Alzheimer’s: how to prepare and succeed with nursing home admission

Table of Contents

1. When to decide on nursing home admission

2. Choosing the right nursing home

3. Preparing for admission

4. The big day and first weeks

5. Managing guilt

6. Maintaining connection after admission

When to decide on nursing home admission {#quand-decider}

Warning signs

Difficult decision: No "right time" (but signs indicate necessity).

Signs for you, the caregiver:

Total exhaustion: Burn-out, depression, deteriorating health.

No personal life: Everything sacrificed (work, family, leisure).

Family tensions: Conflicts, breakups (burden too heavy).

Dangerous for you: Violence (aggression from your loved one), accidents (falls while helping).

Signs for your loved one:

Home dangers: Repeated falls, wandering, domestic accidents.

Medical needs: Constant supervision necessary (you can no longer provide).

Malnutrition, dehydration: Deteriorating general condition.

Severe aggression: Violence toward you, caregivers.

Behavioral disorders: Unmanageable at home.

Social isolation: You no longer go out (locking both of you in).

When home care is possible (if conditions met)

Mild/moderate stages + Favorable conditions:

You are capable: Health, energy, support.

Home care services: Home health aides, nurses (relief).

Day care: Several times/week (respite).

Family helps: Sharing burden.

Limited dangers: Home adapted, secured.

If OK: Maintaining home care (best for your loved one if feasible).

When nursing home becomes necessary

Advanced stages or Dangers/Exhaustion:

You're at the end: Mental/physical health in danger.

Your loved one in danger: Home too risky.

Violence: Unmanageable aggression.

Need 24/7 supervision: Impossible at home.

Nursing home = Solution (not failure, necessary relay).

Accepting the decision

Guilt: Normal, but Nursing home ≠ Abandonment.

You have done: Everything possible.

Continuing home care if impossible = Danger (for both of you).

Nursing home: Trained team, supervision, safety, stimulation.

Your role: Evolves (regular presence, emotional connection), doesn't disappear.

Give yourself permission: "I have the right."

Choosing the right nursing home {#choisir-ehpad}

Essential criteria

1. Alzheimer's's unit (specialized unit)

Specialized: Team trained in Alzheimer's's, adapted environment.

Secured space: Coded doors (wandering prevention), enclosed garden.

Adapted activities: Cognitive stimulation, non-drug therapies.

Prefer: Nursing home with Alzheimer's's unit (vs general).

2. Geographic proximity

Important: You visit regularly (close = Frequent visits).

Balance: Proximity vs facility quality (sometimes compromise).

3. Team quality

Observe: During visits (caregiver kindness, patience).

Turnover: Low = Good sign (team stability).

Staff/residents ratio: Sufficient (1/8-10 ideal, but rare).

Coordinating physician: Present regularly.

4. Environment, facilities

Rooms: Private if possible (intimacy), bright.

Common areas: Pleasant, spacious.

Garden: Easy access (walks).

Cleanliness, odors: Quality indicators.

5. Activities offered

Programs: Regular, adapted (music therapy, memory workshops).

Outings: If possible (stimulating outdoors).

Personalization: Individualized life plan (not "factory").

6. Food service

Meals: Quality, variety.

Adaptation: Modified textures (dysphagia), special diets.

Monitoring: Nutrition (malnutrition prevention).

7. Cost and financial assistance

Rates: Variable ($2000-5000/month depending on location, services).

Assistance:

• Government assistance programs
• Social aid (if insufficient resources)
• Tax deduction (tax credit)

Verify: Sustainable cost (budget calculation).

Selection process

1. List facilities

Via: Nursing home directory (government websites).

Criteria: Proximity, Alzheimer's's unit, available places.

2. Visits

Make appointments: Visit several (compare).

Observe:

• Atmosphere (residents happy, calm?)
• Team (kind?)
• Facilities (clean, pleasant?)
• Activities (posted, visible?)

Ask questions:

• Staff/residents ratio?
• Doctor presence?
• Team Alzheimer's's training?
• Alzheimer's's activities?
• Possibility of personal items in room?

3. Admission file

Preparation: Medical file (treating physician), administrative (ID documents, income).

Wait times: Several months waiting (waiting lists) → Anticipate.

Dependency level: Assessed (determines dependency rate).

4. Register at multiple nursing homes

Strategy: Register at several (increases chances of quick placement).

Preparing for admission {#preparer-entree}

Telling your loved one

Dilemma: To tell or not? How?

