Nursing Homes

A nursing home, convalescent home, Skilled Nursing Unit (SNU), care home
or rest home provides a type of care of residents: it is a place of residence for
people who require constant nursing care and have significant deficiencies with
activities of daily living[citation needed]. Residents include the elderly and younger adults
with physical or mental disabilities. Residents in a skilled nursing facility may also
receive physical, occupational, and other rehabilitative therapies following an
accident or illness. Residents may have certain legal rights depending on the
location of the facility.

We all heard about how people are living longer. Yes but we are living longer sicker. This means
instead of dying, we are living with chronic conditions with the help of medications and or care.
Nursing Homes are where we go when we can no longer take care of ourselves and family
members are unable to care for us at home. It is usually not something that is relished, but there
are people who's life in the community was so hard that they are glad of the safety that the
nursing home provides. Some were victims of abuse by others or self abuse. Of course there are
a lot more who would prefer being somewhere else.

Living In A Skilled Nursing Facility

Nursing homes go by various names. They are called skilled nursing facilities, nursing and
rehabilitation centers or any similar variation. They do this since they have RNs, LPNs, CNAs,
social workers, dietitians, physical therapists, respiratory therapists, dialysis technicians working
in them. Not all nursing homes have all but these are skilled workers offering skilled services.
Some are short term services and some are long term.

When you enter into a nursing home, they become responsible for your safety. You are unable to
to come and go as you please. One of the biggest complaints of residents is that they are like
prisoners in jail. Residents with families can go out with their family if they sign them out, in
essence taking responsibility for them. Others hire companions or have friends who accompany
them out. Though Nursing Homes do give certain residents permission to travel on their own.
This loss of control can be hard to take for people who have been independent all their lives.

I have heard people say that they worked hard all their lives and were looking forward to
retirement and never expected this to be where they ended up. No matter how hard we try to plan
our lives, we can't control everything.

Many residents of nursing homes have problem sleeping anyway. We often hear about how
patients can't sleep when they are in the hospital. That is different, hospitals are mostly short stay.
I have had patients say to me they can't wait till they get home to their own bed. For some,
nursing homes are their homes and they are there for long term if not forever. If they can't sleep
it is a very big deal.

Being in a facility means there might be rules and regulations you need to follow. Many people
still smoke even with the knowledge of the health risks. It is an addiction and is hard to quit.
Many nursing homes are becoming no smoking facilities. There are many reasons for this.
Primary is the ongoing health issues to the smoker. Residents need to be monitored while
smoking because of the danger of fire. There is the problem of second hand smoke with other

Help Me
Coping with the
Nursing Home Decision

by Jean Harker
Preface
Reasons for Entering a Nursing
Home
Losses That Are Experienced
Reactions to Loss and Transition
Conclusion
About Jean Harker

residents and staff. Second hand smoke has been linked to lung disease, heart disease and even
dementia. Some elders have smoked most of their lives and resent the fact that they cannot
smoke at all in the facility or outside.

Complaints about bad food is rampant in nursing homes. Institutions are not known for their
cuisine but nursing homes are even the butt of jokes by stand up comics about their bad food.
Part of the problem is that many of the residents are on restrictive diets so the food has to be
something most can eat. Also budget can be a factor, they buy reasonably priced food and certain
foods that are too expensive are never seen. Much of the food is pre-cooked and just gets
reheated. Cooking from scratch with an experienced cook in the majority of the places is a thing
of the past.

Preface
People who have to leave their homes and families and move into a nursing home
experience lots of grief and loss. This article is designed to help the family members
and friends to better understand these losses and how they are expressed in words,
actions, and/or emotions. During this time of change these people are experiencing
one of the most difficult periods of their lives. Not only is it difficult for the person
making the move, but also for that person's family and friends. Handling grief and
loss also involves the staff and the volunteers working in the nursing home.
Frequently people being placed in a nursing home look at it as a one-stop place before dying.
This feeling has nothing to do with the quality of care that the nursing home offers, but is just
their way of thinking. Such thoughts are very understandable, because few people ever return to
a "normal" life after being admitted to a nursing home facility. It represents a one-way street
which no one really wants to travel, but people seldom have any choice. Lots of these individuals
and their families and friends have little or no help during this very rough time in their life's
journey. Their losses and grief seem overwhelming to them. They have nowhere to go for
comfort, and quite often no one who will listen to their grief story.

This article explains some of the losses that these people experience, their reactions to these
losses, and ways that families, friends, volunteers, and staff might be more understanding and
helpful to them. Also explored are ways that might help them to heal from some of these many
griefs so that they can live the last years of their lives in a more positive way and enjoy life as
much as possible. Since each person is so different and unique, there are many ideas and
thoughts to explore which may be beneficial in helping them to cope.

