Choosing to Stay at Home – Five Things to Consider

One of the most difficult and challenging decisions for the families of clients happens is when they face the dilemma of deciding between having their loved ones stay at home or move them to a facility. One of the major reasons why the facility transfer happens is due to safety concerns. Clients with dementia often forget the directions to their homes with wandering being a common trait. When wandered out, they often forget how to get back to their homes.

Here are a few reasons why families or loved ones need to consider, when faced with the difficult decision to look for home care or to move their loved one to a facility:

Familiarity

One of the major challenges that clients often face is unfamiliar surroundings and people. The feature of clients with Dementia is that they remember older events and places, hence when put into a new facility; they often have problems locating rooms. Also, the facility staff change shifts quite often leading to a feeling of insecurity among clients. Establishing trust is a primary feature in building a relationship with the client. Safety becomes another concern as when put in unfamiliar and new places along with poor judgment leads to constant falls and injuries.

One client with Dementia was in her house for 2 years and her husband along with home care services took care of her at her home. She would enjoy being in her backyard especially during spring. Her favorite flowers were Lilies and she enjoyed watching them bloom. Unfortunately, her husband could not care for her at home as her condition and cognition deteriorated further and she was shifted to a facility while continuing to get respite services from the company.  Her husband was able to be her without burning himself out. She passed away after 6 months and was with her husband while she peacefully passed away holding his hand.

Daily routines

Most nursing homes’ schedules are set in general for all residents. Hence, residents are expected to show up for meals or other activities at given specific times. Shower days and times are set to suit staff routines rather than the client. One client was used to having her hair washed twice a week, but she moved to a facility which had a once weekly shower routine but fortunately because of private care, she was able to stick to her routine and get her shower twice a week as she always enjoyed

Neglect is another issue. Nursing homes are understaffed many times hence pads go unchanged for hours together. Personal hygiene gets neglected leading further to complications like infections, bedsores, etc. Clients who have progressed into later stages of Dementia are often bedridden or do not converse at all. Most of the social activities in such facilities, are set for clients that are socially interactive and often the bed ridden ones get stuck in their rooms.

Nutrition

Food and nutrition is another area that gets ignored unknowingly. The meals at nursing homes are nutritious and well balanced but the taste often does not suit the residents and is quite bland and not home like. Hence, the clients eat smaller portions or sometimes stop eating altogether and must be put on Intra venous fluids or tube feeds. All this leading to weight loss that further causes complications like bedsores and fractures easily.

Depression

Eventually, less desire for social interaction and unfamiliarity causes further deterioration in moods and loved ones end up conversing less or not conversing at all and end up sleeping more often.

End of life care

Palliative clients often wish to be in their house. They often desire to be surrounded by their near and dear ones. This story highlights this need to be around family.

A client who was previously a psych nurse was diagnosed with cancer and one of her sisters contacted the home care company for assistance. The family was not ready to say goodbye. They did not prefer her staying in the hospital and she was definitely not ready to go!  With the option of home care, she was able to receive 24/7 care while she underwent chemotherapy. After two months she felt she was able to be independent and discontinued services. Three months later the family called back for services as her condition worsened and home care services were resumed until she passed away a week later with dignity and respect, in her own terms, surrounded by her family and loved ones, just the way she wanted.

This article was written by Sherin Kurian, LPN Case Manager