The Emotions Involved in Choosing Long-Term Care

Dr. Patrick O'Shea

Last yearLiving Longer, Living Better

A walk through the health care system

This yearHow to know when the time is right to accept

Long-Term Care

Emotions you will experience when making that decision

"Long-Term Care"Nursing Home, Assisted Living, Personal Care

Home

Anywhere outside your home

My own experiencesplus a book:

"Living Well in a Nursing Home"

by Lynn Nickerson and Xenia Rosen

WHY DO WE DREAD THE THOUGHT?old memories of "poor houses"

poor people, ones with no families

most people looked after at home by family

"Good" sons and daughters wouldn't put their

parents away

Nursing Homes are institutionseasy to criticize

not all equal

Why greater need for Long-Term Care?societal changes

People Live LongerIn 1900 the life expectancy was 47

Now it is late 80's

Less Deaths from Pneumonia, Fractured Hips,

Heart Disease

Familiesmore mobile, not all relatives in same village

not as many children

Women's roles have changednot as available for caregiver role

Expectations are that our children will most likely NOT look after us in our own homes

If you live long enough, almost all of us will need Long-Term Care

TWO OVERALL ASSUMPTIONS1) You are responsible for your OWN level of

happiness

You are not responsible for the happiness of your spouse, parents or children and they are not responsible for your happiness

2) In your relationships with your loved ones, you

would prefer to be a "Love-Giver" and not just a "Care-Giver"

"Care-Giver" - attends to a person's physical and

comfort needs

"Love-Giver" - attends to emotional and relationship needs

Roles are not mutually exclusive

- it can be an act of love to be a care-giver

Danger in exhausting oneself being a "care-giver"

and have nothing left for the important task of

"love-giving"

Sometimes better to delegate care-giver tasks and

use your energy for the love-giver role

DECISION TO ACCEPT LONG-TERM CAREnot a lot of planning - sudden change

prefer not to think of need

we plan for the other significant changes

- wedding, buying a house, changing jobs

Change can be stressfulHow much stress depends on:expect or surprise

viewed as "good" or "bad"

how much control we have over change

how much support we have from others

Shakespeare: "There is no thing either good or bad, but thinking makes it so"

A lot of stress from change is in our minds

Positive outlook can help

Is the glass half-empty or half-full?

Long-Term Care is big businessexpansion in last 40 yearsmany new models, more choices

For many, accepting long-term care may be the BEST choice

CAN YOU STAY AT HOME?Depends on:medical condition

strain on people at home

need for community

economics

Medical ConditionDiagnosis?

Around the clock care?

Equipment needed?

Strain on peoplespouse, children - what support do you have?

energy level of people at home

Need for CommunityAmount of social support each person needs is

variable

Participation in community gives sense of belonging, importance, meaning

No one person can fulfill all social needs of another

Many situations at home are akin to solitary confinement

Economicsservices not covered by MCP or insurance

home care workers around the clock? - $16/hr = $384 a day or $2,688 per week

nursing home = $3,500 a month

EMOTIONSfeelings can be difficult to understand

CONFUSIONabout what to do - many conflicting options and

opinion

DESPAIRif no matter what you do, someone will be unhappy

no obvious "best" choice

many need to get counseling with someone outside the situation to avoid depression

HELPLESSNESSif offer of help is rejected; common in dementia

issues

HURTfrom rejection of help, lack of appreciation

WORRYcan make you depressed, diminish your energy

many need counseling, exercise, meditation

ANGERis common - at God, at doctors, at patient, at family

needs to be handled carefully - can be destructive

LONELINESS

RELIEFperfectly normal and natural reaction to resolution of

a stressful situation

GUILTcombination of shame and regret

many of us feel guilty even if we haven't done anything wrong

we aren't responsible for the happiness of others - it's up to themselves

SADNESSinevitable

acknowledge your sadness, cry, feel the pain

it will pass

RESENTMENTfrom patient, from family members

frequently suppressed - can lead to anger and depression

needs to be expressed in controlled manner

Sorting out emotions can be difficult

Usually a combination of several contradictory feelings

Everyone's emotional soup is unique

SummaryIt is difficult to make the decision to accept

Long-Term Care

Planning can make it easier

Be a love-giver, not just a care-giver

If emotions are overwhelming, get help