There comes a time for many families when they can no longer care for an aged member in the home. This timing is often occasioned by lack of economic resources. The aged member's need for supervision and the family's schedule will mean for some families that round-the-clock sitters would have to be employed. For some families, budget will not permit this kind of expense. The expense could run in excess of $4,000 per month.

Securing institutional care for a loved one can be brought on by lack of physical and emotional resources. I have observed seventy year olds trying to care for a parent in his/her nineties. The health (physical and emotional) of both the care giver and the aged family member become factors that indicate when institutional caring become necessary.

The following are some suggestions that can help: FIRST - Avoid judging others who have placed their loved one in a caring institution. If the time comes when the decision to use institutional care is obviously right for you, it will be hard to choke down your judgement of others. Also avoid promising a parent, aunt, or uncle that you would never place them in a "nursing home." This promise is usually made to a person in their fifties or sixties and they are often a different person when they reach their eighties and nineties.

SECOND - Shop around for the facility that would be right for your family member. Talk with the administrator and staff. Notice the cleanliness or lack there of. Inquire as to the type of activity programs provided. Talk with residents. Ask them what they like about the home. Notice whether or not the staff and alert residents are friendly. Talk with families of residents. Make sure that the home matches the personality of your family member.

THIRD - Stay connected to your loved one once they move in. Notify his/her friends, church, etc. If your loved one is able to, take him/her on weekly outings. Arrange to have a meal with them in the home. Encourage your family member to participate in appropriate activities provided by the home. Come to the home and worship with them on Sundays or carry them to church. If you can, continue to do their laundry. Help them to dress and keep their appearance just as they did before coming to the home.

FOURTH - Avoid referring to the caring institution in terms that indicate the residents are being warehoused in anticipation of death. I don't like the terms, "Rest Home" (sounds like a cemetery) or "Old Folks Home." I recently heard a term I like even better than nursing home - Rehabilitation and Living Center. People who come to care giving institutions often improve with rehabilitation and are able to return to life as they previously knew it. But in any case our caring institutions are "centers of living." In these centers people laugh, love, and make friends a lot the way they did before coming to the Rehabilitation and Living Center.

FINALLY - Do not over look the resources of your family physician and minister in securing the compliance of your loved one. Often a person's physician and minister can help in the acceptance of a caring institution once the decision is made. Stay focused on what is best for your loved one in the given circumstances with which you are dealing.

Next week I want to discuss "Hard Choices for Loving People" -Living Wills, Power of Attorney for Health Care, and deciding when not to try to resuscitate.