[ photo by Christian Newman ]

“24/7 care is going to be needed for your mom.” What? How can that be? What am I going to do?!

There are many families who have that family meeting with the therapy team treating Mom while she has been in rehab. You are a bit nervous about the meeting because you are going to learn more about how she has been doing in therapy and with nursing and what her projected needs will be. She had been living alone in her own house prior to her hospitalization and getting by. You were doing some things for her, but for the most part, she was on her own.

This recent hospitalization, however, really caused her to lose a lot of ground in terms of both her physical abilities and her mental capabilities. You sit in the meeting and hear all of the feedback from the therapists and nurses and social worker. You are nearing the end of the meeting and you get the final recommendation, “your mom is going to require 24/7 care.” Well, let’s talk through a few options and scenarios I have experienced during my years of practice.

The first thing is the term 24/7 care.

That is often based on the FIM scores and on how she is doing from a safety standpoint. In regards to the FIM scores, if she is not doing her basic ADLs at a modified independent level, then it will likely be recommended she have 24/7 assist. The next step below modified independent is Supervision, which cannot be completed without a second person around. In regards to the safety standpoint, is she impulsive? Is she not following the safety techniques being taught by the therapists?

If her lack of safety might lead to a fall or the inability to take the necessary steps to get herself to a safe spot in the event of an emergency, then it is likely 24/7 assist will be recommended. 

Monitoring options.

I have had family members with plans in place to have someone with the parent for the majority of the day. They will often have someone checking in on her at nighttime. I have even had families that have monitors set up to watch her when they cannot be physically present. Even in these instances, technically, that is not 24/7 care because there is not another person there all of the time.

Those can be reasonable options, and really, in some situations, best case scenarios. In those cases, I have advised families that if keeping Mom at home with those various set ups will ultimately lead to a better quality of life for Mom, then go for it. Sure, there is still risk involved, but it is a pretty good set up, given the situation. Other times, though, it is just too much added stress or too costly for the families, and then we pursue other options. 

24/7 care at a nursing home.

Achieving 24/7 care is hard and sometimes not realistic. Even in the nursing home setting, a patient is not usually receiving 24/7 care because the patients are often alone in their rooms and only checked on periodically. Unless you hire someone to be with your mom for every hour of the day at home, the nursing home will be the option closest to 24/7 care, however. In many cases, this is reasonable and appropriate. This provides an on call doctor, nurse and aide to administer all medications and closely monitor for any medical changes as well as provide for the basic ADL needs. 

Other care options.

The level below would be assisted living. This is often a fantastic option for that loved one that needs closer monitoring. Most assisted living facilities provide the option of a nurse to administer medications as well as aides to help with some basic ADL tasks.

There is always a staff member present at the facility, so if there is an emergency, there will be someone present to provide assistance right away. The assisted living facilities have dining rooms, so the need for Mom to cook for herself goes away, which can be a huge benefit. Oftentimes, with some additional rehab, family members do very well at this level of care. 

The level after assisted living is moving Mom into a senior apartment complex. These places are generally great. Residents have to be above a certain age, which helps with community and socialization. The majority of these facilities are built to improve accessibility for the patients, including no stairs and accessible bathrooms. Residents generally prepare their own meals. For the most part, residents need to be quite independent to live here because there are limited options of assistance. 

Weigh your options.

Ultimately, the decision on what to do is up to Mom and you and the remaining family members. This can be a tough decision, especially if she is adamant about returning to her home. I generally tell people to weigh the recommendations of the rehab team with what will bring improved quality of life to Mom AND to you.

We often think about the quantity of life, but I believe it is paramount to consider the quality of life. So pick the place that can balance out both the quantity, meaning her being as safe as possible, and the quality, meaning mom AND you can still find some enjoyment and rest in life. In your specific situation this may or may not include arranging for 24/7 care.

Please contact me or leave a comment if you have a question about different levels of care.

© 2020 Jessica Kluetz, DO