Moving a parent into care

Moving a parent with dementia into assisted living, memory care or a nursing home is one of the hardest choices a family makes. Many people feel relief, sadness and guilt all at the same time. Those mixed feelings are common and normal.^1,2

This page walks through the whole move. It covers how to tell when it is time, how to handle guilt, how to plan the move day, what the first weeks are often like, and how to make visits count. The tips work for a husband or wife, too.

How do you know it is time?

There is rarely one perfect moment. Most families decide after a slow build-up of problems, or after a crisis such as a fall or a hospital stay. The Alzheimer's Association suggests asking yourself some plain questions:¹

• Is your parent becoming unsafe in their current home?
• Is their health, or yours, at risk?
• Are their care needs more than you can physically manage?
• Are you becoming easily annoyed or short-tempered with them?
• Are you letting go of your job, your family or your own health?
• Would the routine and social contact of a care home do your parent some good?

If you answer yes to several of these, it is worth starting to plan. Many people need someone watching over them around the clock by the middle stage of dementia.¹ You can read more on middle-stage dementia and late-stage dementia.

Plan before a crisis

Families who have been through this often say to gather facts early and then act once you have them.¹ You can tour places and get on a waiting list long before you are ready to move.¹ A move you planned is usually calmer than one made in a rush from a hospital bed.

Before the move, it helps to:

• Make sure legal papers are in place, such as a power of attorney for finances and an advance directive.
• Ask each place about costs, and what happens if your parent's money runs out.¹ If Medicaid may be needed later, the Alzheimer's Association suggests talking with an elder law attorney before the move.¹
• Ask what changes in health or behavior could lead to a discharge.¹
• Use our guide on how to choose a care place and compare assisted living, memory care and nursing homes.

If you are not ready yet, short-term respite care or adult day care can give you a break. It can also help your parent get used to new people and places.

Guilt, grief and mixed feelings

Many caregivers feel like a failure when they can no longer give care at home. Some feel guilty for still enjoying life, or for wishing the hard days were over. Others set rules for themselves that no one could keep, such as "I must visit every single day." The Alzheimer's Association lists all of these as common sources of guilt.²

These feelings do not mean you made the wrong choice. The goal, wherever care happens, is that your parent gets the care they need.¹ Some ideas that help:

• Name the feeling. Let yourself feel guilt, anger and sadness without judging yourself.²
• Separate what you can and cannot control. You cannot stop the disease. You can make careful choices about care.²
• Expect grief to come back. With dementia, people often feel loss many times, not just once.² Learn more about grieving someone who is still here.
• Talk with someone. A trusted friend, a support group or a grief counselor can help.² See support groups and peer support.
• Agree as a family. Disagreements among brothers and sisters can make guilt worse. A family meeting can help everyone share the decision.

Your stress may not lift right away

Many caregivers expect to feel better once a parent or spouse moves into care. A large U.S. study followed family caregivers before and after a loved one moved into long-term care. On average, their symptoms of depression and anxiety did not go down after the move. Almost half of them were at risk of clinical depression afterward.³

The strain was greatest for husbands and wives, for people who visited very often, and for people who felt they got too little help from others.³ Use of medicine for anxiety also went up.³ This does not mean the move was a mistake. It means you still need support after the move. If you are struggling, read caregiver stress and burnout and when your husband or wife has dementia.

Talking with your parent about the move

How much to say, and when, depends on your parent's stage of dementia.

• Early stage: If you can, plan the move together ahead of time.¹ Let your parent visit the place, choose a room, and decide what to bring.
• Middle and later stages: Long talks weeks ahead may cause worry that your parent cannot hold on to or work through. Many families keep explanations short, calm and close to the day. Focus on comfort: "You will be safe here, and I will visit."

Avoid arguing about whether your parent needs help. A person with dementia may not know they are ill (see anosognosia). Respond to the feeling behind the words, not the facts. Our page on talking with someone who has dementia has more tips.

