A Guide for Families

Family Questions: The First Thirty Days: Helping Your Loved Ones Adjust

Coping With Guilt and Resentment

Mom and I chose this nursing facility because we thought it was the best thing for her, but she treats me like I'm abandoning her to pursue my own selfish pleasures. How can I remind her that we have her best interests at heart?

The decision to admit a family member to a nursing facility setting is never an easy one. But whenever you begin to doubt the decision, remember the many advantages a nursing facility offers your family member:

• 24-hour care, with medical assistance always available.

• A roommate, with whom many residents form a deep and lasting bond that proves both invigorating and supportive.

• A sense of community and activity, which can encourage residents to get up, dress and get out to enjoy a community meal in the dining room or an organized activity in the recreation room.

• Staff members who become attached to the people in their care, and work to make their lives as comfortable and interesting as possible.

• Regular clergy visits and religious services.

• Activities, educational programs, group discussions and outings.

• Personalized physical, occupational, speech and restorative therapies.

• Trained nurses who teach skills and promote self-care.

• Medical staff that tracks the individual progress of each resident, as well as his medical needs, on a daily basis.

• Tasty and nutritious hot meals on a regular schedule, with help for those who need it, and special attention for those whose diets need to be monitored.

• Finally, more satisfying relationships with family members who, with the stress of routine daily care transferred to home staff, now have sufficient energy and time to devote to the emotional needs of their family member.

I know my mother should be here, but I promised her years ago that we'd never put her in a nursing home. I feel like I've gone back on my word.

One of the most difficult situations a person can face in life is having to move an elderly family member into a nursing facility after having promised - often years before - not to.

The decision can lead to guilt and self-doubt, and, if it's not resolved, even to depression. If you've had to break such a promise, whether it was expressed or only implied, it's important to take some time to separate what you feel about your decision from what you know. For example, even though you might feel as though keeping that kind of a promise is very important, you might know that it was no longer safe for your mother to live alone.

Remember:

• As circumstances change in your life, so, too, do your options. The “best” solution to a problem ten years ago might not be the best solution today. If you did make a promise not to institutionalize your family member, it was probably made at a time when home care and independent living were practical options. If they are no longer practical options, they should not be considered just because they seemed like good solutions years ago.

• All you can give is your best. If you've considered all the options and made the best decision you can, you have nothing to feel guilty about. The guilt that often accompanies placing a family member in a nursing facility can actually debilitate you or drive you to give more than you can possibly give.

• Doing the impossible to keep your family member at home is precisely that impossible. Few people can provide the 24-hour care a nursing facility can provide. Your family member needs you for more than lodging, meals and medication. She needs your love, something that can be hard to provide when you're constantly drained, both physically and emotionally. Often the only way to do your primary job right is to turn your secondary over to another.

• Try to listen to your head. It's very difficult to get over the emotional reaction of admitting a family member to a nursing facility. Remember though, that being relieved of the daily physical and emotional stress of a practically impossible home care situation can enable you to enjoy your relationship again. And the time it frees up can be used constructively with your own family or in taking an active role in nursing facility activities, both of which will provide support for your own adjustment.

• You're not alone. At the heart of almost all guilt suffered from placing a family member in a nursing facility is the unspoken doubt that a promise has been broken. Talk to someone who has made a similar decision and share your conflicting emotions. Then ask them to share with you how they coped with the guilt, and how they feel about their decision in retrospect. If your nursing facility has a family council, visit with some of the members, See Family Councils.

Even though I was killing myself trying to take care of my Mom and family both, since she's moved to the home I've felt even worse. Instead of appreciating all the staff does for her, I resent them for caring for Mom better than I could, and guilty for being so childish. What is wrong with me?

Nothing is wrong with you, anymore than there is something wrong with the young mother who is crushed when her only child comes home in love with his kindergarten teacher. There comes a point in all of our lives when we cannot provide our loved ones with everything they need to be happy - when we discover that at this stage in our loved one's life, our best efforts are not as successful as our best efforts combined with those of another.

