Off the Couch

Thoughts about the therapeutic process, and the dynamics of client-therapist interactions.

I Promised My Dad He'd Never Go to a Nursing Home

A therapist's personal story about caring for an aging parent
Kristi Pikiewicz
This post is a response to A New Life at 96 by Kristi Pikiewicz, PhD

My dad and I were not particularly close while I was growing up. I loved him, and I knew he loved me, but he worked long hours and was famous in our family for not being a particularly demonstrative person. At some point when I was complaining in therapy (once again) about his withdrawn behavior, my psychoanalyst asked me about my own role in this relationship. Had I ever shown my dad how important he was to me? “Of course,” I replied indignantly. But as we continued to explore this sticky issue, my analyst pointed out that Dad I were a lot alike – we both tended to withdraw when we felt rejected.  Maybe, he suggested, my father had withdrawn because he felt rejected by me.

It was a powerful insight that had a tremendous impact on my life. I began to reach out to him – and to my amazement, he responded immediately. Phone calls to my “parents” had previously been really conversations with my mother. Now Dad began to get on the phone and stay on – sometimes after Mom hung up!

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As time has passed, our relationship has become stronger.  When my mother became ill, we were able, with the help of hospice, to have her spend her final days at home. Dad watched good friends die in nursing homes, and told us he’d rather shoot himself than go to one of them. We, like many of our peers, promised him that it would never happen. After all, we reminded him and one another, he had long term care insurance for someone to care for him at home. What would be the problem?

Like many other men and women caring for older parents—nearly 10 million, according to a study conducted by the MetLife Mature Market Institute and the National Alliance for Caregiving and the New York Medical College—my siblings and I have recently discovered what the problem is. Dad, an independent ninety year old who lived alone in a second floor walk-up apartment, grew increasingly frail.  As we researched the possibility of using his long term care insurance, we found first that he was not sick enough for it; and then, when a stroke made him eligible, that the amount that the coverage, which was for twenty-four hour care when our parents bought the policy, was now only enough for a few hours a day. Dad could not live at home.

My colleague, Linda Beeler, has a beautiful and touching post on the PT website describing  her mother’s new life in Linda’s home. Unlike Linda’s mother, our dad refused to move in with any of his children. And truthfully, it would have been more difficult than we liked to acknowledge. Enlarging bathrooms to make them accessible to wheelchair and walker is hard and expensive in any home, and especially difficult in one-bedroom urban apartments. Not to mention that in my case, my father, a New Yorker by birth, made it clear that he would rather die than return to New York.

Have I mentioned that he became irritable and agitated after the stroke?

It was clear that the promise was really a pipedream. 

The process of finding and moving Dad into an assisted living facility where he could be close to one of his children and accessible to the others was accomplished speedily and surprisingly easily, even though we all felt overwhelmed and inadequate throughout.  We even found surprising financial assistance—as a WWII vet he with very little money, he was eligible for some financial aid for assisted living, if we could get through the complicated red tape.

Dad did not settle in easily. Angry, confused and frightened, he lashed out at all of us. The fear that we had made a mistake shook each of his children.  We learned something important—amazing support was available from a wide range of sometimes suprising sources. Our mother’s best friend, the medical professionals involved, colleagues, our own friends,  family, websites, Dad’s cleaning lady and the woman who had driven him around (when he would allow it) all told us their own stories and stood strongly by us as we made this decision for the man who used to tell us what to do.  I found that simply mentioning what was happening to almost anyone over fifty immediately elicited tremendous sympathy and stories of their own experiences – current and past – with elderly and ailing parents, and sometimes spouses, siblings, and friends.

A woman in the grocery store overheard me sadly talking on the phone to my brother about how badly I felt about breaking the promise to have him live with me. (I was on the phone all of the time, it seemed). When I hung up, she tapped me on the shoulder and said, “We all make that promise. But we can’t all keep it.” She told me her story: her husband had suddenly become quite ill. She promised him that she would let him die at home, but the nursing care became too much for her to do herself, and she could not afford the twenty-four hour staff he needed.  “I had to put him in a home,” she said. “I agonized about it until I finally told myself that I was doing the best I could, and that he would understand. And I expect our kids will do the same with me, and that I’ll understand that, too.”

These stories made our life much more tolerable.  So did the fact that the place we found was beautiful, and the staff, unlike those in some of the horror stories we had heard, were caring, gentle, kind and efficient. Still, I worried. I had nightmares that my mother was yelling at me for what I had done. I was clearly not being a good daughter. I was afraid of withdrawing once again; or of my Dad's withdrawing from me. But I didn't, in large part because of the backing from my brothers, their partners and spouses, and my own husband. Irritation was often present, of course. But the knowledge that we were in this together made it all bearable.

Dad gradually began to acknowledge that we had found a nice place, but still spoke of planning his escape. My husband and I took him out for lunch and smiled at one another when he said, as he made his slow and painful way back inside the facility, “Ah, home…” But settling in was not yet in the cards. On a beautiful fall day with colorful trees on every side of him, he said, “I miss the palm trees.” I sympathized. It was horrible. His life was turned upside down in every possible way. But it was hard to ignore the intentional barb.  And of course, it would have been nice if he’d acknowledged that this was hard for all of us, too. No matter how old you are, it seems, it’s excruciating to watch a parent begin to fail. It brings up feelings of vulnerability, anxiety, sadness, guilt and loss – and of course, fears about our own aging as well.

But then on another day he said, “I’m sorry honey. I know I’m using you as my stomping post.” (The stroke has made for some interesting new phrases. But I knew what he meant.) After a beat he added, “One thing that’s nice about it. I didn’t realize when you moved me here that I’d get to see you so much more often.” I knew that he wouldn’t remember saying that by later that afternoon. I knew that he would be angry, hostile and confused again by night time. But I treasured the words and the sentiment. And I realized that it was nice for me, too. 

IMAGE SOURCE PAGE: http://www.cfmpl.org/blog/2010/06/30/utility-prudent-or-prejudiced/

Sites that I found helpful for coping with this process:

http://www.oprah.com/health/Caring-for-Aging-Parents-Martha-Beck-...

http://www.agingcare.com/Articles/I-promised-my-parents-I-d-never...

http://www.dailyom.com/articles/2012/34837.html

http://www.agingcare.com/Articles/coping-with-elderly-parent-dyin...

 

F. Diane Barth, L.C.S.W., is a psychotherapist, teacher, and author in private practice in New York City.

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