We make promises with good intentions, but sometimes we just can’t possibly keep them.
Working in the senior health and care field, the promise I most often hear family members recall is: “I promised him/her I would never put him/her in a facility.” This promise haunts people. It tears them up inside when they realize they can’t possibly keep that promise and, even years later, they still carry the guilt.
Overwhelmingly this promise is made from the heart. Everyone wants the best for family members and loved ones. If someone expresses that they want to live at home as long as possible, any reasonable family member will want to make that happen.
Thankfully there are in-home services like hospice, home health (physical therapy/occupational therapy) and caregiving that can assist those who want to safely remain in their home. Resources like long term care insurance, veterans benefits (for veterans and widows) and the Medicaid Waiver program are available to those who qualify as a monetary supplement to pay for private caregiving services. These supports work for many families. For some families these in-home services will be a long-term solution, yet for others it may only work in the short-term because, let’s face it, things change.
Finances change, health status changes, family dynamics change, family employment arrangements change. As a result, the plan that was working may no longer work. Family decision makers and those who have burdened themselves with this promise of “never putting him/her in a facility” need to give themselves leeway to accept that circumstances change, and with new circumstances, there needs to be new solutions.
I recently spoke with a wife who was distraught over caring for her husband. He was experiencing increased signs of dementia and decreased mobility. He was falling daily, sometimes multiple times a day and was now in the hospital. She called me because she was thinking a few hours a day of in-home care for her husband would be enough for him to return home.
Through our conversation, it was clear that he needed much more oversight for his safety and supervision than a few hours a day could provide. While services could have been provided in the home on a 24/7 basis, that was not the solution she sought. With all health and living factors considered, facility placement was the clear option for this couple.
However, she had made her husband a promise years ago that she “would never put him in a facility.” She felt she was dishonoring him and not upholding her promise by now considering a facility as an option.
I asked her what the situation was when she first made this promise. She said it was during days of better health and when they were younger. Now, both nearly 80, and with his failing health, circumstances had indeed changed. I reassured her that the premise on which she based her promise years ago was no longer the same. Through tears, she admitted that she knew she needed to move him to a facility because his care was too much for her to handle at home.
Situations with aging loved ones can change quickly. One diagnosis, one fall or one virus will change the circumstances that a promise was based on years ago. It’s OK to change your mind. It’s acceptable to choose a new solution based on current information. Forgive yourself. Know in your heart, you are always making the best decision for your loved one, and that is the promise to keep.