
- With Mayo Clinic health education outreach coordinator
Angela Lunde
read biographyclose windowBiography of
Angela Lunde
Angela Lunde is a dementia education specialist in the education core of Mayo Clinic's Alzheimer's Disease Research Center at the Abigail Van Buren Alzheimer's Disease Research Clinic in Rochester, Minn.
Angela Lunde
The transfer of information about dementias, as well as understanding the need for participation in clinical trials, is an essential component of the education core.
Angela is a member of the Alzheimer's Association board of directors and co-chair of the annual Minnesota Dementia Conference. She is a member of the Dementia Behavior Assessment and Response Team (D-BART), a multidisciplinary outreach service assisting professional and family caregivers in understanding and managing difficult behaviors often present in dementia. She facilitates several support groups, including Memory Club, an early-stage education and support series, and more recently, helped to develop and now deliver Healthy Action to Benefit Independence and Thinking (HABIT), a 10-day cognitive rehab and wellness program for people with mild cognitive impairment.
Angela takes a personal interest in understanding the complex changes that take place within relationships and among families when dementia is present. She is particularly interested in providing innovative and accessible ways for people with dementia and their families to receive information and participate in valuable programs that promote well-being.
"Amid a devastating disease, there are tools, therapies, programs and ways to cope, and it is vital that families are connected to these resources," she says.
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April 21, 2009
Making the move to a care facility
By Angela Lunde
Several of you recently have asked the really tough question, as Bess did last month: "When, and how, do we make the decision to put her (our mother) in a special Alzheimer's unit?"
The reality of persons diagnosed with Alzheimer's disease or a similar progressive dementia is that many will ultimately need to make a move because they need more care than can be provided at home.
Families can sometimes lose sight of the fact that the demands of full-time caregiving are more then any one person can realistically manage. Understandably though, they may resist the thought of moving a loved one to a care facility.
In making the decision of when to move, there are no right or wrong answers. All caregivers, families, and persons with dementia are unique and will have different circumstances. Friends, doctors, and individual family members will each have opinions about when or if someone should be moved.
However, for most of you the decision to move a loved one is based on a combination of practical, psychological and/or medical reasons that may include one of more of the following:
- Caregivers own health is being compromised (including sleep deprivation).
- Caregivers own physical limitations (lifting, mobility).
- Caregiver is experiencing loss of work and/or the inability to manage other household or family responsibilities.
- Sufficient respite support or qualified home care are not available or become unaffordable.
- Symptoms of the disease are evident and challenging to manage at home (incontinence, aggression, paranoia, wandering).
- Person with disease needs more supervision than can be provided at home.
- Home environment is no longer safe (negotiating stairs, getting in and out of bathroom, narrow doorways).
- Person with disease is becoming more dependent with more activities of daily living such as eating, dressing, bathing.
- Person with disease is experiencing weight loss, dehydration or simply refusing to eat.
- Proper medication management is compromised.
- Person with disease no longer recognizes home as home.
Even when a thoughtful decision is made to a move a loved one, caregivers are bound to feel sadness, grief, fear, and probably plenty of guilt. These feeling are normal. Caregivers may feel guilty over not upholding old promises to parents or spouses, or they may fear what others will think or say, or fear that the care will be inferior. In addition, the decision underscores the inevitable decline of their loved one, resulting in further sadness and grief.
Once the move is made, many families say it was harder than they had imagined, and that they probably waited too long. The degree to which you can reasonably adjust to the transition is often associated with the planning that was done before the move. In other words, accepting the move seems to be less painful when families feel that they took the time to explore options and then made the best decision they could.
Keep in mind that the role of caregiver doesn't abruptly end once a loved one lives elsewhere, it just changes. You still play a vital role as your loved one's caregiving advocate. However, without direct care responsibilities, you can resume with renewed appreciation the time you spend with other loved ones.
Finally, if you love someone with Alzheimer's disease, remember you are entitled to have a life of your own. Taking care of yourself is a gift to your loved ones as well as yourself. You simply cannot meet every demand. Your thoughts and feeling are normal. You feel guilty because you love.
"The promise to always keep mother at home might have been made with the best intentions and hopes, but inherent in that commitment is the idea that the family will do what is best for Mother. It may be a promise that should be broken, because keeping mother at home may not be best for her."
