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Monday, December 4, 2006 05:40 AM

It is Possible to Place Mom in an Assisted Living/Nursing Setting and Not Feel Guilty........

I think there are several salient questions that need to be asked, some from a matter of pragmatics, some from the heart:

What does LW really means when she references not wanting to "abandon" her mommy? Abandonment means to not take care, not tend. Howver, what true care is in this circumstance is a complex answer, and I would suggest that the overt answer - the duplex - may not be the most care-based answer in the long run. Placing mommy in an assisted living facility that has an affiliated relationship with a nursing home may NOT be abandonment, it may be prudent planning.

Why should LW feel guilty about not liking all of her mother's behaviors? And, why should the "penance" for that be to take care of Mom? If, indeed, her behaviors annoy, then anger, then frustrate LW, why would exposing Mom to a pissed-off daughter be a legitimate form of "care"? I am not sure whether LW is making this connection cognatively, but in reading her letter, it seems to me that the drift of her thinking is that her distaste for her mother's behavior is something that she should, because of love and affection, be able to override, place aside, or neutralize..... I fear those feelings about Mommy are deepseated, and will not go quietly into that good night.........indeed, they will be exacerbated by the declination of emotional resiliancy that is likely to accompany her mother's phyical decline.

How many transitions does LW's family expect to subject Mom to? She moves to a northern clime, to a community where she knows no one, to a duplex that will undoubtedly need retrofit for handicapped accessibility (grab bars, handrails, graspable cabinet hardware) where she has no impetus to carve out a new social milieu. Ultimately, given her Parkinson's, she will need to be moved into a care-based community at some point, as is well-understood. Why postpone the alternative?

I would suggest a different planning approach.... I would suggest a family conference, in which everyone agrees to do some core research. One needs to meet with Mom's physicians to find out the specifics of Mom's health and the potential diversity of her health trajectory. One needs to do due diligence on assisted living/nursing home combos within geographic striking distance of where Mom now lives....... One needs to contact an attorney with geriatric law competency to begin to map out the invaluable documents that will allow for transition of decision-making should Mom become incompetent. Is there an advanced directive? A durable power of attorney already written up? No reason to seek to implement these documents when Mom truly decompensates, best to do this while she can be part of an informed decision process. I don't care what Mom's fiscal worth is, is there a binding will, and does anyone know where it is?

Frankly, I would suggest that Mom may actually be able to be more socially comfortable in an assisted living facility that can tend to her long-term declination of health... she will be with peers, and potentially in the same geographic region. And, as her health inevitably declines, she will be able to do so without yet another jarring relocation, another uprooting, another shift.

In this circumstance, I would suggest that true caring for Mom comes in the form of being candid about the needs and abilities, both emotional and financial, of all of her children, and then figuring out what the best medical and social course of action for Mom truly is. If that is done, I seriously doubt that the duplex will surive as a viable option.

Should mom shift now to an assisted living facility, while she still has the ability to form friendships, to interact... then the forms of care comes in visits, in time spent, in monitoring the assisted living environment..... not in taking care of an increasingly debilitated and dependent mom, when one does not have either the emotional resonance or the professional skills to serve in that role. Further forms of care comes in the preparation of the legal pathway to implement appropriate care as Mom's health inevitably will force surrogate decision-making. And the best care comes from a family that may not like all aspects of what needs to be done, but does it with some sense of concensus and focus on the primary objective, which is keeping Mom as functional as possible for as long as possible in an environment where she can self-actualize.

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