Emotional Issues

Major life changes are tough on everyone, but preparation and support can ease the transition.

Q: How can I help my loved one settle into a new home?

A:  You can help your loved one settle into life in the long-term care home best by remembering that they are not just moving into a long-term care home, but into their new home. Although it’s important that any decorative item not interfere with the caregiving mission or safety policies of the centre, thoughtful decorating can help the care team meet its goals of caring not just for the body, but for the mind and spirit of residents as well.

Consider the following:

• You can help restore some sense of home environment by decorating rooms with things brought from the previous home.
• Bring things residents made or collected. Bring items that have always been important to them, like a chair or picture.
• Provide photos of yourself or your family. Provide pictures of their favourite subjects, or of religious or other familiar scenes.
• If your relative is able to enjoy them, supply magazines, books and newspapers; if not, bring tape-recorded books or music.  

Q: My mother is still angry and keeps saying she wants to go home. Will she ever adjust to the move?

A:  Suffice it to say that the first 30 to 45 days may be uncomfortable for both of you. Don’t be surprised if during the early days of your relative’s residency, the whole family experiences some degree of guilt, tension, fear or fatigue.

Your relative may do or say things that will upset you. She may express either verbally or non-verbally her dissatisfaction with the new arrangements and her desire to go home. She may act mad or hurt, berate or ignore you.  Remember that these behaviours — and your reactions to them — are perfectly normal under the circumstances. Adjusting to new living arrangements is a process that all residents go through in their own way, and at their own speed. The adjustment won’t be accomplished overnight, but as the days turn into weeks, you’ll find your relative talking less about her old home and more about her new. In the meantime, the staff is always there to help see you through the peaks and valleys of this very emotional experience. Don’t be afraid to ask for a little moral support.

Q:  I feel so relieved – and so guilty for feeling that way.  Are my feelings normal?

A:  Guilt. Resentment. Confusion. Relief. All of these and more are common and understandable reactions to a family member moving into a long-term care home. Whether the move was long overdue, the result of a sudden illness or a drastic change in circumstance, such a major change in the life of a loved one resonates throughout a family.

Coping With Guilt And Resentment

Learn ways to express that you only have your loved one’s best interests at heart.

Q: My dad and I chose this long-term care home because we both thought it was the best thing to do. But suddenly I’m being treated as though I have abandoned him to pursue my own selfish pleasures. How can I make it clear that I only have his best interests at heart?

A:  The decision to admit a family member to a long-term care home setting is never an easy one. But whenever you begin to doubt the decision, remember the advantages a long-term care home offers your family member:

• 24-hour care, with medical assistance always available.
• A sense of community and activity, which can encourage residents to get up, dress and get out to enjoy a community meal in the dining room or an organized activity in the recreation room.
• Staff members who become attached to the people in their care, and work to make their lives as comfortable and interesting as possible.
• Trained nurses who teach skills and promote self-care.
• Medical staff that tracks the individual progress (as well as the medical needs) of each resident, on a regular basis.
• Tasty and nutritious meals on a regular schedule, with help for those who need it, and special attention for those whose diets need to be monitored.
• Finally, more satisfying relationships with family members who, with the stress of routine daily care transferred to long-term care home staff, now have sufficient energy and time to devote to the emotional needs of their family member.

Q: I know my relative should be here, but I made a promise years ago that we’d never resort to a long-term care home. I feel as though I have gone back on my word.

A:  One of the most difficult situations a person can face in life is moving an elderly family member into a long-term care home after having promised — often years before — never to do so. If you’ve had to break such a promise it’s important to take some time to separate what you feel about your decision from what you know. For example, even though you might feel as though keeping that kind of a promise is important, you might know that it was no longer safe for your mother or father to live alone.

