Dear Laird: Mom never liked the idea that her own mother was in a nursing home late in her life. When my grandmother ended up dying, Mom was extremely distraught. She said the nursing home was a cold, lonely and terrible place to spend your last days. One day she came to me and said, “Don’t ever put me in a home.” I thought nothing of it at the time and promised to follow her wishes. Now, her doctor says she is nearing end-stage dementia and needs a lot of support. My brother and I are doing everything we can, but we both have jobs and don’t have the time to do everything she needs. We agree she needs to be in a nursing home, but are haunted by our promise to never place her. Is there a way out for us?  Signed, Fred

Dear Fred: We make lots of promises throughout life. Situations change. A neurologist once told me it’s hard on families to resolve medical decisions for their parents. When a patient is being supported artificially and has no hope, some family members want to end the suffering and some want to continue life as long as possible. To help the family decide, he gave them this advice: “Remember who your mother was when she was 50. What did she like to do? How did you enjoy your time with her? Now imagine her at 50 looking at the woman in the hospital bed. What would your mother say you should do? Almost all of us would guess she would say, ‘Let me go.’”

Let’s apply that approach to your mother and the promise to never place her in a facility. Ask yourself, “Would she hold me to it, or would she say, ‘You have lovingly taken care of me. You can’t do it anymore. Keeping me at home is a burden to you I can’t stand.”

As caregivers, we often misunderstand our job. It’s not to be perfect. It’s not to do everything ourselves. It is not to find a cure for the incurable. It is three things: keep your mom safe, keep your mom comfortable and create moments of joy. You can do that even if she is under care somewhere other than home. If you place your mom, you can spend your time with her remembering the joys of her life and telling her what she means to you. Caregivers do what is right in the situation, not what they said they would do when the future is unknown. 

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