I have been walking with a couple through the husband's stay in the hospital, then in extended care for physical therapy, and now in a nursing home where neither are happy. 

I could have predicted their unhappiness, neither of them are convinced he needs to be in any facility. They still cling to the idea that she could take care of him in the home. The fact that he cannot get up from bed or chair by himself and can only walk about twenty steps even with the help of a therapist, somehow does not mean the wife, a rather frail woman could not manage just fine. Since this is the mind set, it is inevitable that every detail of the care will be harshly judged and each slight turned into a crisis of care. It is also true, that there are many facilities available that give better care than what they are receiving. It is a bad marriage between a family not prepared for any care, and a facility that is not one of the best. I have watched far too many of these kinds of marriages happen, and been unable to do anything to help.

I have written, spoken, advised and am now blogging about the need to plan for the care as we age. Far too many nursing home decisions are made on the spur of the moment without planning or preparation, and far too many end up in facilities that do not fit their needs, or in a state of mind that means no facility could ever please them. Planning ahead seems to be one of the hardest things possible and there are several reasons for our resistance. 

Such as:

Old slips up on us 

No one thinks they are there until they are really there. Most of us think of ourselves as at least twenty years younger than we are until our health breaks and we are suddenly old. Even then, it takes a while before we realize that condition is not temporary and we will not be "up and at ‘em" again soon. 

Reality dawns slowly

I would watch the husband's struggle to be able to assist in any facet of his care. It was evident to everyone involved that there was no way his wife could care for him in the home unless she could afford full time nursing care. When I would gently try to help her come to grips with this reality, she would immediately change the subject to how much better he would be when the physical therapy treatments were completed. She would acknowledge that we needed to talk about care in case the treatments did not perform the miracles she expected, but she would not allow the conversation to happen.

Like it or not, insurance and medicare determine most of the care decisions for the aging. The day came when the husband's coverage ran out and he had to leave the hospital. His condition allowed him a certain time in extended care for physical therapy, but that too was a limited amount of time. She, like millions of others, woke up one morning and had twenty-four hours to find a nursing facility for her husband. That is not enough time to explore the facilities available and certainly not enough time for the mind to adjust from false hope to reality. The result was, she took the first recommendation she heard and is miserable with the decision.

No one wants to think about this happening to them. Most of us close our minds to the possibility and avoid the subject all together, but we do so at our peril. As we age, we need to plan. As we age, we need to involve the family in the planning. As we age we need to become aware of the facilities and do enough investigating to know which ones we would choose in the unlikely event of our needing such a thing. There is nothing pleasant about doing so, but the alternative can be a quick decision leading to quick regrets. 

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