It’s not easy, but your support can make all the difference.
In an ideal world, everyone’s golden years would be exactly that — enjoying the spoils of your labor, watching your family flourish, and having new adventures in a fulfilling retirement. But as so many of us know, that’s not always how the story ends.
With more than 1 million Americans living in certified nursing facilities, it’s far from uncommon for families to make the difficult choice to put a loved one into long-term care. And if you’ve been through it yourself, you’re aware that the transition isn’t always peaceful.
“It’s an incredible sense of loss — loss of control and loss of self — and not surprisingly, there can be an extended period for adapting to a new setting, whether you’re moving into assisted living or you’re moving permanently into a nursing home,” says Karen Hirschman, Ph.D., MSW, a research professor at the University of Pennsylvania School of Nursing who studies the nuances of transition in care plans for people over 65.
To help us understand how to navigate such an emotionally challenging experience, we asked Dr. Hirschman to share a few insights about how family members can support a loved one through this monumental change, even if they’re unhappy about having to make it.
How to answer tough questions — and what not to say
One of the most common questions you’ll hear from someone who’s transitioned into a new type of care is: When can I go home?
In many cases, it’s a complicated answer. Lots of patients who end up in a nursing home begin that journey with what was meant to be a short hospitalization, which gets extended and eventually becomes permanent as their condition fails to improve. In that scenario, it’s important to be clear about what would realistically have to happen to get them discharged, such as whether they’d need to regain a certain type of mobility, like the ability to climb stairs.
“Explain to them, ‘Here are the goals that you need to meet for us to bring you home,’” Dr. Hirschman says. “It could be that if they can get their strength back, they can come home. However, for someone who fell and broke their hip, it can take a very long time to recuperate from that, and if they’re not making progress, you may have to consider a long-term placement.”
In that case, it’s important to be straightforward — no matter how tough that may be.
“It’s a horrible conversation to have, but you have to be honest,” Dr. Hirschman says. “Unrealistic promises are never good. You shouldn’t say, ‘It’s all going to be fine, you’ll be out of here soon’ when you know that’s not true.”
But Dr. Hirschman makes a critical distinction: Honesty is usually a better policy specifically for a loved one who’s still mentally intact.
“If someone is cognitively impaired, grounding them in reality may not be ideal,” she explains. “It may set them back further to hear, ‘Well, the Ford factory closed 10 years ago, and your husband doesn’t work there because he died 15 years ago.’ If they don’t remember, that’s probably not the best way to handle it.”
Look for ways to make their new space feel like home
No matter what type of environment your loved one is transitioning to, the fact remains that it’s not the home they previously knew, and that unfamiliarity can be jarring, to say the least. But there are simple ways to bring pieces of their old space into their new one to remind them that they’re still the same person, even if their circumstances have changed.
“The most concrete way would be finding out what they can bring with them,” Dr. Hirschman says. “Can they bring a dresser or a nightstand or art for the walls? It can make their room more personalized and reminiscent of the home they lived in before.”
This is, of course, dependent on the policies of the facility where your loved one is now living, whether their new room is furnished or unfurnished and whether they have a roommate. But Dr. Hirschman adds that personalization can be big or small, and something as simple as a small collage of family photos can go a long way.
“It really helps to have the comfort of things that are familiar to someone,” she says. “And deciding how to decorate gives people choice and helps them to be involved with the process, even if they may be angry and hesitant to participate in that.”
And even if they’re only able to take a few things with them, having input about where the rest of their things go is impactful, too.
“You can also ask, ‘Who do you want to give this to?’ Being able to give them some say over what happens to their belongings, their furnishings, and everything they’ve built up over a lifetime is important,” Dr. Hirschman explains.
Commit to regular visits and establish a routine
This one may seem obvious, but maintaining a recurring presence in your loved one’s life is key — and sometimes it’s even better if you can use your visits to support a regular schedule to help them adjust.
“I worked in long-term care as a social worker,” Dr. Hirschman recalls, “and one of the most touching things I witnessed was a resident whose husband came to the facility every single day and spent time with her at specific times of day. He was almost always there for dinner and to help put her to bed at night because that was important for his routine and something he wanted to do with her. So they had familiarity and got to spend time together.”
If the resident is healthy enough to temporarily leave the facility, weekly lunches or trips to places that are important to them — like church or one of their meetup groups, for example — can significantly lift the spirits. You can also help through acts of service (which is one of the five love languages). That might mean doing their laundry once a week, or perhaps getting in touch before going shopping to ask if they need toiletries or household supplies.
Of course, those kinds of regular contributions aren’t realistic for everyone, especially family members who don’t live near the nursing home. In that case, regular calls, emails, or text messages are highly valuable, and you can also make a difference by encouraging local friends to stop by.
“This can often be tough on their friends, because they have to self-reflect on their peer who is now in a long-term care setting, but helping someone to stay social and engaged is really important,” Dr. Hirschman says.
Get to know their care facility — and the staff who work there
The three-to-six month period when your loved one is first acclimating to their new home is crucial — not just for them, but for establishing your own relationship with the people who will be handling their care. The good news: That can be as easy as asking questions and observing the environment.
One simple way to understand how a patient is settling in is to change up the times of day you’re making visits. “Don’t make it just, ‘I’ve come to visit, so let’s go to your room and have some private time together,’” Dr. Hirschman says. “Try being there when they’re having lunch or they’re socializing in a rec room or another location, just to see what they’re partaking in.”
You can also find out what happens when you’re not around by checking in with the staff and asking about the behavior they see: “You can ask, ‘What does my mom do all day? Does she stay in her room? Is she engaged? Does she come out for coffee in the morning and chat?’”
This kind of intel can help open up discussions and give you peace of mind, but it’s also an important opportunity for the staff to get to know you, which is especially essential since you’re one of their greatest resources in understanding your loved one’s needs.
“The psychological health of the residents is certainly something the facility is cognizant of, but they don’t know your loved one the way you do,” Dr. Hirschman says. “So while a staff member can do an assessment and your loved one can answer those questions, you’re the best set of eyes to tell them, ‘Something’s not right with Grandpa. I can see that he’s sad. What can we do to engage them better?’”