Sometimes, in spite of exploring every option, the only solution will be a nursing home, as when someone is severely disabled requiring a level of care beyond what the family can provide, and home care is financially or physically impossible.

If your relative is in this situation, try not to view what is happening as a tragedy. Nursing-home placement is far from being a disaster for everyone. In fact research shows that when people are barely hanging on to coping, going to a nursing home tends to be a welcome relief. My own experience bears this out. During the year I worked in a nursing home I found a good deal of misery, but I also met many residents who were genuinely happy. Some of the most unlikely people flourished in this protected environment.

My mother spent her adult life being pampered; when we had to send her to Four Acres, we knew it would kill her. We did not think she could survive the comedown and the shame. We lived through the agony of our decision and came to terms with our guilt at putting her away. And then there was the happy shock. She is much better off now that she is here! For the first time in years, she is not isolated. She is kept busy and active. She has a reason to put on makeup, to get her hair done. She has taken up painting; because of the daily physical therapy, she can walk by herself again.

Good nursing homes offer a variety of features that home care cannot provide: activities and stimulation, the equipment and personnel for rehabilitation, immediate attention in a medical emergency. There is even research suggesting that nursing-home placement improves family harmony. In one study family members had a more loving relationship with relatives who had entered a home, because the day-to-day worry was gone.

And nursing homes are not just a final holding pattern before death, as a study done at Brown University showed: the researchers found that 26 percent of the residents of the typical nursing home they studied were discharged to the community – most to live independently in their own homes. The patients’ prognosis at entry turned out to be the best predictor of their eventual fate. Most people whom doctors expected should be able to return home did. In other words, the pronouncement “this is temporary” is indeed trustworthy.

This is not to paint a false picture. Nursing homes are not basically desirable places to be. Many people deteriorate rapidly after they enter. Some nursing homes richly deserve the description snake pit. However, taking the following steps can help ensure that placement is not a tragedy.

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GENERAL HEALTH