As you read through this article, you will need to pick out the losses and ideas that are speaking
to you or your friend or family member. Since each of us has unique concerns and an individual
way of life, we need to choose the suggestions and options that fit each person individually.

Reasons for Entering a Nursing Home

There are many reasons why people are faced with the major decision of entering a
nursing home. Very few people, if any, enter a nursing home because they want to.
Usually there is a factor beyond their control which forces this decision on them
and/or their families. The negative feelings and thoughts that arise from the need to
enter a nursing home are not necessarily because of the nursing home, but because
of the possessions and freedoms that must be given up in order to enter. Also
significant is the fact that there are very few people, if any, who are ever able to go
back home after entering a nursing home facility. They have just sort of reached a
point of no return, and this is hard for anyone to accept.

One of the major reasons for entering a nursing home is that the person's health is poor, requiring
nursing care that is not available to them at home. Due to unpredictable changes in insurance and
hospital policies, many elderly people are forced to leave the hospital after a very short stay but
are still in need of care, leading them into a nursing home situation. Home nursing care is not
available in every area of the country, and sometimes, even if it is available, people cannot afford
it and/or their insurance does not cover it. These situations leave the person with no other
choices.

Families today are quite mobile and in many cases live in scattered parts of the country. Years
ago, many of the family members might be located within a few miles of their original home.
When an elderly person needed assistance or care, family members were available locally to help
facilitate this care. People would be cared for in the homes of their children, or some of their
children would move into the parent's home to be available for care. Today this kind of care is
seldom possible because typically the husband and wife both work, or a single child must work
in order to live. So because of the lack of available help within the family, many people needing
care have no choice but to enter a nursing home.

Communities were much closer-knit years ago than they are today. Neighbors would assist an
elderly person and give the needed care. Today such assistance is seldom possible because
neighbors do not even know each other's names. Lawsuits and legal restrictions have frightened
neighbors away from helping each other as in former times.

Churches were different in the past also. Caring congregations would bond together and offer
assistance when needed. Churches used to be very local groups in which everyone knew
everyone else, but today people are more mobile and travel greater distances to church. Since
church membership is not limited to people from just the surrounding community, true closeness
rarely exists in the churches. Many churches have become more of a social gathering than a
helping group as they were in the past. Lack of assistance from church and community, then, is
another cause for someone to need the care of a nursing home.

For some people, caring for a home or an apartment has become more than they can handle
financially or physically. Too much work needs to be done to maintain the home and keep it
clean and livable. Also, a house or apartment may now be too expensive for them in addition to
their other expenses. Several older communities are becoming overrun with violence, gangs, and
other criminal activity, and these elderly people do not feel safe in their homes when they are
alone, nor are they able to make quick decisions or movements. They may fear falling or other
injuries occurring with no one nearby to help them. Fears such as these may make a decision to
enter a nursing home seem wise to them.

Another major problem for many elderly is the loneliness. Their children have grown up and
moved away, and now have families of their own. They often forget Mom or Dad, or have
neither time nor money to assist them. Their old neighbors may retire or move away, or they may
die, leaving the elderly person feeling really alone. For many elderly, loneliness is quite a major
problem. They are unable to drive a car to visit favorite places, but instead just stay in their house
alone. The grief and sadness of being alone may overwhelm them, and thus the need to make a
change is real and pressing, even though they would really prefer to be in their own home. At
least in a nursing home there will be other signs of life around them.

The above are some of the many happenings in people's lives that make a decision to enter a
nursing home or retirement home necessary. Sometimes the elderly have to make their decision
alone, while at other times they will have help in making this choice. For some families there is
the very difficult situation of role reversal in which children must make the decision. The parent
may no longer be able to decide because of mental health problems, a stroke, Alzheimer's
disease, or various other handicaps. Making the nursing home decision with roles reversed can
be quite hurtful and sad for both parents and children. Parents have in the past made nearly all of
their own decisions, and the role of the child was to respect the parent's ideas and suggestions.
With those roles now reversed, each has to accept a new position in life while giving up a
previous one. To do so is painful if the parent protests or rebels against the move.
Losses That Are Experienced
In this chapter we will discuss the many losses that people experience when they
need to enter a nursing home. Each person, being unique and special, will
experience unique kinds of losses, with no set pattern to them. Readers will need to
select the losses described here which apply to themselves or to the person they
are helping, or the one who is special to them. Maybe few of the losses described
will match your family's situation, but there may be many which fit right into your
life's journey.

