. We've never had a problem with him not wanting to go back to the nursing home.
kitchenwitch Oct 2021
I'm so glad that your uncle is in a safe place. My region does not have a vaccination mandate for care workers yet so unfortunately that isn't the reality where we live.

Editing to update now that I've read your longer response - thank you so much for sharing more about his experience in the home. This makes me feel hopeful that when the time comes this could be an option. Like your uncle my dad has spent a lot of his life on farms and in rural communities and loves wide open spaces and independence! I'm so glad that your uncle has a good community and feels safe and happy where he is! Thanks again for sharing.
BarbBrooklyn Oct 2021
Does he NEED skilled nursing, or would Assisted Living be a better fit?

You might get a "needs assessme t" from the local Area Agency on Aging to better clarify that.

What about a facility close to you? As my mother became frailer, it became clear that one of us needed to be able to get to the ER within 10 minutes (the NH will call 911 and have your parent transported, but they don't stay with them).

Look down the road and plan around the long game. Have you read Atul Gwande's On Being Mortal?
kitchenwitch Oct 2021
No, I haven't read it. This is all brand new to me. Do you recommend it?

As I mentioned in my post, the facility close to me is in the midst of a Covid outbreak and so isn't an option right now. The next closest one is an hour or so away from my dad's home. But I also don't live here permanently. So I'm navigating questions like, do I pick up my entire life and move my family halfway across the country?

We've been referred for a needs assessment and hopefully will get one soon.
againx100 Oct 2021
Don't move your family to your dad's area. Unless you really really want to live there and plan on staying there for the long term. If you like where you live, stay there.

I would move dad to a facility close enough to you to visit. While the place nearest you is having a covid outbreak, it will be over soon. It happens and covid is here for the long haul, just like the flu, etc. So, I would ask them the process for admitting your dad. And advice on moving him there. It won't be easy but I'm sure it can be done.

If he stays where he is, you need to get lots of help in his house. Or you can put him in a facility in his area. I guess in a way it doesn't matter how close to his house it is since you would be going back home and managing his care from afar anyways. Opens up options.

While you finish figuring this out, maybe get some help in now to ease your workload.

Good luck getting this taken care of and getting back to your husband.

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