— from "The Best Friends Approach to Alzheimer's Care"
47 comments posted
June 13, 2013 3:54 p.m.
my husband ws diagnosed with alzh. 2 years ago , he is 95 , we have been married 60 years , , we are from Cuba , he is a Dr. I am a nurse , I am 80 ,I have many health problems but even when is very hard to take care of him because his memory is almost gone , he recognizes his children and grands, but sometimes confuses their names but I promised him he will die at home in his own bed , I am very tired but you will never ever heir me saying that time is going too fast and I will not have time to enjoy life or the golden years , etc, those forgot that their mothers carried them 9 months in Gods knows what kind of situation and brougt them to life , its soooo unfair to throw them under the bus when they have no life or money , for those I feel ill , because they will have to answer God at the end of their own life
- nellie
February 23, 2013 3:15 p.m.
My mom is now in a retirement Alzheimer Home. She cries a lot and wants to go home. However her physical being has declined so much. She wears depends all the time, she has lost her mobility, she has lost her appetite and lacks energy. We are on the list for long term care and now my brother and his family want to take her to their home. They are already a full house and have their own family issues. I feel this is a mistake as my moms condition will worsen and they will not be able to cope. What to do?
- Shirley
March 11, 2012 5:20 a.m.
It is true that patients of Alzheimer's disease required lots of attention and care and they can get more attention and care in medical centers or hospitals than they can get in home but at the same time their family want to stay with the patient so they can spend as much time as they can because there is no cure for this disease till date and most of its patients live about 2-3 years after the diagnosis.
- Michael
November 13, 2011 6:00 a.m.
I am about to move my 84-year old mother with mid stage Alzheimer's into an assisted living facility. She has been living in her home with a daily caregiver and after a recent wandering incident she now has 24/7 care giving in her home. Several close friends around her including her a few of her friends, her boyfriend and her sister who lives 2,000 miles away think that home is best place for her simply because she wants to stay there yet they have their own agendas. I have tried to honor her wishes for the past 6 years in keeping in her home but there are many issues that have converged to make me feel that this is the best decision for her long term care. The neighborhood she lives in has been declining with recent murders and break-ins within a block of her home. Half the time she does not even realize she is in her home. The caregivers are thoughtful and caring but she is not getting enough mental and physical stimulation from the one-on-one care giving. She just sits there a lot because I know they get tired of repeating the same thing for hours. But I have been through this before with my father who is now in an assisted living and wish I had moved faster to get him there. It really did improve his health and we shifted from crisis management to care management. Guilt, anxiety, grief, tears and fatigue all will take its toll with any care giving decision for an Alz patient whether in home or in facility. You just try to make the best decision for everyone.
- Rena
February 12, 2011 6:49 p.m.
My dad who is 84 and at stage 6 of Alzheimer's moved into an assisted living home about a month ago. My mom who is 81 was taking care of him at home until then. It was a very difficult decision and she is feeling guilty but also realizes that it needed to be done. Even with my sisters' daily support she was the one who was with him at night, she was the one that he would swear at and call a liar when she told him she was his wife he was looking for, she was the one who felt like a prisoner in her home because if she went anywhere he would work himself into such a frenzie that he wouldn't be able to sleep that night which meant that she would have to be awake to make sure he was safe. She now feels guilty for feeling relief from exhaustion. I think that no matter how old your loved one is or whether it's your parent or spouse you go through these feelings. It is truly a grieving process. My mom says it's like your dad is dead but she can go visit him. They will be celebrating their 63rd anniversary this week. Really it's my mom who will be celebrating it because my dad is not even aware of it. Even though he just moved in to assisted care a month ago he's been asking to go home every night for the past three years. He's wants to move home with his dad and is waiting for his sisters to come and pick him up. I think Alzheimer's is harder than death. At least death you grieve once. We seem to grieve on a daily basis for years.
- Lorie
February 12, 2011 5:45 p.m.
