How common is it for old people to end up in a care home?

[Dappy777]

In general, do most old people die at home? Roughly what percentage of us, would you say, end our days in a care or nursing home?

I have a 79-year-old mother. One of my siblings lives with her and I am within walking distance. Also, my husband is a nurse, so he has experience dealing with illness, helping people get in and out of bed, etc. Can people with so much support still end up in a nursing home? If there is enough will and support can you always keep an elderly person in their own home, no matter what? My mother often says she dreads "dying in a strange bed" (as she puts it), and we want to do all we can to prevent that happening.

The priority is her well being, and if that means selling her house to pay for a nursing home, so be it. But I'd be lying if I said I didn't care about the inheritance. No one wants to lose their inheritance unless they have to. How common is it for an elderly person to have to sell their house and go into a nursing home? And who makes that decision? I mean, can a doctor or social worker intervene and insist she go into a nursing home? I suppose what I'm asking is can you usually keep a parent at home if there is enough support, or are there circumstances in which no matter how much support there is the individual simply has to go into care? And how common is that? For example, I have known people whose parents developed dementia and became violent. Presumably such people need 24 hour professional supervision.

This.

I'm an Older People's Social Worker. Very few people end up in a care home, those that do tend to have complex needs.

When I was small, in the 70s, lots of people went into care homes when they became frail. That simply doesn't happen any more - and nor should it. There is much more focus on supporting people to live independently in their own home.

My MiL has just died, aged 93. She had lost almost all her sight and was physically unable to manage a lot of her personal care. However, she was determined to remain at home and did so until the last week of her life, when she had a stroke and went into hospital. Her husband died 3 years earlier, at the age of 95. He had dementia for the last few years of his life but was very placid/compliant, so was able to stay at home, supported by MiL, until he died.

The key factors leading to someone's move to a care home tend to be about safety, either of the person themselves or of those around them. Dementia can make people very frightened and confused, and they might display challenging behaviour as a result. Or they might leave the house during the night, placing themselves in danger.

As a social worker, I've only ever once been in conflict with a family member over their loved one needing to be supported in a residential setting. In my professional opinion, the family member was very much underestimating their ability to care for their loved one in a way that didn't place them both at risk. I've found that, on the rare occasions where someone's needs can only realistically be met in a care or nursing home, the family have come to recognise this.

If your parents haven't already done so, talk to them about the importance of sorting out Power of Attorney (POA). I can't stress enough how important this is.

Really does depend on the health of the older person.
A relation of mine developed dementia early in their 60’s. She was well cared for at home but after a few years she was up night and day. No long periods of sleep. Might be an hour or two and then roaming around. The trouble with this is she needed constant close supervision due to falls or other risky behaviour plus toileting issues - ie feaces being spread round the house or put in cupboards.
To remain at home, you would need a night carer and day carer every single day. Someone to be up all night watching her. 1-2-1 support.
So realistically who is actually going to be able to do this? Her husband was in his mid 70’s and couldn’t physically do it day in day out himself. Other relations had to work. It would have needed a team of people swapping and living nearby. Or an extended family possibly all living together.
Even when in the care home she fell and was bedbound after that. Needing constant care, hoists etc.
i know another lady with Parkinson’s who is similar to this and is starting to need 24 hour constant care.
So it really does depend on the elderly persons health and condition!

Probably get my arse flamed for this but nowadays frail and elderly folk (often wracked with dementia) dont seem.to be allowed to pass away peacefully. I witnessed this many times as a home carer. Tiny frail little folk fall ill, get taken into hospital, pumped full of antibiotics, rehydrated and sent back home for a few more weeks/months of misery. I witnessed this in glorious technicolour a few weeks back when I had to take a family member to A&E. As I walked down the corridor I counted 10 trolleys, all containing very elderly folk all wearing oxygen tubes, and in the 10 hours we spent there, joined by at least 3 or 4 more. It was shameful. I remember as a young child, my great granny in her 80s, fell unwell. Doctor came (remember the days they did home visits?) Instructed my mum and my nan to make her comfortable and take turns to sit with her. She passed away peacefully a few days later in her own bed. I shudder to think what would have happened to her in these days

This isn’t always the case, my DM will never go into hospital or be treated for anything ever again. If she has a stroke the nursing home will look after and make sure she is comfortable , if she breaks her hip she won’t have an operation, again she will be kept comfortable. There will be no feeding tubes or tests, treatments etc.