Sure you feel resentful, and probably a little left out. You used to be the facility of your mom's universe, and now you feel like an orbiting planet, at best.

Don't fret. This too shall pass. Soon you'll get to know the staff, and realize that they're not taking your mom away from you. Moreover, you'll discover that what you can offer your mom, no one else can provide.

In the meantime, share your feelings either with someone on the staff, or someone whose been in a similar position like a Family Council member. Don't worry about sounding silly. Your reaction is more common than you think.

When my wife and I lived together, I was there for her every minute of every day. How can a nursing facility provide that kind of care?

It can't. On the other hand, it can provide a lot of things you couldn't, and the tradeoff might prove healthier for everyone involved. Granted, your wife may have to wait a couple of minutes for help to get to supper. On the other hand, she'll have people her own age to eat and talk with, and a diet tailored to her needs. And while she won't have you there to help plan her day, an entire staff of professionals with years of experience with her age group will be scheduling activities for the entire community to enjoy.

Moreover, she'll still be getting what she needs most from you, frequent visits full of gossip and confidences, trips out to her favorite hairstylist - in short, the kind of individual attention only a family member can provide.

But one type of care doesn't preclude the other. Take the opportunity to visit with the staff about your wife's likes and dislikes. The quicker they get to know her, the sooner they can try to personalize the attention she will be receiving.

As the only relative in town, I feel I have too much responsibility for Mom, while my sisters out of town feel guilty for not helping more. How can we share the load more equitably?

Your mom is only the first of many family members that will find this life change stressful. Admitting a close relative to a nursing facility brings to the surface all kinds of life issues that we often keep on the back burner. If not handled right, it can also stir up old resentments, sibling rivalries and control issues that you thought were buried years ago. Remember, this dramatic development in the life of the new resident is also a watershed in the lives of her family members, for the event forces each to come face to face with a new family role, accept the new limitations of other family members, and grapple with the reminder of her own mortality.

Often, the caregiver who has assumed the major responsibility for the decision has become the primary caregiver by default, as the only close relative in proximity. By the time the decision is actually made, she may feel exhausted and depressed, as well as resentful of all the responsibilities.

At the same time, she will undoubtedly have made the best decision she could, and be both resentful of criticism and possessive of future decision-making. On the other hand, out-of-town relatives who only see their family member rested, medicated, and dressed for “company,” may argue for care options that they would realize were unrealistic if they were the primary caregiver for just a day. All family members need to make a concerted effort to empathize with others' points of view and the needs and conflicts they face.

For the primary caregiver, it's crucial to remember that failure to keep other family members informed on developments only makes the transition harder for all involved. Out-of-town relatives who are only informed of major decisions may feel they are lurching from disaster to disaster, with no control or input.

But the primary caregiver can help put them back “in control” of their lives by providing them with regular progress reports and suggestions as to what to send or when to plan their visits. She can also help by preparing them for what they will see, since changes in a nursing facility resident's appearance will seem more drastic to them than to her.

If appropriate, the primary caregiver might even review possible future scenarios, soliciting feedback before a decision has to be made, and subtly informing out-of-towners what might have to be considered in the future.

For the distant caregiver, it's important to empathize with the extra demands placed on the nearby family member in her role as primary caregiver. In addition to caring for the nursing-facility resident, she still has to manage her home, her family, her job, etc.

Try to keep family discussions of options and decisions as open and uncritical as possible. Everyone should feel free to express opinions and suggestions without fear of emotional retaliation. When it comes down to the nitty gritty of decision-making, strive for consensus, but don't force it. Try to get only those commitments from family members that can be given honestly and realistically. If that leads to nothing decisive or realistic, try to agree on a temporary or trial measure, recognizing that some family members do not favor the option, but that as yet no other solution has presented itself. Put all involved family members on the mailing list so everyone gets the same correspondence from the facility.

Remember, too, that it's unreasonable to expect a better relationship between family members than they had before the nursing facility decision. And keep in mind that you and your family members will not always be in the role of caregivers for an elderly relative. Trying to squeeze a family member into a caregiving role that doesn't fit may ultimately do more harm than good.