These losses are described from the point of view of people who are entering a nursing home.
Losses do not imply that a nursing home is wrong or bad, but they are discussed in order to show
how people experience their losses.

Loss of independence is one of the greatest losses. Having independence is something that nearly
everyone has worked hard to accomplish in a lifetime. Now that independence must be given up,
it seems that everything they have worked for in life is now ended, and that their
accomplishments were for nothing. Losing their independence in favor of dependence on the
nursing home staff often gives them the feeling that life is just about over. Losing most of their
self-esteem, they feel they are no longer worth much. Their own parents were proud of them
when they became independent, and now they see themselves as a burden. They have little or no
choice regarding what they will do or when they will do it. Most activities in the nursing home
are done according to a schedule or depend on the availability of staff.

Freedom is to a great extent sacrificed and missed. The freedom to eat whenever and whatever
they wish, as they had at home, has changed into eating only when meals are served. They must
also eat exactly what is served or do without, unless they are fortunate enough to have a friend
who will bring them some snacks. Previously, they enjoyed the freedom of going out to eat when
they were able, a luxury that is no longer possible. They formerly had the freedom of cooking
whatever they wanted in whatever way they liked it. Maybe they liked everything fried, and now
nothing is fried. Maybe they liked lots of cakes and cookies, and now the desserts are fruits.
They formerly had the freedom to invite others to share their meals with them, and now this is
often impossible.

In a nursing home, people may lose the freedom of showering when they so choose, since baths
are now given only when the nurses have time to do so, and in whatever manner the nurses
choose.

Their laundry used to be done as they wanted it done, but is now done as an institution does
laundry. Their "good" things are thrown in with all of the other laundry. Their names must be
attached to all clothing, even to very special garments as well as other personal items.

The freedom to watch TV or listen to the radio at any time they choose may also be lost,
especially if they have a roommate.
The loss of their home or apartment, their furniture, and their possessions is tremendously
difficult. Often they must give up heirlooms that have been in the family for generations, and
perhaps keepsakes associated with their deceased spouse. Having these items may have been
preventing excessive loneliness, and could have been their hope for the future or their assurance
that their spouse was always with them while that item was near.

For some people the dwelling they lived in at the time of the nursing home decision was their
lifelong "home" place, the place where their children grew up, and they have many pleasant
memories of it which they can sit and enjoy. Perhaps this "home place" was a house they
themselves designed and built along with their spouse. If so, there will be many losses connected
with leaving that home or selling it. Furniture fits into these same loss categories: some of it
owned by their parents, some of it bought soon after their marriage, and some of it played on or
slept on by their children. These thoughts and memories are most important for people as they
grow old. They focus on important things from the past as they experience so many losses and
changes related to the present and the future.

Another area of loss is friends and neighbors who do not come to the nursing home often to see
the person. The elderly may have received great joy from watching through the window as a
neighbor or a child left for work or school, or as they played or worked in the yard. This joy is no
longer available to them as they sit or recline in a nursing home many blocks or miles from their
former home or apartment. Not to be able to watch neighbors breaks their long, familiar
schedule, causing another loss for these people who are creatures of habit and whose schedules
have become a vital part of their lives. Many people can tell the time of day by an event
outdoors, such as a certain neighbor walking or driving by. Living in the nursing home has
changed all that, creating a loss that they feel.

Another major loss is that of church or community. Because of the location of the nursing home,
people often have to leave their church and community area. If church was a vital part of their
lives, leaving it will create a difficult loss. They will find it almost impossible to become
involved in a new church and feel a part of it when residing in a nursing home. At a time in life
when church and community are so very important, giving these up can be quite difficult or even
devastating. It becomes nearly impossible to meet new friends and acquaintances while living in
a nursing home.

Losing their regular doctor is a difficult loss for people entering a nursing home. Because of a
location change or for other reasons, they must change doctors. If their regular doctor has been
one in whom they have long placed great confidence and trust, losing that doctor will be felt as a
severe loss, especially since there may now be major medical decisions that an unknown new
doctor will be helping them make. Just when security and stability are especially needed, they
are gone.

Mentioned above are just a few of the difficult losses which people experience as they need to
make a decision to go to a nursing home. Considering these losses may help us to better
understand the emotional difficulties these people are undergoing in this stressful phase of life's
journey.

Reactions to Loss and Transition

Following is a discussion of some of the reactions which people have as they
experience the losses mentioned earlier. Again, we are all special and unique, so the
reaction to losses will be different for each person. As the old Indian prayer states, it
is hard to know how someone feels or thinks until "we have walked a mile in his
moccasins."

