About four months ago, my mother and I made the decision to not move my 90-year old grandmother into a long-term care facility when she “plateaued” at a short-term rehabilitation center. You see, my grandmother was deteriorating quickly at the short-term rehab facility and we knew that placing her in a long-term care facility focused on maintaining her then current physical condition instead of focusing on improving her condition would obliterate her quality of life. The nurses and social worker of the short-term rehabilitation facility said my grandmother would never be able to walk and would need a wheelchair. They even had my grandmother fitted for her own chair before allowing her to leave the facility. When my mother, husband and I came home with my grandmother, she seemed so happy and unafraid. In a matter of days, my grandmother was walking more than I had seen her walk the entire two months she was living in the rehab facility. How did this happen? What changed so drastically? I think my grandmother rehabilitated so quickly the moment she left the rehabilitation center for many reasons but, these 8 are my top reasons why:
- Being home. There’s just nothing that can lift your spirits more than being home with a family who loves you and wants to care for you.
- Gaining independence and security. In short-term (and long-term) rehabilitation facilities most patients/residents are rooming with, and sharing a bathroom with, another person. Sometimes up to three other roommates. Plus, the facility, no matter how “homey” they try to make it, always looks, feels and smells like a hospital in some way. At home, she can go where she wants, when she wants and she has her own private bedroom.
- Sharing the same language. There simply weren’t enough people to speak with her in her native language at the rehab facility. At home, that is not a problem. My grandmother is able to express herself, be heard when she has a request and just hold a conversation in general.
- Rehabilitation therapy when she wants. One thing that was severely lacking with the rehab center was that the folks there failed to realize the reason my grandmother always refused therapy. The therapists kept asking a 90-year old woman with dementia and limited language to leave an activity she was enjoying to do therapy on another floor. There were limited activities she could participate in throughout the day (maybe only one the entire day), so of course she never wanted to leave. As a result, the therapists said she plateaued and was unable to walk due to muscle atrophy. At home, we are able to provide consistent therapy when she is willing to do the therapy.
- Dedicated treatment specific for her needs. The week before bringing my grandmother home, we made sure to enlist the help of a home care service that would provide an in-home physical therapist and nurse to prepare my grandmother and us for a successful transition and general care. The physical therapist was able to exercise with her and rebuild her confidence, set goals and milestones for her rehabilitation and prepare us, the caretakers, with the tools we needed to make sure we continued the consistent care when physical therapy was over. But most importantly, the physical therapist and nurse showed us how to redirect my grandmother’s attention when she gets stuck in a loop or is in the middle of a tantrum.
- Community and family. At home, my grandmother can do chores, feel like she is being useful and like she is a part of the family – because she is a part of the family. She enjoys folding the laundry and getting up to do her dishes after a meal. Plus, she is enrolled in a day center that is primarily for Spanish-speaking people so she can continue to stay active and engaged while giving us care takers a much needed break.
- Love and consistency. Not to say the nurses at the facility were not loving. Those nurses were always helpful and patient and kind despite being overworked. The nurses at my grandmother’s facility were all amazing. However, they don’t work there 24/7 and have changing shifts. For someone with dementia, without consistency, the nurse was always a stranger after even just a weekend away.
- Patience. This is actually the most important piece to remember and the hardest thing to maintain when caring for an elderly family member with dementia, regardless of his/her physical limitations. Dementia is a horrible disease because of how much the loved one can change for the worse with regard to personality and treatment of other family members. Forget the terrible twos. The terrible eighties and nineties are the worst! All we can do is stay patient and remember that my grandmother really does have love for us despite what she says in a tantrum. We focus on being in the moment and making my grandmother laugh and smile.
So how did I find strength and love in my life while transitioning my grandmother from short-term rehabilitation care to home care? Staying patient and breathing through the difficult moments really did help me gain perspective and strength. And over time my confidence in knowing that we made the right decision definitely increased. There is no longer any doubt that we made the right decision. I also remember that this transition was and still is just as difficult for my grandmother as it is for us only in a different way entirely. At least we are in this together.