Longevity, brought on by advances in medical science, allow more people to live longer lives. However, at some point, many of us will require help with basic activities of daily living or even supervision due to memory conditions like Alzheimer’s and dementia. Often no advance plan was put into place, and the family must step in. This support from family and friends places physical and emotional burdens on them. It can even create financial burdens, as adult children and their spouses must take time off from work to help care for a loved one. This means they might move to a facility that provides many or all of the long-term care services they need. The transition can be difficult for both the person making the move and their loved ones.
Approximately half of adults with dementia reside in nursing homes or assisted living facilities,1 and approximately 70% of Americans with dementia will die in a nursing home2. Whether the need for a facility is supervision or help with activities of daily living, the need to find solutions for a better transition is just as important as how it will be paid for and the impact of a family’s assets.
“It is very important, even critical, for these patients to have familiar and emotionally meaningful items surrounding them in their rooms. Photos of loved ones, mementos of happy times, and other items with which they have a positive emotional connection really go a long way towards improving the quality of their day-to-day life while living in a nursing facility.”Dr. Thomas Schweinberg
Dr. Schweinberg serves as the staff neuropsychologist for the Lindner Center of HOPE in Mason, Ohio just outside Cincinnati lindnercenterofhope.org Schweinberg has not only worked with nursing home residents but also has had had several close family members who resided in long-term nursing facilities.
He says the unfamiliar surroundings of a Long-Term Care facility can be made to feel more like home, which gives the person more connection to their past life in order to ease the transition.
“This can be particularly true for those patients with dementia. With dementia, patients can become all the more disoriented, and perhaps even upset, by the unfamiliar surroundings and people. However, even those with dementia often have their long-term memories firmly intact. Having visual reminders of their previous lives can be very reassuring for them and can help to keep them grounded and rooted in who they are and what their lives have been about even if their current circumstances are confusing and unfamiliar.”Dr. Schweinberg
Photos and other mementos says Schweinberg, and the memories that they evoke can be psychologically therapeutic. The result is a more positive mood and outlook for an elder family member.
One type of therapy that is used is called Reminiscence Therapy. Reminiscence Therapy, explains Schweinberg, is based on the notion of being able to recall and talk about memories.
“Even memories of difficult life circumstances can help to reduce or alleviate depression in elderly patients.“Dr. Schweinberg.
Since so many people have had multiple pets during their lifetime, can the power of pets be put to good use to help a person make their kind of transition? Schweinberg says yes.
“It has been well-established that pets have a therapeutic and often calming impact on people in general. However, there is also evidence that, for the elderly, owning and interacting with pets can reduce stress, lower blood pressure, increase social interaction, and increase physical activity. These last two benefits are particularly helpful to the elderly, who often begin to limit their activities and increasingly withdraw from the interpersonal world around them.”Dr. Schweinberg.
Ali Orr, a well-known artist who specializes in pet drawings, says she deals with many families in this situation (on Facebook at @aliorrart - www.facebook.com/aliorrart)
“People absolutely adore their pets and really do view them as members of the family. I am obsessed with my dog and cannot picture my life without him in it. A lot of my customers are completely head-over-heels for their pets as well and even view their pets as their babies no matter what age they might be.”Ali Orr
Orr is often asked to create drawings of pets, both living and dead. This can bring strong positive memories and emotions for people.
“These drawings give people comfort, which is an amazing feeling for me and I am glad that the drawing is part of their healing process. I’ve watched or heard people cry as they opened their gift and reminisce on the memories of their pets. Each time is an emotional moment.”Ali Orr
These gifts for older family members can bring a strong positive outlook that Dr. Schweinberg says the key to a transition to Long-Term Care.
“Being able to talk about one’s past life experiences to someone who is genuinely interested and actively listening can provide these patients with an enhanced self-esteem, a sense of meaning about their lives, as well as a sense of validation regarding their worth as a person. Also, the opportunity to reminisce with an interested listener can also provide something that psychologists refer to as “generativity,” which refers to the sense of satisfaction and purpose that comes with being able to pass on the life lessons they have learned, and the hard-earned wisdom that their life experiences provided them, to someone younger.”Dr. Schweinberg
Orr says people will send her multiple photographs of pets through a person‘s lifetime. She creates a piece of art that can hang in a person’s room, which aides in their transition to a Long-Term Care facility.
In this example, three individual photographs become one group drawing.
“My hope that every drawing I make either brings someone comfort when remembering the pets that have passed away or brings happiness when they see the resemblance of their pet in the drawing. I hope when someone looks at the drawing of their pet(s) that it brings a lot of memories, big and small.”Ali Orr
Orr explains that photographs, paintings, furniture, etc. are all items that make space feel like home. She says these items bring comfort.
“A drawing of a pet is more than a picture, though. We all take pictures of our family members and capture memories, but a drawing brings a pet to life. These drawings have sentimental value and are physical and visual reminders of memories of their pet. I hope that my drawings allow the pet owner to immediately recall the memory."Ali Orr
Dr. Schweinberg says the process of moving into a long-term nursing care facility requires many substantial adjustments, many of them being difficult to accept.
“It involves not only giving up one’s own home but also giving up many aspects of one’s independence and identity. Because of this, such an adjustment is often accompanied with a significant sense of grief and loss.”Dr. Schweinberg
He explains family members have the challenge of helping their loved ones on making this life transition which is often unwanted and resisted. Schweinberg indicates this is often a frustrating process for the whole family. He encourages preparation in advance as much a possible. Meeting with staff at the facility will give the family information and can reduce some of the fears that an elder family member will have when leaving their past life into this new “home”.
“It is extremely important that family members remain supportive, positive and encouraging throughout the process. This includes listening as their loved one talk about what they will miss about their home and the life that they are leaving behind."Dr. Schweinberg
Schweinberg says this validates the difficult feelings that such a transition into long-term care can bring.
He suggests family members should remain patient and understanding. Their loved one will often be resistant and negative about the need for Long-Term Care, their own issues and how they feel about making a big life transition. Advance planning, in part with the use of photographs and other memories, including pet drawings, can ease this fear many will feel.
“This is a transition for the entire family system, not just for the elderly family member. Typically, the more family members who are involved in preparing for and facilitating this transition, the better the outcome.”Dr. Schweinberg
The cost of this care is another major concern for both the elder family member and the rest of the family. If they had put in place a Long-Term Care Insurance policy prior to their aging, or health event, much of the cost will be paid for, thus reducing the financial pressure on the family. If a Long-Term Care policy is not in place, personal assets will be used, if any, and then Medicaid; the medical welfare program can pay if assets are exhausted. Health insurance and Medicare(including MedicareSupplements) will pay for a small amount of skilled long-term care services only.
Some planning ahead of time will make the transition to a facility easier for everyone.
1Reimer MA, Slaughter S, Donaldson C, Currie G, Eliasziw M. Special Care Facility Compared with Traditional Environments for DementiaCare: A Longitudinal Study of Quality of Life. J Am Geriatr Soc. 2004;52:1085–1092
2Mitchell SL, Kiely DK, Jones RN, Prigerson H, Volicer L, Teno JM. Advanced DementiaResearch in the Nursing Home: The CASCADE Study. Alzheimer Dis Assoc Disord. 2006;20:166–175.