Your Elder Adjust to a Residential Facility
By Geri Hall
After grappling with the difficult tasks of
caregiving to your loved one at home, you may find it necessary to place him/her into a
residential care facility. Once you have selected the appropriate facility for your elder,
be it an assisted living facility or nursing home, all of you will have to deal with the
challenges of adjusting to new routines.
Some facilities have a "30 Day Rule" which allows them to
decide whether your elder "fits in" with their facility. The 30 Day Rule seems
more than fair to me. If a patient is going to show signs of adjustment the facility will
be able to make the appropriate decision. This protects them from having to keep people
they absolutely can't manage in their environment and who might injure other residents.
The vast majority of people with dementia have difficulty with
adjusting to a new home environment. For at least two weeks the person can't find things,
is besieged with new people and routines and has feelings of frustration and/or anger.
There are some ways to help your loved one adjust:
- Expect agitation for 2-3 weeks. You might ask your elders
doctor for a light prescription for Ripserdal, Haldol, or Seroquel and use it for a few
weeks (in a VERY light dose) BEFORE the placement. The patient may be confused, but not
upset and agitated.
- Do not necessarily avoid visiting for two weeks, even though the
facilities suggest this. Follow a formula something like the following:
Geri R. Hall, PhD, ARNP, CNS, FAAN
- Expect the person to be agitated and angry, but stop beating yourself
about it. You did what had to be done. Your loved one needs to grieve. To expect happiness
- Plan a BRIEF visit. 10-15 minutes will be enough for you to know your
loved one is well-cared for and to give them reassurance. A 3-hour visit is going to cause
agitation. If the loved one demands to be taken home, DON'T try to explain. Look at your
watch and say, "I have to go now." It will break your heart, but will minimize
the behavior after a few times. Many patients start the "take me home" stuff
after a 30 minute visit when they get tired. Take it as an indication that it is time to
- Take something to do. Do their nails, have a snack, listen to a new
piece of music or share an activity. Once you are done, it is time to go. Have the staff
divert your loved one to an activity such as a meal.
- Call before you come so you know what kind of day your loved one is
having. If you know they are agitated and having a bad day and if you can't face it
without becoming upset, don't go when they are agitated . . . or go later.
- Talk with the staff. Smile. Find the staff doing something right and
complement at least one on each visit. There is nothing worse than the family who comes in
with their microscope looking for flaws. They will become apparent soon enough -- we are
talking working with demented adults here.
- Know that the facility and staff have no magic for dealing with
behavior problems. If it was difficult to manage at home, it will be worse in the care
facility -- especially with 7+ other people who are also demented.
- Before you leave, talk with an administrative staff member to see how
things are going and what you (as a team) can do to improve care throughout the
- I can not stress this too much: select an activity-based program!
And, if your loved one is not a socializer, make sure the staff knows to let him have some
time to himself daily and introduce him slowly to the group.
- Last, do not let the adjustment period dissuade you from the
placement. It most likely will work out.
Associate Director for Outreach
University of Iowa Center on Aging
Iowa City, Iowa 52242