There's No Place Like Home
A nursing home creates space for a new kind of family bond to emerge.
By Ali Moore
I was in my third week interning with a hospice organization when I was asked to visit a woman who was actively dying. Without hesitation, I told my supervisor I would go and see this woman, Jill. I spent part of my thirty-minute drive preparing for our encounter, but mostly I was preoccupied with other things. I did not anticipate that on the drive back, and in the years to come, I would spend hours thinking about this visit.
I walked into the nursing home where Jill resided and was greeted by a friendly staff member. I took a deep breath and confidently entered Jill’s room. I immediately choked up with tears as I saw two of Jill’s loved ones by her side. I was prepared to sit in silence with Jill, maybe hold her hand and help her to feel like she was not alone. But I was not prepared to meet people who would be grieving just four hours later, when Jill passed away.
This was my first close encounter with death. It brought back memories of seeing my grandmother in the hospital, dying of cancer, when I was only five years old. It made me wonder, did Jill know the Lord? Am I fit for this career? I only spent 10 minutes with Jill, but I felt like I knew her. Being with someone at the end of their journey on earth is intimate.
When people move into a nursing home, they usually intend to live out their final days there. Nursing home employees get the honor of caring for residents as they near their deaths. I am thankful that the Lord has given me the strength to follow through in my pursuit of becoming a social worker in long-term care; without His strength, I would be crippled by the grief.
Many people have an idea of what constitutes a “good death.” It might involve holding your loved one’s hand or dying peacefully in your sleep. For most Christians, the ideal part is meeting Jesus face-to-face. It is amazing how God’s timing can sometimes match these ideas—and when this happens, it is truly beautiful.
One of my greatest honors is being invited into several people’s homes every day.
I knew a woman named Cheryl who passed away only moments after her daughter arrived at her nursing home in New Hampshire. No one thought the daughter, coming all the way from California, was going to make it in time. Many people in the nursing home say Cheryl held on so her daughter could be there, but I know God was the one who held off on bringing her home. We believe Cheryl died exactly how she would have wanted to—with her daughter by her side.
Another woman, Bridget, had expressed her desire to pass alone. She did not want her family to be there when she took her last breath, most likely knowing how this moment would stick with them—just as seeing Jill so shortly before she died has stuck with me. Bridget’s family, however, had round the clock visits with her because they wanted to be there for her, comforting her until her time of death. In the end, Bridget got her wish. God took her during one of the brief windows in which her family went home to rest.
While people may not agree on what a perfect death looks like, many agree that it would not be in a nursing home. Even though nursing home staff cannot change the place people die, we can change the environment. We can make residents’ desires known and work to ensure their comfort and dignity.
Nursing homes have an overwhelming stereotype of being horrible places to which people send their loved ones to avoid caring for them. Yes, there are some terrible nursing homes and yes, there are some families who are overjoyed at not having the “burden” of caring for their loved ones. However, there are also nursing homes that act as a family. I am fortunate enough to be working at one right now.
One of my greatest honors is being invited into several people’s homes every day. I knock on a resident’s door and, if they let me in (which they almost always do), they are letting me into their world. If you’re reading this in your house, your apartment, or even your hotel room, it may be hard to imagine what it is like having all your personal belongings in one room. It is hard for residents to come to terms with the fact that their space has been dramatically reduced, whether they were coming from a mobile home or a mansion. There is often a grieving period when a resident enters a nursing home.
The other day, I was completing a mood assessment with an 88-year-old woman, Tammy, and she told me she felt like she was in jail. Disclaimer: Tammy used to work at the nursing home and believes that it is the best one in which she and her husband could reside. However, she still misses her garden, the freedom of being able to cook whenever she pleases—even the chore of cleaning. The staff are doing all we can to help make Tammy feel at home; she now cleans the tables after dinner and will start planting a garden in May. There are many things taken away when someone enters a long-term care facility, but there are also many things gained: quick access to care, pre-planned activities, and, like I said, a family.
The moment a resident moves into a long-term care facility, they are supported by persons from all specialties and surrounded by a community of people their age facing similar life circumstances. I get to meet residents as a social worker intern, someone who can tend to their emotional needs and who wants to take every opportunity I can to learn from them. I care for these residents with my whole being. I pray for them. I laugh with them. I hold them. I support them. I can be like a family member to them when they do not have any—or do not have any that visit.
When nursing homes act like families, negative aspects of those types of relationships are included in the package.
