How to tell dementia patient going to nursing home?

According to the CDC, over 6 million Americans are living with Alzheimer’s disease, the most common form of dementia, often necessitating a move to a long-term care facility. Knowing when and how to tell a dementia patient they are going to a nursing home is one of the most difficult and emotional challenges a family can face, requiring careful planning and compassionate communication.

Quick Summary

This guide provides practical advice for approaching the challenging conversation about a nursing home move with a dementia patient. It details key signs indicating the need for a higher level of care, offers respectful communication strategies, and outlines steps to ease the transition.

Key Points

• Identify safety risks: Look for signs like wandering, unattended appliances, frequent falls, and neglected hygiene as clear indicators that a higher level of care is needed.

• Communicate with simplicity and positivity: When explaining the move, use short, clear, and simple sentences that focus on the benefits like safety and companionship, rather than the person's decline.

• Validate emotions and avoid arguments: Never argue or try to logically reason with a patient who resists the move. Instead, acknowledge their feelings of sadness or fear and provide gentle reassurance.

• Use a consistent family script: All family members should use the same simple, rehearsed language when discussing the move to avoid confusing or agitating the patient.

• Personalize the new living space: Decorate the patient's new room with familiar and beloved items like photos and a favorite bedspread to help them feel more at home and reduce anxiety.

• Recognize caregiver burnout: Understand that chronic stress and exhaustion in the caregiver are significant signs that a transition to professional care is necessary for the well-being of both the caregiver and the patient.

• Engage facility staff proactively: Share your loved one's personal history, likes, and dislikes with the nursing home staff to ensure they receive more personalized and compassionate care.

Recognizing the Signs That Indicate the Need for a Move

Making the decision to move a loved one with dementia to a nursing home is rarely easy. It is often driven by a change in their needs that can no longer be safely or effectively met at home. Caregivers must be vigilant for several key indicators that point toward the necessity of 24/7 professional care.

• Increasing Safety Risks at Home: This is one of the most critical red flags. Is your loved one leaving the stove on, forgetting to turn off the water, or wandering out of the house and getting lost? Have there been frequent falls or unexplained injuries? These incidents signal that their living environment is no longer secure.
• Decline in Personal Hygiene and Daily Activities: A noticeable drop in the ability to perform activities of daily living (ADLs) is a strong indicator. This includes forgetting to bathe, not changing clothes, or struggling with eating and using the toilet.
• Worsening Behavioral Symptoms: As dementia progresses, behavioral changes like increased aggression, agitation, and extreme confusion become more common. If these behaviors become difficult for family caregivers to manage, a move may be necessary for everyone's safety.
• Caregiver Burnout: The physical and emotional toll on a primary caregiver can be immense. Signs of caregiver burnout—including chronic stress, anxiety, and depression—show that the current care arrangement is unsustainable and risking the health of both the caregiver and the patient.

Preparing for the Conversation and the Move

Once the decision is made, the next step involves communicating it to the individual with dementia. This must be handled with immense care, as their cognitive impairments mean that standard logical explanations are often ineffective and can cause further distress.

Communication Strategies

• Choose the Right Time and Setting: Have the conversation during a time of day when your loved one is typically calm and clear-headed, often in the morning. Choose a familiar and quiet place free from distractions.
• Simplify Your Language: Use short, simple sentences and avoid medical jargon. Instead of focusing on their inabilities, highlight the positive aspects and benefits of the move.
• Focus on the Benefits, Not the Deficits: Frame the move in a positive, reassuring way. Focus on the community, activities, and having friendly people available to help. Phrases like, “We are moving to a beautiful new place with lots of friends and activities,” are more effective than, “You can no longer live here safely”.
• Validate Their Feelings: Acknowledge any sadness, fear, or anger they express. Reassure them that they are loved and that this is a change being made for their safety and well-being, not because they are a burden.
• Prepare a Consistent Script: Ensure all family members use the same simple language to avoid overwhelming the patient with conflicting messages. Gentle repetition of this core message will be necessary.

Easing the Transition

• Personalize the New Space: Involve your loved one in choosing familiar items to bring with them. Decorate their new room with their favorite photographs, bedspread, and cherished belongings to create a sense of continuity and comfort.
• Coordinate with Facility Staff: Share your loved one’s personal story, preferences, and routines with the staff. This helps them get to know the individual and provide more personalized, respectful care.
• Consider a Trial Period: Some facilities offer respite care, a short-term stay that can serve as a trial run to help your loved one adjust to the new environment and routine.
• Maintain Connections: Regular, short, and positive visits are crucial after the move. These visits reinforce that they are not being abandoned and help them adapt. It may be beneficial to initially delay visits for a week or two to allow them to build relationships with the new staff.

Comparing Care Options for Dementia Patients

Choosing the right environment is critical and depends on the patient's stage of dementia and their specific needs. Here is a comparison of different residential care options.