Remember:

• As circumstances change in your life, so, too, do your options. The “best” solution to a problem ten years ago might not be the best solution today
• All you can give is your best. If you’ve considered all the options and made the best decision you can, you have nothing to feel guilty about.
• Doing the impossible to keep your family member at home is precisely that — impossible. Few people can provide the 24-hour care a long-term care home can provide.
• Try to listen to your head. Being relieved of the daily physical and emotional stress of a practically impossible home care situation can enable you to enjoy your relationship again.
• You’re not alone. At the heart of almost all guilt suffered from placing a family member in a long-term care home is the unspoken concern that a promise has been broken. Talk to others who have made a similar decision and share your conflicting emotions.

Q: Even though I was killing myself trying to take care of both my relative and family, since my relative has moved to the home I’ve felt even worse. Instead of appreciating all that the staff does for my relative, I resent them for caring for my relative better than I could, and guilty for being so childish. What is wrong with me?

A:  Nothing is wrong with you. Soon you’ll get to know the staff, and realize that they’re not taking your relative away from you. Moreover, you’ll discover that what you can offer your relative, no one else can provide. In the meantime, share your feelings either with someone on the staff, or someone who has been in a similar position, like a Family Support Group member. Don’t worry about sounding irrational. Your reaction is much more common than you think.

Q: As the only relative in town, I feel I have too much responsibility for my parent, while my siblings out of town feel guilt for not helping more. How can we share the load more equitably?

A:  Your parent is only the first of many family members that will find this life change stressful. Admitting a close relative to a long-term care home brings to the surface all kinds of life issues that we often keep on the back burner.

Often, those caregivers who assumed the major responsibility for the decision have become the primary caregiver by default, as the only relatives in proximity. By the time the decision is actually made, they may feel exhausted and depressed, as well as resentful of all the responsibilities. On the other hand, out-of-town relatives who only see their family member rested and dressed for “company,” may argue for care options that they would realize were unrealistic if they were the primary caregiver for just a day. All family members need to make a concerted effort to empathize with others’ points of view and the needs and conflicts they face.

When it comes down to the nitty gritty of decision making, strive for consensus, but don’t force it. Try to get only those commitments from family members that can be given  honestly and realistically. If that leads to nothing decisive or realistic, try to agree on a temporary or trial measure, recognizing that some family members do not favour the option, but that, as yet, no other solution has presented itself.

Making Your Visits Count & Visiting by Mail

Discover how to make the best of your visits with your loved ones and how to communicate by mail.

Q: Dad and I never did talk much, and now conversation is even harder. What can I talk about that won’t make us both uncomfortable?

A:  Often relatives and friends find it painfully difficult to visit a family member during the early days of his residency. They may feel it their “duty” to keep the conversation light and to avoid any topics that might make everyone uncomfortable.

Talking about the “uncomfortable” things can be therapeutic for long-term care home residents and for their family members. If he can’t talk frankly with you, his family member, with whom will he be able to “talk it out?”

Remember, encouraging discussion of difficult topics is one thing. Forcing a discussion is another. Some individuals may simply prefer not to talk. Perhaps they’ll be ready to talk at another time when it suits them better, or perhaps they will decline to talk at all. Our job is to listen for the signals, reopen the invitation from time to time in case feelings and needs have changed, and always respect the other person’s right to privacy.

Q: How can visits seem like they used to be at her home?

A:  Successful visiting is like any other social skill — it can be improved upon with a little bit of work and some practice. Consider these tips for better visiting:

• Plan ahead. You can help avoid the “duty” visit by remembering why you used to visit your relative before she became a resident. If you shared a passion for jigsaw puzzles, bring one along and help her get it started. If you’re both big readers, read aloud a chapter from a book each time you visit.
• Write letters for her, take her out to lunch and to the mall, or to get her hair done, meet her new friends, or brag about the kids — with report cards, photographs, school projects, and even videotapes to back you up!
• Ask your family member for a tour of the home. Don’t feel pressured to entertain; instead, if she’s able, let her be hostess to you.
• Don’t fear reminiscing. Gerontologists are showing that such “life review” is an important adjustment mechanism that helps elderly people put their situation into perspective and deal with lingering conflicts.
• Volunteer to help in the home’s group activities to get better acquainted.

Q: My kids can sometimes be a handful. Should I bring them on visits or will they just wear Dad out?

