Self-awareness is often keen in the early stages of dementia. People with dementia recognize that they can't remember quite as well as they used to, or that they make errors in judgment, or they see and hear things that can't possibly be there. The people who care for people who have dementia reach a point they don't see a choice that allows their loved one to continue to live independently. There is a point that help is clearly needed.

Try to put yourself in your loved one's shoes
The actress Bette Davis famously said, "Old age ain't for sissies." There are many changes that make living harder. Your joints may ache. You may have one or two or three or more medical conditions that require daily management. You don't have the income opportunities you once did, and if you didn't plan your finances well, you have constant financial stress. And if you are aware that you are developing dementia, you may understandably feel that you are losing everything.
When you discuss placing a parent in long-term care, it's important to be clear about facts. That means that everyone in the family needs to be on the same page when discussing these matters with the parent. It may be necessary to insulate the parent from the influences of peers and extended family members who would discourage the placement.
Ask questions before you take action
People who have dementia sometimes are more "with it" than you realize. Sometimes they may already have their own ideas about the in-home help they need or the nursing facility where they would like to live. Before announcing your plan, ask open-ended questions about the kinds of care they think they need. If their self-assessment is ill-considered, completely wrong, or delusional, don't get in a rush to correct them. Ask more questions. Listen to more answers. This procedure doesn't always help, but it is another way to reduce anxiety, agitation, and aggression when your loved one is placed in care.
Be patient during the transition to care
You may need to spend extra time with a parent the first few days they have a new caregiver or they go into a nursing home. Avoid overstimulation. It's fine for a new patient to meet a roommate or a next-door neighbor or to chat with an old friend who happens to be in the same home. But nobody with dementia needs to meet everyone in the facility the first day.
Give your loved ones options whenever possible
Allow your loved one all the independence they can handle. Give choices whenever you can. That can apply to furnishings, clothing, visitors, photographs, and food. They may realize that their independence is illusory, but still appreciate the choices they can make. Avoid situations in which every minute of every day is scheduled by staff, and avoid letting your parent feel rushed. What you lose in waiting time you gain in freedom from agitation.
Take it slow
It is not unusual for an adult child to have "done everything" for a parent and then run into problems of their own. Maybe the child's health is failing. Maybe children need time that has been invested in elder care. Maybe the child is just burning out.
It's important to realize that your need for your own life is legitimate. But if you have dedicated yourself to taking care of an elder and now you are getting help, it is critical to acclimate your parent to letting other people do things for them.
Intensely personal tasks like using the toilet, changing diapers, and bathing are often areas of service into which children should not venture. If parents are modest about these tasks, it is probably better to use "hired help" from the beginning. For other tasks, just make sure that you don't make your parents feel like an imposition, and do your service to them at their pace, not yours.
- Davidson GH, Austin E, Thornblade L, Simpson L, Ong TD, Pan H, Flum DR. Improving transitions of care across the spectrum of healthcare delivery: A multidisciplinary approach to understanding variability in outcomes across hospitals and skilled nursing facilities. Am J Surg. 2017 May.213(5):910-914. doi: 10.1016/j.amjsurg.2017.04.002. Epub 2017 Apr 5.PMID: 28793094.
- Lima CFDM, Caldas CP, Santos ID, Trotte LAC, Silva BMCD. Therapeutic nursing care: transition in sexuality of the elderly caregiving spouse. Rev Bras Enferm. 2017 Jul-Aug. 70(4):673-681. doi: 10.1590/0034-7167-2016-0256. English, Portuguese. PMID: 28396033.
- Kiwi M, Hydén LC, Antelius E. Deciding upon Transition to Residential Care for Persons Living with Dementia: why Do Iranian Family Caregivers Living in Sweden Cease Caregiving at Home? J Cross Cult Gerontol. 2018 Mar.33(1):21-42. doi: 10.1007/s10823-017-9337-1. PMID: 29170865.
- Photo courtesy of SteadyHealth
Your thoughts on this