Entering a nursing home is not only stressful for the resident, but for those close to her as well. Just as your loved one must work to build new structure into her life, you as a caregiver must work to build new routines into your changing relationship. The trick here is to find a set of routines that works for both of you-routines that keep you connected but still allow you to live independent lives. Here's what you'll need to know.
Unlike hospitals, most nursing homes have no set visiting schedule-family members can come and go as they please and stay as long as they wish. However, as you'll soon discover, each nursing home has its own unique rhythm, and residents' schedules tend to be quite full. Yes, your visit will usually get priority, but be prepared for a few glitches early on: If your arrival coincides with that of the physical therapist, you're going to find yourself cooling your heels until the therapy session is over. Until you get into the swing of things, you may feel as if you're forever showing up at an awkward moment.
The rhythm of the nursing home
Nursing homes have fairly regimented schedules. Residents must be washed, dressed, and ready for meals at specific times (many residents have to eat at a particular hour to accommodate a medication regimen). Therapy sessions and group activities can be hard to reschedule on short notice. Outside consultants generally arrive during standard business hours; most off-grounds trips take place during the daytime as well.
To a surprising degree, the nursing home day is defined by the staff's shift changes, which usually take place at 7:00 AM, 3:00 PM, and 11:00 PM. The half-hour periods right before and right after those times tend to be pretty hectic--people are leaving, coming, and settling into their work routine. Shift changes can be difficult for some residents as well, especially those who are disoriented or confused.
Bedtime in nursing homes is earlier than you think. For many residents, bedtime rituals begin soon after the dinner dishes are cleared. Evenings tend to be quiet, although a few activities may be held quite late, to accommodate night-owls with disrupted sleep patterns. (Most of us sleep less as we age, and the average seventy-year-old sleeps only six hours per night.)
Timing of visits
New residents' schedules are established within the first day or two and fine-tuned as staff get to know the person better. Most facilities give residents printed copies of their schedules as soon as they're available, to help them adjust to the new routines. To time your visits correctly, learn the schedule. Figure out when your loved one will have some "down time" (late mornings, late afternoons, and early evenings are good bets). Whenever possible, avoid visiting when hard-to-reschedule events are taking place, like bathing or therapy.
During the initial settling-in period, it's best if you avoid interrupting activities that help the resident connect with new neighbors. You might enjoy meeting Mom's roommate, but don't let your presence distract from the roommate's account of her beagle's life story-this might be an important opportunity for the two of them to bond.
While some people delight in "surprising" their loved ones, the planned visit is usually far more appreciated by residents and staff. Residents like knowing when you'll be there, so they can look forward to your visit and plan around it. (Besides, the joke's on you if your arrival coincides with a roommate's enema.)
Length of visits
This should be determined by the resident's mood and attention span. If things seem to be going well, stay longer. If not, leave sooner. If you can't tell how things are going, err on the side of brevity. Shorter, more frequent visits tend to be better than fewer, longer ones, especially for confused or demented residents. If your schedule permits, you might find that popping in for a few minutes once or twice a day-perhaps on your way to and from work-is better than spending all day Sunday with your loved one.
It's easy to forget that when you're visiting, your loved one is your "host"-she might not feel comfortable telling you to leave. Don't wait for her to tell you she's tired or that your arrival coincided with her hairdressing appointment. Instead, watch carefully: She'll let you know in her own, subtle way. (Many people clam up or become a bit vague in their answers, hoping you'll take the hint and scram.)
Who should go?
Everyone who wants to visit should do so, but not all at once. While nursing homes almost always have parlors, gardens, and lounges available, many folks like to meet with visitors in "their" space. If your loved one has a private room, there's no problem. But if he's sharing a room with two other men, and they all have company at the same time, you'll soon reach standing-room-only capacity. If possible, spread visits out-you go one day, your brother goes the next day, and so on. Special occasions may warrant getting the whole gang together, but only if the resident can tolerate a crowd.
People sometimes wonder if children should visit loved ones in nursing homes. It depends on two things: the age of the child and the condition of the resident. Generally, infants and toddlers seem comfortable in nursing homes. Slightly older children may be frightened or confused by some of the sights and sounds. If your loved one's health and appearance have taken a significant turn for the worse, consider carefully whether it's appropriate for a young child to see him. Sometimes it's kinder to let children hang on to their memories of a healthy, vigorous grandparent rather than introducing them to harsh reality.
Older children who visited the resident at home can-and should-continue to visit after the resident moves to the facility, but they should hold off on visiting when they are ill. Nursing facilities almost always have some residents with impaired immune systems, and visitors with upper respiratory infections may be banned during flu season. Remember, too, that children tend to absorb a lot of visitor and staff attention. If your loved one is feeling a bit needy himself, he might not be happy about sharing the limelight with someone far cuter, even if he doesn't say so directly. Other residents sometimes resent the noise and activity children can generate. Some residents may become snippy around high-energy kids; other residents (especially confused ones) become agitated and fretful. Keep in mind that you are the visitor here: If your presence is upsetting other residents, you owe it to them to quiet things down or leave. Wouldn't you want others to do the same for your loved one?
What should you do?
Pretty much what you'd do at home. If you used to spend time chatting or watching TV, just pick up where you left off. Eat lunch or dinner together. If you're not sure what to do, take this opportunity to develop some new common interests. Play chess or cards. Put a jigsaw puzzle together. Or try bird-watching in the garden, reading aloud, or strolling around the grounds-whatever feels comfortable.
Two activities bring with them special concerns. For both of these, think before you act:
Focusing on the past.
Reminiscing about the "good old days" can be a way of renewing longstanding bonds, but it may also deepen your loved one's sense of longing for things that once were but can never be again. If you know from experience that talking about your grandmother gets mom upset, don't do it unless it's absolutely necessary. On the other hand, if your mother finds joy in thinking about her mother, by all means, talk about her. (An important caveat: If your loved one is suffering from an advanced dementia, she may have difficulty separating past from present. This is generally not a problem for her, so try not to let it upset you. Correcting her errors isn't helpful-she's not going to "get it" no matter how hard you try. Just listen, nod, and gently steer the conversation elsewhere.)
Sharing bad news.
Your husband needs surgery, your daughter failed math, and on top of all that, the cat has worms. You might be tempted to shield your loved one from bad news, but unless there's a compelling reason to do so, it's better to be honest. You needn't dwell on troubles, but neither should you hide them. Admission to a nursing home shouldn't deprive people of the right to be involved in their loved ones' lives, in good times or bad. Besides, if you're sad or irritable over problems at work, your loved one might assume you're angry with her if you leave her in the dark.