Esther Heerema, MSW


“Oh, I can’t wait to get into a nursing home! I’ve waited my whole life for this opportunity and it’s finally here!” said no one ever.

While we can all agree that expecting people to approach nursing homes with glee is not realistic, how about other expectations? Often, facilities, family members and residents all have different expectations, and that’s where things can get challenging.

As someone who’s had loved ones in nursing homes and has worked in the industry for years, I’ve pondered how we can all get on the same page. Wouldn’t it help if we all knew ahead of time what was realistic (and not, in this case) to expect from each other? Let’s start with these nine:

1.     Don’t expect a one-to-one ratio.

Nursing homes exist to provide care to the residents they serve. But, that care (and the funding for it) is not the one-on-one care families might have been able to provide at home to a loved one. Expect that help will be provided as soon as possible. If the call light is turned on, it might take a few minutes for someone to answer it, depending on what the needs of the other residents are at that moment.

2.     Don’t expect the same routine.

The staff should ask questions about the resident’s history and preferences, and together arrange a routine that works well for the resident. Things will probably be a little different from how they were at home, but resident choices should be honored as much as possible.

3.     Don’t expect that all medications will stay the same.

The nursing home industry is one of the most regulated industries in the United States. These regulations include the dosages and types of medications residents receive. For example, while the hospital (or family) may have been able to provide a sleeping pill to you or your loved one every night, the nursing home needs to try alternatives before doing this on a regular basis because these medications can increase the risk of falls.

4.     Don’t expect perfection.

We all know there’s no such thing as perfection in life, and unfortunately, it won’t be found in a nursing home, either. The facility will not do a perfect job of caring for your family member.  When they can improve on something, please tell them. (We know there are always things we could do better!)  Effectively advocate for the resident by calmly expressing your concern to the supervisor.  A good supervisor will be thankful that the resident or family member shared a tip with them on how to improve the resident’s care.

5.     Don’t expect a large, private room.

Sometimes, a family member ends up unexpectedly in a nursing facility. He may have fallen, broken a hip, gone to the hospital for surgery and is now in an unfamiliar place. Although a private room is possible, be aware ahead of time that one might not always be available.

6.     Don’t expect that falls will never happen.

Speaking of falling, if your only reason to move your mother into a nursing home is to keep her from falling, you may need to pause. Facilities should evaluate the potential for falls and implement interventions tailored to each resident to reduce the chance of falling, but they aren’t always able to prevent all falls. Restraints, which include full-length bed rails, pose significant hazards to residents; thus, many facilities are restraint-free for the residents’ safety.

7.     Don’t expect the family’s stress to fully disappear.

Watching residents struggle with Alzheimer’s disease or the effects of a stroke may symbolize the potential decline and eventual loss of their own family member, and this can trigger guilt and grief. Additionally, adjusting to not being the main hands-on caregiver can also be a significant loss, even if that caregiver was tired and experiencing burnout. This stress can be decreased by participating in support groups as well as receiving reassurance and evidence that the loved one’s needs are being met.

8.     Don’t expect all facilities to be a horror story.

Yes, there are some bad nursing homes, and some staff members who don’t care about their residents.  However, there are also many good facilities with employees who deeply care about the residents and go the extra mile. Many people who work in nursing homes want to do a good job and have chosen to work there because they feel it’s their privilege and calling to do so.

9.     Don’t expect that the resident will never adjust.

Understandably, it takes time for most people to adjust to a nursing home, as well as for the staff to become familiar with the resident’s personality and needs. While there’s no guarantee that the resident will live happily ever after, I’ve known many people who have experienced a joyful, active and full life in a nursing home. Encouraging positive relationships, providing choices when at all possible and offering meaningful activities can all facilitate adjustment and improve quality of life in nursing homes.

And, in this list of anti-expectations, that’s an expectation on which we can all agree.  

Esther Heerema, MSW is’s Alzheimer’s/Dementia expert at She also serves as the assistant administrator for Christian Rest Home Association in Grand Rapids, MI.