Deciding when to opt for home care

My mother has been living in a skilled nursing facility for the last six months. She is on oxygen, confined to a wheelchair, and in need of 24-hour care. Despite her physical problems, she is as sharp as a tack mentally and continually asks my brother and me when she can return to living with him. He is open to the idea, however, I agree with my mother’s physician and think she should stay in the nursing facility where she receives good care. Who is right?

This is a difficult situation, but the question shouldn’t be “who is right?” but rather “what’s right for mom?” It seems like each person involved with your mother’s care, you, your brother, her physician, wants what is best for her. This is a great start, but your mother’s voice should resound above all others. As a competent individual, she has the right to determine where she lives.

It’s great that your mother is receiving good care at the nursing facility. But, what if that same level of care could be offered in the community, i.e., your brother’s house? Your mother would receive the care she needs and would be living where she clearly wants to live. Fortunately, there are many services available today that may allow your mother to live at home. In fact, depending on her physical limitations, she may qualify for up to 24-hour care in the home.

Listen to your mother’s request, but make sure that you and your brother are realistic about what would be expected of you if your mother were able to come home. No matter the amount of outside services that she might receive, the informal or family caregiver is an essential part of most home care situations. Do you or your brother have the time and energy to help prepare meals for your mother, assist with bathing, and do her laundry? Can you assume responsibility to take her to regular doctors’ appointments? These are just a few of the questions that you should ask yourselves. Individuals dealing with disabling conditions need the help of both professional services and family caregivers to remain at home.

You mentioned your mother’s physician. A physician should approve of the transition from a nursing facility to home. Physician approval is required if your mother’s home care services will be reimbursed by Medicare. Payment regulations aside, your mother’s doctor should have confidence that she can live safely at home. Physicians, like all of us, have seen a major shift in the past 10 years from nursing home placements to more community-based care. You and your brother may have to educate your mother’s physician about the breadth of care options now available in the community setting. If he or she is still resistant to home care services, you should seek a second opinion from a physician who regularly treats elders and/or adults with disabling conditions who live in community settings.

The idea of transitioning your mother from a nursing facility to home is a complex subject that needs to involve many people, most important of whom is your mother. You and your brother need to recognize the responsibilities that will be placed on you. Social workers and nurses from the nursing facility should be consulted. Elder care advisors from agencies like Mystic Valley Elder Services (MVES) are available to offer suggestions and detail home care services. Physicians, as mentioned, play an integral part in the conversation. With all parties discussing your mother’s wishes and capabilities, she will likely find the setting most suitable for her while meeting the very real needs and wishes of the caregivers. 

Are you in a dilemma caring for an aging family member? Talk to an MVES elder care advisor by calling 781-324-7705.

Do you have a question? Write to Dan O'Leary, Attn: Q&A, Mystic Valley Elder Services, 300 Commercial St., #19, Malden, MA 02148 or send an e-mail to questions@mves.org.