How Should I Respond When Mom Says “Promise Me You’ll Never Put Me In A Nursing Home”?

 

How should I respond when mom says “promise me you’ll never put me in a nursing home”?

 

 

I frequently hear from adult children that their parents made them promise to never put them in a nursing home [NH].

A parent’s wish to avoid the NH is undoubtedly related partially to the less-than-perfect reputation NH’s once had.  However, since 1987, when the government created quality  standards for nursing homes and mandated that State ‘inspectors’ visit each facility every year, care has improved substantially.

The most common reason for admission to a NH is a dementia (at Glenwood Healthcare, where I’m Medical Director, over 70% of our residents have Alzheimer’s or some other type of dementia) and their behaviors—hitting, yelling, wandering, etc.—are such that the person can no longer be cared for at home by their family:  providing 24/7 care is incredibly stressful and results in more frequent health problems for the caregivers.  Attempts to reduce that stress by hiring sitters isn’t always possible because of the associated costs.

It’s rare that a senior wants to live out their final days in a NH.  But, in today’s busy world, with a complicated disease like dementia, it is both unfair and unrealistic for a parent to expect their offspring to make such a promise.

So I tell the ‘kids’ (we’re always ‘kids’ to our parents), if that expectation is made, they tell their parent they’ll do their best to keep them at home, but it may become necessary—as an option of last resort, for the emotional, physical, and financial health of both the parent and the children—to place them in a nursing home.