An 80-year-old man is diagnosed with terminal myeloma. After his admission to the hospital’s palliative unit, his wife becomes increasingly confused, begins eating and sleeping poorly, and one day becomes lost and disoriented en route to her daily hospital visit.

A former mathematics professor descends into dementia. A large, stubborn man, he loses his command of English and refuses help from everyone except his frail wife, who is quickly breaking down under the burden of his care.

A 70-year-old man has repeatedly postponed shoulder surgery, because he is unwilling to leave his confused wife at home alone. Recently, his pain has become so acute that he is unable to drive, do household tasks, or even enjoy life.

An elderly lady is released from hospital after heart surgery to convalesce at her sister’s home. Two years later, she is still there and her sister’s impatience—and encroaching dementia—has exploded into physical abuse.

The remedy in all four cases was short-term placement in a long-term-care facility or retirement home. Also called “respite stays,” short-term stays are longer than a mere trial stay and can be set-up for a variety of reasons, including palliative care, caregiver respite, post-operative care, emergency placement, or as a dress rehearsal for a permanent move.

Getting started

When arranging short-term stays for a loved one, caregivers should consider the following questions:

1. Should I choose a public or private facility?
In Ontario, long-term-care facilities are public: they are licensed, regulated and funded by the provincial government; daily rates are set, and may be subsidized, by the government; and no one can be denied access for financial reasons. The government mandates that a certain number of respite beds must be made available within a region. Many faith-based, charity or municipal residences are termed “not-for-profit” facilities, which provide both long-term and retirement care. They adhere to the same regulations as a government-owned facility. Any profits are re-invested to enhance the level of care. Retirement homes are usually privately owned, for-profit facilities designed for independent living, although higher levels of care are often available.

2. How much care is needed?
It’s helpful to have a needs assessment done by a qualified professional such as a doctor, social worker or community nurse. People seeking more active, hotel-type living are best suited to retirement homes.

People requiring 24-hour assistance are best served in long-term care (government or not-for-profit) or the extended-care unit of a retirement home (private or
not-for-profit). Palliative care can be offered at home, in a hospice, or in a hospital.

3. How much will it cost?
Costs are the major variable in any placement: government-run facilities charge a rate of $32 per day, and private retirement homes may charge $120 a day or more. These rates include accommodation, meals, a varying level of personal assistance, and all activities and amenities.

Before rejecting a higher-priced placement cost, do the math; it may be more affordable for the limited time that’s required.

4. How do I access the facility?
Long-term-care facilities are accessed via your provincial access centre (e.g., in Ontario, these centres are called Community Care Access Centres). Contact your provincial or territorial ministry to find your local office or ask your family doctor for a referral.

Ironically, long-term-care placements entail a waiting list—although emergency placements are accommodated—so it’s essential to plan ahead. Retirement homes are a landlord-tenant arrangement. You can contact the home directly for an application form. Many large retirement-home chains have quick-response services for emergency placements.

5. How long can my loved one stay?
Long-term-care facilities allow short-term stays from two weeks to 90 days. Retirement homes are often more flexible, based on their occupancy.

Achieving the best results So how did the people in our aforementioned scenarios manage?

1.Mary moved into a retirement home in her neighbourhood. She was placed on a “high attention” floor that did not restrict her activities and ensured she was accompanied at all times. A non-medical service was engaged to accompany her when she visited Bill three times a week instead of daily. This routine relaxed Mary and greatly relieved Bill, who eventually died in palliative care. Mary stayed in the retirement home and is doing well.

Care tip: Work with the staff to create a supportive atmosphere and routine. Move in furniture and possessions and forward the home phone to the new suite, but don’t list the house for sale yet! Follow staff’s advice about home visits and allow a settling-in period. A supervised visit back to her home made the wife realize that waiting in an empty home was no longer an option.

2.Howard, the math professor, was offered a respite placement, but his wife refused to let him go alone; after all, it was her duty to care for him. The long-term-care facility accepted them both, and after a struggle, she allowed the staff to assume his care under her watchful eye. By the time a permanent placement became available, she was much more able to relinquish control instead of waiting for a perfect solution.

Care tip: Transferring caregiving from family to professional staff can be stressful. Work with the staff and your parents to manage expectations and to transition from hands-on care into supervisory mode. Anticipate the stages of grief (denial, anger, depression, despair)
and get help for your parent and for yourself.

3.Roger planned carefully for his shoulder surgery. He booked a month in a retirement home’s heavy-care floor for his wife to cover the period he would be in hospital and rehab. His surgery went so well that no rehab was needed, so he moved into the retirement home as well! Despite his earlier objections to any assistance, he allowed home care to be set-up for their return. When a second shoulder surgery was required, he did not hesitate to arrange a short-term stay at the retirement home for his wife.

Care tip: Experiencing care in a non-threatening environment can help overcome objections to other forms of help.

4. Elissa was quietly removed from her sister’s home to an emergency placement in a long-term-care facility. She declined to press charges against her sister and has required extensive counselling to recover from her ordeal, but she is now safe.

Care tip: Sometimes, waiting is simply not an option, so whenever possible, educate yourself on what’s available before an emergency arises.

All of the above scenarios share one other common thread: the short-term stays brought welcome relief to each couple. If you’re in a similar situation, why make waiting just another source of stress? Help your parents “move on” and get started on life’s newest chapter.

Pat Irwin is the President of WorkingWomen+, eldercare solutions for adult children. Visit www.workingwomenplus.com.