I cannot stress this enough: VISIT. As often as you can, every day, if possible.
I'm not going to sugar-coat it, visits these days are hard. My mom lives in a different reality than I do. She barely talks and barely eats. She's not able to follow a TV program or a movie. Most of the time, she can't follow a story I read to her. I have heard many people say things like "I can't stand to see my loved one like that, I just can't go very often!" And I am the first person to admit that it is tough. I have so many memories of the Mom that I grew up with....and now I have this shell, that kind of looks like her, but isn't anything like the Mom I knew before. But....my response to the "I can't visit" people? How many times was your loved one there for you, even when it was hard? Yes, it's hard to see my mom wearing diapers. But she stayed with me when I was wearing them.....she fed me when I needed help eating....hugged me when I needed a hug.....how on earth could I deny her the same things that she gave to me????
I didn't set out to do it this way, but I do visit my mom almost every day. Sometimes my visits are only 15 minutes, but that's usually enough for me to reassure myself that she's ok and give her a hug. Other times, I may stay several hours. I've come to realize how important my visits are, so even now, when my mom doesn't know who I am any longer, I continue to go as often as I can.
Here are some reasons why:
1) Your loved one will thrive on the visits--loneliness is common in nursing homes and assisted living settings--your visit, even if it's a short one, may be the best part of the day! With my mom, well, like I said, she doesn't know me as her daughter any more. She calls me "Donna Mae" (my real name is Carol) on good days. On most days, she just mumbles. But I believe that somewhere in there, her heart and soul still recognize me, and even if that's not the case, I want my mom to know that someone loves her, even if she doesn't know who that is.
2) The aides do the best they can, but they are (in almost every nursing home I have ever heard of) chronically understaffed, and do not have time to notice everything that is going on with your loved one. Even if you are not very observant, chances are, you will notice changes faster than the staff will. Sometimes this can be the difference between life and death, and sometimes it is just a comfort issue, but that can be a big one, too. There have been several times where I have asked about a change in my mom that I observed, and it turned out that the staff had not noticed or made the right connections. For example, when my mom received a new Geri-chair (this is a wheelchair that allows for different body positions and reclining, etc), she became very agitated. The staff at the nursing home did not have time to delve into "why" she was agitated, but they spent a lot of time trying to calm her down. At my visits, my mom kept saying that she "couldn't walk". But she had not been able to walk for a long time, so that seemed odd. Eventually I realized that "I can't walk" was her way of expressing that she was upset that her feet were not touching the ground in her new chair. We notified all the aides and nurses, and, sure enough, once her feet were back on the ground, the agitation was gone, too.
3) More attentive care. The more often you visit, and the more active a role you take in your loved one's care, the more attentive the care that your loved one will receive. It's not that the aides care less about the residents that receive fewer or no visitors, I think it kind of goes back to #2 above--if you, as a family member are there, you are more likely to notice things, point things out, and ask questions. Every day when I arrive, I ask the aide(s) what and how much my mom ate. Then I ask if she has had a good day. Now that they know that questions are coming, they usually don't even have to look it up! And, since they know that I am thrilled when my mom eats a lot (she often only eats 200-300 calories a day these days), there are some aides that will try extra hard to get her to eat "just one more bite".....better care, you know?
4) You can help with the cares that you are comfortable with. An especially good example of this is mealtimes and snacks. Many elderly people eat very slowly and have to be assisted with their food. But in the dining room, it is usually the same aides that are responsible for everything else. That is, each aide might be responsible to care for six or seven residents, or even more. Now some of those folks can eat on their own, but certainly some of them need help. So the aide does not have time to sit with my mom for 30 minutes to help her eat. And at snack time, if my mom can't feed herself, she gets a juice instead of ice cream or a cookie, because the juice is the lease time-consuming. Once again, this is not because the aides are lazy, they have to make sure that every person gets a "snack", and they just don't have the time to help as much as they would like. This is where I come in, as my mom gets better nutrition if I am there at mealtimes or snack times. If I get there between meal/snack times, I will ask an aide for something and they are happy to get it for me.
"BUT I LIVE TOO FAR AWAY TO VISIT OFTEN!"
If your loved one can still talk on the phone, try to call as often as you can to let them know that you are thinking of them and to keep them connected with the rest of the world. Your loved one may tell you things that they aren't telling the aides, such as aches and pains, or likes and dislikes, and you might pick up on changes in your loved one that need to be looked into.
If your loved one has difficulty on the phone, talk to the nursing staff and find out when a good time to call for an update is. Ideally you should call as often as you are able, of course. Be considerate of the nursing staff's schedule--remember they have other residents to tend to--but your priority is your loved one. Ask lots of questions--is my loved one eating and drinking? Any bruises or fevers? Any behavior problems? What does he/she do during the day? What is he/she doing right now? This will give you a good idea of how things are going.
Another thing you can do is look into having a volunteer visitor for your loved one. Some senior organizations and most hospice organizations have volunteer visitors who can go and spend time with the resident. This can help you have a better idea of where things are really at, and will undoubtedly comfort your loved one.
In general, whether you are near or far from your loved one, the more attention you can give them, the better they are going to do--and the better you will feel about the decisions you have already made, and the decisions that you will need to make in the future.