Letting Go - Entering a Nursing Home

by Marc Ringel M.D.


Many years ago, before I knew better, I promised my parents they would never have to live in a nursing home. They are still healthy of body and mind, and could well avoid long term care all together.

Since I made that promise, though, I’ve learned a thing or two about seniors, including that a nursing home may not be the worst thing in the world.

We’ve all known older people, living alone or with an aged spouse, who just aren’t quite making it. At first they may need to depend on friends, family, or paid help to do the heavy chores like installing the storm windows or cutting the grass. Gradually, more tasks must be delegated or left undone. Cleanliness of the house and personal hygiene may deteriorate. There may be good reason to worry that the person isn’t getting enough to eat.

Aging people can carry on their valiant struggle to stay at home, reluctantly accepting some help; still doing, with extreme effort, as much of the cleaning, marketing and food preparation as they can.

They cut corners. Things deteriorate further. They resort to easy to prepare foods. One of my grandmothers, for example, lived on corn flakes for the last several years of her life. Someone - family, doctor, social worker - mentions a nursing home, spurring a redoubling of efforts to keep the person at home, surrounded by mementos of a lifetime. Dispersing all of the estate minus what would fit in a small apartment or a single room is still unthinkable.

But over the next months or years the person copes less well, and becomes even more miserable. Finally, the inevitable conclusion is reached and the person enters long term care. And guess what happens? Everybody does better, not just the family, relieved of a huge load of chores, worry and guilt, but the newly admitted patient too.

Released from the day-to-day struggle of just getting by, nursing home patients are as likely to celebrate their newfound freedom as to grieve the loss of their home. I’ve seen this response again and again: relief rather than loss. Where the person may have been alone at home, now there’s a whole network of potential friends, all in the same boat. In the rural areas where I’ve worked, people admitted to the nursing home already known many of the patients. Old friendships are rekindled and new ones struck up.

“Long term care facility” is a better term than “nursing home” because it covers a much wider range of accommodations; from apartments where functional older adults choose to eat catered meals, to custodial care facilities where patients with end-stage Alzheimer’s receive total care.

The most important predictor of happiness is a good match between patient and long term care facility. Balancing enough help with as much autonomy as possible is the key. Social workers, ombudsmen, and others who specialize in services to the aging, can help make the all-important choice of a living situation.

If you or a loved one is not getting along so well at home, here’s my advice: face it as soon as you can. Start talking about it now. Get in touch with the Area Agency on the Aging. They have all the information on services and institutions in your area, including how to pay for them. Visit facilities. Ask a lot of questions. Get comfortable with the idea of long term care. Make the best choice you can and, if it doesn’t work out, make another.

So, Mom and Dad, I take back that promise to keep you out of a nursing home, no matter what--not because I don't love you, but because I do.

Dr. Marc Ringel lives in Greeley, Colorado, and is a practicing family doctor in Brush. He is also a writer, speaker, and consultant in medical education and medical information. This article is a reprint of a commentary on KUNC-FM, January 31, 2000. Printed with permission from the author.