A:  Bring them. It’s easy to underestimate the importance of a connection between children and elder family members, but studies show that the relationship between grandparent and grandchild is second only to that of parent and child.

Q: Mom’s long-term care home is two towns over and I can’t always visit. Should I send mail?

A:  Few things can brighten a resident’s day more than receiving mail. Whether you use it to stay in touch with a family member between visits or to remember you can’t visit as often as you’d like, don’t ignore the therapeutic benefits of regular letters and notes to your family member.

Finding Help for You

Learn how to take care of yourself during this stressful time.

Q: Dad seems to be getting all the support he needs, but what about me? Where can I go for some encouragement and feedback?

A:  To the person responsible for caring for a family member, it may sometimes seem that there is no lack of support for the elderly, but very little support for the caregiver. Check out some of these resources for caregiver support:

Outside the long-term care home:

• Many local phone directories now include an index of “helpful numbers,” which may include a category for aging or elderly care. Look for provincial and local offices on aging, plus local programs sponsored by long-term care homes, hospitals or civic organizations.
• Watch the health section of your local newspaper and the community calendar. Visit the local library and talk to the librarian.

Inside the long-term care home:

• Talk with the long-term care home administrator, social workers and staff. They can often help you sort out and identify the conflicting emotions you may be experiencing, as well as provide some practical solutions for some of the more mundane problems you are facing.
• The long-term care home may also have a family association or Family Support Group that you could join.

Q: What is a Family Advisory Board/Family Council?

A:  A long-term care home Family Advisory Board/Family Council is, in effect, a consumer advocate group, comprised of relatives and friends of the centre’s residents. A typical group meets regularly at the centre, is run by the relatives and friends of the residents, and focuses its energies on several established goals and objectives.

Q: What is the purpose of Family Advisory Board/ Family Council?

A:  A Family Advisory Board/Family Council has two main goals: to protect and improve the quality of life in the long-term care home and within the long-term care system as a whole, and to give families a voice in decisions that affect them and the residents.

Q: I want to do more than simply visit my husband in his new home. Do long-term care homes ever need volunteers?

A:  Yes, long-term care home staff are usually delighted at the prospect of a new volunteer, especially one whose family member is a resident. Ask about participating in one of the various support groups the home may offer, like the Volunteer Group, Family Advisory Board, etc.

Issues Unique to Residents with Cognitive Impairment

Many people who live in our long-term care homes suffer from injuries or diseases that damage the brain. The damage might be temporary, or permanent. Either way, it usually means that the person’s ability to think and act is changed. In medical terms, this condition is referred to as “dementia,” or “cognitive impairment.” The resident is referred to as being “cognitively impaired.”

Sometimes people mistakenly refer to all forms of cognitive impairment as “Alzheimer’s disease.” However, the fact is that many illnesses and factors cause cognitive impairment in people. Alzheimer’s disease is only one of them. It’s important for all members of the long-term care home’s health care team — including families and friends — to understand that different people with different factors causing different types of cognitive impairment might need to be treated and helped in different ways.

Q: Every time I visit my mother-in-law, I seem to only confuse her further. What am I doing wrong and how can I avoid upsetting her by my visits?

A:  Visiting the cognitively impaired can be difficult for both emotional and practical reasons. Not only is it difficult to admit that your mother-in-law of 25 years doesn’t recognize you, but it’s quite a challenge to carry on a conversation with someone with poor, short-term memory. As your mother-in-law’s condition progresses, she will recognize fewer and fewer names and faces. The long-term care home will make every

effort to keep you informed of her needs, progress and condition through plan-of-care conferences, family informational meetings, and individual contacts, so you will not be caught unaware by deterioration in her behaviour.

In order to make your visits more pleasant for all involved, speak to staff about when might be the best time to plan your visit. If too much is going on — meals, special programs, therapies, etc.— it could disrupt your mother-in-law’s ability to enjoy your visit.

Q: I know interaction is supposed to be good for people with cognitive impairment, but I can’t hold my mother’s attention long enough to carry on a conversation. How can I get her to focus on me?

