I was in for a shock when I began my experiences with care facilities. I thought they were miniature hospitals with nurses in track shoes just waiting for a call button to ring so they could run to the room and take care of my loved ones every need. I envisioned people highly trained in medical care being available twenty four hours a day. I guess I thought event the house keeping staff would be some kind of specially trained professionals skilled in keeping the place spotless and pleasant smelling at all times. My expectations were elevated to say the very least, and those expectations made my adjustment to the new and very real world of nursing care much harder and added a great deal of conflict between me and the facility.

There is no place like my imagination described. If there were, no one but Bill Gates could afford to have a loved one live there. No facility can replicate living at home. No facility can give medical care like that offered in a hospital. No facility can cook food for a large group of elderly people with various dietary issues and make it taste like momma used to make. No facility can smell wonderful at all times. No facility can guarantee your mother will never fall. If she fell at home, she will probably fall in the facility as well. There are some special things to wear that will help guard against a broken hip if a fall happens, but elderly people fall. 

No facility can guarantee there will never be a bed sore. Lying in bed on aging skin can create problems in spite of the best care possible. While you should not find your loved one needing a diaper changed on any kind of regular basis, it will happen sometime. While the place should not smell of urine except on rare occasions, it will do so at some point in your stay.

I do not want to paint a picture of horror or scare anyone who is facing a care decision, but we need to go into the process with our eyes open and our expectations set at a realistic level. There are no perfect solutions to long term care. There are no perfect facilities to produce a perfect solution to long term care. In an ideal world I would have lived at home with my wife until I was over one hundred years old and then both of us would have died at the same time bungee jumping in New Zealand. Anything short of that is a compromise. Life is full of those things isn't it.

So with realistic eyes, how do we begin the process of looking for a facility to care for your loved one? This question will consume several blogs and hopefully create a large number of responses before we can even begin to think we have covered the subject. We can start with:

EXPLORE THE OPTIONS. We now have a full continuum of care available to meet whatever level of care a loved one might want or need. The first level of care are the retirement facilities which usually offer independent living with some meals provided in a central cafeteria. The next level are the assisted living centers which offer just the physical care needed by each resident. This may include assistance in bathing, dressing, and sometimes transportation needs. These facilities usually require that the loved one be mobile enough to come to the dining facility for meals. Quite often, some very active and mobile people choose to live in this type of home, some do so even while they are still actively employed. The next levels move toward what is called acute care. This level is required if the loved one is not mobile and or if they require a great deal of medical care or are bed ridden. There are also special facilities for those suffering from dementia. Since some facilities now offer assisted living for people with early forms of dementia there are levels of care to meet these needs as well.

KNOW WHAT TO LOOK FOR. In future blogs we will deal with knowing what to look at in order see what we need to see before we make a decision. This time we are limiting our scope to knowing what we really want in general terms. I have been through this experience with three loved ones and four levels of care, and the best advice I can give is "don't approach the place like a mother-in-law looking for dust." What I really am looking for is the spirit of the place. Is it warm? Is it happy? Do you see any of the staff joshing with the residents? I like nice furnishings and pleasant surroundings, but I have been in facilities that were far too nice. They seemed stiff and regimented. Remember, one of the losses your loved one will feel the deepest is the loss of independence. The loss of control of their own lives. I want a place that is relaxed and happy. 

I spent several years traveling around the country speaking on aging issues often sponsored by nursing home corporations. I have probably toured more nursing homes than almost anyone imaginable. I have seen some magnificent facilities that I would recommend to my mother and some that I would not allow her to live in. I have seen some not as fancy places that are the same. I have seen some that made me shudder. None of these passed or failed because of the décor. They passed or failed because of the spirit I felt there.

I remember an administrator asking to take me on a tour of her facility. It was not the fanciest place by far. It was clean, but a little bit rumpled. It took us almost an hour to walk through the place. The administrator had to stop and hug every resident we came across. She knew them by name and it was evident she hugged them quite often. I saw staff people doing the same thing. The administrator knew each staff member by name and took the time to speak a word to them. They conversed with such ease it was evident this was just a normal day. A place like that would be my choice for my loved one or for me.