Residents often long for their biological families. Many with dementia cannot even remember the last time they had a loved one visit. Sometimes, even an hour feels like eternity. This is often the case for Betty, a charismatic woman diagnosed with dementia.
Now, if you ask for guidance from anyone who works in a long-term care facility, they will most likely tell you “Do not pick favorites!” But if you work in a long-term care facility, you will inevitably hear, “I know I am not supposed to have favorites… BUT…” I try to treat all residents with the same amount of care and concern, but I am no different! I have my favorites.
Which means I have to tell you about Betty now… I often visit Betty when I need a genuine smile. She dances with me, tells me jokes, and gives me the best hugs. But when I visited Betty recently, she looked extremely distressed. After sitting with her for a while, I realized what was causing her concern; she had gotten it in her head that her son had passed away. Fortunately, this was not the case, even though it felt that way to Betty since she had not seen her son in a while. I was able to reassure Betty he was okay, and she even got a chance to talk with him on the phone. It was so comforting seeing the look of pain wash away when she heard his voice.
Another one of my favorite residents, Paula, has dementia. At this point, I can answer almost any question Paula asks me about the details of her life, which she can no longer remember. At the end of one of our times together, she told me I was like a cousin to her (Paula does not recognize our 70-year age difference!). Even though I have to reintroduce myself to Paula every time I see her, I know she knows me. She knows that I make her feel loved, joyful, and supported, just like her cousin did.
When I said that nursing homes can be like a family, it might have horrified you. For people like Betty, Paula, and myself, “family” has a positive connotation. We had the blessing of growing up in homes where our family brought about that cozy, warm feeling. However, this is not the case for everyone. For others, like a man named Larry who passed five months ago, “family” is something to steer away from. Even when Larry was actively dying, he repeated to several staff members that he did not want his estranged daughter to know.
When nursing homes act like families, negative aspects of those types of relationships are included in the package. Some residents feel like they can never rest because people are constantly bothering them with mood assessments, medicine, physical therapy, etc. Others experience the noisiness of families… something I can relate to coming from one that annually spends a week together in one house—all thirty-six of us.
Most people working in long-term care do so because they have a genuine desire to care for or work with older adults.
There are also familial relationships that work their way out between staff members. On the positive side, a nursing home that acts like a family often means that staff have each other’s backs, which has been especially important during worker shortages that have been exacerbated by the pandemic. It also means we care for each other’s well-being, checking in with each other after emotional situations. My supervisor, Lila, went to deliver a care plan invitation to a resident, only to find a single rose on her bed, a respectful symbol of a resident’s passing. Lila came back into our office in disarray, and we were there for each other.
Many team members care deeply about their residents. They often think that they are better positioned to know what is best for residents than other staff members—even those with more experience or authority—just as a mother might think she knows what is best for her children better than anyone else. This can sometimes lead to disputes. Just today I witnessed a resident, Ron, become so agitated by Betty that he attempted to slap her. Thankfully, I was present and able to intervene. I reported the incident to the unit nurse and a spirited discussion followed. The nurse and an LNA proceeded to tell me all the reasons why Ron should not be on the dementia unit. My supervisor, the director of social services, had another opinion; she thought that this unit was the safest option for him, because he is often exit-seeking, and the dementia unit is the only one always locked. Disagreements like this one occur in all families—the only difference is that in a nursing home family they must be carried out and resolved professionally!
By the grace of God, I have observed more people diligently and thoughtfully doing their job than people who are there just for a paycheck. Most people working in long-term care do so because they have a genuine desire to care for or work with older adults. Long-term care is not for the faint-hearted! The first thing I do when I come into work is check the resident list to see if anyone has passed away. When I call families, the first words out of my mouth are “There is no emergency”—families usually hold their breath when they get a call from their relative’s nursing home.
My involvement in the nursing home has given me new family members. I will finish my internship in May and will have to say goodbye to all the residents who have made a significant impact on my life. I will lose the privilege of learning about their lives and being a part of their care. I will hold on to the memories, and I will share my experiences; I want people who have not had the opportunity to spend time in a nursing home to know they can be wonderful places filled with worthwhile lives and meaningful deaths, where strong family bonds can be fostered among residents and staff.
Ali Moore lives with her husband in West Lebanon, New Hampshire. She graduated from Dartmouth College in 2020 and is currently earning her master’s in social work from Louisiana State University, with a goal of working in long-term care.