Contents

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

Mr. and Mrs. M had been married for more than 50 years when Mrs. M began to develop dementia. Both had had long, successful professional careers and had retired in their 70s. As children of the Depression, they had lived well, but frugally. As Mrs. M’s disease developed, Mr. M took care of her at home, slowly assuming more responsibility for managing the house. Her behavior became disruptive, and after she was hospitalized for a mild stroke, he accepted the advice of their geriatrician and geriatric care manager that she should be discharged to the dementia care unit of one of the local assisted living/nursing care facilities. Here’s a brief look at some of the challenges he faced when he made the transition from caring for her at home to caring for her at the facility.

• Although Mrs. M had seen a number of physicians in the hospital, including her usual one, once at the facility, she was in the care of a new doctor. She had adult-onset diabetes, so Mr. M was concerned that she was getting her insulin correctly and that her diet was appropriate.
• Early in her stay at the facility, Mrs. M had gotten out of the unit on her own and gone to the main entrance, where she asked someone to call her a cab so she could go home.
• The director of the unit spoke American English, but none of the CNAs were native speakers of English. However, they were from diverse enough backgrounds that for many of them, English was the language they had in common. They were as culturally diverse as their languages and had little cultural common ground with the White middle-class women in the unit. Mr. M, who was an introvert, had to learn how to communicate and interact effectively with his wife’s caregivers.
• Mr. and Mrs. M didn’t have a network of friends—Mrs. M had been the more outgoing of the two, and as her disease progressed, they became more isolated. Their children lived far away and mostly had contact by telephone. Shortly after Mrs. M entered the facility, the geriatric care manager said she could no longer work with them because she had to help her own parents move in with her.
• The facility did have a family council that met at least monthly, and though his children encouraged him to participate, Mr. M said he “wasn’t interested in doing things like that.”
• The Ms were unusual in having a retirement income large enough to cover the cost of Mrs. M’s care without causing Mr. M any hardship. Although Mr. M didn’t have to worry where the money was coming from, he did have to manage it—paying for care in the facility, sorting out payments from Medicare and their coinsurance for her hospitalization, as well as Medicare payments for her medical needs at the facility.
• Mr. and Mrs. M had made wills and advance directives about their care, as well as giving the child who lived closest durable power of attorney and health care power of attorney.
• Unlike many men of his age cohort, for whom household responsibilities were assigned by gender, Mr. M was used to housekeeping tasks—he could cook and clean and do laundry. However, even though she needed supervision, Mrs. M had still done or helped with many of these tasks, and when she was gone, he had to do them all for himself, as well as his “usual” outdoor tasks.
• The facility was about five miles from his house, and Mr. M went to visit every morning. However, because he kept this schedule, he stopped doing some the activities that had kept him connected to his former work life and colleagues.