How do we help my mother with dementia adjust to life in the nursing home?

A fellow caregiver asked...

My mom has been in a NH for less than a week for long term care. She has vascular dementia along with heart and other ailments, but is mobile. My sister and I are trying to help with her transition but has always been difficult. If we visit, she wants to go home. After we slip away with help from staff. She calls me at home screaming and demanding I come get her. I do not know when is the best time to visit. I know we have to wean the visits, but it has only been a few days and she is so "out there".

Expert Answer

Kay Paggi, GCM, LPC, CGC, MA, is in private practice as a geriatric care manager and is on the advisory board for the Emeritus Program at Richland College. She has worked with seniors for nearly 20 years as a licensed professional counselor, certified gerontological counselor, and certified geriatric care manager.

The transition into long term care is difficult for both the patient and her family, perhaps more so with a dementia patient because they can't understand what is happening. I'm so sorry you've had this sad experience - but it is easy to fix.

First, "I want to go home" is a common complaint for dementia patients. It may mean 'I want to return to my house' but most often it means, 'I want to go back to a time when I was in control of my life.' Often a person who is still living in their house will request to 'go home.' Since you are a loving caregiver, you would like to take your mother home - but you cannot work a miracle and take her back to the time when she did not have dementia.

The solution is to agree with her that you would like for her to go home, but there is a temporary problem. The roof is leaking, the carpet is being repaired, there is water damage, etc, for some reason, perhaps she could return once she can walk 100 yards, or whatever. In this way, you do not tell her she can never go home, but give her a reasonable explanation of why she cannot go home now. And you do not argue with her - this is a major plus.

Next, when you visit, as soon as she starts to complain, leave. Don't be rude, just leave, say goodbye, tell her you love her and that you will be back, but leave. After a few times of you leaving when she is difficult, she will catch on that the visit lasts longer if she is pleasant. This works, even with dementia patients.

Next, get the phone OUT of her room. She does not need to be able to call you. There are phones that have no dial pad. You can have one in her room so you can call her but she cannot dial out. As long as she can call you, she will. Dementia means a loss of social inhibitions and an ego-centric world view. She does not have the ability to stop herself from calling to complain, and sees no reason not to bother you. You must help her by preventing it.

These are the final months or years with your mother. For her sake, for yours, and for your sister, make them pleasant. Take wonderful projects with you when you visit, so that when she has a good day, you can enjoy a quality visit. Reduce the possibility of ruining her times with you by eliminating the phone, and by leaving when she has a bad day.