Coping requires time and honesty

November 26, 1991

THE DECISION to move a relative to a long-term-care institution can be one of the most difficult you'll ever make.

Elizabeth Isenhart and Sally Smith, health-care professionals at Keswick nursing home who routinely counsel families on this subject, offer these suggestions for easing the experience:

* Avoid making the promise, "I'll never put you in a nursing home." If a parent or spouse asks for a vow, promise that you will do your best to see that he or she gets the best care possible.

* Once your loved one is admitted, recognize his reaction as grief, and support him through the three stages of shock, depression and anger. Don't deny the enormity of what has happened or that it makes him sad. Let him talk about his loss the way you would let a grieving person talk about someone who has just died.

* Visit when you are comfortable with the idea and in an "up" mood. If you find it hurts to visit a loved one who has severe

dementia and who doesn't recognize you, avoid visiting for a while, while you regain your emotional strength.

* Don't over-visit. One mistake some families make is to be too available to the patient, discouraging his involvement with other people and activities in the home. Don't become an excuse for the patient not to get involved in his new home.

* When visiting a patient with dementia, keep in mind his reality is not the same as yours. Don't expect to sit down and tell him how things are at home. Go for a walk or a ride, if he's willing, or talk about something that doesn't require using his memory.

* Be advocates for the patient, but don't overdose on a loved one's complaints. Check out complaints with a nurse, but don't try to make things perfect at the nursing home. An institution is not a home no matter how you cut it, says Smith.

* Don't get sucked into a guilt trap. When a parent says, "They drag me out of bed at 5 in the morning and feed me cold food," recognize this as the anger stage of grief. The person is venting his anger at a situation he can't control. Acknowledge his anger, be sympathetic and listen.

* Remember that this is probably not the first time you have felt guilty over the patient. If a parent had a knack for stirring guilt in younger days, you may be prone to it now, too. Remind yourself that your loved one has suffered a major loss, but it would be just as significant if he were taken somewhere else. Remind yourself that you're doing your best.

* If you take a patient home for a holiday visit, be prepared for some surprises. People with dementia, once settled in, come to view the nursing home as "home" fairly quickly. If, after 20 minutes, your loved one starts talking about wanting to "go home," she probably means the nursing facility.

* Give yourself time -- to grieve your loss and your parent's or spouse's loss, and to get over the loneliness.

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