AFTER MARION Albert's husband was admitted to a nursing home, she went home and looked at his old room and cried.
For 10 years she had nursed Ken Albert and watched as symptoms of Alzheimer's disease increased to the point that he sometimes didn't even recognize her or their children.
Finally, after she suffered a heart attack last month, she gave up her fight and turned over the care of her husband of 53 years to professionals at a long-term-care facility.
"I went upstairs and I looked at the bath where I had shaved him every morning, and I got real blue," says the 79-year-old woman. "I'm still not used to the idea of sleeping the whole night and not having to get up at 2 or 3 in the morning."
The sense of loss is inevitable, says Elizabeth Isenhart, a psychiatric nurse at Keswick nursing home, who with social worker Sally Smith regularly counsels people who are in the process of admitting family members to institutions. About once a month the two professionals invite spouses and children of people newly admitted to the home to a dinner to share their feelings.
The dinner gives families an opportunity to reveal the emotional toll their loved one's illness has taken on them, and to get some sound advice on handling the problems that come with this major life change.
When placing a loved one in an institution, the family goes through a range of emotions, not unlike the grief one feels when a death occurs, says Isenhart, a clinical specialist in dementia and its related problems. While the family feels the loss of a person's presence in the home, the person is grieving the loss of his vitality and his independence.
There is almost always some guilt on the part of a spouse or child who may feel she has "failed" the loved one, says Smith. Some people even feel guilty because they experience relief at having made the right decision, knowing their loved one was well overdue for professional care.
"You are taking on the decision-making, the parenting role of people who may be your parents. And that doesn't feel right," Smith told guests at the most recent admissions dinner. "But you have to do it. You have to look at the bottom line and not get caught in details."
Spouses and children at the round-table discussion nodded in agreement as Isenhart and Smith suggested the scenarios that might be playing out at home.
"It's difficult when you see your father who used to play ball and such go through this deterioration process," said Joseph Albert, who attended the dinner with his older brother Charles. "It's hard for me to adjust, but I knew he needed to be in a place where he would get good care and be happy." Their mother, however, was less easily convinced that her 78-year-old husband should leave home.
"I would say, 'Mom, you know this is gonna kill you.' She would shave him, clothe him, do the wash, do it all. We would offer to help, but every time we went over there, there would be a lot of hollering and screaming. She was like a time bomb, she was wound so tight."
Last month, Marion was hospitalized with a heart attack, and Ken, robbed of his care-giver, was admitted to Keswick. Joseph attributes his mother's heart attack, at least in part, to the years of stress.
"Female care-givers can operate on guilt a long time," say Isenhart. Often, she says, a family member's guilt is compounded by a promise once made, "such as 'I'll never put you in a nursing home, Mom or Dad or whoever.'
"Well, none of us grows up wanting to go to a nursing homwhen we get older. But you can't make a commitment to something that you're not going to have control over," she says.
Part of Isenhart's job is to visit potential patients at home or in the hospital for an evaluation before admission to Keswick. The majority of families she sees want to keep an elder in the family home as long as possible, despite the person's deteriorating condition and the stress of caring for him. She says that avoiding institutionalization is not necessarily a financial decision -- indeed it can cost a family more to hire around-the-clock nurses to come into the home or to forfeit income potential in order to stay home with a loved one. It is more often an emotional decision, says Isenhart. People just can't let go.
"I felt like the bottom dropped out, and I haven't got over it yet," said one dinner guest in his 80s whose wife had been admitted to a nursing home less than a month before. "I was going to go up [to see her] every day, but now I find I can't go. It's just too emotional."
"I know [moving her to a home] is the right thing to do," he said about his wife of 54 years, who is suffering severe dementia and is unaware of her surroundings. "But, here I am in my nice house and she's up there. Of course I feel guilty."
The man, who asked that his name not be used, said the loneliness is overwhelming. He characterized his latest conversations with his wife as "just a pack of lies."