Monday 16 February 2015

Never is a very long time

A statement which always makes me feel shivery is

I would never put my parents in a home.

I've heard this so many times. Mainly, from people with healthy parents who are able to help them and not in any need to aid. Sometimes, and particularly when I was at work, from people who were now faced with managing a parent with complex needs. Sometimes, they would manage somehow and sometimes, they would have to sadly, and guiltily renege on a promise.

Should Christians ever allow their parents to go into a home? Is this ever right and should we promise our older family members that we will always prevent them entering a care home?

Of course, this statement assumes that the parent can't make that decision. As children, we can't dictate where parents live if they still have the ability (capacity) to make that choice.

What are the circumstances when it can be difficult to care for someone? These fall mainly into three groups.

Relating to the older relative: These difficulties are usually around issues such as wandering, aggressive behaviour, faecal incontinence, difficulties with transfers and hoisting, very high falls risk and difficulty with feeding. Some of these issues can be overcome with appropriate medical management but some will persist despite the best of intentions.

Relating to the younger relative: These difficulties often relate to poor health. Major health problems such as needing chemotherapy, severe depression or painful arthritis would make caring challenging in the extreme. A sick spouse or child may change a manageable situation into something impractical. There is good evidence that care givers have poorer health than the rest of the population and often fail to be able to make time to visit the doctor for themselves. 

Then the combination of the frailer person and the person providing care may just not work. There may be a personality clash or there may be the risk of elder abuse. Yes, none of us are exempt from this and there are going to be times when we are tempted to shout or worse. 

The Bible talks very clearly about our responsibility to older family members.

Honour thy father and thy mother.
Exodus 20 v12

If any widow have children or nephews, let them learn first to show piety at home, and to requite their parents: for that is good and acceptable before God. 
1 Timothy 5 v4

If any man or woman that believeth have widows, let them relieve them and let not the church  be charged; that it may relieve them that are widows indeed.
2 Timothy 5 v16

So, yes, we are responsible but there is nothing that says that we necessarily have to do all the hands on caring ourselves. The wife in Proverbs 31 had servants to help with her duties and we may need help with ours. For me, at present, that means that we have carers come into the house twice a day to help. Yes, I could do everything myself but it would be difficult to manage with my other responsibilities. 

For others, that means that an relative has to go into a home. I know about this from personal experience. My Mother was loving cared for at home by my Father and care workers but latterly, her health needs dictated that she was better being looked after in a high quality care home.

Why is it damaging to promise never to put someone into a home?

  • It can lead to broken promises.
  • It can lead to major guilt.
  • Making this promise, leads to placement in a care home happening in an emergency, often from hospital. Researching and finding a place in a high quality home most suitable for that person is difficult in this scenario. A thought out choice to go into a home means that time and care can be put into choosing and changes of care home are less likely to occur.
  • Sometimes, it can mean that someone struggles to provide adequate care as the amount or type or care needed is more than one person can provide.
  • It makes the assumption that once a parents is in a care home, the family is no longer involved. This need not, and should not, be the case. That would be reneging responsibility.
So please, think twice before making this statement. It isn't fair to yourself or your relative.

And yes, I have vested interests!  I currently look after my husband's Mother who lives with us. We hope that she will be able to live with us for the rest of her life but don't want to make promises we can't keep. My Mother was cared for beautifully in a Christian care home with nursing for the last years of her life. Although currently, I do not practice as a doctor, I worked as a consultant in Medicine for Older People for nine years until January 2011.

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  1. I agree. My grandma (mum's mum) lived with my parents for 8 years - they actually sold both houses and bought a bigger one together. My mum worked part time for some of it, but in the end was pretty much a full-time carer. Agency staff would come in every day to help (some more help than others!) but when it started to be all night as well as all day, Mum just couldn't provide Grandma with the care she needed. Plus being in a home doesn't mean you are then abandoned - she went to visit her nearly every day. I fully intend to do as much for my parents (and in-laws) as I can, but I will remember not to make those promises. I feel similar about all such statements, like I'd never send my children to school!

    1. Thank you. Yes, I think that there is a level of care which is really difficult to manage at home. Your Mum exemplifies how having someone in a home doesn't mean that all responsibility is given away.

  2. Thank you for sharing that. It really is something to ponder. At this time my parents are healthy and living in their house. My in-laws are in an apartment in a retirement community. My mother-in-law is getting to the point that she needs more care. It is a difficult situation.

    1. These decisions can be so difficult. I know here there can be complicated rules about the amount of care that is allowed in retirement communities. I don't know whether the same it true in the US?

  3. I would very much agree with what you say here. Whilst looking after elderly relatives at home may be seen as the ideal, there can be many reasons why it is not always possible or for the best for all involved.

    1. Sadly true but realising this does free up the ability to plan ahead perhaps for a Christian home.

  4. You are quite correct. Some care cannot be provided at home, and at a certain point the caregiver may be unable to continue what used to be possible. We never know how God will lead our lives, but we can trust that he will be with us when we need to make difficult decisions.

    Another option is respite care. Sometimes, if the caregiver is no longer able to cope, having some time off each week, for example, may just make the difference.

    1. I agree about respite although sometimes the process of arranging respite or having to arrange the transport to get to the respite care can be so stressful that it almost negates the beneficial effects of a break. Last summer, the respite for our family holiday was only confirmed on the afternoon before we were due to go. We had to make contingency plans about leaving someone behind to care. Our experience certainly isn't a one off!