There seems to be an ongoing tension/tug of war among health-care policy-makers, members of the public and families about where people should live out their later days. I was recently invited to give a public lecture in another province – the topic was to be based on my book, written with my co-author Bart Mindszenthy –Parenting your Parents.
The conference organizer asked me if I was planning to provide strong opinions about the benefits of nursing homes for frail elders. He was concerned that, considering the government funding of the lecture, I not should espouse opinions in conflict with current government public policy, which is to try and keep elders in their own homes.
Aside from the idea that at an invited public lecture there would be a concern about what the speaker would be emphasizing, the issue raised for me important thoughts about the decision that many elders and their families must face as to where they should live during the later days, or often years, of their life.
It reminded me of the experience I shared with my sister when it came to trying to convince my late father that he would be better off moving from his home, where he had been living on his own since the death of our mother a few years previously. At first glance, he seemed to be “managing” – although in his characteristic “messy” fashion – from the evidence we had: he was still shopping for his personal needs, driving to where he had to go, and he even arranged to have his cataracts successfully treated in a day surgery setting.
I spoke to him at least once a week, and as part of my at distance mental status examination, I would ask him how his stocks were doing and would bring up a topic in the news, as I knew he was an avid New York Times reader. I and/or my sister would visit from time to time, and although were always amazed at the state of the house, which always seemed to be in some process of repair, he seemed to be managing in the restricted confines of the neighbourhood.
He went out in the morning to get the paper, maybe a bagel at the local convenience store or some other minor items, and once a week, he went to a nearby supermarket where he bought supplies paid for on a credit card that my sister co-owned – so she knew that he was shopping regularly.
When things started to very gradually deteriorate, we became convinced that he had to move into a supportive housing environment of some kind. He refused adamantly to consider it – but after a while, and through a long process of his own gradual cognitive decline and recognition of the benefits of a retirement home that he had moved to near my sister on a trial basis, he finally complied. He realized that living alone was no longer a viable choice for him and moved into the facility not far from my sister’s home. He eventually required a full-time personal support worker, but for many years, he enjoyed and benefited from the social structure and the activities and support he received.
Living at home sounds great. For those who can do it and have the financial and social means, it might be the best of choices. For many others, the social isolation of living at home may be counter-productive to the need for social interactions that we now recognize as being important for the well-being of those with cognitive decline.
Being a hermit in one’s home is not necessarily good for frail elders. Each individual and family must make the best decision for them. Governments should avoid forcing people, through public policy and financial means, away from finding the best solution for their personal, social, familial and economic needs.