No one ever wants to admit a loved one to a nursing home...but it can be the right thing to do. And sometimes, it is the only thing to do. When the care responsibilities become so demanding that they begin to affect your health as the caregiver (or start negatively impacting your family), then the time may be right.  As hard as it may be, think of it this way: Would your loved one want to negatively impact your health, or the well-being of your family? The answer is most likely a resounding no. Take comfort in that thought, and then do everything you can to make the nursing home experience a positive one for both you and your loved one.

Begin with this family alternate care checklist.

1. Meet with the nursing home staff.

It's important to be comfortable with the executive director, director of clinical services, director of resident and family services, and charge nurse who will be responsible for your loved one's care. Get to know them. Let them know if there are any special issues with your loved one, or any special requests you might have. Remember, your loved one and family members are the customers - the facility and its staff are there to assist you.

2. Get to know the nurses' aides.

Nurses' aides provide the largest amount of care to residents. The better you know the aides caring for your loved one, the easier it will be to talk with them. Like anything else in life, the better the relationship you have, the more responsive people tend to be.

3. Communicate your needs and concerns.

If the level of care is not up to your expectations, tell the staff. It's always best to start at the level where the issue may exist. Voice your concerns to the nurses' aides or the charge nurse. If you don't get a satisfactory resolution, then go to the director of resident and family services, the director of clinical services and finally, to the executive director. Following the "Chain of Command" is important.

4. Participate as much as possible.

Participate as much as possible in the care of your loved one. Let the staff know through your presence how much you care. In addition, this is a great way to monitor the care they are receiving and for you to identify any concerns or issues.

5. Be polite and friendly.

As in all aspects of life, you can accomplish more by being friendly and polite than nasty and demanding. The nursing home staff is comprised of ordinary people doing a very challenging job. Thank them for their efforts. Be polite, friendly, and specific when you request changes or bring problems or concerns to their attention.

6. Stand your ground.

As the Bible reads, "There is a time for every purpose under heaven." There is a time to be polite and a time to be friendly. But if your loved one's needs (or your expectations) are not being met, there may also come a time to be demanding. Hopefully, this will never happen. Most facilities try to be responsive and provide the best quality care. If, however, after following the chain of command, you reach a point where a resolution is not possible, consider moving your loved one to a more responsive facility.

7. Have realistic expectations.

Your loved one is in a nursing facility because her/his care needs are significant. But this doesn’t mean that someone will be standing by his or her side every minute of the day. Nurses' aides typically care for seven or eight residents throughout their shift. It’s important, therefore, to have realistic expectations about the nursing home environment and the amount of care your family member will receive.

• Know your expectations. Communicate your concerns and issues. Meet the key staff. Be polite and friendly. Participate as much as possible. And don’t forget to keep your sense of humor! Humor can be the best therapy of all in getting you through these difficult times.

John Whitman -2005