THE LONG GOODBYE: THE PAIN OF PLACING A PARTNER IN CARE
After 40 or 50 years of marriage, placing a partner in a nursing home can be a traumatic experience. No matter how necessary or rational the decision, after a man has placed his wife in care, he usually goes home bereft. The relief in knowing that she is being properly cared for is mixed with remorse and sadness.
After such a long marriage, the partners’ identities are intimately linked. These ties are ‘broken’ when a wife is placed in a nursing home, and the husband feels guilty. He believes he has failed to fulfil his marital obligations and vows.
Agreeing to have his partner placed in care often goes against a man’s sense of fairness, particularly if he and his wife have weathered many difficulties as a couple. ‘She looked after me and the kids and did so much for us. Now she needs help and I can’t provide it,’ is a typical response.
Apart from being involuntary, the separation is incomplete and turns into a long goodbye. Unlike widowers, who can fully grieve for a loss and are supported by community rituals that acknowledge it, men putting their aged wives in an institution experience complex emotions that are little understood.
Men find themselves in this situation when their wives need more care than the men can provide at home. The wives may have suffered a series of strokes, have advanced Alzheimer’s or be physically disabled, and their husbands may not have either the strength or the finances to provide 24-hour-a-day home care.
If a joint marital decision about the placement is not possible, men often feel intense guilt. Instead of being seen as a medical transfer, the relocation is framed as a family eviction, and men have described taking a confused and clinging wife away from home as the worst day of their lives.
It is very important for both parties that the transition to the nursing home be carefully managed. After a partner has gone, men who remain at home are generally more lonely than women in a similar situation. Women are kin-keepers: they keep social relations going, remember birthdays and talk to neighbours. By comparison, men are socially isolated and at 75 may not have the skills to develop a social life as a separate person.
Their loneliness is compounded by the loss of contact with the people who might regularly have visited the wife at home, such as physiotherapists, nurses and doctors, and by the loss of the structure of care. Many men withdraw from outside activities to care for their wives. When the wives go, there is a void.
Men expect to die first and are not prepared for living alone, going out alone, eating alone or making decisions alone. Left to themselves, they feel their independence is threatened. There is uncertainty about their own health, no-one to care for them and the worry that they too might have to move into a nursing home.
It may be difficult for them to be in the house alone. Some men report that they feel suicidal the first day they return to the empty house. They view the house as their wives’ territory and feel wrong living in it by themselves. The sense of grief and loss they experience can be so painful that they may move out of the marital bed, close off sections of the house and live in it differently.
Men are more task-focused than women are and often deal with the situation by taking a practical approach. A man is likely to think, ‘She needs more care, she has to go to the experts, it can’t be helped.’ A woman, however, will probably think that no-one else could look after her husband as well as she can.
Similarly, men are often much happier with the quality of care and with the nursing staff because they accept them as the experts. Women are more likely to come into conflict with nursing staff because they see themselves as the experts in caring for their husbands.
Commitment to the marriage does not end with placement. Visiting is the only way of continuing the relationship and demonstrating affection. Men are generally more likely to express this affection through tasks. They will take in fruit from the garden at home or find something to do at the nursing home.
When they find a task, like taking tea around, it frees them from the inactivity of sitting next to the bed of a partner who perhaps no longer knows them. Many men want and need to be included in the life of the nursing home.
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