With the increasing demands of dementia caregiving, a day may come when it is no longer possible to care for your loved one at home. Whether it is for safety, health or financial reasons, it is now time to move to a specialized dementia care facility.
You have done everything right. Your hard work and discipline have paid off. You’ve contacted a placement specialist and visited several homes. You were able to match the services different care facilities had to offer with your loved one’s needs, and found the most appropriate one.
You interviewed the staff and administration, asked all the right questions and feel comfortable with their approach to dementia care and the quality of services provided. You have made financial arrangements and secured the means to pay for residential care for years to come. You had your trusted lawyer read and approve the admission agreement, and you are ready for the move.
So why does it feel so bad?
The logistic and administrative aspects of moving a loved one to a dementia care facility are important elements of a successful transition. But we must not forget the immense emotional toll that is also involved in the move.
For starters, you are the one who has to make the decision. The person with dementia is often unable to participate in this decision because of the lack of insight brought by dementia itself. She may not understand that she needs care, and may not be able to recognize the amount of care needed. That is your job as a caregiver, often a solitary one. And you will have to make this decision based not on who she once was, but rather who she is today, after the on-set of dementia. She may now be a much different person than before.
That may leave you feeling uncertain that you’re doing the best move for your loved one. Add to this uncertainty the feelings of guilt and grief that you may be going through at this very moment, and even after all the research, soul searching, hard work and self discipline, moving still tastes painful.
The following tips are meant to help ease the move for people with dementia and to better accommodate their special needs during this vulnerable transition time. Use your own discretion on how to use them and consider your loved one’s personality when doing so.
» 1. Do not announce the move in advance.
Avoid anticipation anxiety by not telling her that she will be moving on next month or so. Wait until it is close to the date to inform her, or even tell her only at the very moment of the move.
Moving anticipation anxiety can cause extreme negative feelings that may escalate into extreme behaviors. By not giving her too much advance notice, you will promote a calmer state of mind for the transition. Some homes provide opportunities for socialization, such as dinner parties or day center activities, prior to residency. These are great ways of initiating the adaptation process without being too obvious about the move itself.
» 2. Use fiblets.
She does not need to know right away that this will be her new home for the long run. She may be happier in the idea that the stay is just for a short period of time (say, the home is being fumigated this week, or the family will be out of town and in the meantime she can stay in the hotel). You can repeat the same information when asked again until he’s used to her new surroundings. Collaborate with other visitors and the staff so everybody provides her with the same message and work together as a team to ensure a successful move.
» 3. Use medication wisely.
Consult with her doctor to adjust her medications for those vulnerable days around the move. A good doctor should be able to prescribe anti-anxiety medication to make the transition much easier for her, and for you. You may want to start the prescribed regimen about a week before the move and start weaning her of the medication after a couple of weeks after the move, as she becomes more familiar and comfortable with the staff and new surroundings.
» 4. Bring familiar items to the new home.
Decorate the new home with some of her own furniture, mementos and items that bring her comfort, such as photos and familiar books. Objects and belongings should be packed and moved outside her view, to avoid generating anxiety. Consider eliciting the help of a family member or friend to do some activity with her elsewhere, so you have privacy to make the decisions on what to bring or not.
This is also a tender moment for you as well, and when in doubt about the sentimental value of an item, keep in mind that you can always bring it to her at a later date.
» 5. Avoid visiting on the first week.
Yes, I know it’s hard to let go! But those very first days can be crucial when it comes to developing new relationships with staff members and other residents. Your presence may remind her that this is not really her family and compel her to ask you to take her back home with you, setting backward the already sensitive process of adaptation. Keep open communication channels with staff and work with them to build up their relationship with your loved one, until your visits can be safely made on a regular and supportive schedule.
» 6. Take care of yourself.
This is a very tender time for you, too, so make sure your needs are being addressed as well. Get some extra rest and relaxation; get some exercise and fresh air. Visit with friends and do something nice for yourself. You need to be cared for, too, because the journey is not over yet. You are still your loved one’s voice and guardian, only now you have a qualified team to do the hands-on care while you take a more managerial role.
» 7. Remember that it, too, will pass.
As difficult as this transition is for your loved one with dementia, it is also very hard on you. In time she will make new friends, bond with staff, enjoy the activities, move on and thrive. You will be the one left with the traumatic memories of all the responsibilities related to the transition. Later, she may still ask you to take her home with you once in a while; she may still feel lonely once in awhile. But ultimately, she will adjust, have much better care and enjoy her social life because you took the time to prepare and find the right kind of care for her.
And because of your efforts she will have a better quality of life, safe, comfortable and content, during her remaining years.
— Luciana Cramer is a care specialist for the Alzheimer’s Association-California Central Chapter.