Facing Difficult Choices in Senior Care

Every day, loved ones of a senior adult face the reality that choices must be made for the ongoing care of that adult.

Life can change in an instant. Someone who just yesterday was a vibrant, fully active adult has experienced a sudden decline in health. The changes may be physical and/or mental, but the outcome is the same. Life as that senior knew it is no more. Changes and adjustments are not years away, but on the doorstep immediately.

In the best-case scenario, the involved senior will have talked to loved ones about care preferences before the need arises. Many times, those discussions haven't taken place and the family or spouse must make the decisions necessary.

Her husband was receiving physical therapy and related services in a nursing home after a hospitalization for a suspected stroke. Therapy progressed well and a plan for the husband's return home was made. On the day of his scheduled discharge, the husband suffered an episode that left him not only physically weaker, but robbed of his cognition to varying degrees.

The happy home reunion was postponed.

Physical and occupational therapy was re-initiated, but the husband's progress was almost nil. During episodes of acute confusion, he would become agitated and combative with the staff and inappropriately angry with family members. During his lucid moments, the husband stated his longing to return home.

An agonizing decision period followed for his wife.

Fortunately for this couple, they had discussed what to do if this circumstance ever arose. The husband had stated his desire to go into a local veteran's long-term care facility. But that was all decided in advance; the realities of situations are rarely so black-and-white.

All the husband wanted to do was go home. Because he only had periods of lucidity, he couldn't understand the problems to be faced.

Understanding that she couldn't properly care for her husband herself, the wife considered the option of bringing her husband home and employing home care workers. Home care is an excellent choice for many people and situations, but there are also concerns, as this wife found out.

She was reluctant to give up her privacy to strangers and felt distrustful. Assurances that the health care workers could be hired through a licensed agency provided no reassurance.

The wife was also concerned about her husband's combative behavior and how it might manifest at home.

After sleepless nights and countless conversations with her adult children, the decision was made that the husband would be admitted to the veteran's home about which he had previously spoken.

Guilt. Many times family members and loved ones second guess the decisions they have made about care choices. All too often, guilt hangs heavy, even though logically the best decision under the circumstances has been made.

Family members and friends can help assuage the guilt to a degree by reinforcing the choice maker's decision and decision-making process.

There are no easy choices in these situations. Each one offers positive and negative benefits. In the end, the circumstances particular to the people involved must dictate what actions are taken.

Few people relish talking about the what-ifs of life, but rational adults understand the need to do so. Just as having a will and advanced directives in place relieves loved ones of unnecessary burdens, so do conversations about choices to be made in the event of a devastating illness.

If your parents or grandparents haven't broached the subject, you may be the one who needs to do so.  You can offer to help look into the options available, including assisted living, family caregiving, in-home health care and long-term care facilities.

Have the conversations sooner than later; only today is promised.