Is it time to think about residential care?
Please note: This is an article about understanding when to think about residential care and how to start the conversation with elderly people who are not living with dementia or memory loss, and are able to engage in the discussion. While the first part of this article (knowing when it’s time to look at residential care) might be widely applicable for carers, the conversation part is far less so when dementia or memory loss in a loved one is advanced.
How will I know if it’s the right time?
There’s no one simple indicator that tells you it’s time to think about residential care for a loved one. What we do know from our research is that there tend to be two main pathways that lead people to residential care:
Injury or illness: either after a hospital stay, or a big shift in their health, or capacity to live at home independently.
A decision that residential care is the best option right now.
If you’re in the latter camp, it can be harder to know for sure if it’s the right time, as the decision might be based more on general circumstances rather than any particular sign or event. Regardless of which pathway you and your loved one are on, there will often be a sense of guilt and second-guessing yourself. Let us just say, you’re not alone.
We know there’s not much we can say to take away that feeling of guilt, but we will remind you to be gentle with yourself. We are all human, we can only do so much, and sometimes residential care is the better option for both the care of your loved one and your own sanity.
What to ask yourself
When it comes to working out if it’s the right time to consider residential care for a loved one, considering the following questions can help clarify your thoughts:
Has your own world shrunk and/or is caring for someone starting to negatively impact your life, work, or family?
Caring for someone often changes gradually, with more and more added to your responsibilities until you wake one day to find that your own world has shrunk to nothing. It can be difficult to get out from under this, and when care eclipses everything else it’s hard to know who you are anymore. If you feel you’re getting to this point, or that things are heading in this direction even slightly, think about residential care as an option.
Has your loved one’s world shrunk and/or their ability to help themselves become almost non-existent?
Again, your loved one’s needs will often change gradually, so it’s hard to know when that line of “can’t help themselves” has been crossed. This is especially true when you take up the slack. But if you’re worried about them whenever they’re alone, or even simple daily tasks need more help than you’re able to give, this might be a time to start the conversation about residential care.
Do you have the available funds to pay for more in-home care?
And by this we don’t mean getting into debt or mortgaging your home to finance it. We mean, are there funds available to use that wouldn’t leave you or your family in a poor financial position? If those funds are available, and you’re happy for them to be used for in-home care, then this might be an alternative to residential care. If you don’t have the funds, or finding them would be detrimental to your own financial position, then residential care might be an option.
How do I have the conversation?
If you’re able to, begin the conversation early. The best time to talk about residential care is well before it’s even a consideration. However, this doesn’t always happen, or it can simply be hard to get your head around it when they’re still independent.
Ideally, these early conversations would set some triggers – points at which you both need to think more seriously about getting more in-home help and/or about residential care. For example, when they can no longer perform certain tasks alone, or when their concerns about security or loneliness reach a certain stage.
It would also be good to discuss different levels of residential care. For example, at what stage would you start to think about more in-home care? At what point would you think about a retirement community? And when would you think about more hands-on residential care?
These early conversations set a basis to work from later. They are about setting expectations, and providing some tests that can be applied down the track to think about whether it’s time to think about a change.
Be aware though, that these early discussions can create a level of stress for your loved one. Knowing that there are certain trigger points for change may mean they keep trying to engage in certain tasks well beyond the point that it is safe or sanitary for them to do so. They might see these points as the line at which they’ll be sent off to residential care.
Make sure that these initial conversations include an understanding that nothing is a foregone conclusion, and that these triggers are merely review points rather than decision-makers.
Later stages
If these early conversations and defining trigger points don’t happen early on, that does make the conversation more difficult to start once their care needs have become more involved. However, it is not impossible. The way to begin should be less about “Let’s have THE conversation” and more about “Let’s talk about where we’re at.”
A few tips going into this conversation:
Try to have the conversation when you both have time to be fully present.
Maybe have a cup of tea together and start with “I just wanted to chat about where we’re at and how we’re both feeling about the current situation.” This is not a conversation you want to have when you’re feeling stressed at the end of a day, or resentful and lacking your usual conversational filter.
It can help to prepare.
You might write down four or five key concerns or points you want to make sure cover during the conversation, just to refer to if things get a little emotional. But remember that although you’ve had time to prepare, your loved one may not have. This might mean they need a chance to digest what is discussed, and maybe another conversation to respond.
Talk about how you both feel the current situation is working out.
This is where you might raise any concerns about your ability to provide the level of care they need; what you’re worried about for the future; and how the current situation is impacting you and your life. Try to avoid bringing any blame into this discussion. Your loved one might want to share their own concerns too – what they’re worried about, and their fears for the future.
Work through together what the future needs to look like.
Keep in mind what you need for your life and sanity, and what they need to feel comfortable and with some control over their own life. This is not about categorically saying “It’s time to move”, but more about looking at some of the ways you can achieve what you both need, with residential care being one of the options.
Not every parent will take the conversation well – in fact, they may actively resist having it, or they may have unrealistic expectations of how much care you are able to provide. The key point for you as a carer is to share your perspective, to set some expectations, and to make sure you are taking care of yourself as well as your loved one.
The outcome of these conversations might not be a decision to go into residential care, they could be about deciding what external help you might need, or making sure your loved one understands there are limits to what you’re able to do for them.
The conversation might be ongoing, in fact it is often better if it is, so that expectations and understanding evolves as the care you provide changes over time. The key is simply to start the conversation.