Some of the many questions which affect people and their reactions to losses are: How have they
dealt with other losses in their lives? Did they seek help and support? Did they internalize the
loss and limit their connections with other people? Have they customarily been positive thinkers?
Do they have a strong faith? How is their self-esteem? The answers to all of these questions will
influence the way they respond to entering a nursing home--a major loss in their lives.

One of the most common and also most difficult reactions to loss is anger, a feeling which can
override every other feeling, such as sadness, hurt, loneliness, guilt, and others. Anger is a cover
feeling in that it allows a person to hide all other feelings underneath it. People experiencing
anger will often push blame onto others, especially onto dear family members or friends (usually
the ones who help them the most). If they can push some blame, they can avoid dealing with
their own feelings.

For example, I might be placed in a nursing home because I need skilled nursing care that is not
available to me in my home. I then become very angry at my son who has made the decision to
place me there. I direct all my thoughts of anger toward him in order to avoid dealing with the
hurt and sadness I am feeling as I cannot take care of myself. I am losing my home, friends,
church, community, and many other comforts because I can no longer live alone. Anger allows
me not to think about the fact that I probably do not have much time left to live, and that I should
value each moment I have. My anger toward my son for placing me in a nursing home can mask
out many weaker but uncomfortable feelings and thoughts.

A reaction of anger to these losses may cause further losses, such as a break in the relationship
between child and parent, which can cause the burden for both to be much heavier. Losing a
child through death or just through anger can be one of the most difficult losses that we ever
experience in our lives. Our children are among our most precious possessions. Loss through
anger is very difficult for the children as well as for the parents, and will often stop all interaction
between them. If the parent-child relationship becomes stressed or broken, the whole family may
experience huge losses which may grow even worse. These broken relationships quite often are
never mended or renewed, creating much hardship as the parent eventually dies and the child or
children grieve.

As a family member working with loss through anger, let go of the things in this interaction that
are not your problem. You need to have a support person who is non-judgmental and who will
allow you to tell your story and share your feelings without trying to stop you or change your
thinking. With this support person you can share your "gut" feelings. As you express your
feelings and get them outside of yourself, you gain a much clearer thinking ability. A very large
percentage of your problems you can solve by yourself, but you occasionally need a sounding
board so that you can use all of the ability you have. While talking about your situation you will
be able to better see whether you are really comfortable with your decisions and what you have
done. Were you open and honest about your thoughts and decisions with your family member or
friend? These and other questions are ones that you need to discuss as you share your feelings
and thoughts.

Did you do it for them or for you? To have made the decision because they really needed your
help and maybe could no longer successfully make decisions for themselves--that is usually a
good decision. If you did it so that you would not have to make contact as often, or because you
wanted to control their life for whatever reason, or because you simply disliked their choices,
then maybe you should rethink your decisions.

Did you do it to help them or change them? If you did it because you wanted to "fix", "cure", or
change them, then possibly you need to rethink your decision. If you did it for them because they
actually could not stay alone anymore, or they needed help that was not available to them, then
most likely you have made the right decision.

Being open and honest is a help to both you and them. This leaves nothing that is not openly
discussed. No one assumes anything, but rather they know, if they choose to listen. If they do not
listen as you talk, you have at least given them the opportunity even if they choose not to accept
it. For example, they may know that your decision to put them in a nursing home is not because
you do not love them or because you do not care for them, but rather it is because you do not
have the ability to do the things that are necessary for skilled nursing, that you cannot afford to
stay with them and quit your job because your family needs you and your paycheck--and so on.
It is difficult for people who are experiencing losses to think clearly since grief and loss affect
their entire system, and at the time of the loss almost nothing in the body seems to work
correctly. They may be so overwhelmed with the loss of body functions, along with the fact that
they are approaching death, that they are physically unable to take care of themselves. If the
above conditions describe their lives, then it will be impossible for them to convince themselves
of any need for being in a nursing home. It is just too much for them to deal with.

Another major reaction to all of these losses is to withdraw from participation in all activities,
even eating meals. Because of having to face so many changes while often having physical
problems too, it is just too difficult to reach out again for new friends, new ideas, or new
thoughts. Instead of attempting anything new, they will simply stay in their room or in their bed,
hoping that it will all go away. Frequently they just do not know how to try again, or they are not
physically or mentally able to accomplish anything new. Because they are not the person they
used to be this kind of reaction is again very difficult for the rest of the family and friends, who
in turn have to grieve the loss of the parent or companion they used to know.
Sometimes family and friends want to "change them" or "cure them" to make them "normal"
again, which is not possible. Patience is a key word in this type of situation. We cannot change
someone else--we can only change ourselves. If a person is at a certain place in his or her
journey of life, we need to accept this. The first thing we need to explore is: are they really
physically and/or mentally able to do what we are hoping they can do? We need to be sure that
we are answering this question honestly, and not just in the way we need it answered in order for
us to handle it. It is a real grief for children and family to accept the fact that a parent or
grandparent can no longer do the things they used to do. Commonly we just keep trying to push
the blame on the other person in order to avoid dealing with our feelings and our grief about
losing that significant person we used to have in our lives, even though that person is "still
alive." We need to work hard on accepting them where they are and doing all we can to
encourage and support them in their difficult journey.