If mild/moderate stage (still understands):

Announce gradually:

1. Mention idea: "You know, we could consider a place where you'd be well cared for."

2. Visit together (if accepts): Discover place beforehand.

3. Explain reasons: "I can no longer help you alone, but I'll visit often."

4. Reassure: "You won't be alone, nice team, activities."

Resistance: Normal ("I don't want to!", tears).

Listen, validate emotions: "I understand you're afraid."

If advanced stage (no longer understands):

Announce or not: Debate (won't remember).

Often: Don't announce long before (anxiety without understanding).

Day of: "We're going to a new place, I'll stay with you."

Each situation unique: Adapt to person.

Preparing family

You, primary caregiver:

Support: Family, friends (difficult decision).

Share decision: If possible (family consensus).

Visit distribution: Organize (each visits regularly).

Collective guilt management: Talk together.

Preparing room

Personalization = Adaptation key:

Familiar objects:

• Photos: Family, happy times (room walls)
• Furniture: If possible (favorite armchair, lamp)
• Objects: Knick-knacks, frames, favorite blanket
• Clothes: Their clothes (not all new = Familiarity)

Label:

• Clothes, objects (name): Prevents losses

Bring:

• Photo books
• Music (CD player, playlists)
• SCARLETT tablet: Continuity of stimulation

Goal: Room = "Their home" (not anonymous).

Preparing yourself

Emotionally:

Accept guilt: Normal (but not founded).

Grief: End of home caregiving (transition).

Relief: You have the right (no shame).

Support: Psychologist, support groups (before/after admission).

Practically:

Visit organization: Plan frequency.

Home: What to do with apartment/house? (keep, sell, rent).

Personal life: Recover (work, leisure, family).

The big day and first weeks {#jour-j}

Admission day

Timing:

Morning: Arrive early (full day adaptation).

Your presence: All day (if possible): Reassures.

Welcome:

Team: Introduction to caregivers, director.

Tour of facilities: Show room, common areas, dining room.

Room setup:

Arrange together: Clothes, objects (anchoring).

Photos on walls: Together (familiarization).

Your role:

Stay calm: Your anxiety = Contagious.

Reassure: "I'll be back tomorrow, you're safe."

Introduce caregivers: "This is [Prénom], she'll help you."

Departure:

Difficult moment: Tears possible (your loved one, you).

Say goodbye calmly: "See you tomorrow."

Leave: Don't prolong (worse if dragging out).

First night: Difficult (for both of you). Normal.

First weeks: adaptation

Critical period: 2-4 weeks (progressive adaptation).

Your loved one:

Disorientation: Increased confusion (new environment).

Anxiety, tears: "I want to go home."

Refusal to eat, activities: Resistance to change.

Sometimes aggression: Anger (normal reaction).

Phone calls: "Come get me!" (heartbreaking).

Your role:

Regular visits: Daily if possible (first week), then 3-4 times/week.

Reassure: "I'll be back, you're well here."

Don't promise: "I'll bring you home" (lie = Worsens).

Team collaboration: Communication (how is it going? Difficulties?).

Visit rituals: Same times (reassuring routine).

Team:

Observation: Behavior, adaptation.

Adjustments: Activities, care (personalization).

Treatment: If severe anxiety (temporary medications).

Patience: Adaptation = Time (several weeks).

Signs of successful adaptation

After a few weeks:

Calming: Less anxiety, tears.

Activity participation: Accepts workshops, communal meals.

Interactions: With residents, caregivers.

Routine: Settles in (temporal markers).

Your loved one: May even "forget" it's new (temporal confusion = Advantage sometimes).

Not everyone adapts: Some remain anxious (but generally gradual improvement).

Managing guilt {#culpabilite}

Universal caregiver guilt

Almost all caregivers: Guilt after nursing home admission.

Internal phrases:

• "I'm abandoning them"
• "I should have continued at home"
• "They'll think I don't love them anymore"
• "I'm a bad son/daughter/spouse"

Guilt ≠ Reality: You're not abandoning.

Deconstructing guilt

Facts:

You have done: Everything possible, beyond limits.

Continue: Impossible without destroying your health.

Nursing home: Safety, care, stimulation (that you could no longer provide).

You remain present: Visits, love (not disappearance).

Relay ≠ Abandonment: Passing the baton = Responsibility, not cowardice.

Contradictory emotions

Relief + Guilt:

Relief: Normal (enormous burden removed).

Rest, personal life recovered.

Guilt: "How can I be relieved when they're suffering?"

Truth: Two emotions coexist (both legitimate).

Right to relief: You've earned it (difficult years).

Liberating words

Support groups: Other caregivers say:

"I placed Mom 1 year ago. Terrible guilt at first. Now, I see: She's better cared for, I'm less exhausted, our visits are quality (not care chores). Good decision."

