Happiness in long term care is (mostly) up to the resident

As I wrote in my post two weeks ago (January 29, 2015,) my Grandma thrived in her nursing home despite our initial struggles with the decision on where she should live after her broken hip (discussed in my blog post of January 22, 2015.)  Similarly, my Aunt Gert chose to live in her nursing home over her own house (blog post of January 16, 2015.)

My family’s good fortune with nursing homes resulted from the mindset of my Grandma and my Great Aunt more than from anything else.  Grandma and Aunt Gert entered their respective nursing homes with open minds.  As a result, both thrived.

Fortunately, Aunt Gert and Grandma didn’t torture themselves about the life that was behind them.  They accepted (well, actually, plunged into) their new homes.  They made new friends.  They got involved in new activities.  They acted like they had just moved into a new apartment in a new neighborhood (just with less to unpack.)

We all probably know seniors who have made the lifestyle transition into long term care well.    If they receive in-home care, they accept the caregivers (family, friends, or professionals) willingly or even eagerly.  Seniors who make successful moves into assisted living or nursing homes, have the “new place to live – new people to meet” attitude that Grandma and Aunt Gert had.

Unfortunately, there are many seniors who let their long term care make them unhappy.  Has anyone found the secret to helping others adopt a different mindset?


My Family’s experience with Nursing Homes – Grandma Cook in hindsight

As I wrote in last week’s post (January 22, 2015), we struggled with the decision on where my Grandma should live after her broken hip.  Our positive experiences with Grandma Schneider (blog post of January 10, 2014) and Aunt Gert (blog post of January 16, 2015,) caused us not to fear nursing homes.  Still, each person has an individual personality, individual desires, and individual expectations.  After Grandma had lived alone for 34 years after Grandpa died, we worried whether she would like the nursing home (even though she had made the decision herself to stay there rather than return to her house.)

Grandma died on Halloween, at 100 years old, after 8 years in the nursing home.  I’m not sure her nursing home stay could have been much better.  She seemed happier during those 8 years than I ever remember her being before.  (It’s not like I haven’t known Grandma my whole life.)  She smiled more during that time than ever before.  Her voice was cheerier than ever before.  It was a great experience.

When living alone, Grandma had always been active.  She got out of the house and had breakfast with friends almost every morning.  She stayed out for card games or activities at the senior center and then had lunch at the center.  After lunch she had more things to do before returning home for dinner.  (Years ago, we bought her an answering machine so we could have some chance of letting her know we were trying to reach her.)  Because of her busy day out of the house, we weren’t sure how she would adapt to spending most of her time in one building.

We shouldn’t have worried.  It was the activities that interested Grandma and not the geography.  The daily activities at the nursing home kept her busy.  And, I believe she really liked not having to drive to get to her activities.

They had bingo every day and twice on Saturdays.  (Grandma loved bingo – always did.)  They had music every day.  (I’m not sure anyone in the building could carry a tune, but they sure had fun.)  She attended religious services.  (Now, Grandma was never religious.  At the nursing home, a religious service – Jewish, Presbyterian, Lutheran, Catholic, whatever – was just something for Grandma to participate in.)  There were lots of group outings, and Grandma went on almost all of them.  She stayed behind only when there wasn’t room for her because it’s someone else’s turn to go.  (Admittedly, Grandma did slow down somewhat as she aged.)

Grandma was also happy that someone else took care of meals.  She didn’t have to decide what to cook and didn’t have to do the cooking.

Grandma’s experience in her nursing home was about as good as it could have been.  We were lucky.  I’m sure, though, that the biggest reason it was successful is because Grandma made it successful.  She didn’t fret about what she didn’t have anymore.  She dove in to enjoy what she had.  Grandma was great!

My Family’s experience with Nursing Homes – Grandma Cook

As I wrote when I discussed my Grandma Schneider in my post of January 10, 2014 and my Aunt Gert in my post of January 16, 2015, many people seem revolted at the thought of moving into a nursing home or putting a loved one into a nursing home.  I’ve heard many people speak of seniors abandoned in nursing homes living, seemingly forgotten and alone.  My family’s experience with nursing homes is just the opposite.  Yet, we struggled with the decision on where my Grandma should live after her broken hip.