Getting ready for move day

1. Set up the room before your parent arrives. Hang familiar photos, put a favorite blanket on the bed, and place a well-known chair by the window. Ask the home ahead of time what you may bring.¹
2. Label clothing and belongings. Put your parent's name on clothes, glasses, hearing aids and dentures. Bring only what fits, and leave valuables and heirlooms at home.
3. Write a "this is me" page. List your parent's routines, food likes, nicknames, past job, what calms them, and what upsets them. Give copies to staff.
4. Bring a full medicine list and recent doctor notes. Tell staff about allergies, hearing or vision needs, and any recent falls.
5. Pick a good time of day. Many people with dementia do best in the morning. Late afternoon can bring more confusion (see sundowning).
6. Keep the group small. One or two calm, familiar people is usually better than a crowd.
7. Plan how you will leave. Ask staff to help with a gentle hand-off, such as inviting your parent to lunch or an activity. Then say a short, warm goodbye.

The first weeks: what to expect

Settling in takes time. Some people adjust within days. For others, it takes weeks or longer. Your parent may ask to go home, seem angry or sad, sleep poorly, or pace. These reactions are common after a big change, and they often ease as the new place becomes familiar.

How the care plan works

In a Medicare- or Medicaid-certified nursing home, federal rules set a schedule:

• Within 48 hours: The home must make a baseline (starter) care plan. It covers doctor's orders, diet, therapy and social services.⁶
• Within 14 days: Staff must finish a full assessment of your parent's needs.⁵
• Within 7 days after that: A team must write a full care plan. The resident and their representative should take part when possible.⁶

Residents have the right to help shape their care plan and to see it.⁴ Go to these meetings if you can. Bring your "this is me" page and your notes. Assisted living and memory care follow state rules instead, so ask each place how and when it plans care.

How you can help

• Share what you know. You are the expert on your parent's history and habits. Staff can use your tips to prevent problems before they start.
• Ask about activities. A busy, pleasant day can help a person settle. See meaningful activities.
• Watch for sudden changes. Sudden confusion, fever, falls or a big change in eating should be checked by a doctor. A quick change can be a sign of illness, not just adjustment.
• Ask how the home will update you. Find out how staff will tell you about changes in your parent's condition.¹

Visiting: how to make it count

Nursing home residents have the right to see visitors of their choosing at the times they choose. Close family must be given access right away, and others may visit with the resident's consent, within reasonable health and safety limits. Each home must have a written visiting policy.⁴ In Virginia, assisted living residents may have guests in their rooms and have privacy during visits.⁷

Some homes suggest that families stay away for the first days so the person can settle. There is no single rule that fits everyone. Talk with staff and watch how your parent does after each visit.

You do not have to visit every day. In the study above, caregivers who visited the most had more anxiety and depression.³ Many find a steady, sustainable plan works better. A care circle can help share visits among family and friends. If you live far away, see long-distance caregiving.

If something seems wrong

Most problems can be solved by talking with the nurse, the social worker or the director. Write down what you saw, when and who you spoke with.

If that does not work, contact your state's Long-Term Care Ombudsman program. Ombudsmen look into and help resolve complaints for people living in nursing homes, assisted living and similar places. Families can raise concerns too.⁸ You can find your state's office through the national directory at ltcombudsman.org.⁸ The Eldercare Locator, at 1-800-677-1116, can also connect you with local services for older adults.⁹

Getting help for yourself

The Alzheimer's Association 24/7 Helpline is free at 800-272-3900. Staff can talk through housing options, moving a loved one into care, and caregiver stress. Interpreters are available in more than 200 languages.¹⁰

Look after your own health. See your doctor, rest, and accept help when it is offered. Signs like exhaustion, poor sleep or snapping at people are reasons to talk with your doctor.¹¹ Depression is different from stress.¹¹ It can be treated. See depression and try a calming practice like the cyclic sigh.

If you feel hopeless or have thoughts of harming yourself, call or text 988 any time, day or night.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.