Book: Transitions

The decision to place someone in a Nursing Home for a short or long period is not made easily. For many Carers it is a decision about doing the right thing for the person they are caring for and for themselves.

Here are some considerations that might be worth thinking about:

Values are expressions of what is important to you. In late stage dementia it may be values such as safety, 24 hour care or knowing that the person with dementia is with family and friends. A person's values can influence one's health care decisions, and this may be especially true in the transitional period when the person with dementia may not be able to make decisions for him or herself. For example, as a carer you might choose for the person with dementia to have less night time medication so that they can walk without assistance in the morning.

Feelings and emotions can provide important information for our choices. Emotions can affect not just the nature of the decision, but the speed at which you make it. For example anger can lead to impatience, and rash decision-making. Some people feel bad when they do something wrong,(driving beyond the speed limit) but many people feel good even though they are doing something wrong ( some people keep driving, they want to be there quicker).

To act in the person's best interests – this is considering what is best for the person. What is the right thing to do, at this time? Will the quality of the remaining days / weeks be improved by this decision? (This is also called Beneficence, ‘doing good’, by health care professionals)

To do no harm - will leaving the person at home bring him/ her harm? Do I have the right skills to give care? (This is called Non-maleficence, ‘doing no harm’ )

The person with dementia has the right to be treated fairly - the person you are caring for has a right to care in an appropriate setting, regardless of their diagnosis. (This is also call Justice, everyone has equal access)

The person with dementia has a right to have a say in what is happening to them - what would the person want?  Knowing him/ her all their life, what would they want for themselves ,now? What wishes if any, has the person expressed prior to losing their capacity to communicate? (This is called Autonomy)

In summary; values, feelings and emotion together with logic and correct information have a role to play in helping us make positive decisions.