In case you’re trying to draw the family tree, Grandma is my mom’s mom.  Grandma Schneider is Grandma Cook’s mother-in-law (by her first husband) and my mom’s paternal grandmother.  Aunt Gert is Grandma Cook’s sister-in-law by marrying Grandma Cook’s brother.

Grandma Cook was 92 when she broke her hip and needed rehab.  Deciding where to go for rehab wasn’t a big deal.  We knew and she knew that she needed rehab.  Mom and her brother chose a nursing home close to my mom’s house but not so far from my uncle’s house as to be inconvenient for him.  So there she went for rehab.

Now, this wasn’t “rehab” for Medicare payment purposes.  This was honest to goodness rehab.  Grandma got better and, after rehab, could go home.  She would need a walker, but she could go home.  Anticipating that her rehab would be complete, we faced a difficult choice of where Grandma should live.

All through rehab, Grandma talked about going back home.  She talked about things she would do when she moved back home.  She certainly didn’t seem to dislike her nursing home stay for rehab.  She didn’t complain.  On the contrary, she enjoyed the activities, the staff, and (most of) the other people in her nursing home.  Still, throughout her rehab, she continued to talk about going home.

Similarly, throughout Grandma’s rehab, Mom, my sisters, my uncle, and I talked about Grandma going home.  We didn’t talk about it as a foregone conclusion, like Grandma did.  We talked about what we could do to facilitate her return home.

We talked about whether she could get in and out of her house because there were stairs at both the front and back doors.  We talked about a home care service and how many hours of care she might need.  We talked about whether she’d accept the person from a home care service into her house.  We talked about the need to have a way for Grandma to get out of the house frequently.

Before her broken hip, Grandma was out of the house almost every day that the weather permitted.  She was up and out in the morning for breakfast with friends.  Then she would go to the senior center to play cards or bingo and participate in an exercise class.  She would have lunch (and frequently serve lunch) at the senior center.  After her afternoon activities (at the senior center, or visiting with a friend, or shopping,) she’d return home before dark.  If Grandma were going to return home after rehab, we needed to find a way for her to maintain as much of her schedule as possible.  So, the home care aide would need also to be her driver.  Otherwise, her return home would be a failure.

We considered having Grandma move in with Mom or my uncle. Unfortunately, both Mom’s house and my uncle’s house had steps in the living areas of the house.  Grandma wouldn’t be able to live in either house without risking the steps or being limited to certain parts of the house.  Neither of those options seemed a good idea.

We also considered finding Grandma an apartment or a new house that didn’t require steps to get in and out.  Our concern was Grandma’s emotional and psychological comfort in a new place.  Grandma’s memory was slipping a little.  (If she had Alzheimer’s or anything similar, it was very LATE onset, it seemed to us medical laypeople.  To us, Grandma seemed sharp as she could be until she was about 90 years old.)  Because of her slipping memory, we really worried about taking her into a new home.

While we were still pondering what seemed best for Grandma (still during her rehab,) Thanksgiving came.  My mom and I picked up Grandma and brought her to Mom’s house for Thanksgiving dinner.  She barely could stay at Mom’s for two hours.  She didn’t even stay long enough for dinner.  She wanted to get back to her nursing home.  She was afraid she was missing something.

That Thanksgiving was an epiphany for us in our decision-making.  We wondered if Grandma really wanted to return to her house.

A couple of weeks after Thanksgiving, when Mom had Grandma out for lunch and some shopping, Mom took Grandma to her house.  Mom pulled up in front of the house and asked Grandma if she wanted to move back in.  Grandma sat there in silence, looking at the house for a few minutes.  Then she told Mom that she wanted to stay in the nursing home.

Mom then asked Grandma if she wanted to go in the house.  Grandma said, “no.”  She didn’t care to go in.  She was ready to go back to the nursing home.

On the short ride back to the nursing home and during the rest of Mom’s visit that day, Grandma didn’t seem to be at all sad about her decision.  When it was time for the afternoon activity, off Grandma went without a second thought.

