When is the right time to move a relative into care?
This, like the issue about moving from one care home to another is a hard question to answer, but the simple answer is the same, when the result will be better than leaving them where they are.
If someone has been living at home, often with domiciliary care, the trigger is often a trip to the hospital after some kind of acute episode. The 3 most common acute episodes that I see are a chest infection, a UTI or a fall at home. There can be an acute cognitive reason, such as being found in the garden/street at 2am in only their night clothes in mid winter.
Moving them to a care home will be unfamiliar and they will have to learn how to live in the care home. Whilst their care should be personalised, care homes are intuitions and the care of the residents is easier if they adapt to the routines of the institution. Therefore it is helpful if the residents sleep at night, eat breakfast in the morning and have lunch in the middle of the day for example. Some people adapt well and others don’t like being told what to do.
If the individual has been primarily self caring prior to going into care and it has not been that successful, then admission to a care home can see an improvement in their wellbeing. If they are cognitively impaired, so forget to eat and drink regularly and to take their medication, as all of this will be managed for them, they improved at first. Then the decline of their condition will overtake the initial improvement and the slide of their deterioration will continue again.
The move into care will be confusing, especially if they have lived in their current home for a long time and will therefore be very familiar with it. They may have community ties that will be hard to give up, such as good neighbours or familiarity with the local shop owners.
People who are cognitively impaired have difficulty learning something new and moving home into care will require some learning. Although there is 24hr support, they still need to learn where their room is, where the loo is, and where the lounge is etc.
Like the issue of moving someone from one care home to another, the question should be considered; can they stay where they are with a little more support? Social Services can get involved and can be the trigger for more support. Age Concern can also provide support, usually at a lower level than Social Services can provide, they tend to get involved where the need is more acute.
A key issue for this problem is the issue of capacity of the individual. If they have the requisite capacity to decide where they want to live, then no matter if their choice is unwise, it must be honoured. The only way to admit someone to care against their will would be to section them under the Mental Health Act, and that is a difficult route to take. If they have debateable capacity, then an opinion of capacity can be obtained. If they don’t have capacity, then their wishes should be taken into account. If they want to stay at home and they might need some more support to achieve this, then that should be the first option. Not everyone is fiercely independent, but those that are, will have difficulty adapting to care. If a relative does express the wish to stay at home and it simply isn’t possible, then care will be the only option, but it should be the last resort.
No-one ever says I’d like to get old and infirm and go into care, but sometimes there is just no other choice. Most people don’t end up in care, but it can be hard for those that do and in particular very hard for their families.