1. Tom realized he could no longer continue to care for his confused wife one cold, December night when he awoke to find the door open and his wife halfway down the driveway and walking fast. For Becky, the day arrived when her father escalated from calling her at work once or twice a day to calling her 15 to 20 times per day. Each time he told her he was "being held captive" and "wanted to go home." He lived alone in the house where he had resided for 56 years.

    Deciding that the time is right to place your loved one in a facility is one of the most difficult choices the adult caregiver can make. Most caregivers feel a combination of guilt that they can no longer keep their loved ones at home combined with an overwhelming sense of relief that their long, solo journey is finally over and that someone else will be assuming the role of hands-on caregiver.

    It is easy to get so tied up in your own emotional storm that you forget your loved one will have feelings and reactions as well. Here are some ideas to help your loved one adjust to placement in a facility.

    Give Your Loved One Input

    If your loved one is so confused he or she can’t participate in the decision in any meaningful way, just skip this step. But if your loved one is still able to make choices, discuss the options with him or her. Your loved one might prefer to go to an assisted living facility, for instance, rather than a nursing home; or your loved one might like one facility better than another. Honor these wishes as much as possible.

    Let Your Loved One Express His or Her Feelings

    A few years ago, I was working with a man whose son was moving him to an assisted living facility. The man had lived on his own farm for more than half a century, and he was heart-broken about having to leave it. On my last visit to the farmhouse, the patient said, "I’ll miss this place so much."

    The son jumped in front of me and stuck a finger in his father’s face. "What did I tell you, Dad?" he demanded. "Positive thoughts only!"

    While there is something to be said for the power of positive thinking, it is unrealistic to expect your loved one to make such a major move and have no negative feelings about it.

    It may be hard for you to listen to your loved one’s tears and sadness, especially if you’re already feeling guilty about the move, but the most precious gift you can give your loved one at this time is to listen quietly and without judgment. Don’t try to cheer him or her up. Instead, respond with empathy. "I’m sure it’s really hard for you to leave here, Uncle Ted," or "I can hear how angry this makes you, Mom."

    Help Orient Your Loved One to the Facility

    Make sure to introduce your loved one to the staff. Help your loved one find his or her room, the dining room and the activity room. If your loved one will be sharing a room, make sure he or she meets the roommate understands which side of the room is his or hers, and which is the roommate’s. Handwritten signs or labels may be useful until your loved one gets used to the concept. 

    It’s also a good idea to ask to speak to the dietary manager so you can share your loved one’s nutritional needs, likes and dislikes.

    Before you depart that first day, try to get your loved one involved in an activity. If there is no activity scheduled, ask the nurse to provide distraction while you slip out the door.

    Visit When You Can and Keep Tabs on Your Loved One’s Care

    Some facilities suggest that you not visit your loved one for the first week or so after placement. In some cases, this may be a good idea, but more often, it is not. Your loved one has already lost so much already–his or her home, friends, belongings, perhaps a precious pet. He or she does not need to worry about losing you as well. As long as your loved one responds positively to your visits, try to stop by at least a few times a week.

    While you are there, take a look around your loved one’s room. Is it clean? Do the clothes in your loved one’s closet really belong to your loved one? Are there items of clothing missing?

    Take a moment to talk to the nurse in charge of your loved one’s unit. Have there been any problems such as falls or altercations with another resident? Has the nurse noticed any changes in your loved one’s condition? Have there been any changes to your loved one’s plan of care?

    When Visiting is Difficult

    Some caregivers can’t face seeing their loved one in a facility, so they tell themselves, "He doesn’t know if I’m there anyway" or "There’s nothing to do, and Dad doesn’t really talk to me anymore."

    It’s true that your loved one may not recognize you as his or her daughter, son, spouse or friend, but your loved one will know someone who cares about them has been there and spent some time with them. It’s also true that your loved one may not remember the visit ten minutes after it is over, but he or she will have enjoyed the time during your visit, and that’s worth quite a bit.

    If you have trouble thinking of what to do during a visit, try to schedule your visit during a meal when you can eat with your loved one or help feed him or her. Another good time for a visit is during an activity such as a Bible study group or a music program. Of course, you can always bring your own activities, too. Give your loved one a manicure, bring along an old photograph album and talk about the people pictured or read to your loved one from a favorite book. If you can’t think of anything to do, ask the activity director at the facility. He or she will be delighted to give you some ideas.

    Make Your Loved One’s New Space Familiar

    Bring along a favorite quilt or coverlet for the bed, paper the walls with old family pictures and move in your loved one’s favorite pieces of furniture. Do whatever you can to make your loved one’s new space feel as homey and familiar as possible.

    Ask the staff for help in keeping your loved one’s schedule as normal as possible. For instance, if your Aunt Sally always watches the Chiefs play on Sunday afternoons, ask the staff to help her find the game on her television set. If your dad prefers to stay up late, remind the staff not to rush him off to bed right after dinner.

    Transitioning from home to a facility isn’t always easy, but with your help and support, your loved one will tolerate the move well, and will probably benefit from the increased care.     

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