6 years ago my brotherand I had to put our angel mother in a family care home. It broke my heart, but I knew it was best for her - lots of tears after, but the decision had been right. My husband of 55 years was diagnosed 5 years ago and I have been his sole caregiver. Things had been getting a little rocky lately, but still manageable. Last week he became delusional and had no idea who I was - i was the enemy who had locked all of the doors so he couldn't get out (he had gotten out and took a swift walk for about a mile - terrified me, but we finally got him home...so the locks were upgraded to deadbolts needing keys) We went through 4 days of horror before the meds prescribed finally began to work. He knows me occasionally now - but is very suspcious of the 5 hr/5 day a wk caregiver I have hired. He still wanders and thinks he has to "go home" - I know what is coming, though I am trying hard to hold off as long as possible, but I can't continue to stay awake all night - then try to be there for him during the day...(I'm 73 - he is 77) but I am so sickened by the probability of having to put him somewhere. I was so sure I was right with mom - but with him I am so frightened I will make the wrong choice... I adored mom - and it hurt me - but this is taking my breath! The decision and when to put it into action--the hardest thing I've ever done in my life. I sympathize with those who have done it and feel guilt. I don't know if I can
- No name given
November 14, 2010 5:32 p.m.
My mother in law is suffering from Dementia and it is getting steadily worse. She still lives in her own home but will not be able to much longer. She suffers from many of the symptoms described in this article. Unfortunately she is resistant to entering a nursing home and her children are afraid to make her angry and also afraid that she will enter the home and go into deep depression and just "wilt away and die". It is very frustrating as we have no good solution to getting her to enter the nursing home. I guess there are no good solutions and we will just have to pray that the Lord helps us to be strong and do what needs to be done. It helps to read other peoples experiences though. I salute those of you who have parents living with you. That is not an option here though. I believe she is beyond that stage.
- Donna
September 23, 2010 1:31 p.m.
After 27 yrs my husband is now in a health care facility.......... I took care of him totally before and now am almost doing the same in nursing home......... he wanders, falls, and has minimal care, and is so over drugged to keep him under their thumb. Becarefull what you wish for in placing them in a facility...........
- Victoria
July 8, 2010 8:23 a.m.
I have read with interest a number of the blogs on this page. I have my mom with severe, end stages alzheimers living with me - she is paralysed in her legs - she cannot do anythine at all for herself - is obviously wearing diapers, has to be fed and bathed, etc. I have an exceptional, full-time caregiver living with us. As a result of all my experieces with my mom over the past 2 years, I have decided to open a small exclusive home for frail/step-down/alzheimers elderly people. I am currently looking for a suitable home to purchase and I have a website being designed at the moment - it will be in the Northern suburbs of Jhb. I (with my caregivers) plan to look after the 6 (to max 8) elderly people with the same care and consideration and love that I look after my own mother. I have a real burning desire to provide a service like this as I am sure there are many children of frail/alzheimers parents who don't know where to turn and who to trust with their loved ones. You are more than welcome to email me if you would like more info or to discuss or even advise.
- Debbie
June 15, 2010 3:40 a.m.
information is the best tool i have found so far! please keep it coming
- janice
June 3, 2010 4:38 p.m.
My Mom has been diagnosed with Alzheimers' almost five years ago and has been placed in an Assisted Living Facility for only dementia and Alzheimer patients. She seems to do very well there, except for when we visit her, she still insists that when she can walk well again she wants to go home. She is not like most of the patients there. She is well aware of her surroundings and is very smart and answers all the puzzles and questions that the Activity director gives the patients. My problem is, of course, even though she is getting great care and balanced meals every day I still feel the guilt of putting her there instead of taking her home with me and my husband. We live in a two story home and all bedrooms are on the top floor. She cannot climb stairs and also is incontinent and very forgetful. For example we visit twice a week and usually after her lunch, but she cannot remember what was served or even that she had eaten. We were told at the rehab center she was at due to two falls six months apart, which caused both hips to have hip replacement surgeries, that she could not go home and be alone. After researching various choices, the Assisted Living Facility was the best choice for her and us financially. I pray every nite for strength and forgiveness from my God for having to put her there, but everyone says I've done my best for her own good. Somehow this doesn't erase my guilt. I am happy to be able to have this blog to express my concerns. It helps venting
- Karen
May 20, 2010 8:43 p.m.