A:  First, find a quiet, non-distracting setting in which you can face your mother and she can observe your body language, facial expressions and mouth movements. Once you’re sure you have her attention, speak to your mother in a slow, calm manner, enunciating your words carefully. If she has difficulty understanding some particular phrase or word, rephrase it rather than keep repeating the original words over and over.

Most older persons like to talk about the “good old days,” but in the case of a person with cognitive impairment, that is often all they can talk about. Allow your mother to reminisce, but encourage interaction by tying in one of the facts stored safely in her long-term memory, like her childhood on a farm, into a more current topic, like your children’s field trip, for example.

Don’t expect a long attention span from your mother. Break up your conversations with short periods of rest. As soon as she indicates that she’s tired or distracted, bring the conversation to a close.

Visiting Policies and Trips Out of the Long-term Care Home

Q: Can I take Mom out occasionally?

A:  Yes. Residents are encouraged to go on outings as much as possible. Plan outings for your relative, especially on Sundays, holidays, family birthdays or anniversaries. If overnight outings are planned, check with your long-term care home regarding the policy on overnight stays.

Q: If I take Mom out, does she need to be back by a certain time?

A:  Not usually. However, the nursing staff needs to know when you are leaving and the estimated time of return. Medications may be given to you for your mother.

Clothing and Laundry

Q: What personal items should I pack for my wife?

A:  First ask your wife what clothes and special items she wants to bring. Then ask your long-term care home for its recommended clothing list and if your wife’s situation warrants additional items.

Q: Should I send Mom’s personal items and valuables with her?

A:  Ask your mother if she would be upset if an item was broken or lost. If the answer is “yes,” don’t send it. Leave expensive jewelery, cash, credit cards and valuable collector’s items at home. If, however, certain items carry great symbolic value — such as a wedding ring — look for creative options. For example, replace the valuable wedding ring with another ring that keeps the symbolism alive but that would not cause as much distress if it were lost. Or, bring the wedding ring with you so your mother can enjoy it for the duration of your visit.

Q: Is there someone in the long-term care home I can leave some cash with, so Dad will have money if he needs it?

A:  See the coordinator in the business office about setting up a trust account that your father can access to cover personal expenses.

Q: How will my wife’s clothing be laundered and how often?

A:  Find out how the laundry is handled on the floor your wife is assigned to. Make sure she has plenty of clothes to wear while her dirty clothes are being laundered. If she is incontinent, she may need additional clothes.

Q: How can I help keep Mom’s clothes from getting lost?

A:  In a place the size of a long-term care home responsible for laundering clothing and linens for scores of people, it can be challenge to keep everything straight. If possible, ensure clothing is labeled before your mother is admitted to the long-term care home. If you leave unlabelled clothing with us in a bag, make sure the resident’s name is attached to the bag. After admission, you’ll need to let the long-term care home know if additional items are brought in or removed. It won’t be long before staff members recognize her clothes themselves. Don’t panic if something turns up missing. First check to make sure it wasn’t taken home by another family member, then report the missing item to the staff.

Q: Can I do my husband’s laundry at home?

A:  Yes, but check with the long-term care home. Make sure there’s an adequate supply of clothes available to your husband while you’re laundering his dirty clothes at home. These clothing items must still be labeled in case they are ever laundered by the long-term care home staff.

Food and the Dining Experience

Q: Will Dad be made to eat food he doesn’t like?

A:  No, but the staff cannot be expected to know what those foods might be unless you or he tell them. The staff will try to encourage your father to try different foods, and will help him order and season his food the way he likes it as soon as they learn his preferences.  Many long-term care homes now offer two selections so that residents can choose what they feel like eating.

Q: Who will help my aunt eat?

A:  Everyone who needs assistance in eating receives it. Your aunt will be encouraged to feed herself if at all possible. Special equipment may be used to help her eat independently. If she is unable to do so, however, someone will help her. Family members are also encouraged to assist in feeding their loved ones.

Q: Can I stay to eat supper with Dad occasionally?

A:  Your dining with him will add to his pleasure. Each long-term care home has its own policies on guest meals and any other services the home might provide.