I’m sitting in a home right now next to my mother’s bed and she is probably in her last hours (the GP was definite that it’s almost over but my mum has defied the odds multiple times). She is 90, bed bound, nonverbal and doubly incontinent; she can lift a spoon if you hand it to her but can’t feed herself if alone. Also, during the four years she has been in a home since her severe stroke, we have had similarly advanced care needs for her two sisters, her brother in law, my dad, my godmother and my mother in law. When talking about care in the abstract people only ever seem to talk about having one elderly relative to care for at a time, or they talk about people who don’t have children at home as well, or they envisage someone who is essentially capable of quite a lot ‘choosing’ to go into a home, rather than someone who can choose a squash flavour in a good day. It’s notable as well that there are now 7 nursing homes in the UK that specialise in Asian residents.

So in our family it’s quite common, but that’s because we have ‘lucky’ genes plus money. The general population dies a lot younger and so the proportion going into a home is low. She probably won’t need one, but you should never say never - you simply don’t know what the future holds.

It depends, part of the stress of looking after elderly parents is not knowing how long or how bad things will get. You really just have to manage each day as it comes.

My DM was looked after at home, mainly by my DF with carers going in twice a day. Eventually she lost so much mobility it was simply no longer possible to keep her at home - she needed turning once or twice during the night and that's simply not manageable in a domestic setting.

My DF was so depressed when he realised he couldn't keep her at home, he was so low for a while that I was quite worried. However, it was absolutely the best thing for both of them. She was so well looked after at the home and it was valuable social contact for him too.

My MIL spent a miserable final year, refusing any help, refusing to admit there was a problem (she had Alzheimer's but had other health problems too). Although we visited several times a day she spent so much time alone and confused.

It was so much harder looking after MIL (or trying to) resources were so much more stretched by then (10 years later than my Mum) and it was very hard to find good care home places and good home care, even if you could afford it.

I agree, it's awful. I'm not sure it benefits anyone. We were so afraid that this would happen with my mother. It was a huge relief when the care home she was in promised that any decline would be managed by them, and that she would not be sent to hospital.

This was nearly 10 years ago and I know that the home she was in has since had to cut back on that level of nursing care.

@YourPeppyAmberTraybake not everyone has family to advocate for them. My mum, when she still had capacity made my brother myself power of attorney. She had been diagnosed with a heart complaint and was offered surgery. She declined as she was in the early stage s of dementia and was adamant she wanted to go peacefully when the time came. She spent 4 months in a care home not recognising anyone, close the end, the staff asked us if we wanted her to be hospitalised. We declined and she passed away peacefully hours later, as was her wish

I have a medical background , so am trained in manual handling, can sort out catheters etc but between family members taking turns to visit every day and carers going in 3 times a day , we are on our knees, once an elderly person becomes very immobile, it's not just popping in to make them a meal, it's emotionally and physically draining.
We can't force our mother to go into a care home but we are trying to persuade her , she's very lonely and between visits can spend hours in the same chair as she can't get up on her own.
We all work full time and would love it if mum could stay in the house she's been in for 67 years but it's getting harder and harder to care for her.

My mum has just moved into a care home. She has advanced dementia, is very active but also very confused about basics of life, sleeping, dressing, toileting. If my dad had not been her carer she would have needed residential care 2 or 3 years ago. But it just got to the point where her care needed a professional team, not one elderly guy. She's safe where she is and as content as she can be.
However the only elderly relatives in our family that have gone into care homes have been dementia sufferers. The others managed at home.