My mom was diagnosed with Vascular Dementia 5 years ago and Parkinsons last year. She was living alone in another state 5 years ago and she recognized she was no longer able to live alone so far away from family. After much discussion and with great doubts I agreed to try having her live with my husband and I . We discussed what would happen when she was no longer able to care for herself and she stated she would want to move to a facility as she would not want to be a burden. She has become increasingly dependent on us and as a result of so many health crises and emergencies I was forced to retire early from my job. My husband and I cannot go anywhere without her and we are unable to travel or even visit with our adult children or participate in outings with them unless it is an activity she can easily do. In spite of our early talk and plans she does not want to leave, She does not see herself as a burden and in fact thinks we can do what ever we want and she is fine alone. She has no understanding of her dependence and inability to be independent. It is a terrible situation and I feel very trapped. My husband and I feel we are getting older quickly and soon enough we will not be able to enjoy things we could now. Life goes so quickly and the biggest lesson I have learned is we will never burden our children. We plan to continue caring for her as best we can for now but we have to make some changes before it is too late for us to enjoy our "golden years&q
- BarbaraWcwfgk
April 4, 2010 9:10 p.m.
I am in the same boat as many of the posters here. My mother in law has severe alzheimer's and is at the point that she needs to go to a care home, and has been for sometime. My husband has been her caretaker for over ten years. He is pretty resistant to placing her in a home, and I don't know how to encourage him to do so. During the past one or two months, she has started falling often, and in the past week or so, she has become unable to feed herself. She gets angry at him and starts screaming horribly. Just giving her medicine is often a huge battle, not to mention when she needs to stand and walk a few feet to use the toilet. This has caused an enormous toll on him physically, and worse emotionally. It is causing grief with our entire family. He has hired respite care, but I don't see that it is helping him much, as he feels the need to stick around the house while they are there. I hope that I can help him decide that it is time for her to be moved, and help him overcome the intense grief and fear he has.
- Missy
March 31, 2010 3:25 p.m.
We recently relocated my mother in law to an assisted living facility for dementia/Alzheimer's patients. She is 83 and in the early stages of the disease, and the early discussions were predictably hostile, angry and guilt laden. At some point she made some peace with the decision, and is better than she has been in some time. She is on a protocol of anti-depressants, and is, I believe, relieved to know that she is safe, and won't be able to wander, fall, or have any issue that won't be addressed with some immediacy. We are fortunate, and I want others to know it isn't an easy transition, but it can work out for the best. She is happy, safe, and is in a loving and non-judgmental environment. She is eating, socializing and prospering. What a gift...
- bcw
November 25, 2009 8:05 p.m.
i have waited too long. for 8 years i have watched my mothers capabilities decrease. arthritis has crippled her, dementia has kept her from performing daily activities for a very long time, but now her vision is greatly impaired. lately i am up most of the night, and i cherish the nights she sleep through. she is a danger to herself. constant observation is needed. i work full time and did not realize that i would be greatful that my husband wasn't working. it has effected my entire family. i can't do it any more..and have taken the first steps to nursing home placement. she should be there now.........i waited too long....and i am a nurse. there is no way to do it all. depends, commode, lift chair, i am now her walker.
- stacey
November 6, 2009 8:29 a.m.
I have just made arrangments to move my uncle of 88 years of age with Alz to an assisted living phycility closer to me by 186 miles. I have restled with this for so long. Being the only family member taking on the responcibility of making sure my uncle is taken care of has been a donting undertaking but I wouldnt have it any other way. I always have worried am I doing the right thing on every aspect of his care since he really can not tell me how he feels with out either being very angry and aggitated or being very compliant and just going with the flow. I had promissed him I would keep him in his apt (ind Living) but after having to add 4 nurses aides at least 4 times a day it just isnt enough. Going throught boughts of not eatting, taking his meds,wanting to stay in bed all day, not maintaining daily hygen etc. In addition to doing this for a year and a half with 2 falls, fracturing his hip, breaking a rib and just overall brusing. I needed to do more than I was and I am glad that there are places and organizations to assist familys with this loving care that is needed to make our loved one have the best that they can have during these ever changing times.
- ruby
November 5, 2009 3:31 p.m.
The gals at the facility beauty shop will often take some appts. from the community. It is a good way for your loved one to get to know the place so if respite care or long term placement is necessary; they already know the place and so do the caregiver. I am doing this with my husband who always went to a barber until the barber retired. He likes the gal because she understands and is patient with his memory and word problems. He also is making friends with some of the men and feels helpful to them.
