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Elder Care: Institutional or Home Care?

EldersThere has been much in the news about bed closures in care facilities, new nursing homes opening, and the stress for the elderly of being moved. Many issues should be taken into consideration when deciding if an elder care facility is the right choice.
 
A mid-eighties couple I know illustrates the latter point. After decades together, failing health has forced her into a care facility. He walks there every day and visits with her for a few hours. If he had to go into care, but couldn’t be with her, or if she were moved to another facility that he couldn’t get to, it would probably kill both of them. Either event would take away the last thing that gives their lives meaning.
 
The Holocaust and other wartime trauma comes back to haunt the elderly…
 
There is, however, another less-discussed issue involving eldercare. Most people as they age experience some diminished cognitive capacity, usually starting with short-term memory problems.
 
It is emerging that as holocaust survivors go into nursing homes, the old holocaust traumas resurface. With diminished capacity, survivors can’t tell the difference between the nursing home and the death camp—strangers in uniform, orders, medical procedures, regimentation and frequent deaths. The setting triggers flashbacks for many. The nightmares, absent for 5 or 6 decades, return nightly. They live and die in terror.
 
Estimates are that there are over 100,000 holocaust survivors still alive in North America. Jewish organizations worldwide are trying to keep them out of nursing homes, mostly by organizing groups to provide homecare.
 
What happens to other trauma victims as they age?
 
Many Canadian veterans remember the trauma of WWII and the Korean War. Some were in prison camps, others were injured and most had friends die around them. The worst trauma for some was having to kill other people just to survive.
 
Some living Canadians, as civilians living in England, Germany or other European countries, were subjected to the trauma of ongoing bombings and deaths.
 
Some of the survivors never recovered from the effects of war. I hear about those souls through the lips of their adult children and grandchildren.
 
Most, however, went on to live normal lives. However, as they get old, cognitive capacity diminishes and they are increasingly vulnerable to the old traumas re-emerging.
 
A man I will call George served in WWII in Europe, and then came home to live a normal life. At 82, he got a friendly call from another veteran and that triggered ongoing flashbacks and unremitting nightmares about combat and being taken prisoner. He was sufferring full-blown “Post Traumatic Stress Disorder, Delayed Onset,” When I met him. In his case the delay was over 60 years. Fortunately for him, he lived with a supportive family, received homecare,  we were able to conduct appropriate trauma reduction therapy.
 
Could George have adapted to living in a nursing home? I doubt it. Moreover, his life would have ended in terror. George died a little over a year later. His wife commented on the peace he enjoyed in their final year together.
 
This is not an indictment of elder-care facilities. I have seen friends and relatives adapt and enjoy their lives in extended care facilities. If that time comes for me, I think I personally would adapt and be happy.

What I am trying to say is that for the many among us for whom going into a nursing home would make us relive wartime or other extreme trauma, we as a community need to come up with more non-institutional alternatives so that all our elders can live out their lives with relative peace.

Not to do so constitutes elder abuse at the community level.

Psychologist Dr. Neill Neill maintains an active, in-office and telephone practice, focusing on healthy relationships and life after addictions. Check out his book, Living with a Functioning Alcoholic: A Woman's Survival Guide. http://drneillneill.com

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