How do you help someone accept a change to assisted living?

A fellow caregiver asked...

How do you get beyond "I want to go home" phase once you place your loved one in assisted living?

Expert Answer

Kenneth Robbins, M.D., is a senior medical editor of Caring.com. He is board certified in psychiatry and internal medicine, has a master's in public health from the University of Michigan, and is a clinical professor of psychiatry at the University of Wisconsin-Madison. His current clinical practice focuses primarily on geriatrics. He has written and contributed to many articles and is frequently invited to speak on psychiatric topics, such as psychiatry and the law, depression, anxiety, dementia, and suicide risk and prevention.

Adjusting to assisted living is almost always a process that takes time. As a family member or close friend, your response to questions about that process, depends on the circumstances. If your loved one has been moved to assisted living because they have dementia and they are too confused or dangerous to be living at home, the response takes finesse. People who have dementia in the later stages often do not have a clear sense of the home they had been living in, and what they are really saying is they want things to be as they were in the past. If you ask them about home, they may tell you about the house they grew up in, or they may have no real concept of home at all. If they do remember the place they had been living, it is often in a very distorted way. It is very unlikely they have the insight to recognize why it would not be safe for them to return to their home, and it is therefore not helpful if you try to reason with them about it. The best thing is to acknowledge their feelings and empathize with them; let them know you wish they could go home as well. I would suggest you then gently change the subject. If they persist in wanting to discuss it, it is generally best to let them know their doctor did not feel they were safe at home. It is not usually helpful to tell them you think they are best where they are. You should expect such questions to continue as long as your loved is aware things are not as they would like them to be. These questions can be a source of much guilt, so you too have to remember this decision was made in the best interest of your loved one.

If your relative has been moved to assisted living because of physical limitations or because of a mental health problem, the response will need to be different. I would suggest starting with an empathic response, letting them know wish they could have what they want, but it may then be helpful to discuss with them the circumstances that led to their placement. It may be there are specific goals they must reach before they can return home. If that is the case, this can be an opportunity to help motivate them and to discuss how they might reach those goals. If they have problems that are not likely to get better and the placement is thought to be permanent, this can be an opportunity to help them strategize about how to make the placement work for them. Things to consider are such things as asking them if they would do better with more books or books on tape; whether their hearing and sight have been checked; would they do better with a radio or different music; are they aware of activities at the facility; are they getting enough physical activity; is there anything that can be done to make meals more enjoyable; have they had a chance to meet other residents they might enjoy spending time with; are they having any medical problems, especially pain; might they be depressed; would they do better with a single room or with a roommate; do they have a comfortable bed; is there anything that could make their room more homey, etc. Seemingly small changes can have a profound effect on someone's adjustment. If you think they may be struggling with a medical or psychiatric problem, it would be wise to contact their physician, who may not be aware of what you have seen.