Practicing family medicine, I am honored to work with families struggling to care for aging parents. Most of us rightly have a strong desire to help our parents stay independent for as long as possible. The book of Sirach directs us: “My son, be steadfast in honoring your father; do not grieve him as long as he lives. Even if his mind fails, be considerate of him; do not revile him because you are in your prime” (3:12-13). So we truly do owe respect and love to our parents, and it is our duty to care for them in their old age.
Frequently, when discussing the option of placing an aging parent in a nursing home, I hear that patients who are placed in a nursing home are put there because their family was not willing to care for them. This, in turn, casts a very negative light on nursing home care in general and any decision to move a parent there in particular. However, I rarely have met a family who is inappropriately considering nursing home placement out of a lack of love or lack of desire to care for a parent. While this is the most common misconception about most folks placed in a nursing home, the opposite is much more often the case. Here’s an example.
“I just can’t do it anymore,” sighed Maggie, a tearful, fatigued woman in her early fifties. She had come to my office to “check her hormones” because of her lack of energy and growing lack of enjoyment with daily life. She didn’t feel like herself. After some discussion, we identified that her symptoms really worsened about 14 months ago since her mother, Veronica, moved in with her. Over the last five years, Veronica had many hospital visits due to falls. Recently, her memory was sharply declining, and the family had decided that she could no longer live on her own.
Initially, Maggie described how she was excited to spend more time with her mom, but it soon became clear that Veronica required a full-time caregiver. While Maggie was happy to take on this role, with everything from getting up at night to having to arrange for someone to come visit so that Maggie could run to the store, it had become exhausting. Seeing this, I suggest that Maggie may be suffering from depression brought on by her full-time role as a caregiver, and I introduced the idea of considering a nursing home. Maggie immediately bristled at the idea. “Oh, I could never do that to her. She always did so much for all of us, and I want to keep her at home with me. I just need a little help.”
This story illustrates a common scenario. Families correctly feel a strong desire to support and care for their parents in any way possible, and I regularly see children going to heroic, self-sacrificial lengths to help care for a parent. When needed, many, like Maggie, joyfully invite parents into their home. While these actions are highly commendable, and while they ought to be the standard practice, they also can be carried on too long, especially as parents age. In some cases, what was initially thought to be a good idea may instead reach the point where it is jeopardizing the health of the parent and the caregivers.
When it comes to aging parents, there is a limit to the care that can be provided by loving family members, and this limit is dependent upon the type of care needed and upon the family’s resources. While some families are able to designate a full-time caregiver to look after the parent, for many families dependent on two incomes, this is not possible. Furthermore, the degree of disability of the parent can vary greatly from needing assistance with shopping to needing help with ambulation and hygiene. There are vast spectrums of need and ability to care, and any decision addressing care of a parent must dealt with on an individual basis.
For families who need additional help in caring for a parent, a multitude of assistance is available. For relatively healthy seniors, senior communities and assisted-living facilities offer a variety of options in terms of housekeeping and maintenance, and are able to provide healthcare workers to assist with daily medication administration and meal preparation, if needed.
For parents with more needs, but who can live with family, visiting nurses are available to come into the home to help with medical needs, such as wound dressing changes and bathing. As a patient’s medical needs increase, a traditional skilled nursing facility would be able to provide around-the-clock access to nursing care. Eventually, patients may even require palliative or hospice care, which can be provided both at home and in a nursing facility.
Overall, children do have an objective duty to care for aging parents. However, there usually comes a time when the increasing medical needs of the patient or the limited resources available to the families necessitate the utilization of professional long-term care facilities. I routinely observe children feeling inappropriate guilt or remorse when they are no longer able to care for their parents and make the decision to place them in one of these facilities. While each situation is different, when this time comes, it can be most charitable to take advantage of these options. Utilizing these facilities is a legitimate means of fulfilling your duty to care for your parents when it cannot reasonably be done at home.
Families who choose to take advantage of nursing facilities should take solace in the fact that they are not shirking their obligation. Though the form of fulfillment may take a different shape than what that had initially imagined, they should feel free of guilt. Children of parents in long-term care facilities should prioritize frequent visits and phone calls, and could even ensure that holy Communion is brought to their parents. These and other loving and supportive actions are just some examples of continuing to help fulfill their parents’ social, emotional and spiritual needs. In caring for our parents in all of these ways, we do indeed fulfill and convey the gratitude our parents deserve.
Dr. Andrew J. Mullally, MD, is a family physician who co-hosts the “Doctor, Doctor” radio show on EWTN and practices in Indiana.