Moving into care: Who decides?

Making a decision about residential care often requires the consideration of complex and difficult issues. Should the older person stay at home or should they go into residential care? In some cases the older person makes the decision themselves but often, the family is involved. Each family member will have his or her own thoughts on the matter.

It is important not to lose sight of the fact that the older person is central to this decision. Their best interests and what they want to happen should be a high priority. This consideration can get ‘buried’ by other things, particularly if there are many competing concerns. Competing demands and stress, especially if they are not spoken about or acknowledged, are an invitation to misunderstanding and conflict. Careful and sensitive consideration of all the issues will help all concerned work their way through the situation.

Make sure you approach this subject with careful consideration and discuss it sensitively. Make sure you allow plenty of time for the discussion and let everyone have their say without interruptions. Listen without judgement and have a positive attitude. Everyone should understand and be prepared to compromise. Sometimes the best solutions are those no-one had thought of beforehand.

It is a good idea to get an understanding of what the older person’s expectations are. Only then can you begin to work towards a solution that works for everyone involved.

Involve the older person in the decision making process as much as possible. Pressures on families today are quite different to those experienced by the previous generation. These significant differences often impact on families’ ability to provide care and support. No two circumstances are the same. There will be issues unique to your own situation. Older people and their families therefore need to be very clear about:

  • what they do and do not expect
  • what the obstacles are to having their expectations met
  • what they can and cannot realistically do to meet the expectations

Expectations that are ‘out in the open’ are much easier to deal with than those that are hidden. If you can’t work this issue through ask for a referral to a social worker. They are located in all areas of the country. An independent person can help you work though the issues more easily and arrive at a decision that everyone is more understanding of and satisfied with.

Who should make the decision about where to move?

Ideally the older person should make the decision themselves, however if a person’s ability to make a selection of residential facility is affected in any way e.g. by poor health, they will understandably be more dependent on others to help them make a choice. This is a big responsibility for those who assist. To make things more difficult there is often only a short time in which to make a choice. How you make the decision is just as important as who makes it. Keep in mind the rights of the person you are assisting.

A sense of powerlessness results when people feel that they have no input into decision making.

When it comes to choosing a residence it is important to avoid choosing a place that the helper would like ‘for themselves’ or one that they think would be ‘good for’ the other person. The most helpful way someone can assist is to try to choose a place that the person themselves might choose. One way that this can be done is to identify the things that are important to the older person, prioritise these; then find a facility that is most suited. (The Eldernet search function may be useful for this. Similarly you could email the facilities you are considering with your prioritised list and see what response you get.) A social worker or service coordinator has skill in this area. They can help you identify the things that you need to consider and that are specific to your situation.

A good idea is for family members to check out as many facilities as is possible/necessary, narrow this down to 2-3 ‘finalists’ and if possible encourage the older person to make their choice from this list. This way the final choice is still theirs.

Remember too that if residential care is decided upon and if the first choice of facility is not what you had expected (bearing in mind that it takes a reasonable time to settle in and assess this) then a change can be made. Contact your service co-ordinator to discuss this further.

Once a decision has been made keep the channels of communication open by reviewing things on a regular basis.

About Eve Williams

Eve Williams is the Content Developer and Social Media Administration for Eldernet. She is currently studying towards her Masters at the University of Canterbury. She has a passion for learning new things.

One comment

  1. Very timely and some great reminders in here. Thanks very much!