Q: I’d like to surprise my mother-in-law with some of her favourite foods occasionally. Is there any reason I can’t bring her treats occasionally?

A:  No, but discuss it with the staff first to make sure the item does not conflict with her diet. Each time you bring in an item, let the staff know. Also try to time your visits so that your mother-in-law can eat the item. The long-term care homes have strict regulations to follow on storing and refrigerating foods to keep them as safe as possible. If you bring in

something for her to keep in her room that can be stored at room temperature, also bring in an air-tight container to store it in (provided that the long-term care home’s policies allow this).

Providing Personal Care

Q: How fast will Mom’s call light be answered?

A:  The staff checks everyone on a regular basis, whether they need assistance or not. The staff would be aware of any problems your mother may be experiencing, for example shortness of breath while she’s fighting a cold. The staff does not rely solely on a resident’s signals for help.

Q: My uncle is supposed to take half a dozen pills at all different times of the day. Will someone make sure he keeps to his schedule?

A:  Yes, you can rest assured that medications are monitored strictly in the long-term care home, and that the medical, nursing and pharmacy staff is continually checking and double-checking medication schedules.

Q: How many people work a given shift? Is the weekend staff adequate? What is the staff-to-resident ratio?

A:  Staffing requirements are set by provincial and/or regional guidelines designed to provide enough staff for the appropriate care level at all times. Ask the director of care for the specific statistics for the long-term care home.

Q: Does the staff take everyone to group activities, or only those who express an interest? I know my mother-in-law would enjoy some of them, but I’m not sure she’ll think to ask.

A:  All residents able to attend activities will be encouraged to do so. In fact, the staff is required to have a personal plan of care for each resident that includes activities and programs. This plan of care will be personally tailored to your family member’s physical and cognitive abilities. If your mother-in-law wishes, you can attend care planning meetings, held regularly, and any group activities.

Q: Who will be taking my grandmother to the bathroom and how often? Will someone get her up at night or will she use a bedpan?

A:  The long-term care home maintains staffing 24 hours a day, seven days a week. Members of that staff will continually check on your grandmother to monitor bathroom needs. At night, and depending on her condition, your grandmother may choose the bathroom or prefer a bedpan to getting out of bed. Some residents, of course, will require a bedpan or other options to meet their needs safely and appropriately.

Dealing with Complaints

Q: How should I handle complaints?

A:  If your family member complains, remember:

• Never hastily dismiss a family member’s complaint. Even if the complaint appears petty or simply a way to register dissatisfaction with his new limitations, ignoring complaints will only further damage your relative’s morale.
• Try to really listen to what he is trying to say. Don’t prejudge the validity of the complaint, and pay particular attention to his nonverbal cues, such as body language, facial expressions, posture and gestures.
• If you do feel a complaint could be warranted, raise it with a staff member you’re comfortable dealing with. Lingering or more serious complaints should be taken up with the long-term care home’s administration. Most long-term care homes have a specific complaint procedure. If you’re uncertain, ask.
• Complaints may be channeled through the Family Advisory Board, or fill in the quality assurance card available at all of our long-term care home and mail it to the vice president of operations. Every complaint is acknowledged, investigated and acted on.

Financial Information

Q: What financial benefits are seniors entitled to?

A:  Canada Pension Plan (CPP):

• Monthly retirement pension for those who are 60+ and have contributed to CPP.
• Apply six months before retirement.
• Death benefits, spouses’ and orphans’ benefits available.
• CPP benefits are available if you are between the ages of 60-64. But, you will receive a lesser amount than you would if you had waited until 65.

Guaranteed Income Supplement (GIS)

• Monthly allowance added to Old Age Security.
• For low-income seniors.
• Based on combined marital or single income, and age.

Old Age Security (OAS)

• Apply six months before 65th birthday.
• Based on number of years of residence in Canada.

Spouse’s Allowance

• Monthly allowance for the spouse 60-64 years of age married to a pensioner receiving OAS.
• Based on combined income of the couple.

Widowed Spouse’s Allowance

• Monthly allowance to widow or widower 60-64 years of age with low income.