A Dangerous Promise to Loved Ones?

The Washington Post’s Tara Bahrampour has a very thoughtful article this month focusing on a common fact pattern.  One family member asks — or another family promises — that “a nursing home” will never be utilized for care needs.  While fear may be driving the request, guilt and strong feelings of moral obligations may be driving the promise.  Both sides, however, may need more information to make the best decision:  

For many, the idea of being sent to a facility implies abandonment. Older Americans remember the poorhouse , where the old and infirm were hidden away to die. But many younger people also are repelled by the idea.

 

There’s now a wider spectrum of facilities catering to different levels of need, but even the best ones can feel institutional. Daily life is often rigidly regulated, robbing residents of autonomy, and the familiar faces and spaces of a person’s life are gone….

 

A couple of generations ago, families were more likely to care for their parents at home — but people didn’t live as long. Thanks to modern medicine, even those with devastating illnesses such as Alzheimer’s can live many years past their diagnoses. But caring for them at home becomes increasingly difficult as cognition and self-care skills worsen. Safety, of the patients and of other family members, can also become a factor.

Ultimately, as geriatrician Bill Thomas explains for the article, instead of “red herring” promises that may be impossible to keep, everyone could benefit if there were stronger advocates, including families, demanding more of the nation’s long-term care industry:

“The nursing home industry has, ironically, benefited tremendously from the low expectations people have,” Thomas said. “They have successfully persuaded people that you’ve got no other choice — it’s got to be cold and sterile and rigid.”

As some family members explain, they have learned the more important promise is to keep caring, regardless of the better “place” for care.  For the full piece, read “Promise You’ll Never Put Me In A Nursing Home.”   

Special thanks to George Washington Law Professor Naomi Cahn for sharing this article.