A.E. Randal reflects on the care available to nursing home residents.

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“He made bail.”

I’ve grown accustomed to walking into my Mum’s room and hearing her start a conversation, well, in the middle. As a resident of a nursing home, she spends a lot of time watching the TV news. Her body has utterly failed her, but she still knows a story when she hears one. In this case, she was talking about Oscar Pistorius.

Although, for the most part, my Mum has borne the indignities of old age with good humour, one of the things she misses most is adult conversation. When your table mates in the dining hall are partially deaf, slipping into dementia, or have lost the will to communicate, a nursing home can be a lonely place.

The Nova Scotia Nurses’ Union Broken Homes report itemizes the systemic problems in long term care: the clientele is older than ever, and their medical needs are more complex, the nurse to client ratio is inadequate, holiday staffing is a nightmare, people only get one bath a week, the meals are…. wait a sec – one bath a week? That one always stops people in their tracks. It’s true, and Mum looks forward to her weekly dip. The rest of us are horrified.

I would point out that the people who care for my Mum wash her every day. It’s called “top and tailing”. These caregivers – underpaid and overworked – are the kindest, most patient people I’ve ever met. I couldn’t do their job in a million years. While I’m grateful for the care they provide, the intimacy they share with my Mum has unsettled me, by times. The first time I saw a Personal Care Worker plant a kiss on my Mum’s face and coo lovingly at her, I was taken aback. Hey, that’s MY Mum, go kiss our own, you’re invading her space. My Mum didn’t seem to mind. Old people in institutions never get enough hugs, never enough casual embraces, never enough expressions of care that remind them that yes, they are in fact still part of this world, still loved.

The author being held by her mother, and her sister, circa 1957

But all the kindness expressed at my Mum’s nursing home (population about 70 on three floors, one being a dementia ward) can’t hide the fact that nursing homes are rotten places to end up. And not all homes are created equal. Our family’s experience at another massive nursing home complex – too many people, rooms too small, lack of compassionate care – was nothing short of a nightmare. When we got the chance to move her to a newer, smaller and brighter place, we ran for the exits.

And wept buckets of relief when we got there.

Recreation staff at Mum’s home do their best to create programming that ranges from word games to the hated bingo (well, my Mum dislikes it intensely), to bowling and musical concerts. They religiously come by to ask her to come and play (she doesn’t have the strength to propel her own wheelchair). They keep meticulous records of what she attends. They ask her opinion about the food she’s served. It isn’t bad. There are birthday parties. I’ve seen one cleaner break into song at the drop of a hat because she knows my Mum likes to sing along. The doctor makes rounds every week. He’s kind, attentive, and a surfer dude, which Mum finds endlessly funny.

So why am I so sad about where she has ended up? It’s easy to rationalize why she’s there. Her special, tilting wheelchair weighs a tonne. She’s a two person assist when it comes to toileting, so she couldn’t possibly live with us. She needs the 24 hour a day care and safety a nursing home provides. She’s warm, her clothes are kept clean…..and yet…..

At the other end of the spectrum is my mother-in-law, whose determination to stay out of a nursing home has become a paranoid obsession.

But as her mind slips, the only way she can continue to live alone is because we make constant trips to her apartment to make sure she is okay, has food, takes her meds, and hasn’t left the burner on. We arrange foot care, Meals on Wheels and cleaners, which she interprets as an assault on her independence. She cancels them. So, we suck it up, accept the fact that she isn’t the same person she was, hope she isn’t a danger to herself or others, and get on with it.

Everyone we know is wrestling with some version of elder care, and agonizing over the decisions made, or not made. And I always ask myself – will I do it any better? Will luck be with me? Will I be able to make good decisions, to downsize, or accept help when the time come, before I become incapable and someone else starts making decisions for me?

It’s clear that humans are a successful species because we utterly refuse to deal with the facts before us. Denial, I guess you call it. As I ‘round the Horn (and have never been as fit, or happier, I hasten to add) I am no different. I have made no real plans for my inevitable declining years. Will I do it differently? Will I just hope to fall abruptly off my perch one day (my preferred option)? Or, will I quietly fade away in a nursing home, hoping my daughter will have time to drop in to chat about the Blade Runner?

When I started writing this, I hoped to have something profound to offer.

Sorry.

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A.E. Randal is a pseudonym to protect the identity of the author and her family members.