Feature	Assisted Living (Memory Care)	Nursing Home (Skilled Nursing Facility)
Level of Care	Best for moderate dementia; assistance with daily activities (ADLs), medication management, and structured activities.	For advanced dementia; 24/7 medical supervision and comprehensive medical care for significant health and mobility issues.
Environment	Residential, home-like setting with secured premises to prevent wandering. Emphasis on social activities.	Clinical setting with a higher level of medical staffing and equipment. Less emphasis on social programming.
Staffing	Staff trained in dementia care, available 24/7 for supervision and assistance.	Higher ratio of licensed nurses and medical professionals; staff is equipped to handle complex medical needs.
Activities	Specialized programming designed to engage residents with memory impairment, such as music therapy or reminiscence activities.	Activities are available, but medical care is the primary focus. Not always tailored specifically for memory care patients.
Cost	Varies widely, often not covered by Medicare. Typically costs less than a skilled nursing facility.	More expensive due to high level of medical care; often covered by Medicare for a limited time or by Medicaid for eligible individuals.

Conclusion

Deciding to move a loved one with dementia to a nursing home is a profoundly difficult decision. However, when a person's safety is compromised and the care needs exceed what can be provided at home, it becomes a necessary step to ensure their well-being. The process can be smoother with a careful and compassionate approach that focuses on clear communication, reassurance, and proactive planning. By acknowledging their feelings, highlighting the benefits of professional care, and personalizing their new living space, families can help their loved ones transition with dignity. It's a journey that takes patience, understanding, and support for everyone involved, but ultimately leads to a safer and more manageable care solution.

Frequently Asked Questions

How do you approach the conversation about moving with a dementia patient?

Approach the conversation calmly and choose a good time of day when they are most lucid, typically the morning. Use simple, clear, and reassuring language that focuses on the positive aspects of the move, such as new friends or a safe environment, rather than their limitations.

How soon before the move should you tell a dementia patient?

It is often recommended to tell the patient about the move closer to the actual moving date to minimize anxiety and stress. Forgetting the details multiple times can cause repeated distress, so giving them less time to anticipate the change can sometimes be more compassionate.

What if the dementia patient gets angry or refuses to move?

It is common for patients to feel anger, fear, and sadness. Instead of arguing, validate their feelings and gently redirect the conversation. Avoid trying to reason with them logically, as this is often not possible. Reassure them of their safety and your continued love and support.

Should I use white lies to make the transition easier?

In some cases, using therapeutic fibs can be a compassionate way to reduce distress, especially if the patient is in a late stage of dementia. For instance, you could frame the move as a temporary stay or a new adventure. The goal is to prioritize their emotional well-being over factual accuracy when reasoning is no longer effective.

What are the signs that a family caregiver is experiencing burnout?

Signs of caregiver burnout include chronic stress, anxiety, depression, resentment, and a decline in your own health. When the demands of caring for a person with dementia exceed your abilities, it's a major sign that professional help is needed.

What items should we bring to the nursing home?

Bring familiar and cherished items that provide comfort and a sense of continuity. This includes family photos, their favorite blanket or bedspread, a comfortable chair, and favorite keepsakes. These personal touches help make the new room feel more like home and can reduce disorientation.

How can I make the moving day itself less stressful?

Keep the moving day as calm and stress-free as possible. It can be helpful to move during an activity that the patient enjoys, like an art class or game of bingo, so they can become engaged with their new surroundings immediately. Having their new room pre-decorated with familiar items also helps.

Frequently Asked Questions

What is the best way to explain the move to a dementia patient?

The best approach is to be simple, positive, and reassuring. Focus on the benefits of the new location, such as safety and social opportunities, rather than emphasizing their memory loss or inability to care for themselves.

How do you respond if a dementia patient asks to 'go home' after moving?

This is a common behavior. Instead of arguing that they are already home, acknowledge their feelings and distract them with a comforting activity or conversation, such as looking at family photos. Reassure them that they are safe and loved.

Should I involve my family member in the decision-making process?

It is important to include them as much as their cognitive abilities allow, especially in the early stages. You can involve them in touring facilities or choosing items for their new room to give them a sense of control. As the disease progresses, too much involvement might cause stress, and your approach should be adjusted accordingly.

What if the patient becomes agitated or aggressive during the conversation?

If they become agitated, pause the conversation and try to redirect their attention to a pleasant activity. The aggression is a symptom of their disease, not a personal attack. Stay calm, empathetic, and try again later during a less stressful time.

How long does it take for a dementia patient to adjust to a nursing home?

The adjustment period varies significantly from person to person, ranging from weeks to months. Patience is key for both the patient and the family. Visiting regularly and coordinating with staff can help ease the transition.

Is it better to tell them a few days or a few weeks before the move?

For many dementia patients, telling them close to the moving day is less stressful than telling them weeks in advance. A longer lead time can cause anticipatory anxiety and repeated confusion, which can be more distressing.

How can I prepare the new room to feel familiar for my loved one?

Gather personal items that hold significance, like family photos, a favorite bedspread, a comfortable chair, or cherished knick-knacks. Set up the room in a way that is familiar and comforting to them before they arrive.