What is a "home burial?

What do nursing home staff think about familes who are estranged from patients in nursing homes? And what is it like to care for someone who has alienated his or her entire family?

• The reason I ask is because yesterday, I had  to call the nursing home where we thought my husband's mother was before  ordering flowers for what will surely be her last Mother's Day.  It  turns out she was moved to a different nursing home.  No one told us,  but then there was very little reason why anyone would. She  lives in another state, and there are several legitimate reasons why my  husband is estranged from her.  I feel bad for her dying all alone, but  at the same time, I understand that she has arrived at this place  through her own choices and actions.  And probably through mental health  issues that are not entirely her fault. My  husband says he still loves her, but he feels like he already said  goodbye to her years ago, and he's not willing to fly out there to see  her one more time before she goes.  He feels it would only be awkward  and would not bring any added sense of closure for him. For  the past 10 years or so, the extent of his contact with her has been a  very occasional phone call,  intermittent cards on Mother's Day, and the  occasional gift at Christmas. I  personally have never met her.  My first priority is helping my husband  make his own choices with integrity as this estrangement winds down to  its inevitable conclusion. So  when I called yesterday, I couldn't help but wonder what the people on  the other end of the phone think of us.  We were able to get the address  for the new nursing home, and we sent flowers for Mother's Day. I can't  help but wonder what the staff at the new nursing home will think of  this son who sends flowers and a card but doesn't show up in person. At  most, he might call her.  I've never been with him when he has called  her.  Every phone call takes a lot from him.  It's like diving off the  high diving board when you're afraid of heights.  If he thinks about it  too long, he can't do it.  Doing it in front of me would be too much  pressure, I think.  So he'll be cleaning the garage, or out on a bike  ride, and suddenly he'll get the notion to call her, and he has to do it  right then before he loses his nerve.  So he probably won't call her on  Mother's Day, but maybe he'll get the notion to call one day the  following week. According  to the social worker at Hospice, she's expected to live at most another  2 or 3 months.  As fate would have it, in two months we will be in her  city for another event.  (Which makes it sound like we could afford to  do this any time if we wanted to, but in fact, we have been budgeting  all year to attend a reunion on my side of the family.)  After much  hemming and hawing, my husband has decided that if she is still living  when we go, we will go see her for a brief visit. So  basically, in the cost/benefit analysis of life, if he has to take time  off of work and arrange and pay for travel, then he doesn't think the  benefit of seeing her one more awkward time outweighs the costs.  But if  we're going to be there anyway, he's willing to put up with the awkward  long enough to fulfill one of her dying wishes. We  have two kids, my stepchildren, who have not seen their grandmother  since they were young children, maybe 6 and 8.  They are now 15 and 18.   They used to want to see her again, and as they got older, they reached  out to her through Facebook.  But after some phone calls, they have  both decided they really don't want to see her again. They  used to ask their father to explain "what she did wrong."  My husband  always declined to give them specific details, and in fact said that it  wasn't anything specific she had done.  He just couldn't handle contact  with her.  He didn't interfere with their efforts to talk to her, other  then to caution them about boundaries.  They discovered on their own  what he meant by that. If  she is still living when we visit her city, we have decided to bring  the kids to the nursing home waiting room.  They can decide for  themselves whether to take the walk down the hall to her room.  At least  in years to come, they will know that it was their choice. Assuming  she is still living by then.  I thought about writing in her Mother's  Day card that we will be there in July.  Maybe it would give her a  reason to carry on until then.  But I couldn't decide whether that would  be a good thing.  In the end, I decided it was best not to interfere  with the normal course of things. The first person who answered my questions said that health care professionals don't judge.  And I probably sound really  defensive.  But for anyone who is going to take the time to answer my question, I thought  I would take the time to offer a glimpse of the other side of the  equation.  In her answer, Sweetbottom BethPruitt said that nursing home staff try to help patients approach the end of their lives with integrity.   And I guess I just want you (nursing home staff generally) to know that we are also trying to navigate a difficult situation with integrity. Since  I've never met her, or even spoken to her on the phone, I think it's  easier for me to think of her as just this lonely old woman, dying  alone, and I wish that I could bring her some comfort.  Still, I have  faith in my husband and I know that he is not coming from a bitter or  vengeful place.  He's just doing his best to navigate his own life and  the difficult legacy she is leaving behind. Until  recently, she was living independently.  Although most people dread  going into a nursing home, in this case, I am grateful that in her last  days, she will have other people around her.  My hope is that even  though she can be difficult, maybe it's easier to handle difficult  personalities one shift at a time and without the baggage of family  relationships.  I hope the people around her are kind.

• Answer:

  Of course health care workers judge-  we're human!  What we try very hard to do, however, is not show our judgement.  You're in a tough spot;  I am not sure, but in my facility, your Mother in law would have a Medicaid case worker and probably a Public Fiduciary since there seems to be no family involvement.  Those two people might know a little something about the situation, but then again, maybe not.  And they do not judge, publicly, either. I can tell you that, in my facility, if we encountered a situation where someone we thought had no family suddenly had family visitors during the Hospice phase of life, we'd be very happy for everyone concerned.  We would do what we could to make everyone comfortable, including making sure our Resident-  your Mother in law-  was not made upset.  So, if you visit, make sure there are no recriminations, no arguments.  The time for that is long past, and cannot be brought to the now.  Now is the time to say only the good things.  Your idea for a card is wonderful.  And if that upsets your Mother in law, you'll have time to deal with that, too. Before you arrive, get in touch with the Social worker, and let him or her know what time you'll be coming in;  that will give Staff a window of time to make sure your Mother in law is at her best.  Don't come bearing a bunch of gifts-  she doesn't need much of anything.  Plan on two days, if you can, one to do the reunion stuff, one to say good-bye.  Take lots of Kleenex, pictures and remember to smile.  This will be a very difficult time for all of you, but your husband needs to be there for his mother, and you need to be there for your husband. Good luck.