Expert: Mary Gordon - 11/15/2006

Question
I have so many questions. My Mom has diabetes and all that goes with that. 2 and half years ago she fell and fractured her knee. It was like a bullet to her head. Her mind has never been the same. In the last 2 years we have home cared and most recently Assisted Living, peppered with stints in Rehab. She will have to go to a new facility in 2 days. I am sure she will be frightened. I am not sure what to tell her. She wants to go home but home was the worst for her.
The new Facility has an Alzheimer unit where she will be placed. She will be very angry. How do I sooth her fears?
HELP!!
Diane

Answer
My advice is not to do a lot of talking about the subject - you will only get her upset - and she may not even remember what she is upset about (the emotion will last longer than the memory of the idea that sparked the emotion).

Don't do the packing and sorting around her or the unpacking. The best idea is to get her out of the way for this so she won't be distressed by the bustling. She also won't be able to make sensible choices about what to take with her, so you'll have to make the choices for her (a few weeks prior to the move for my mother in law, I tried to get her to help me, and I gave up - she was getting agitated for no purpose and she really couldn't help - not unless she had a major need for silver lamee party dresses she hadn't worn in 30 years!  We sent my mother in law to her sisters for the day and night before the move, for a nice visit. While she was out enjoying her day, we descended on her apartment, and selected and packed up all the appropriate things, put them in the truck, and moved them to her new room. We unpacked her things, had her pictures hung on the wall, all the familiar things the facility would let us bring (they allowed some personal furniture etc.). In other words, we wanted it to look comfy and pretty as possible, and not have her around to get upset by the unpacking and arranging.

When we brought her to the new place, we arranged to eat lunch with her and then we turned her over to the director of care and went home. We were very matter of fact. If you have to, tell your mother something soothing like a white lie about why she's there or for how long. In other words, don't get ito distressing confrontations. This is no different than helping a kid adjust to their first day of school - if you are in a state about this, she'll pick up on it.  

I know you know, people with dementia often have some trouble with adjusting to a new home environment. I know you are scared, and nervous and want this to go well - I also know you know that this is the best of a lot of hard choices you've had to face, and there really isn't a viable alternative, so hang in, hang in, hang in.

Expect agitation for 2-3 weeks. You might ask your mom’s doctor for a light prescription for Ripserdal, Haldol, or Seroquel and use it for a few weeks (in a VERY light dose) BEFORE the placement.  She may be confused, but not upset and agitated. If you don't want to try this before she goes in, it might be an idea to have the prescription ready and on hand, in case she needs it during the first few days (my mother in law did - she was getting agitated at night, and just for the first week or so, she needed a little something to settle her down at bedtime - after that, she was fine).

I'm presuming you have met with staff and told them all the things they need to know about your mom as a person - things she likes to do, is she social or shy, etc. etc.  That helps give them some clues on how to handle her (i.e. would she do better with time to herself or be introduced to the group and thrown into the social whirl of new people?).

Do not necessarily avoid visiting for two weeks, even though the facility may suggest this - instead - expect she might be agitated and angry, but stop beating yourself about it. You did what had to be done. Your mom may need time to grieve. To expect instant happiness is unrealistic.

Plan BRIEF visits. 10-15 minutes will be enough for you to know your loved one is well-cared for and to give them reassurance. A 3-hour visit is going to cause agitation. If the loved one demands to be taken home, DON'T try to explain. Look at your watch and say, "I have to go now." It will break your heart, but will minimize the behavior after a few times. Many patients start the "take me home" stuff after a 30 minute visit when they get tired. Take it as an indication that it is time to go.

Take something to do during your visit. Do their nails, have a snack, listen to a new piece of music, go for a stroll, bring a photo album or share an activity. Once you are done, it is time to go. Have the staff divert your mom to an activity such as a meal so she's occupied (this requires you have some idea of the schedule, so you can time your visit with a potential exit time that lines up with something interesting going on).

Call before you come so you know what kind of day mom one is having. If you know she's having a bad day and if you can't face it without becoming upset, don't go when she's upset . . . or go later.

Talk with the staff. Smile. Find the staff doing something right and complement at least one on each visit. There is nothing worse than the family who comes in with their microscope looking for flaws. They will become apparent soon enough -- we are talking working with demented adults here.
Know that the facility and staff have no magic for dealing with behavior problems. If it was difficult to manage at home, it may seem worse in the care facility -- especially with other people around who may also have behavior issues related to their dementias. You want to get off on the right foot with the staff, so they see you as a partner - it also gives you more influence if they like you and see you as supportive.

Before you leave, talk with an administrative staff member to see how things are going and what you (as a team) can do to improve care throughout the adjustment.

The vast majority of people adjust and adapt, and do just fine, and their families are often surprised at just how well! Hopefully, you have picked a facility with lots of activities, since it does help when they are kept busy and occupied (less time to dwell on distressing thoughts).

Hope this helps. Thinking about the move is the worst part. I think you will feel very relieved when you know she's safe and well looked after. We certainly found we were hugely destressed. We didn't realize how much we'd been worrying when she was still at home and any hour of day might bring some new disaster.

You are doing the right thing. Hold tight!

Mary G.