Psychologist: Helps process guilt (therapy).

Doctor: Validates decision (professional support).

Maintaining connection after admission {#maintenir-lien}

Visit frequency

First week: Daily (if possible).

After: 2-4 times/week (depending on distance, availability).

Quality > Quantity: Short but regular visits > Long rare ones.

No guilt: If can't come every day (personal life = Important).

Activities during visits

Not just "being there": Share moments.

Ideas:

Garden walk: Hand in hand.

Look at photos: Family albums.

Music: Listen together, sing.

SCARLETT games: If brought tablet (continuity).

Eat together: Sometimes, share meal (conviviality).

Grooming, care: Style hair, apply hand cream (kind touch).

Reading: Read story (even if no longer understands, voice soothes).

Quality of presence: Being there, fully.

Team collaboration

Regular communication:

Ask: "How are they? Eating well? Sleeping?"

Inform: Habits, preferences (helps team personalize).

Communication notebook: Sometimes (family-team exchange notes).

Meetings: Personalized plan (participate if offered).

Team respect: Kind relationship (they do daily work).

Care quality monitoring

Observe:

General condition: Clean, well dressed, no bedsores.

Nutrition: Stable weight.

Mood: Calm or constantly anxious.

Team: Attentive, responsive.

If problems:

Dialogue: Director, coordinating physician (report).

Nursing home change: If insufficient quality (possible but difficult).

Special occasions

Birthdays, holidays:

Celebrate: Cake, family (at nursing home or outing).

Outings: If possible (restaurant, home for short duration).

Maintaining family bond: Important (not isolation).

Living after admission

Recovering personal life

You have the right:

Work: Resume career.

Leisure: Recover passions.

Relationships: Friends, family (social life).

Health: Take care of yourself (physical, mental).

Rest: Sleep, relax.

Not selfishness: Necessity (you're a person too).

Redefining role

Before: Daily caregiver (care, supervision).

After: Loving visitor (presence, emotional connection).

Liberation: Thankless tasks entrusted to team (you = Quality moments).

Continue training

DYNSEO Alzheimer's's Training:

Even in nursing home: Understand progression, communicate better.

Adaptation: Your role evolves (training helps).

Testimonials

Claire, daughter who placed her mother

"I placed Mom in a nursing home after total burn-out. Enormous guilt. First week, she cried 'Take me home'. Heartbreaking. But after 1 month, adaptation. Now (6 months later), she's calm, eating better, participating in activities. Me, I'm living again. Our visits = Quality (not exhaustion). Good decision, even though painful."

Marc, son who institutionalized his father

"Dad had severe aggression, dangerous at home. Specialized Alzheimer's's nursing home. Team manages crises (I couldn't anymore). Visit 3 times/week. We listen to music, look at photos. Peaceful relationship (no more daily care conflicts). Dad is secure, I'm relieved. Nursing home saved our relationship."

Sophie, wife who placed her husband

"My husband in nursing home for 1 year. At first, devastation (end of living together). Psychologist helped me: Nursing home ≠ Divorce, relay. I come every day (retired). We have lunch together, garden walk. He doesn't recognize me anymore, but smiles when I arrive (emotional memory). Presence matters. New form of couple, but bond persists."

Conclusion: A relay, not abandonment

Nursing home admission is not the end of your role, it's its transformation. You stop being the exhausted caregiver with impossible tasks, to become the loving presence who comes to share precious moments. You entrust care to professionals to preserve what really matters: the bond, love, presence. This is not abandonment, it's a clear-sighted act of love.

Keys to successful admission:

1. ✅ Decide at the right time (limit signals)

2. ✅ Choose adapted nursing home (Alzheimer's's unit, quality)

3. ✅ Prepare transition (announce, personalize room)

4. ✅ Support adaptation (frequent visits at start)

5. ✅ Manage guilt (normal, legitimate, deconstruct)

6. ✅ Maintain bond (quality visits, shared activities)

7. ✅ Recover life (you have the right)

You're not alone. Our Alzheimer's's training accompanies you. SCARLETT can continue stimulation in nursing home. Free guide: Advice for all stages.

DYNSEO resources to support you:

• Alzheimer's's Training: Supporting all stages
• SCARLETT: Cognitive stimulation continuity
• Free guide for supporting people with Alzheimer's's

Nursing home admission is letting go of the hand to better take it again. It's stopping exhausting care to find caresses again. It's entrusting the impossible daily routine to preserve precious moments. You're not abandoning. You're choosing to continue loving without destroying yourself. And this courageous choice, even bathed in tears, is the ultimate proof of your love.