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I am so frustrated with my 91y/o mother. She expects to sit in her little grannie cottage we had built for her and be waited on hand and foot. Yes she has been a narcissist all my life.
She has terrible back pain which if she got ahead of the pain with simple Tylenol, and moving around would not turn into the horrible pain she lets it get to. She had a stroke which she uses to play helpless at times, which I see right through. The majority of times it is an act. When we have company she refuses to visit. Then acts depressed because she misses her friends that she refuses to call to visit with. She is capable of living in her little place for now, but I know the day will come when she will need more than I can do. I have help 3 days a week for 3hours which is a blessing. I would like to know from all of you when did you know it was time that a nursing home was the answer. We have cared for her through her fight with cancer for over a year. Then moved her here with us at our after her stroke 7 years ago. I feel guilty even asking the question, but I need to. I know I'm not the only caregiver out there wondering how do you know. Also what do you look for in a facility. If anyone knows publications on this I would read them. I'm not that great surfing the internet. I just need some guidelines to work with to analyze our situation for the future. Thank you in advance for your valuable insight.

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I wondered the same thing about my mother (79, with dementia) and I wasn't able to nail down a definitive answer. As a caregiver, it's hard to see when you're destroying yourself because chances are the demand for help has increased subtly and grandually, so you've just taken it in stride. Friends and co-workers, however, will noticed that you are run ragged. I would say it's time for a nursing home when (1) your loved one needs more care than you can provide; (2) you've basically given up your own life, but the person is no happier for it (3) they cannot safely be left alone (4) they are not taking care of their own hygeine like brushing teeth and bathing and it's a fight to get them to do so (5) they hallucinate (6) they are incontinent (7) they need to be lifted and/or carried (8) you're exhausted and your own health is suffering; that is unsustainable (9) you are basically running another person's entire life (10) you're suffering emotionally and cognitively yourself, for example, excessively depressed, anxious, or fearful. (11) except for you, your loved one is isolated (12) you're afraid they might get hurt if they are left alone. If several of those statements are true for you, it's probably time.

The best advise I received is "plan for two steps ahead." I think you should start touring nursing homes now, before you HAVE to admit your mother. While you're there, pay attention to the intangibles. What's the "feeling" of the place? Does the staff seem respectful? How are the residents spoken to? How does the place smell? Accidents happen, but if the place always smells like a dirty diaper, the staff is not attentive enough. I contacted 22 nursing homes in my area and toured 16. Applied to 4. Of those 4, two I toured twice and two I toured 3 times. There's nothing wrong with going back for a repeat tour. Definitely ask to see the available room, shower room, and physical therapy facilities. Ask then their stand on "psych meds." Confirm that they won't unilaterally pull aricept and namenda without your consent if your loved one has dementia.

Even if you don't admit your mother right away, you'll feel so much better knowing there is a contengency plan. As for me, I started touring in early August. But the end of October, unpredictable, my mom HAD to be placed. She was moved into a place that met my approval on November 5th. That would not have happened if I hadn't started looking 3 months previously. I would have panicked, stressed out, and been forced to choose among options I may not have really been happy with. Start looking now. Even apply (that's a process in and of itself, as is medicaid). If something comes available and you're not ready, turn it down. But if and when the urgent need for placement arises, you will be SO happy your ducks are already in a row.

Good luck to you and please keep us posted.

My mother moved into
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When you find yourself worn down to a little nub, it is time for her move. She can go on virtually forever like this, but you can't, you will die before she does. It really does come down to your own survival .
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In think whatever prompted you to ask the question tells me that your intuition knows it will not be long from now.

Here is a link to articles on this sight that address your question in more detail.

https://www.agingcare.com/search.aspx?searchterm=signs+that+it+is+time+to+place+someone+in+a+nursing+home
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Dear RatherBeFishing,

My 91-year old mother-in-law's decline was gradual. She went from living independently, to having a live-in friend/caregiver to help with meals, shopping, and dispensing meds.

The precipitating event that led to her move to assisted living was a hip fracture from a fall. She had been experiencing more and more falls over that past year, was having more memory problems, and it was clear--especially after the hip fracture--that she would be unsafe and incapable of caring for herself without assistance.

I think you will come to realize when it's time for your mother. Friends, family and doctors can also provide feedback. Or there may be some accident or health condition that makes the move necessary.

And, please consider that an assisted living facility is another option to a nursing home. If she is able to dress herself, is able to get around with a cane or walker, and doesn't have severe dementia, that might be a better fit. She would have more independence and would probably be more accepting of the move.

But no matter what type of facility, her needs would be met, she would have constant supervision and the opportunity for social interaction when she wants it. She wouldn't be lonely and the socializing might turn around her depression. And maybe not having you there to wait on her "hand and foot" might encourage her to do more things for herself.

Facilities normally send out a representative to do an assessment. They can determine if your mom is a good fit for that kind of living arrangement.

As for what to look for in a facility, go visit them. What is your gut impression? Do the staff and the residents look happy? Is it clean, with no funky smells? You can always read reviews online and ask friends and family if they have any experiences with any facilities.

But the main thing I'd like to get across is that I believe you will know when it's time.

I hope this helps.
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Rather,
I think you need to be proactive at this point. Visit all the skilled care facilities in your area. See how they smell, feel, friendly staff, taste the food, visit with residents and their family members if possible. Nowhere is perfect. Nowhere will have delicious food. ( Isn't seasoned like you would at home, no added salt, etc.) Try to get a feel for the place. Ask around of friends and neighbors if anyone has had any experience with any of the homes. Ask her doctor what his opinion is. Get your ducks in a row now. Ask admissions people at the facilities questions. Get informed.
Then.........when it gets truly too much for you physically, it's time. Remember, nursing homes have staff 24/7 and it's not the same person. They take 8 hour shifts. No one can do it ALL, all the time. From what I'm hearing in your letter, you are getting there emotionally. You must take care of yourself first. Do your homework and get going. You can do this
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