Facing the Dreaded, Unavoidable Decisions

I remember once reassuring myself life would get easier as I gathered wisdom and experience along my unique journey. However, it seems the stronger and more equipped I feel, the more challenges I am thrown; typically from external sources, which tug at my heart strings.

Sensing the feeling of powerlessness and sadness emanating from an elderly, unwell loved one, who recently entered their twilight years in residential aged care, is heartbreaking, especially when it wasn't their preference. For the sake of their health, safety and 24 hour care at the touch of a button, the powers of attorney in the family pulled rank.

Hundreds of thousands of families have had, are having or will face similar experiences revolving around this difficult and highly emotional stage of life. Whether it's a son or daughter, a spouse, another relative or a primary care giver, it is typically not an easy road to tackle, especially for the elderly.

Ageing is inevitable - if we're fortune to experience it. As our bodies endure and accumulate years of impressive, repetitive mechanics, issues of wear and tear naturally make themselves known through health disturbances such as, deterioration, pain, weaknesses and declining mobility. Add prolonged injuries, incurable illnesses or disorders affecting the brain, sooner or later a degree of assistance is required. That's when difficult, unavoidable decisions need to be addressed.

There are definitely many benefits for the elderly to remain at home, especially a home which holds a lifetime of precious memories. Maintaining independence and staying connected to the community and favoured social groups is vital for the well-being of the aged.

Government subsidised home care packages are available through the approval of the Aged Care Assessment Team (ACAT) for people experiencing difficutly managing at home, although there is a considerable waiting list. Assistance can be temporary or long term and may include such help as personalised care or maintaining a cleanliness inside and around the home. 

There are four levels of home care, which provide a diverse range of services depending on the assistance required. As the elderlies' needs increase, ongoing assessments determine the necessary care to remain at home, while a higher level of the home care package is put into place.

However, while families typically help out as much as possible, eventually they may experience the dreaded, confronting realisation their ageing relative can no longer live alone - often after another stint in hospital. Once their loved one is unsteady on their feet - even while using a walking aid - falling is too great a risk. They may become increasingly forgetful and leave the cooktop turned on placing themselves in a dangerous situation, or they may simply forget to eat. Undeniably, sadly, 24 hour care is necessary, but how does one convey that to the person in question?

The family's recognition and voicing of the signs of failing health and emerging fragility may not be acknowledged by a loved one desperately attempting to hang onto their independence and familiar surroundings. Conflict and mistrust toward their family along with a feeling of uncertainty, can further cloud their troubled mind if they're already quite confused. 

Professional, objective voices from doctors or the like, can help to convince the frail of their increasing, higher needs. Every situation is, of course, different with individual health, personal, family and financial circumstances. An appropriate, mindful, approach is warranted.

Sarah from Leongatha claimed, "My mum passed a couple of years ago and dad is fairly new to residential care and realises it is the safest option. He accepts his fate, grateful to have assistance at hand and to no longer feel a burden to myself and my siblings, which, of course, he never was. In fact, he enjoys family visits more as quality time now and loves us to take him on outings. Emotionally I was a mess for a while, but I'm getting used to the idea of him being in the best place he could be. I still find it hard to be inside our family home, which we're preparing to sell. There are so many wonderful memories."

Tom, a retired, new resident of Venus Bay shared, "My father died suddenly at a young age. My mother never looked at another man again and managed to raise five kids on her own. She was fiercely independent. I was the only son and when it was obvious she couldn't look after herself anymore, it was my responsibility to place her into residential care, as my sisters conveniently all ran for the hills! My mother blamed me for the transition. She was so angry, she didn't speak to me for six months, even though I visited her every second evening after I finished work. She would sit in silence as I attempted to have a conversation with her. I'll never forget it."

Sharon from Korumburra voiced, "My mother desperately needs to enter residential care, but she's so stubborn. I managed to convince her to go into respite at one of the local facilities for a couple of weeks after a minor operation. A permanent room became available during her stay and I frantically completed all the necessary paperwork involved. But no, she was adamant she would return home, which she did. She won't even accept home care! She's an endless worry on my mind when I'm not with her. I just can't be with her all the time."

Managing the legal and financial issues involved in gaining a place in a residential care establishment can be complex and bewildering. Actually physically moving an elderly relative into a facility, even more overwhelming. There is a significant, emotional process during the transition for the new resident as well as their family. 

Taking responsibility and control for another, albeit keeping them in the loop each step of the way, is an enormous amount of pressure, especially when the tables are turned. Making the best decisions regarding a parent's health and finances, for example, feels odd. It's like parenting the parent and feels completely wrong.

Besides family members commonly experiencing flashbacks of childhood memories, a combination of emotions are often evoked such as guilt, fear, denial, sadness and lingering self-doubt. I remember reassuring my loved on many occasions, "I will never place you into a nursing home." In family dynamics one person typically takes on the responsibility of care. Often it is the female, but not always.

It's imperative for all involved to find their own way to cope with the transition by incorporating strategies that build resilience and maintain well-being. The elderly are required to rebuild their perception of a "new home"; to turn it into a place of meaning. It's a big ask when often they experience feelings of anxiety, confusion, hopelessness, depression, loneliness and a loss of identity once they've moved into residential care.

Validating loved ones' feelings is a good start. Supporting them through the orientation of their new home, and reassuring them their health needs will be met, offers some comfort. Decorating their room with much-loved personal belongings promotes familiarity. Regular visits from family members play an important role in nurturing elderly relatives' emotional health.

Once a loved one has moved into a residential aged care facility, it's helpful to get to know the staff, the program and its limitations. Familiarising yourself with the practices and sharing quirky habits and routines your relative followed in their own home is beneficial. A diverse range of organised activities and entertainment play a major role in the aged care program led by creative teams. These pursuits are customised to suit lifestyle and leisure preferences, including individual skillsets and awareness levels.

Residents are encouraged to find purpose within their new surroundings through feeling they belong to a group, working towards goals, challenging their minds, being creative, remaining as fit and healthy as possible, having fun and being of service to others. They are also supported to continue to follow their religion of preference if they so wish. The individual and their needs is the focus of their care. 

However, whether a loved one wishes to partake in any of these activities is entirely up to them. Some elderly have no desire to socialise in groups, particularly newcomers, who benefit from compassion and understanding during the weeks, sometimes months, of acclimatisation. 

As I sat with my frailing mother in her new, somewhat clinical, but lovely accommodation overlooking a garden, I silently questioned how we ever got to this point. I never expected to. We sipped our lattes I brought with me from the local bakery and suddenly the sound of a flock of birds interrupted our conversation. We watched them through the window as they playfully darted from the roof down and around the shrubs. I had placed a bird bath and seeds in front of mum's window when she first moved into the facility, to entice the feathered critters. Mum always loved watching birds.

"They are homemade birds," my mother said. 

"Really?" I answered.

"Yes, they are made here," she claimed.

I smiled in acknowledgement.

This ageing woman in front of me was once the backbone of our family unit - strong, resilient and competent - while my father worked tirelessly to finance us. Mum managed the whole operation ... and what an amazing cook and baker she once was! 

"It's nice here, but it's not home. I wish I could go home. Maybe when I'm feeling a little better, I can," mum voiced.

"You'll need to be much healthier and more mobile," I replied. "I have to go now, mum. I'll come back again soon."

"Please can I come with you?" mum asked with a sincere, hopeful expression.

"No mum, I'm sorry. I have to go to work now," I answered as my heart broke into a million pieces - again.

I hugged her goodbye and left the room as I felt her eyes following me. I turned around in the open doorway for a quick wave, but she was already somberly staring out the window.

I pray this gets easier ...