Dear Family Advisor

Nursing Home Decisions

Last updated: Aug 01, 2009

I'm the youngest of three. My brother and sister moved away, and Mom died of breast cancer at 69. Dad is 80 and is in a nursing care facility after breaking his hip. I can't see him moving back on his own, and I have three kids and no extra room, plus a job. I visit often and think he'll be happier there than living solo.

My problem is, my sister tells me I'm horrible for leaving him in the home. She's single, travels internationally, and can't take him in. She tells our relatives how rotten I am for breaking a promise, and harangues me so often that I don't want to see her any more.

It's hurtful to be accused of mistreating a parent, but try to take a step back. Your sister isn't really mad at you -- she's mad at the situation. Her mom died and she knows her dad will follow (although it won't necessarily be soon). Her fixation on your keeping the family promise is a way of excusing herself. She feels guilty but hasn't come around to admitting it.

No one needs to feel guilty. Many of us, including me, promised our parents never to "put them in one of those homes." We said it out of love, but it's just not that simple, and sometimes we end up needing to do it.

Many people have an unfairly negative view about care homes. Nursing homes used to be the only option, and many weren't pleasant and had inadequate care. Nowadays, that type of facility is the exception, not the norm. There are many types of care homes: rehab centers, assisted living, retirement communities, full nursing care homes, and more. Many are gorgeous, associated with nearby hospitals, and offer an array of amenities and a small patient-to- staff ratio. Some older adults actually prefer one of these living arrangements.

Your sister is not willing to change her lifestyle but expects you to do so. That's unfair. You may have to go through a difficult period before you make peace with her. She has to learn to respect your choices -- and realize that no one needs to be judged. Don't worry about what she says about you to your relatives. People can think for themselves, and those who can't, well"¦you can't worry about them. If they really care for you and your dad, they'll call, stop by, and find ways to be involved.

You know that old saying, "If it ain't broke, don't fix it?" Your dad sounds like he's in a good place. He's nearby, you can check on him often, and he's content. Moving him again will be upsetting for everyone involved. The sooner he starts to feel at home, the sooner he can create a routine and make friends, and the family can get used to visiting him instead of worrying about who's doing what. Doctor visits, physical care, and the daily duties of caregiving can wear a family to a frazzle and leave little time for conversation, hanging out, and simply enjoying your dad. He could recover and create a nice life for himself there. We forget that our elders get lonely and isolated. Care homes, senior centers, and activities with others close to his age can be nurturing.

Tell your sister you're doing the best you can. Have that heart-to-heart and really open up. Emphasize that he needs all of you -- and that no one gets off the hook just because they live farther away. After she processes her emotions, you can focus on what's best for Dad. Remind your siblings you can all make "secret" visits and observe your dad at lunch, when he's chatting in a common area or interacting with staff. After you've seen how things are going, you can go over to him. Visit a few times at odd hours to make sure he seems genuinely happy and cared for.

Care homes can seem scary at first, but they're not! A good care home is a safe place. Order a pizza and take it there -- share it with the staff. Rent a movie and hang out in Dad's room. If your kids are hesitant, start out with short visits and reward them with ice cream or skating afterward. Share their accomplishments with your dad -- show off that soccer trophy, or take pictures of your daughter's ballet recital. Dad needn't miss out on being a part of the family.

Wherever he lives, your dad needs interaction with all of you. Stop by often, get to know the people caring for him -- and thank them for what they do. Will this home let you bring him home for holidays or weekends? If so, do it.

Since you're the "designated caregiver," you have to dig deep and do what you know is best -- for you and for your dad. Even though you're making one choice for now, it may change later. Having Dad in a care home frees all of you to listen to him, be with him, and love him as only family can do.