I remember the early reports from nursing homes during the Pandemic. Both here and in the UK, when those institutions came under fire for the number of deaths caused by Covid, some of them protested, “We aren’t medical facilities, we are social institutions.” Plainly, that is not what people assume when making decisions about their own care late in life or about the care of their family members.
This is not a new challenge, of course. Anyone who has been deeply involved in providing pastoral care knows that nursing facilities vary wildly in the quality of the care provided and the state of the facilities themselves. But Covid-19 has certainly underlined those variations, and they have alerted people to the problems that they might encounter, if they rely upon those facilities without looking beyond the advertising you see online.
What I have tried to offer here are a few suggestions that might help frame the decision-making process. But I will offer this one caveat. These are not easy decisions, whether you are making them for yourself or for someone you love. And nothing I say here is meant to suggest that there is one way and only one way to make these decisions.
One: Take Stock
Deciding how to navigate these difficult choices entails an endless number of variables: age, physical circumstances, cognitive acuity, fall-risk, available family support, communal support, and financial resources, to name a few. Take stock, make a list. This will aid you in the decision-making process.
Two: Take Time to Talk
If you aren’t making these decisions for yourself, involve all those who will be affected by the decisions you make. This may not always be possible, especially if cognitive decline is involved, but do everything you can to avoid robbing a loved one of their own agency in the process.
Three: Consider Home-based Care
If possible, rely on home-based care. A visiting nurse or therapist maybe one option. This can be done in your own home or in the home of someone in your family – or it can sometimes be accomplished by inviting a relative to live with you. This is not always possible. The nature of an illness, physical circumstances, or cognitive decline can make it impossible. But it is worth considering. Generally speaking, we are all better off at home. But, that said, it isn’t always possible. Circumstances, costs, and available insurance are all in play when we make these decisions.
Four: Look Closely at the Facilities
If you do need a care facility, look at them closely. Visit them more than once and preferably at different days and times. Look online for reviews. Find out what close friends or family may know about them. As I have said, care facilities vary wildly in quality and, frankly, there are more bad ones, than there are good ones. It will sound strange but consider how they smell. Look at the fabric of the facility (Is it in good repair and well maintained?) Find out what you can about the staffing at each facility. What kind of training do they have? What is the staff-resident ratio? If it is a graduated care unit, what are the financial variables at each step in the care provided? What are the criteria used for making those decisions?
Five: Visit Often
If you or a family member decide to rely on an institution, try to choose a facility that family members can visit. Visiting on a regular basis, but at different times and on different days signals to the staff that you are invested in a family member’s well-being. It also gives you current, firsthand knowledge of just how well the facility is doing.
Six: Be an Advocate
Whether you are speaking up for yourself or a loved one, don’t hesitate to be an advocate. Hopefully the institution you have chosen is staffed by competent professionals. But every institution changes and you should never surrender your own agency to others.
Seven: Be Prepared to Change Care Providers
It may not always be possible to change care providers and for that reason, it is important to scrutinize the contracts you sign or – better yet – have an attorney examine them. But if you can’t get the care you need and you can walk away, then find another alternative.
Eight: Be Gentle with Yourself
These are not easy decisions. You can approach the decision-making process with care. But you cannot control every outcome and this is one of the most difficult decisions you will make for yourself or in conversation with those you love.