Caregiver's Home Companion Caring for someone who has trouble hearing the phone?

Posted: November 29, 2008

When a Loved One Enters a Nursing Home

Understanding Your Role as Advocate

Despite the difficulty of caring for her wheelchair-bound husband suffering from advanced Alzheimer’s disease, Joanne Simonson never planned on having her husband enter a nursing home.

“Frank can’t say what he wants anymore, but I understand him,” Simonson, of Reedsburg, Wisconsin, explains. “Strangers wouldn’t know what he was trying to say.” However, when Simonson’s back started giving her serious problems, her doctor warned her, “If you continue taking care of Frank, he won’t be the only one in a wheelchair.”

When Barbara Meltzer realized her mother couldn’t live alone anymore, she never considered having her move in with her in Los Angeles. Meltzer says, “I work all day. If she lived with me, she’d be alone. She’s better off in a facility where she’s surrounded by other people and has activities available to her all day.”

Drive Longer, Stay Independent
Whatever the reason for your loved one’s placement, remember: you have not abandoned her. While your responsibility of being the moment-by-moment overseer of her caregiving stops, your love and concern doesn’t. You can now become her advocate by bridging the gap between her and both the nursing home and the community.

When You Visit

When determining how often to visit your loved one after she enters a nursing facility, consider that she may be there several years. Are you sure it’s practical to visit every day? How often did you see her before? Too frequent visits, especially in the beginning, may interfere with her settling into the home’s routine. She also may not develop friendships with other residents or become involved in the facility’s activities, if she knows you’re going to be there all the time.

Overly solicitous help can take away your loved one’s motivation to think or act on their own behalf. Encourage her to do as much as she can for herself, no matter how much more convenient and quickly you can do it.

No one knows your loved one like you do. Your unique position allows you, when visiting, to observe subtle changes in her behavior and habits that could indicate a problem. Areas to watch include differences in her eating or sleeping patterns, falling, facial expressions, new aches, pains or weaknesses, skin changes, or new lesions These conditions should be reported to the staff and her doctor immediately. They all indicate potentially serious medical conditions that, if cared for early, could be successfully treated.

Meltzer says, “I not only look for changes in my mother, I check out what is going on in her room and at the facility. I’m very vigilant. My mother is no longer able to speak for herself. I am her memory and her voice. She sits on my shoulder all the time.”

Meltzer realizes, however, she can’t anticipate everything her mother needs. “I always ask the aides if they know of anything else that my mother wants,” she adds.

Linking with the Outside World

Pam Brown, a licensed clinical social worker and certified private fiduciary in Sun City, Arizona, says, “Residents miss their contact with the outside world. Try to keep your loved one up-to-date as much as possible with newspapers, magazines, recent photographs, family stories, and other interesting anecdotes. Visit often.”

If your loved one is able to get out and she belonged to a club or organization before, offer to take her to their next get-together. With the staff and your loved one’s approval, you may also want to see if the group would be willing to hold an occasional meeting at her facility.

Good communication with her healthcare provider(s) is essential. You need answers to her concerns and your questions, and they’re a logical source. What is her exact diagnosis? What is happening now? What can you both expect later? How can you help your loved one now and subsequently?

Life with Meaning

By the time people go into a healthcare facility, they’ve dealt with major loss – their independence, declining health, depleted income, death of loved ones, etc. Despite these losses, you can help your loved one still find meaningful involvement in their life.

Geriatric care manager Renee Glazier, of Newton, Massachusetts, explains it this way: “What was important to her before? If she’s interested, plug her into an area where she’s had some interest and experience. For example, if she was she a volunteer and enjoys knitting, she might like making slippers for hospital patients. A teacher might enjoy reading to other residents who aren’t able to anymore.

Listen Up

To be a good advocate, you need to be a good communicator. Listen with compassion, and when it’s appropriate, add your own comments. Let your loved one know their opinion is still valued. Don’t continually try to “cheer her up” when she’s having a bad day. This suggests to her that her negative feelings are bad and shouldn’t be expressed.

She may complain or criticize. Listening intently, and understand that affirming her feelings may be all that she wants. Maybe you’ll hear:  “Thanks for sharing this with me. I understand why you feel the way you do. Can we work this out together? Or is this something you want to take care of?”

Reminiscing is important for your loved one and provides both of you with an additional sense of identity and purpose. “Older people have so much to contribute when we encourage them,” Brown notes. “They are walking history books.”

After experiencing world-shaping events and living through them, your loved one has developed skills for coping. Don’t make an emotional cripple out of her by not including her in family decisions, if she’s capable of understanding and responding. This tells her that her feelings and ideas are important and that, even though she now resides in a nursing home, you still appreciate, respect, and need her.

Cynthia Laverty, co-founder of the Care Company in Valley Village, California, sums up the caregiver’s new advocacy role: “Approach it from a loving place. Being an advocate requires diligence, fortitude, and clarity of purpose delivered with dignity. Find people who share your common goals for your loved one and who understands that you will settle for nothing less. Convey your message to those now charged with the daily care of your loved one. They need to understand you and your goals, and that even though you might not be present every day, you are most definitely present.”


Rachel Davidson is a freelance writer focusing on elderly care. She published a quarterly magazine for nursing home administrators for 15 years, as well as a caregiver newsletter for five years. Rachel lives in Baraboo, Wisconsin and can be reached at


Aging Care (866-627-2467) has an objective article on the perceptions and realities of nursing homes and what you can expect when your loved one becomes a resident in one.

National Family Caregivers Association (301-942-6430) offers workshops to help caregivers communicate effectively with healthcare professionals. In addition to providing courses in some communities, it’s accessible in written form from their website.

US Department of Health & Human Services has a detailed online article on nursing home selection. It includes information on payment and patient rights, as well as a nursing home checklist for comparing and rating Medicaid and Medicare certified nursing homes located throughout the United States.

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