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How Family Caregivers Can Deal With Guilt Over Placing a Family Member in a Nursing Home

Look at the big picture to help understand and ease conflicted emotions


spinner image an illustration shows nurses caring for various older adults in a nursing home setting.
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When the time came, I knew that my mother needed to move into a nursing home. She knew it, too.

Because of her poor balance, she’d had several falls during the previous year and suffered broken bones that required hospitalizations. It was no longer safe for her to live alone in her apartment, and we could not afford to hire round-the-clock aides to stay with her. Providing her with good care in an appealing, well-run facility seemed to make good sense. Like a trouper, my mother agreed to go. I made the logistical arrangements. And then I felt overwhelming guilt.

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As I mulled over this big decision we were making, I repeatedly asked myself one damning question: Couldn’t I have done more to help her remain in her home? Perhaps I should have withdrawn money from my kids’ college accounts or my retirement funds to pay for more home care for her, though even having an aide right next to her did not always prevent her from falling. She strongly opposed moving into my house. Yet I still dwelled on having possibly let her down.

The decision to move a relative into a nursing home is often among the most excruciating that caregivers make. In one 2019 research study, over 50 percent of caregivers felt at least “somewhat guilty” about nursing home placement; over 13 percent felt “extremely guilty.” These percentages are likely to have increased in the last four years, as some Americans have lost confidence in nursing homes after the pandemic revealed many facilities’ inadequate staffing and infection control. For family members with severe dementia and/or physical disabilities who can no longer care for their own basic needs, however, it is still a necessity to find them 24/7 hands-on care.

Every family caregiver wants to do what is right for their family member. All fear future self-recriminations and regrets. How can they make what they believe to be prudent decisions today that they won’t kick themselves about tomorrow? Here are some ideas.

Weigh all the options

The media sometimes report nursing home horror stories of neglect and abuse. Residents’ clothes and other possessions occasionally disappear, presumably taken by other residents or staff. And individuals can fall in facilities just as they do while still in their homes. But when it comes to safety, those with marked cognitive or balance issues are probably better off in a nursing home with experienced staff and built-in barrier-free hallways, well-placed grab bars and other environmental supports rather than in their multistory, cluttered houses. In short, nursing homes offer older adults and caregivers better odds. I knew that if my mother remained in her apartment, she would almost definitely keep falling and getting hurt. Today, years after her death, I take some solace in knowing that she never fell or went back to the hospital after making her big move.

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Factor in additional social stimulation

Too many older adults spend their last years alone in their apartments watching TV most of the day. Even if their family caregivers live with them or frequently visit, those older adults are usually socially isolated, a significant risk factor for developing physical and/or mental health problems. Facilities offer greater opportunity for group activities, communal meals and other ways of rubbing elbows with others. Increased social stimulation has clear salutary effects. During my years as a psychologist, more than a few psychotherapy clients have told me that their parents with dementia seemed dull and inert while at home but much more alert, engaged and conversant in nursing homes. My mother made friends and attended religious services and concerts in the company of others at her nursing home.

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View caregiving decisions broadly

Family resources, such as money, time and energy, are typically finite. Helping an older adult remain in their home and not go to a facility when they need intensive care often requires diverting some resources away from other family members and their needs, as well as the caregiver’s needs. All major caregiving decisions should be considered in the larger family context. If the caregiver cuts back or quits work because they need to take care of an older adult in their home, then what other family financial obligations will be compromised? If the caregiver devotes more time and energy to the older adult, then which family members get less?

Ratchet down the guilt

It is not possible to eliminate all guilt about placing a family member in a nursing home or assisted living facility. To this day, eight years after my mother entered hers, I still feel twinges of self-criticism and discomfort. But I reason to myself, we were in a no-win situation. Given my mother’s independent personality, she was not likely to take much joy in living in a nursing home, despite the friends she made there and activities she attended. But if she had remained in her apartment, fallen and suffered even more serious injures than broken bones, I am not sure I could have ever forgiven myself.

Caregivers face many no-win situations in which someone they care about is going to feel short-changed or hurt by decisions that must be made. Because caregivers are caring people, they are going to feel guilty about it. And that is normal. But they must keep saying to themselves, with sincerity, “I tried my hardest and did the best I knew how.”

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