“I promised my mother I would care for Dad after she died.”
“Our family has always taken care of our own. I can’t break my promise.”
“My father made me promise never to put him in a home, no matter what.”
We are all taught to keep our commitments, but what if keeping a promise means separating your parent from professional medical care? What if it means increased risk of a fall or mismanagement of medications? What if it means risking your own physical and mental health? These are all common results of hands-on, nonprofessional caregiving.
“Promise You’ll Never Put Me in a Home”
“It’s unfair,” Lola said near tears, “for a daughter to have to choose a nursing home when her mother has instructed her never to do such a thing. But Mom’s been to the hospital twice in the last month, first with aspiration pneumonia and dehydration; then she fell and hit her head on the corner of a table and had to go to the emergency room for sixteen staples to her forehead. Now, she’s back at her house, but she calls me four or five times during the night. I’m getting tired and even resentful. I’m convinced she needs attention as much as physical care.” Lola lowered her voice and confided, “I threatened her with a nursing home if she really needs me that often. I can’t believe I did that to her.”
However, the fact that she was now sitting on the other side of my desk showed that Lola was finally giving long-term care serious consideration. “It isn’t just the promise to my mother,” Lola continued. “My aunt Mabel is looking over my shoulder, too. She says the family has always taken care of our own. Stella, I just want to do the right thing. Between my own guilt and the pressure from family and friends, I feel paralyzed.”
“Lola,” I sympathized, “many of us promised never to place our parents in a nursing home. Frequently, this vow is made in better times when our parents can’t imagine themselves in declining health and we can’t comprehend the old-age disabilities they will face. Your promise may have been a loving one but—in the long run—it will cause grief and misunderstanding. If your mother had known years ago the anguish it would cause you today, I don’t know that she would have asked for the promise.”
“I’ll take her home one more time,” Lola said tentatively, then added, “but she can’t continue this back-and-forth existence, in and out of emergency rooms.”
Six weeks later, I received a phone call from a hospital discharge planner. Ethel had fallen yet again and fractured her right elbow and wrist. With her arm immobilized, she required assistance with bathing, dressing, eating, and going to the bathroom. Lola, telling her mother about our conversation, suggested she move into a nursing home just until her arm was functional again.
Two weeks after Ethel’s admission, Lola stopped by my office. “Stella,” she began, “I love my mom and I’d much rather be able to take care of her at home, but I’m so grateful for the care she gets here. Even though certain family members resent my decision, I’m finally sleeping at night. My family and my boss say I’m a nicer person to be around.”
As caregivers, we face complex emotional issues that each family will approach differently. There is no right or wrong way. Taking care of an impaired elderly parent at home is a proper and loving endeavor. Consider, though, that a time may come when professional long-term care is the only safe solution.
Roberta and Helen
Roberta was the primary caregiver to her eighty-four-year-old mother, Helen. A successful psychologist, single parent, and mother of three, Roberta was going through a divorce and “just treading water” in keeping up with her demanding life. In my office, she explained that although her mother was mentally alert, she required assistance with bathing, dressing, and going to the bathroom. Two years earlier, Helen had been diagnosed with Parkinson’s disease but chose not to accept the diagnosis even though it was confirmed by three physicians. As she required more and more care, she told Roberta, “Don’t be thinking I need to be in some sort of home or anything! Remember you promised I could stay in my house.”
“I don’t know what to do,” Roberta sighed. “Mom can’t cut her own food anymore and even has difficulty bringing a spoon to her mouth. We were so grateful for Rosa, a full-time caregiver who was with Mom for nine months. But Rosa went to El Salvador for a visit and, five months later, she hasn’t returned.” A parade of caregivers followed. Two of the aides were not able to meet Helen’s physical needs. A third seemed promising but left after three weeks. Still another had not been dependable, and the current caregiver had an unpleasant personality.
When an open sore from unattended cellulitis on Helen’s leg became infected, she was admitted to the hospital with a high fever. Returning home five days later, Helen again ordered Roberta not to consider nursing home care. But the following week, Helen was back in the hospital, this time with a urinary tract infection. At this point, Roberta found herself in a dilemma. In view of Helen’s medical and health needs, the discharge planner at the hospital recommended long-term care. Given twenty-four hours to find a facility, Roberta sat in my office crying.
“Now what do I do?” she asked. “Break my promise, or do what the hospital recommends?”
“Roberta,” I said, “there is no guidebook to tell you when it’s time to relinquish the care of your parent to others. But even a twenty-four-hour live-in caregiver cannot provide the care your mother needs. You made a promise you cannot keep.”
“Yes, I’ve known it for some time now,” Roberta replied. “Mom should have had more care all along.”
“Roberta,” I continued, “nursing home placement does not mean abandonment. It’s a change, but you are still your mother’s child, her chief advocate, companion, and support. A long time ago, you made a promise to your mother out of a sense of duty. In effect, you were promising to do the best you could. Now you must assure your mother you will still always be there for her.”
Helen joined us the following day. Wanting to make her feel loved and important, Roberta brought her grandchildren to visit. At first Helen barely spoke to her daughter, but gradually she began to look forward to her daily visits. Two months later, Roberta e-mailed me: “Mom is coming around. Now she actually worries that I’m stopping by too often! The ‘promise’ is no longer hanging over my head.”
Promises made years ago blind you to the realities of present needs and can immobilize you when you most need to make appropriate decisions. Having to choose a nursing home on twenty-four hour’s notice can be nerve-racking; a good decision is nearly impossible. Think ahead. Prepare yourself for what may come. Even if you have to keep your research secret for now, investigate available options. Preplanning offers you control and better choices. It stabilizes a crisis during emotional times.
When asked to make a promise you’re not sure you can keep, ask yourself WHAT IF…
…your parent has a stroke or a fracture and can no longer walk unassisted?
…your parent develops dementia and begins to wander?
…your parent becomes incontinent of bowel and bladder?
…you cannot find or keep quality caregivers?
…your parent will not allow a caregiver in the house?
…you fall ill and cannot give the support your parent needs?
FAIR PROMISES
No one plans to place a parent in a nursing home. The parent doesn’t want it, and neither do the adult children. But the fact is a majority of seniors will not live out their lives at home. What promises can you make to a parent who has flatly stated she will never leave home? Place yourself in her shoes. How would you like to be reassured and spoken to? Here are some fair promises you can safely make to your parent to reassure her of your commitment and love:
“I will never abandon you. If you ever need long-term care, I will be there to watch over you. To the best of my ability, I will ensure your comfort and care, and together, we will find solutions that work. I will always be an active voice for you.”
“If you enter a nursing home, it will mean you are getting the kind of medical care I can no longer give you, but I will be there to oversee it. I will still be your child. You will still be my parent. And we will make the facility an extended part of our family.”
“For the rest of your life, your happiness and safety will be a priority to me. With your welfare in mind, I will make the most responsible decisions I can for you. I will never place you in danger. Nor will I allow you to place yourself in danger.”
Fair promises are harder to make than unfair promises, and they are even harder to discuss. It is easier to make an unfair promise: “Don’t worry, I’ll never put you in a nursing home.” The conversation ends; everyone feels better. On the other hand, fair promises, although difficult to make, can reinforce your parent’s sense of security and her need to remain included in the family. While she may not feel happy about it initially, fair promises will reassure her of your continued involvement in her life, and of your long-term commitment to her well-being.