We have a note at mums GP that she will not be admitted to hospital unless it's an absolute necessity.

I am a social worker and we try to avoid someone going into residential care only at the last resort. Nursing care would require nursing needs that can't be met by community nurses. A GP might recommend someone going into care but it isn't their call.

My mum was independent until she was 86 and fell, broke her hip/upper thigh and was suddenly in a wheelchair.

No way I would have been able to provide any kind of care she would have needed.

She improved but not enough to be able to live alone and honestly - even dealing with the shopping, finance and paperwork I do for her - I am worn out. I couldn't imagine having a family, work, a house and caring for a relative.
You may need to think about re-vamping bathroom, any steps may need to go to allow a wheelchair or walker.

She is now in a place with plenty of staff, they have social events, she has company, it's sometimes hard to find her in the building.

My PIL are similar age and so far on their feet but I can see them moving when one of them is not able to be on their feet properly.

My mum cared for my gran who was bedridden for 6 months and it was awful for the rest of the family.

My mum didn't have dementia but otherwise this was it.
I really, really don't want that slow decline to misery myself and I want very much to pop off before I need care.

The trouble is that many people can't care for their parents because they've moved away for work. It's rare that family members are all two minutes up the road.

When the relative is getting up innight falling needing 24 7 care doubly incontinent etc then is up to you if one of you will give up jobs etc and devote that time. Full time. Every day.
If has dementia they may not even realise they no longer at their own home . So keep options open

Big hugs to you at this time

I am in a group of six lifelong friends all in our late fifties. Two of the group's parents ended up in care homes with dementia and they got very little inheritance. Two's parents ended up with care packages at home which have taken a lot of their savings but houses not had to be sold. One still has both parents living independently. I have one parent aged 88 living independently. Between me and dh we have lost three out of four parents very suddenly and not paid for any care for any of them. I know my remaining parent would not want to go into a care home and as I only live a couple of streets away from him I will do everything to keep him at home. Realistically though it will just be me doing the caring and if he couldn't manage at home with me and a care package then he would have to go into a home.

I feel this way. I get around to doing a living will/advance directive, but I've had the conversation with my children. There are worse things than death imho ( though my nearly 90 year old mother thinks people like me are weak!)

In the past 5 years, my dad and aunt have had to go into care homes. Dad had a stroke, leaving him very permanently disabled, and aunt has dementia which progressed very quickly.

I hadn’t even considered the thought of it previously. Both were mid 70s and extremely healthy until then.

Neither could be cared for at home. My aunt’s dd tried for too long.

I’m sorry to be blunt but these days if you don’t write it down and do it properly (preferably PoA for health, plus good quality Advanced Refusal of Treatment in your notes, maybe a DNACPR or Respect form) then you are still at high risk of overtreatment. There are lots of sensible doctors out there, but an out of hours GP who has never met you and only has the written records to go on, is not going to risk his medical registration on the pleas of a family member with no legal authority. And frankly, why should he?

It's refreshing to hear about such a close and caring family. Yes, if your mother is unable to care for herself, you can care for her at home, it's what families used to do in our culture, and many other cultures continue to do. If it becomes difficult, you may need to use carers at home to help, and in the unlikely case that you can't cope, there are excellent care homes that will involve you in her day to day welfare. If you make it clear that you are there for her, her GP services should give you every encouragement.

Oh I know @PermanentTemporary I just need to get it done.

Sending you and you mother peaceful wishes 💐

Sending you love @PermanentTemporary and hoping for a peaceful end.
You've had such a hard time of it.

It isn't a question of ignoring it. I was just curious what happens. If a doctor feels someone needs round the clock care, but the relatives refuse, can they (i.e the doctors) intervene?

There's lots of factors here OP. Most people simply can't afford to give up work and look after their parents.

Also if in 10 years your MIL got dementia she could need close monitoring. Its the mental and physical drain of looking after someone it would be exhausting OP.