My Family’s experience with Nursing Homes – Aunt Gert

As I wrote when I discussed my Grandma Schneider in my post of January 10, 2014,  (Wow!  It took a long time to circle back around to my family’s experiences with nursing homes,) most people seem revolted at the thought of moving into a nursing home or putting a loved one into a nursing home.  I’ve heard many people speak of seniors abandoned in nursing homes living, seemingly forgotten and alone.  My family’s experience with nursing homes is just the opposite.

Aunt Gert was my Grandma’s sister-in-law.  She had married my mom’s mom’s older brother.  (I hope you could follow that explanation.)  I guess she was my Great Aunt, if I understand family “titles” correctly.

Aunt Gert lived about an hour from us.  She was widowed in her late 50s or early 60s, losing her husband to cancer.  Her kids were adults with their own families.  She stayed in the house, spending time with her kids, her grandkids, and her friends.

A few years later, one of Aunt Gert’s friends needed to move into a nursing home for rehab and was really scared.  Aunt Gert volunteered to move in with her.  To my knowledge, Aunt Gert didn’t have any need for care or supervision.  She went just to be with her friend.

As often happens, the friend’s rehab turned into a permanent stay.  Aunt Gert stayed with her.  Aunt Gert stayed until her friend passed away.  Then, Aunt Gert moved back home.

After a few months at home, Aunt Gert moved back into the nursing home BY CHOICE.  She had made friends there.  She had activities there.  She had really enjoyed her first stay and decided she preferred the nursing home to her own house.

Aunt Gert stayed in the nursing home until see too passed away.  She sure didn’t feel abandoned, forgotten, or alone.

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My Family’s Experience with Nursing Homes – Grandma Schneider

Most people seem revolted at the thought of moving into a nursing home or putting a loved one into a nursing home.  I’ve heard many people speak of seniors abandoned in nursing homes, seemingly forgotten and alone.  My family’s experience with nursing homes is just the opposite.

I’ll start with the worst experience we had, I guess.  It’s the worst not because of the nursing home but because of the rapid decline that my great grandmother suffered after an accident.

My great grandmother was a tough woman.  (She was Grandma to my mom, but my sisters and I always called her Grandma Schneider.  I guess we called her that to distinguish her from my mom’s mom, whom we call “Grandma.”)  Grandma Schneider maintained her own house (light carpentry and repairs in addition to the everyday cooking and cleaning) well into her eighties.  Even when her husband had been alive, she did the hard work.  He would hold her tools while she repaired the car.  (No kidding.)

One day, she went out walking (to the grocery store, we think.  She could never tell us.)  She fell about a mile from her house.  She broke her shoulder and needed surgery.

After the surgery, the Grandma Schneider that I knew didn’t seem to be there anymore.  She wasn’t in a vegetative state, but she wasn’t far from it.  My mother thinks that she had a reaction to the anesthesia.  (My mom’s not a doctor, so she doesn’t have any way to be sure.)

Grandma Schneider went from completely independent to requiring 24-hour skilled care.  Mom, my uncle, and my Grandma (Grandma Schneider’s daughter-in-law) chose a nursing home close to all of us.

The nursing home took great care of Grandma Schneider.  She always got anything she needed.  Mom, my uncle, and we children visited often.  The thing I don’t know is whether she enjoyed it there.

Grandma Schneider was almost completely unresponsive after the surgery that preceded her nursing home stay.  I have no way to know whether she loved the nursing home, hated the nursing home, or had no opinion.  She may not have been aware of her surroundings and may not even have been self-aware anymore.  Her body was well cared for at the nursing home, I just don’t think her mind was there anymore, even before she moved in.

I guess Grandma Schneider’s stay in the nursing home was neither pleasant nor unpleasant for her.  It just was.

I write about Grandma Schneider’s experience in the hopes that some of you will let go of the guilt that you might feel when moving a family member into a nursing home. Sometimes, like with Grandma Schneider, a nursing home is by far the best care choice for a family member.

I’ll write about my family’s other (very positive) experiences with nursing homes in future posts.