Contents

• Introduction
• The Case Example
• Managing the Practical Aspects
• Managing the Emotional Aspects
• What Formal Help Is There for the Transition?
• Resources

Developing Trust

In the first week of her stay, Mrs. M almost walked away from the facility, and shortly after that, she fell and hit her head, leaving a large bruise. Apart from concerns about the management of her medications and diet, Mr. M also had to judge whether she would be physically safe in this new setting (and it wasn’t looking good). It takes time for caregivers to judge either the quality of care or the degree of trust the place merits, and they may have no basis for comparison.

Developing New Relationships

Because Mr. M was not a very sociable person, this might have been more difficult for him than for some other people. Nonetheless, caregivers relinquish control and have to negotiate with others about the care of their family members, rather than just making decisions and acting on them. Some may have considerable difficulty learning how to negotiate effectively.

Another complication that may be fairly widespread is the ethnic, cultural, and linguistic differences between the staff of the facility, the new resident, and the caregiver. All may have very different expectations about how older people are treated and cared for.

Caregivers of people at home or in institutions may benefit from support groups or from participating in the facility’s family council. As with Mr. M, this strategy is not for everyone, and these groups are not always available (but check your local senior center and religious congregations). For those with computers, there are now online groups that may be more convenient. It’s important to help caregivers identify what support does work for them.

Changing Roles and Tasks

Unlike many men of his generation, Mr. M had learned how to clean house, iron, and cook. Managing a household took more of his time than it had before, but he didn’t have to learn a whole new set of skills. Many older men, however, may not know how to do these things (and be embarrassed to ask), while many older women may suddenly be faced with managing finances, maintaining cars, or mowing the lawn—things their husbands formerly did.

Although residents in long-term care have the right to privacy, for spouses the transition of one of them to a facility brings a substantial change in physical aspects of their relationship, one that is rarely discussed. Losing touch (quite literally) can be devastating for both partners.

Coping with Guilt, Anger, and Loss

Research tells us that caregivers who place their loved ones in a nursing home experience far greater grief than those whose loved one dies at home. Guilt is a major source of stress when their family member enters a facility, because caregivers worry that they have somehow not cared enough or that they could have done something to prevent placement. Caregivers also often feel anger—at the person they’re caring for, at other kin who didn’t share the caregiving, or at a social system that seems to place economic hardship on them.

It’s hard to identify an area where caregivers do not suffer loss—to their identity as a caregiver (they still are, but often not recognized as such), to their role in the family, in their relationship with the care recipient and with other family members, to their control of the situation, and very often to their financial well-being and time. Many realize that the move signals the last phase of their family member’s life and go through anticipatory grief or real bereavement.

The Bottom Line