Adult children and family caregivers want the best for their aging loved ones. But that can get tricky when advanced dementia turns a senior’s greatest wish — independent living — into a safety hazard. If you’re facing the difficult task of transitioning a parent with dementia into residential care, you’re not alone. According to a report from the Alzheimer’s Association, 59% of patients who stay over 100 days in a nursing home have memory diseases.
Discussing the move to long-term care with your loved one is a must, according to Dr. June McKoy, a geriatric medicine physician at Northwestern Medicine in Chicago. “Dementia is a continuum,” she adds. “You don’t know how much they understand.”
And the sooner you talk to a parent with dementia about an upcoming transition, the better. “Dementia and Alzheimer’s are not a sudden change,” reminds McKoy. If your parent is exhibiting signs of cognitive decline, she recommends discussing their wishes while they can still be part of the decision-making process. If the decision has already been made, the time is now.
So how do you clearly and compassionately tell a loved one who has dementia that they are moving into assisted living or a nursing home? Below, McKoy and Edie Weinstein, a Pennsylvania-based social worker, share their insights.
Tips for talking to a loved one who has dementia about moving to long-term care
McKoy says this conversation is particularly difficult for family members who are unsure of exactly which senior care facility the loved one themselves would have chosen. Here are McKoy and Weinstein’ tips for navigating this challenging conversation.
1. Clearly explain what will happen.
McKoy emphasizes that a loved one’s dementia does not preclude them from understanding a major transition. That’s why it’s important to be precise when explaining the nuts and bolts of the move, and touch on the where, when and why. Weinstein suggests opening up about how much you love your parent or relative, then point out that they need more day-to-day care than you can offer.
2. Be empathetic to fear and distrust.
In addition to causing memory loss, Alzheimer’s and other types of dementia can heighten paranoia. McKoy says some patients with dementia might say “You’re trying to harm me!” or “You’re taking my things!” She adds that some seniors with dementia fear being “locked up” by family members.
If your parent shows signs of extreme suspicion or distrust during the conversation, follow these tips from National Institute on Aging:
- Assure them that they’re safe. Rather than arguing with a parent’s unfounded fears, remind them that they’re safe with you. Tell them how much you care.
- Don’t get pulled into the blame game. It hurts to hear your mom or dad accuse you of harming them. Try to remember paranoia is a symptom of dementia — it’s not personal. Respond calmly with a simple explanation, assurance of your love, or even a distraction.
- Use comforting distractions when necessary. If a parent reacts with suspicion and paranoia, change the subject for now. Lift their mood by talking about a family photograph or beloved memento.
3. Use visuals.
Living with memory loss can be disorienting. Weinstein says you can help make the transition to residential care predictable by thoroughly describing the new living arrangement.
Start out by keeping them posted on all the details of their upcoming transition. For example, offer to look through website photos, take a virtual tour or even set up a time to tour the community before moving day.
4. Talk about familiar items they can take.
The thought of moving to an unusual place can be daunting for your loved one, especially if they have lived in the same house or apartment for many years. Weinstein recommends focusing on what might stay the same. “If they are verbal, ask them how they want to decorate their room, what family photos they want to take, what personal items they want with them,” she says.
When Tina J., a family caregiver in Indiana, helped move her mother-in-law into assisted living, she brought a stack of beloved books, family photos, and fresh flowers. “At the very beginning, make sure all their favorite things are there,” she suggests. “As much as you can, make them happy in their world.”
Before you ask a parent with dementia which items they love, chat with the admissions coordinator or social worker at the assisted living or nursing home to get tabs on items residents may not bring. Weinstein says a lot of possessions that might make your loved one feel more at home — bedspreads, books, lamps, framed photos and radios — are typically allowed.
5. Outline the new schedule.
For a smooth transition to long-term care, do your best to maintain continuity of your loved one’s routine, notes Weinstein. While you can’t assure them that life will be predictable, you can give them a heads up on what their schedule will look like. And let the care providers know the specifics of your loved one’s regimen with the hopes that they will adhere to some of the same.
How to set up a low stress moving day
The days leading up to a loved one’s move can be mentally and emotionally taxing. McKoy says it’s common for family members to feel guilty about the inability to care for the senior at home. But don’t let personal emotional turmoil keep you from continuing to have conversations to prepare the loved one for the transition. Follow these tips to foster an atmosphere of care and respect in the days leading up to the move:
Remind the parent of the move.
Because dementia can erode short-term memory, you might have to have the same conversation about the move more than once. Weinstein suggests reminding your loved one or parent of the move the day before. Then, explain how they will get to start the transition tomorrow, framing the steps ahead as a positive experience.
Choose your words carefully.
Words matter, even if a loved one will not remember the full conversation later. Both experts emphasize the importance of respectful, caring language.
For example, McKoy suggests referring to the new place as a community rather than a facility, which can sound sterile and unwelcoming. Weinstein adds, “I wouldn’t say they’re going to a new home since they might legitimately say, ‘This is my home.'”
Emphasize how much they’re loved.
McKoy recommends reminding your loved one just how much you care — and reassuring them that you’ll visit. Note how often and when you will see them and even detailing an activity you’re looking forward to doing together in the near future.