There’s no place like home
Q. Which do you endorse, in-home or facility care?
A. My objective is not to endorse, but to present information so each family can make the decision that is best for them. Would I rather spend my final days at home surrounded by family, or in a facility with care provided by a variety of professional caregivers? Of course, I (and research shows most people) would prefer home care; but that is not a viable option for everyone. Yes, I want to encourage families to choose home care when possible, because in my opinion, home care has many advantages. Here are some that are important to me.
Pleasant Environment: The other day, my two oldest granddaughters had just left (I teach them several home-school classes on Monday morning). I poured myself a second cup of tea while looking out the kitchen window. The rain had stopped; the sun was peeking out from fluffy clouds. I listened to the silence – what a beautiful sound. In a facility, the sound of silence is usually punctuated by routine and unavoidable noises: roommates snoring; bed alarms going off; too-loud television blaring from the room of the hard-of-hearing insomniac down the hall; residents calling out; staff performing their duties.
Some facilities have private rooms (at a cost), but most accommodations include a roommate. Inevitably, one prefers temperatures in the eighties, while the other insists she needs a continuous arctic-like blast from the air conditioner to make her comfortable. One wants the blinds wide open; the other prefers dimly lit settings. Then there’s the scenario of the “dueling televisions.” A small room with two televisions and two very different viewing choices is not just loud but chaotic. Another negative – facilities almost always have single-sized beds which can be a real adjustment for people who have been able to stretch out in larger beds at home…and plastic-covered mattresses – I don’t even want to go there.
Maintaining privacy and dignity: Some people have no problem with “strangers” providing care of the most personal kind. It is not unusual for a patient to have care provided by six or more aides in just a week’s time. I would be very uncomfortable, especially if the staff person bathing me or providing incontinent care was of the opposite sex. (That’s just me; I had some female patients who preferred having male caregivers!) While guidelines are in place to respect a resident’s privacy, it is impossible to achieve the degree of discretion in a facility that home care provides.
Preventing isolation: Even with regular (though not constant) supervision by staff and unlimited visiting hours, a facility can be a lonely place, especially at nighttime and on holidays. I remember embracing one of my patients as she sobbed uncontrollably, relating how her cherished belongings and life-long home were being sold at auction that day “to pay my bills here.” When a loved one is able to remain at home, the familiar surroundings provide a degree of comfort that is hard to attain in a facility.
Quality of care: Some people express the idea that their loved one can receive better care in a facility. That depends on the degree of skill needed and the willingness of the caregiver to learn. With appropriate training, family caregivers can take care of loved ones with feeding tubes, tracheostomies, and even those requiring dialysis. I have a cousin who provides dialysis care for her husband at home. Recently she shared with me what a precious experience this has been for her. Although I know many wonderful professional caregivers who provide extraordinary care, no one is going to love your family member as much as you do.