The Only Game in Town

As I pass through small but remarkable towns, I am pleased to see a long-term care community in their midst.  With the over 65 segment of the population being our largest, it is important that every town have an option for rehabilitation and long term care.  The one option may be a skilled nursing facility or an assisted living with sometimes even memory care.  I hesitate to investigate.  My hesitation comes from both national research and personal experience.

When looking for care for a loved one, be aware of the phenomenon called the “only game in town”.  Regardless of the venue, competition breeds excellence.  This is true in long-term and rehabilitation care as well.  When there is no other option, the consumer has no other choices.  This may seem easiest but it often comes with a price. 

National healthcare research has found that rural healthcare options are limited and less up-to-date.  This translates into less treatment options, less specialists and less overall choice.  An example, an individual with dementia needing a secure community may have only one option, if that.  This may be a back hall that has had an alarmed door as the sum total approach to memory care.  After all, it’s the only game in town.  Your husband wanders and breaks into others’ homes.  He needs a “locked unit”.  It’s this or the jail.

Once you have made the decision to place husband or father in the rural long-term care community you may start to see the less optimal conditions.  From personal experience–your complaints may be met with, we had a flawless survey last year.  You may wonder who set the criteria?  How high is the bar?  Is the regulatory community going to penalize the only game in town?

Another answer to your concerns may be it’s important that your mother stays near her friends.  You cannot underestimate the value of friends.  This is true. But check out the reality.  Are friends really visiting?  Over time many friends drop away either due to discomfort at visiting or having their own health problems.

Another answer is this is near her church.  If her pastor of 40 years comes every week, perhaps that does mitigate the restraint being used to keep her from wandering.  However, ask him if he also visits the town 20 miles out that has several communities to choose from.  If so, visit and look for less obstructive techniques to address her wandering. 

Long term care options require committed advocacy and diligence.  Assess the only game in town carefully.

About Cate

Passionate about dementia care and quality of life throughout the last days of life----sums up Cate McCarty, Dr. Cate, Dementia Coach. With close to forty years of long-term care experience in nursing and recreation, a Master's in Thanatology and a PhD in Aging Studies, Dr. Cate seizes every opportunity to translate research into quality of life for individuals with dementia and all of us who have the honor to "rub elbows" with them.
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