By Amy Hoover Tuso

I met my husband in 10^th grade. We became instant friends and dated for seven years before getting married. During those years we made many plans, as all couples do. We had visions of our future together and leaned towards not having children. As the years rolled by and our life fell into place, we mutually decided that we would not become parents. We loved the life we were building, just the two of us, in our very private family union. Sure, we had our extended families. Grandparents, aunts and uncles, parents, siblings, but we were each others’ family.

And then one day life took over.

It happens to all of us. Death in the family. A remaining spouse without their life partner now, all of a sudden, in major need. At the time this occurred in my life, I thought my mother would take care of her mother…after all, she was next in line. 

Up to that point in time I thought my mother was stronger than she was. She had been projecting a front that was not real. She was emotionally unable to take the reins to do what was necessary, to care for herself and her mother, and so she leaned on me. 

On that day, I became a parent to my grandmother, who was well into her eighties, along with my mother, who was in her late fifties. Bam…the birth of two older children at the same time! All of a sudden, I had to step up to the plate and start parenting.

I am blessed with a major “common sense” gene. Although emotion plays a huge role in my life, common sense trumps emotion in many circumstances. When it became obvious that grandmom could no longer live alone in her apartment at the senior citizens complex (her mind was starting to imagine all sorts of different things, not all of which were rational), the next logical place for her to be was in a nursing home. It was a difficult and emotional choice, but the only realistic solution for our family. My mother was still working as a teacher and my husband and I had a business to run. Grandmom could not be left alone for any period of time and we could not afford to hire live-in help. 

As the story goes, my mother literally was unable to tell my grandmother that we were placing her in a nursing home (or as grandmom called it, “the nursery”). Mom just couldn’t handle it emotionally. Guilt and fear crippled her, and therefore I was the one who would have to talk with my grandmother about this.

I discovered that securing a room in a nursing home meant that many aspects and details needed to be researched, planned, and followed through. Up to that point in time, I had absolutely no experience in this aspect of caregiving. The road map that I followed was one of trial and error, but my “common sense” gene did most of the directing. Logic took over and a pathway emerged. 

First, there was finding an acceptable facility. I placed phone calls to the nursing homes in our general area asking if they were accepting new residents and quickly found that gaining entry into a nursing home would be a lengthy endeavor. The patient’s physician can help greatly in this regard. Entry into a home may be easier and faster if the physician documents the need for constant care of the patient. When we realized this, we immediately set up a phone appointment with grandmom’s doctor to discuss the situation. Getting the physician involved is also helpful because the staff physician will become the resident’s primary care provider within the facility. Your primary care doctor (or your loved one’s primary care doctor) can help you ask the right questions of the nursing home’s doctor, and ensure that your loved will be taken care of properly. The staff physician will work with the admitting physician (your loved one’s primary care physician) during the stay at the home, or if future hospitalization is necessary.

I made unannounced visits to the nursing homes that I was considering. During these visits I would pay close attention to how the building smelled. I noticed if the lobby, dining room, and hallways were clean. As I walked down hallways, I looked into the rooms I passed, noting their cleanliness along with noticing where the patient was within the room. Was the patient asleep in their chair/wheelchair without any means of getting to their bed? Could there possibly be neglect implied by the surroundings? At the nurses’ stations I looked for order as well as smiles on their faces and within their voices. If a patient was being spoken to by an attendant, I paid close attention to the interaction and reaction of the patient. I inquired about special services available to the residents, such as hair salons, music rooms, laundry services, and exercise and physical therapy departments. I walked around the grounds and saw for myself if there were nice sitting areas with cheerful plantings and shade available. 

After visiting the homes, it became apparent which one I would choose. The next step was setting up an appointment with the administrator. I inquired about what documents would be needed during our visit and found that financial, insurance, health records and power of attorney were vital. During my scheduled visit, I asked questions about the staff, attendants, special programs offered to the residents, meal schedules, visiting hours, and more. I was also taken on a tour of the facility. 

There was a waiting list for the nursing home and during that time grandmom became ill and was briefly hospitalized. As hospitals have a Social Service Department, I inquired about obtaining their help in placing grandmom into the nursing home upon her hospital discharge. They were able to make that arrangement happen. Next came the hardest part of this new life plan…telling grandmom she was moving into the nursing home. 

The day prior to the arranged discharge from the hospital and move into the nursing home I spoke with her about the new plan. I can remember holding her hand as we spoke quietly and she began to cry softly. I assured her that we were not “dumping” her somewhere to be forgotten. I told her that either mom or I planned to visit every day. By rotating our visits, it would allow us personal time. We also planned on doing her laundry for her instead of using the central nursing home laundry because of her skin sensitivities. I told her that we had set up her room with her favorite pictures and personal things, and that we had gotten her a beautiful rose print quilt set for her bed. I described the gazebo and told her that I looked forward to sharing many visits sitting with her there amongst the flower boxes. I promised her that she would not be lonely or afraid while gently reminding her of the difficulties she had been having with living alone which made this move a necessity for her safety.

That discussion was difficult to approach, no doubt, but isn’t all parenting difficult? I have found that when life places me in an uncomfortable position and I have to become the bridge of transition, the facilitator, as long as I approach the situation with honesty, respect, dignity, and love, anything is possible. I can remember holding my grandmother that day, slowly rocking her…or was it she who was comforting me?

The following day, she was transported to the nursing home by ambulance from the hospital. My mother and I arrived prior to grandmom and tried to help her acclimate to her new surroundings in the best way we knew how. 

During the next few years I upheld the promises I made to my grandmother. My mother and I visited on a regular basis. We would bring bouquets of flowers, her favorite cookies, and fresh laundry. We would visit out on the gazebo in the fresh air, under blue skies, and talk about wonderful memories. We made sure that her needs were taken care of, not just daily physical needs, but emotional needs as well. We would laugh and cry together and sometimes just hug each other. And when time took more and more of its toll on her, we would massage her favorite lotion onto her face and arms, easing away the tension. 

I did find it important to continue making unannounced visits at the nursing home, changing my timing so the staff wasn’t always sure of when I would be dropping by. Although I never witnessed any real neglect, there would be times that it was apparent everything was not being done in a timely manner. I would report such findings without hesitation to administration and follow up to see if changes were being implemented. It was vital to be my grandmother’s patient advocate. Medicare does have an ombudsman who checks with the patient, but there are times that what the patient is saying may not be reliable. It was at those times, I was able to be her voice.

The experience of having to place a loved one in a nursing home evokes deep emotions.  Guilt, fear, sadness, helplessness, worry…these are only a few of the emotions that I experienced. It turned out there was much happiness as well. Some feelings I am unable to put a name on, but the one emotion that was always there, was love.