Can Doctors Force Patients to Live in a Nursing Home?

Certified Care Manager, Aging Life Care Professional, and Certified Master Guardian

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There may be no more heart-wrenching decision than to consider putting a loved one in a nursing home. Even with a doctor’s recommendation to place someone in nursing home care, it is a difficult choice to make. Many people may have heard the expression, “Whatever you do, don’t put me in a nursing home!”

Jump ahead to these sections:

Although a doctor can’t force someone to go to a nursing home, their suggestion is a serious one and reflects the need for that level of care. Their recommendation can be a shock to everyone. It can take some time to digest the fact that nursing home care may be the only safe alternative. 

Why Would a Doctor or Nurse Want to Put Someone in a Nursing Home? 

Health care professionals may take what sometimes appears to be a dispassionate and overly objective view of their patients. Their primary concerns focus on the safety and the best opportunity for health and well-being for their patient. It is not at all unusual for a healthcare team to recommend a level of care that either you or your loved one believes exceeds what is necessary. 

Yet, these professionals have very good reasons for recommending nursing home care, and here are a few of them:

  • Your loved one may require 24-hour nursing access. Most assisted living communities have limited nursing availability. Examples of nursing care include wound care, IV medications, catheter care, respiratory therapy, and regular injections, to name a few.
  • Some patients may need two people to transfer them. Many assisted living communities do not have the staff to provide two people for transfers. Nursing homes are required to use whatever means necessary to transfer someone whether it is a Hoyer lift (often not permitted in assisted living) or two people.
  • Someone has such severe dementia or other psychological problems that present a safety risk to other residents. This might include aggressive or sexually inappropriate behavior. 
  • A doctor or nurse recognizes that as a family caregiver you are burned out and that perhaps a nursing home placement could be the best alternative.
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Are Doctors or Nurses Allowed to Put People in Nursing Homes?

Doctors and nurses are not allowed to put people in nursing homes because they do not have the legal authority to do so.

However, the care team comprised of doctors and nurses will not hesitate to strongly recommend such a move. Only a person with legal guardianship can place someone in a nursing home, and even then, they cannot physically force someone to go against their will.

How Can You Encourage a Loved One to Consider a Nursing Home?

There are several compassionate and respectful steps you can take to encourage someone to consider a nursing home.

No one likes to feel as though they are being forced to do something they don’t want to do. By taking a measured and empathetic approach, you can keep your relationship with your loved one intact and also increase your chances for success. 

1. Do your research first

Start by investigating nursing homes in the area before discussing the subject with your loved one. That way, the stress of finding a place is not hanging over you as you consider a caring approach to help your loved one with placement.

Here are some tips for finding the best nursing home in your area:

  • Talk to the Ombudsman program. According to the Administration for Community Living “States’ Long-Term Care (LTC) Ombudsman programs work to resolve problems related to the health, safety, welfare, and rights of individuals who live in LTC facilities, such as nursing homes, board and care and assisted living facilities, and other residential care communities.” The Ombudsman should be able to give you information on complaints lodged against any nursing home under consideration. 
  • Visit if possible. During COVID-19 restrictions, nursing home visitations have been severely limited. If you are able to visit, drop in unannounced to get an idea of cleanliness and staff interactions with residents. 
  • Talk to your loved one’s healthcare team. Your family member’s physician or nurse may have personal recommendations based on patient experience. 

2. Talk through the reasons for nursing home care

Having multiple discussions allows you and your loved one to make the decision together. Here are some suggestions on how to best have these conversations:

  • Be honest about the care needs that make it necessary to consider nursing home care. If you are a family caregiver, it is OK to talk about the toll that caregiving is taking on you and your family. Be careful not to shame the person into compliance.
  • Taking a respectful tone shows that you care about your loved one’s opinions and feelings on the matter.
  • To the extent possible, approach the subject as a collaboration where you are making the decision together.
  • If your family member suffers from dementia it may not be possible to have reasonable discussions about the need for care. 

3. Enlist the help of another family member

If you aren’t having success encouraging a loved one to move to a nursing home, consider asking another family member for support. Another family member can broach the subject and explain the reasoning, which might help that person see things more clearly.

Collaborate to develop an approach that won’t make your loved one feel as though they are being ganged up on,  but rather another caring voice of concern. 

4. Negotiate a limited time

Consider negotiating an amount of time that your aging parent or loved one will be in a nursing home. This may or may not be realistic, but it may help buy you some time. Once your loved one is in the nursing home, do everything you can to keep them happy there. If your parent wants to leave the nursing home, deal with that problem when it arises. 

5. Be thinking of alternatives

Let your loved one know that you will think of alternatives to nursing home care. Assisted living is the logical choice in these situations, but you will want to make sure that any assisted living can handle the needed nursing requirements. 

Possible alternative solutions could include the following:

  • Assisted living with private nursing. This can be expensive, but if you can afford it, this might be an option instead of nursing home care.
  • Consider private duty home care for 24-hours a day or live-in help. It is possible to find a nurse or a licensed practical nurse (LPN) to fill some of the hours if you go outside an agency. Private duty through an agency does not generally offer nursing care, so this would have to be arranged separately. 
  • Although expensive, there is the possibility of moving your loved one to a private apartment or condominium with private nursing and home care 24-hours a day.

6. Augment care

Let your family member know you can supplement the care they may receive in the nursing home by scheduling private duty caregivers. This is positive on several fronts. 

Private caregivers can be the eyes and ears for problems and concerns with care. They can also provide some much-needed companionship to combat loneliness and isolation. If your loved one’s medical condition permits, caregivers can take someone out in the nursing home community.

7. Take concerns seriously and address them head-on

If your loved one has concerns prior to going into a nursing home, it is important to address them. It is also equally important to address them even after they arrive there. While nursing homes are increasing in numbers and availability, many institutions have been dogged by reports of poor care and inadequate infection control.

Take their concerns seriously and talk about them thoroughly with your loved one. Perhaps your family member is worried about being isolated if visitors aren’t allowed. Make sure to set up video conferencing prior to admission to a nursing home and instruct your loved one on how to use it. Your loved one will be glad to see and talk to a friendly face, instead of simply hearing your voice. 

If at all possible, visit the nursing home before the move. Assure your loved one that they can take some mementos and other personal items and that you will store the rest. 

After admission to a nursing home, you will need to be vigilant. If visiting is not allowed, find other ways to assess the care. Call the director of nursing with any concerns and if those are not adequately addressed, go to the executive director. After these avenues have been exhausted, call the Ombudsman to file a complaint. If it is necessary, you may need to move your loved one to a different nursing home.

Putting Someone in a Nursing Home

Since a doctor can’t put someone in a nursing home, that ends up leaving the decision to you and your family. While it may be the only option depending upon your circumstances, hopefully these suggestions will help the process go more smoothly.


Sources

  1. “Long-Term Care Ombudsman Program.” Administration for Community Living, U.S. Department of Health and Human Services, 1 August 2019, acl.gov/programs/Protecting-Rights-and-Preventing-Abuse/Long-term-Care-Ombudsman-Program.
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