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The Nursing Home Promise – Keystone Elder Law

Americans live in a society in which youth is highly valued and many people become uncomfortable when asked to think about or discuss the aging process.  News stories about nursing homes generate greater public interest when an unfortunate event related to patient care has occurred or some type of conflict exists regarding long-term care services.  These types of stories may lead an individual to briefly consider the possibility of one day needing additional help with activities of daily living, and to generate a discussion with a spouse or among other family members.  These conversations can include the statement, “Promise me that you will never put me in a nursing home.”  Let’s consider the implications of this promise.

This type of promise may appear to be very logical.  During free public seminars about planning for long-term care, our elder law firm has asked hundreds of people over the past few years, “Who has it as one of your life goals to spend your final days in a nursing home?”  Can you guess how many hands have been raised?  Not a single one.  Since everyone agrees that one’s own home is the place to be, a promise to never admit a loved one to a nursing facility is easy to verbalize when all involved in the discussion are generally healthy and independent.  Although it may be easy to verbalize, following through on the promise can prove to be more challenging than one might imagine.

Whether an individual’s mental or physical health declines as the result of a sudden catastrophic event or chronic disease, or one experiences a general slowing down due to age-related changes, the need for assistance with the tasks of life will require someone else to be a caregiver. Caregiving can range from providing help with a single task every once in a while to a monthly, weekly, daily, or 24/7 commitment.  Caregiving can include a multitude of tasks such as household chores, transportation, scheduling, medical monitoring, and hands-on personal care.  Are you ready to sign up yet?  Paying bills or driving someone to the store or doctor’s office may sound manageable. But how many of us would feel comfortable if asked to bathe a parent, or assist them in the bathroom?  Since we do not possess the ability to see into the future, this type of scenario could happen.  Caregiving often starts out as help with a few tasks here and there, and over time the number of tasks and their complexity gradually increases.  Some people may be emotionally, physically, and socially equipped to provide intense and intimate care for a loved one, but certainly others are not.  Factors such as family relationships and structure, stage of life of the care recipient and caregivers, economics, geography, and the actual care tasks all factor in as to whether or not home is a safe place to stay, with or without the help of paid services.  Therefore, making such a promise to avoid a nursing home or other care facility, before having the understanding and experience of how life will unfold, is highly unrealistic.

Couples may view the promise as an extension of their vows.  After all, didn’t they say “…for better or for worse; in sickness and in health…”?  The intent behind these vows is to remain committed to each other.  Sometimes this commitment involves recognizing one’s limitations and being responsible to utilize available resources to make sure the other partner’s needs are met.  When one partner promises never to place the other in a nursing home, it is often made with the belief that care at home will always be available, more thorough, and safe.  The intent behind the promise is to provide the best care possible for the partner.  Sometimes, the best care is care outside of the home.  While the recipient of care may not understand this, it is important for the healthier partner to keep this fact in mind when feelings of guilt for not being able to fulfill the technical wording of the promise are experienced.

Learn more about the costs and various types of care that are available at Keystone Elder Law’s free seminars on Thursday, January 29th.  Two attorneys and I will answer your questions about planning for, obtaining, and paying for long-term care. Morning, afternoon, and evening sessions are available; please call our office for times.  The seminars will be held at the Hampton Inn, 4950 Ritter Rd, Mechanicsburg (in the Rossmoyne Business Center).

Do you listen to the Michael Parks radio show?  A discussion about “The Promise” will take place on WHP 580 AM on Saturday, January 24th at 7:30 am.  Tune in for commentary and additional insights about this topic!

Karen Kaslow, RN