Adjusting to a Nursing Home Can Be Rocky—and That’s Normal

For many families, placing a loved one in a nursing home can be an excruciating decision, laced with guilt. But when medical needs and safety issues exceed your family’s ability to provide appropriate care, a nursing home may well be your loved one’s best living situation.

So what happens when you make that decision, move your aging parent into a good and appropriate nursing home setting, and she tells you she’s better off dead?

Hard as it is to hear your loved one say those words, and difficult as it is not to take them personally, it’s important to recognize that she’s expressing genuine grief. What may feel like a guilt trip that pricks all of your own misgivings about the move is more likely the beginning of your loved one’s natural and necessary process of grieving the loss of independence, privacy and comfort of living on her own.

Grieving is Not a Neat Process

Much has been written about the grieving process, drawing from the seminal work of psychiatrist Elizabeth Kubler-Ross, who defined five stages of grief and loss: denial, anger, bargaining, depression and acceptance. More recent research shows that the grieving process doesn’t necessarily follow such a neat path; rather, individuals come to terms with loss—of their health, a loved one, a home, a job—by following their own unique process. Some may skip steps, others may bounce back and forth, while still others may ride an emotional rollercoaster.

Regardless, people come to terms with grief and loss over time, and need permission—from themselves and others—to work through loss on their own terms (provided they do not engage in risky or injurious behavior for themselves or others). Inevitable denial and anger (I’m better off dead) ultimately leads to acceptance.

Here are some ways to help your loved one along that path—and to help yourself, too:

1. Listen without judging your loved one or yourself.

Listening by simply being present, without offering solutions or defending yourself, can be a very powerful way to help your aging parent process feelings. All too often we assume that we need to “fix” another’s sadness or grief. The act of accepting the legitimacy of those feelings, without passing judgment or accepting blame, can be healing for both of you as you come to understand each other more deeply.

2. Set boundaries.

That said, you don’t need to shoulder the full weight of your loved one’s grieving all by yourself. Neither should you tolerate abusive, blaming diatribes. If the conversation is too caustic, you may need to limit your time together. Be honest with yourself about your emotional needs and work with the nursing home social worker and other members of your loved one’s care team to ensure that he gets the support that you yourself cannot provide.

3. Give your loved one time to adjust to her new living situation.

The losses she is experiencing are real and profound. Grieving her change in status, health and ability; losing her privacy; adjusting to a smaller living space and unfamiliar surroundings—even when you’ve done your best to decorate her room with her favorite things from home—takes time to accept. It may take months, or even a year. We each have our own timetable for major life transitions, and your loved one’s needs should be respected.

4. Watch for signs of depression that may need medical attention.

While grieving is a normal process of coming to acceptance, if your loved one exhibits changes in behavior that indicate more serious mood shifts—a refusal to participate in social activities when he was always gregarious, or a pattern of self-isolation and refusing visitors when she always loved company, for example—it’s time to seek a professional evaluation from the care team. Medication may help, but is not always the answer. Explore non-pharmacological options, such as providing a personalized music playlist, to help your loved one feel more at home.

5. Ask for help.

A certified Aging Life Care Manager® can assist you and your loved one in evaluating best living options for your loved one; making the transition from home to an appropriate care setting; assessing when and what kind of additional support is needed; mediating between you, your loved one and other family members as necessary; and helping you to understand what your loved one is going through, as well as your own adjustment to this new phase in your relationship.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care Manager™. Drawing on more than 35 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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Image: Fernando Reyes

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