Dad went into the memory unit at Christian Rest Home a week ago. A week before that, it didn’t seem that admission was imminent. However, that previous Wednesday, my mom said for the first time, “I can’t do this anymore.” Not “I’m reaching my limit” or “I might not be able to do this anymore,” but “I can’t.” Caregivers from Elders Helpers were assisting three mornings a week and I was providing care most mornings and evenings, but mom was there around the clock every day, with only occasional breaks. Dad, who has dementia, had been having increasing difficulty understanding even the simplest tasks, which made such tasks an ordeal for both him and the caregiver. He also was having trouble standing and walking because of arthritis and the depletion of cartilage in both knees. He needed to be steadied, and sometimes whoever was with him had to support nearly his full weight until he got his balance. The latter was particularly difficult for my mom, who, at age 88, is just two years younger than him and in frail health herself.
I called the nursing home the next day, but couldn’t schedule an assessment until after the weekend. When the nurse came on Monday June 2, she indicated that dad clearly qualified for skilled nursing care, and recommended that he be placed on the memory unit. Fortunately, there was an open bed. We initially hoped the move would be the end of that week, but, because of a regulation that he be evaluated by a physician within 48 hours of admission, it was best for him to go in on Wednesday, the day there would be a physician on-site. We had just two days to get him ready to go. Those days were a whirlwind of making phone calls, shopping for clothes, marking all his belongings, and packing. On Wednesday June 4, my sister, my brother, and I took him in. My mom stayed home, since we all agreed that the initial adjustment for both her and dad would go more smoothly if she wasn’t present
Here are a few observations about the week leading to admission:
• The difference between managing and not managing caregiver stress can be tiny. Dad’s deterioration in functioning was very gradual—he was barely different two weeks ago from the previous week, and had not changed much the week before that, or the week before that. Similarly, mom was not markedly less capable of handling the caregiving load from week to week. Still, the cumulative changes crossed a threshold, and coping gave way to not coping.
• In the rush to get everything ready for admission, we spent less time than usual with dad. Thankfully, outside caregivers were present, so his needs weren’t neglected. Still, it started to seem as if he was partly gone even while he was still there. He didn’t understand what was happening, so from his perspective everything was the same, even though for the rest of us everything had changed.
• Knowing that dad would be leaving soon added poignancy to everyday activities. Even such prosaic tasks as helping him get ready for bed seemed more special when it was the last time we went through that particular routine together.
• My mother, sister, brother, and I all worked to make the transition as successful as possible. We did pretty well at getting tasks done. We didn’t talk much about our feelings regarding this major life event, though. Mom and I talked some about our sadness, but I can’t recall any other discussion of emotion. I wonder, is our family just not very good at talking about loss, or is entry into a nursing home a particularly difficult thing to discuss?
• My sister, brother and I weren’t all needed to transport dad to the home and provide information about him to staff. We all wanted to be there, though. I suspect our participation was for our sakes more than because he or the home wanted us all there.
This is probably a good place to stop. I’ll try to provide occasional updates on how dad, mom, and the rest of us are handling this change.