Nursing Homes: Are Your Expectations Realistic?

Making the decision to place an elder in a nursing home is one of the most grueling decisions many adult children have to make. Ideally, we'd always be able to take care of "our own" for the duration of their lives. However, life is often not ideal.

My mother was in her own apartment for a number of years after my Dad had entered a nearby nursing home. There wasn't even an option for us to care for Dad at their apartment or at my house. He'd had brain surgery that, for all practical purposes, destroyed his brain, and the kind of care he needed was physically impossible for us to handle in a home.

Dad's needs were so extensive, with his poor delusional brain causing such misery for him, that the first days and weeks of his nursing home experience were as difficult for me as it would have been leaving a small child in someone else's care. I rarely compare an elder to a child. As a matter of fact, it's something I generally find demeaning to the elder. But the vulnerability of each is comparable, so sometimes it's nearly an unavoidable comparison.

Dad was so vulnerable to those who cared for him that I trusted no one. Only when I was with him, struggling to figure out how to help him find some sort of contentment, could I feel I was doing what was needed for him. I was his daughter and some days I had trouble getting into his brain and figuring out his off-the-wall needs - how could a stressed nurse or CNA with so many to care for do that?

Painful as it was, I gradually had to let go of my expectations of perfect care and accept a realistic way to care for Dad. That meant I couldn't be with him day and night. I had four other elders who needed me, plus a family at home, including a son with multiple health problems.

I also needed to accept that even I couldn't always get him to a place of contentment, no matter how hard I tried. Gradually, a pattern developed with the nursing home staff and our visits. I took my mother there everyday, and we visited Dad (and my uncle who had a stroke and was there at the same time). I also visited Dad alone. I did everything I could to help him feel complete.

As is normal in any atmosphere (even families) there were certain staff members who were better with Dad than others. Sometimes it was just a matter of swiftness of movement, tone of voice or tendency to smile (or not). However, there was one CNA, Sandy, who was so good with Dad that often when I had to leave, teary because I couldn't settle him down myself, I'd know in my heart it would be okay because Sandy was there. She knew as well as anyone how to cope with Dad during his most difficult times. I had to let go of ego and expectations of myself, do my best and leave the rest to Sandy.

There were days when I had to leave Dad and I knew the person on that shift didn't really "get" him. The person was good at her job, but it wasn't what I wanted. I wanted Dad to be content with the personality of his caregiver. Yet, I had to leave. I knew Dad was well cared for even if he didn't have his favorite person all the time.

We, as caregivers, can't always do everything our elders want. We can't fix them and we can't even keep them constantly content. That doesn't mean we're bad caregivers. We have to remember that the same goes for caregivers in a nursing home.

We are part of the care team when we have an elder in a good nursing home (if this isn't allowed, find another home), but we have our elders there because we can't, alone, provide for their needs. How, then, can we expect that they will be always happy and joyous when they are in a nursing home? They will have good days and bad days. They will have favorite caregivers and some they don't like as much. That is reality.

I'm not talking about abuse or neglect issues. That's a whole different topic. I'm just talking about expectations about a decent facility and reality. Whether we care for an elder in our home or in a nursing home, there will be limitations on what can be provided. We'd all love to have one-on-one care for our elders in a nursing home - or at home for that matter - but unless you are wealthy enough to hire a private care nurse, that isn't going to happen. So, reality is what you are working with. We need to make reality as good as we can, and accept it as that.

All in all, if your elder is in a home that strives to be resident centered; one that is staffed as well as can be expected; one that has a knack for hiring good people who like their jobs, then you and your elders are fortunate. Even then, you are the advocate and you need to be available. You need to keep any eye on things and make sure that your elder is truly getting the care he deserves. However, accepting reality will go a long way toward your feeling peace. And if you feel peace, that will carry over to your elder.

Keep your eyes open for good and not so good care. Reward good staff with your friendship and assistance (and maybe even a holiday gift). Let them know you respect them and that you are willing and able to be part of the team.

Make your presence known in a non-aggressive manner. If all goes well, your elder will receive good care. Not one-on-one care, but good care. If you don't eventually find a comfort level with that care that is provided, maybe there is something wrong with the facility. But first, examine your expectations. See if you are being realistic about what the home and you together can provide. If you are lucky, together you'll provide good enough care so your loved one will find a reasonable amount of contentment.

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Carol Bradley Bursack
Meet Our Writer
Carol Bradley Bursack

Carol Bradley Bursack is a veteran family caregiver who spent more than two decades caring for a total of seven elders. This experience provided her with her foundation upon which she built her reputation as a columnist, author, blogger, and consultant. Carol is as passionate about supporting caregivers work through the diverse challenges in their often confusing role as she is about preserving the dignity of the person needing care. Find out much more about Carol at