As the person has to try to adjust to all the various changes, they are often just overloaded with
grief and hurt and other negative feelings, and they may make statements such as: "I just wish I
could die too"; "I wish that God would have taken me first"; or "I'm tired of living". Statements
such as these are quite difficult for family and friends to hear and accept. In response, they may
try to change the person or close the person off when they talk. Trying to prevent the person from
talking about such things will only cause them to turn their feelings inward and perhaps develop
more severe problems later. They need the freedom to express these feelings outwardly in order
to relieve some of the pressure and sadness they are experiencing. Quite often, just letting them
express these thoughts and feelings outwardly can be very healing for them. No reply or
comment is necessary--just a slight indication that you are listening to them. Most of the time
their negative comments are really cover statements for their true feelings. It is often very helpful
to do reflective listening as they talk to you in this negative manner. For example, they might say
to you "I don't know why God didn't take me first." Your reflective statement could be "It sounds
like you are really sad or lonely now." A statement like this gives them an opportunity to share
their real feelings with you. You are giving them a real gift by doing this, because as they
proceed to share their feelings of sadness or loneliness, they may begin to heal. Remember that
the only way we can heal in grief is to express the grief outwardly in some manner, and the
above technique is helping them to do that.

Repetition is another way they may choose to deal with their losses. It is quite helpful to their
healing if they can unload their grief or loss story outwardly. The more they tell it, the healthier
they will become. Such a technique requires the caregiver to be very patient while continuing to
listen to their story. I have learned that to listen in a different way is helpful. As they tell their
story repeatedly, listen for the things they do not say, or the parts that they leave out, which may
indicate to you that they are healing in their grief and gives us more encouragement to listen
patiently non-judgmentally.

As people experience losses in their lives, they often regress. Regression is a way for them to
return to a time and place where they felt safe and loved. Older people usually regress to a time
when they were children at home. Mom and Dad were present then and were able to help them
with their problems. Now, as they are in a nursing home, they will talk about their childhood
days in order to feel safe. They may become so involved with this regression and grieve so much
that they will rely on this device most of the time. They will become so involved in that safe time
that they will apply the names and actions of many years ago to friends and others in today's life.
Even if we correct them, their behavior will not change. They are very focused on the safe past.
Sometimes caregivers and family feel hurt when they are not identified properly. However,
people who are using regression need to be accepted where they are, for we understand how
helpful it is for them to feel safe.

Fear is another reaction to the losses--not only fear of the many changes taking place in their
lives at this time, but perhaps also the fear that they are either dying or soon will be. Being a
good listener is very important. If they share their fear and express it outwardly, and if we reflect
back as we listen, they can understand the fear and the options they have. Also, to offer support
or direct them to someone who can be supportive can be quite helpful when fear is involved.

Helpless feelings may be very prominent at this time, and may be quite accurate. If they are
unable to do things for themselves, they may need assistance for most events in their lives. As we
listen to their story, we can help them see the small things that are positive in their lives and
anything they may be able to do for themselves. Pointing out the small positive things is very
important when they are overcome by huge negative pressures. We need to help build their self-
esteem in any way possible. Finding words to describe the positive things they can do or are
doing (no matter how small) is helpful, as well as helping them to look at alternative
possibilities. Seeing anything positive is very difficult for them when they are grieving or
experiencing loss.

Conclusion
Entering a nursing home is a most difficult time of life, with all of its changes and losses. The
more help, love, and caring you can share with these people and their families, the easier it will
be for them. Listening to them is so important as they share their story with you. Listening helps
them to express this story outside of themselves, and it is also most helpful to you in
understanding their thoughts, concerns, and griefs. As you understand their story better, you can
be of more help to them in this part of life. Let them teach you where they are so that you can
walk with them. One of the greatest gifts you can give anyone is to be a good non-judgmental
listener--a gift that money cannot buy. Listening indicates that you really care and feel
concerned, and also that you really want to help.

Sometimes people do not have a choice as to what they must do, but we can help their lives be
the best they can possibly be under the circumstances. Be there for them and show that you love
them and care.