Post No5…3 things families say to a loved one, when they don’t know what to say

Introduction:

Deciding to look into care for a loved one is an extremely difficult decision, and knowing what to say to them about it is even harder. As a result, a number of families often ask me what the best approach is, or ask what other people might have said. In this post I look at some of the ways families choose to break the news to a loved one, including some slightly 'undercover' approaches.

If families choose to go a little incognito, they often go down routes 1 or 2:

1) It’s not a care home, it’s a hotel

This is more common in a purpose-built care home than a converted care home, because in many ways modern purpose-built care homes look like hotels. Of the many viewings I have conducted in purpose-built homes, it’s a genuine 50/50 this comment will be made, and of course this then presents an opportunity to disguise the care home.

However, although modern care homes may look like hotels, they are not hotels. For a start all of their ‘guests’ are elderly, and they operate in a very different way. If the person susses this out right away it may lead to a difficult admission into the home, and leave the resident feeling angry or unsettled. I have actually seen a person discharge them-selves within an hour of realising they are in a care home, with family members having to cancel their holidays as a result.

In contrast, if a person has dementia and is living with memory loss, explaining to them that they are going ‘to a hotel’ may cause them less anxiety than explaining they are moving into a care home. Repeatedly telling a person a piece of information that makes them anxious may not be the best ploy, and in some cases the ‘little white lie’ (it’s a hotel) might actually be a better approach. However, this is not a one size fits all approach, and really depends on the person and their capacity level.

2) It’s a ‘holiday break’

Utilising respite care can be a very useful way of introducing a person to a care home, without fully committing. Respite care is a termed agreement, so naturally it comes to an end on a set date, and sometimes this can soften the blow when families are trying to explain the situation to loved one.

In many ways this approach can actually work well. If a person tries the care home environment, they may end up enjoying themselves by meeting new people, with the added comfort of always having someone on hand.

It can of course have the opposite effect, particularly if the person feels they have been duped into staying. In this case, when the person knows they are going to go back home, they may not make much of an effort to join in. In another scenario, if the family have delayed telling their loved one it’s actually going to be a permanent placement (after the respite ‘holiday’ has ended), the person could remain unsettled for longer.

If a person has dementia, and is confused in time and place, this explanation could end up having a positive outcome. For example, to reduce anxiety, if a person with dementia is told they are going for a short break and they agree, the concept of time may become lost and forgotten due to their dementia. This may seem like a cruel thing to write as it appears to be a trick, but actually it can aid the settling in process. Living in the persons world, when they have dementia, can actually be more kind than cruel.

3) Come clean

If a person has capacity, being honest with them maybe the best policy. From my experience, when a person knows they are coming into a care home it reduces the risk of causing additional complications when they arrive, and may eventually help them to settle into a care home environment. The risk with this approach is that the person says no, and if they have capacity, then no definitely means no.

If a person has memory loss, this approach might not be as easy. As referenced earlier, if a piece of information is not being retained (but is causing anxiety when told) then it might seem like the wrong thing to do to repeatedly tell the person and repeatedly make them anxious. However, just because a person has memory loss does not mean families should not be truthful with them, but if it is causing anxiety, it might be best to only say it once.

Summery:

Going ‘incognito’ is a very understandable decision in many ways, but it doesn’t always make the scenario of moving someone into a care home any easier than being honest. My advice would be to consider all options, but most importantly look to the the persons history, their personality and their capacity level, as these may direct you to the best way of approaching them.

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