I took her to the bank and to pay bills as she got older. She had a big, big heart. I'd
leave the job and take her on my lunch hour. There was no one else to do it, and I was
close at hand. I could jump in my car and be there in forty minutes…. It became more
and more…. She asked me to take care of her. It chopped off my life at a point when
I was getting a little older, when I wanted to drop a hook in the water.
—A resident's nephew, four years after his aunt's admission
As LIFE CONTINUED for the residents and their relatives and friends, all of the residents reached a time when they needed assistance because of changes in their physical and/or cognitive functioning. This chapter focuses upon the changes in those relationships when the resident had debilitating conditions that did not result in immediate placement but in the need for assistance with instrumental activities of daily living (IADLs) and/or activities of daily living (ADLs) at home. As indicated in chapter 2, IADLs include household chores, home repairs /maintenance, gardening/lawn care, errands, and transportation, and ADLs are personal care activities, including dressing, bathing, eating, and toileting. The most prevalent diagnoses for the residents at the time that they were admitted to the nursing home were strokes (CVAs) and problems related to cognitive loss, conditions that are most likely to occur as people become older and that can result in chronically impaired functioning (see chapter 1).
The severity of debilitating health conditions and the availability of family, friends, and agency services were critical variables for the residents in their efforts to remain at home. Some experienced long-term changes in their health that affected their lives and the lives of their relatives or friends for many years before they were admitted to a nursing home, and others remained in good health until a few months before admission or until a sudden change mandated admission. Eight of the African American and Jewish residents functioned without assistance with IADLs or ADLs until almost immediately before a hospitalization that preceded admission to the nursing home. All of the Latina/o residents and forty-two of the African American and Jewish residents experienced illnesses that resulted in the need for