- Joan
October 24, 2009 9:22 p.m.
Well...I have promised to keep Mom here until the end. I don't suppose she knows or cares much anymore. She is still marginally continent but getting out of the bathroom is often a major war. She eats better for me than anyone else, and I just got a lift to pick her up on "bad" days. She is fast losing the ability to stand up making transfers a nightmare. Having been a caregiver for 12 yrs I worry about putting her in a facility. I have worked in those places and know what goes on. My own physical inability to go and visit her regularly would impair my advocacy and likely lead to a swift demise. I am struggling here to keep her home. I know eventually I will have to give in and thanks to those who have written here and made me feel a tad less guilty about it. I just pray I will recover some physically so I can care for her better. Though I have to admit it would be very nice to sleep in one day without feeling guilty about mom person not getting her care soon enough. Let's hope we all die quickly and painlessly. Thanks for listening
- Vicky
October 20, 2009 11:10 a.m.
I am the oldest child and I have been taking care of my 83yr old mother for over two years in my home. She came to live with us when she could no longer drive, cook, take care of daily things and not remembering her meds. So we moved her up here to live with us in north georgia. She has now progressed to the stage where she has tremors, walking is difficult, memory is gone, can't dress or bath herself I thought several mmonths she could go into an assisted living and we were on a waiting list but now she is getting owrse and the doctors are saying that a skilled nursing facility is best. I have most everything in order but would like to know if anyone if familar with the medcaid law in georgia. My mom has a condo in florida and she and my dad (who died in 2003) had the business and the condo put into a Living Trust as to protect these assets. The business was given to my brother and now the condo is still in the trust for me and my sisiter. I would like to know if anyone knows if this Living Trust would still be protected in the state of Georgia? Please reply soon.
- Sherry
October 8, 2009 9:45 p.m.
I married a man 26 yrs. older than me. He is now 86 and has AZ. It is so very hard for me not to feel guilty. Some things he still knows and he makes me feel guilty for being younger. He cannot walk or stand. Can't dress or bathe himself. I have a sitter 5 hrs a day 5 days a wk. It is the only time I have to run the business, shop for necessities, go to bank or postoffice, etc. I do all housekeeping. Cracked two ribs picking him up when he fell. I know I need to take him to the nursing home but feel sooooo guilty about it. He really plays on this, too. What to do? What to do? I am at my whits end but love him so much and know that if he goes I will miss him and feel so alone. This is a terrible disease. I hate it for him and for me. I try to go to support meetings but it is hard to find time to go.....but I know I need it......it helps me help him. Fay
- Fay
October 6, 2009 3:47 p.m.
My was diagnosed in 2007 with Alzheimer's Disease.She is 84 & has always been independent & has always taken care of herself, my dad (before he died), her kids. grandkids, etc. Now, without the help of my siblings, I am caring for mom by myself. She is moving from the mild to moderate stage. She lives alone; gets up mornings & makes her bed, makes her instant coffee; fixes herself cereal, works word search puzzles' goes to church with friends, etc. However, she is becoming severely paranoid. She has always been paranoid, but the disease has accentuated it. She imagines a stereo & cedar chest are missing from her driveway. No matter how many times we tell her there never were such things in the driveway, she continues to call & say the thieves took them & she calls the police. The police now speak to me on a first name basis. Accept for the paranoia, mom does well in her home. BUT, she is killing me & the neighbors with her constant phone calls about the things stolen. I have had to take time off from my job just to be available for her. I have meals delivered to her house; I buy her groceries; I buy her clothing; I pick up her meds (her neighbor gives her medicine); I take her to her doctor appointments; I have tried to get her into clinical trials. I do everything for her even though she is capable of living at home. Trying to get funding to get her into an adult day care center. I don't have the money for assisted living or nursing homes. There i
- Chere
October 5, 2009 2:50 p.m.
Trying to live up to the traditional Italian definition of "bella famiglia" hasn't been easy for my family's situation. My father-in-law of 83 was kept at home for 2 and a half years and watched over by his aging wife, children and the "nuora' (me). Incontinence, inability to eat and being lifted by a type of manual crane has finally taken its toll on all of us. Lack of sleep, eating improperly while trying to maintain jobs has just about destroyed this nice Italian family...We've all been sick and even lost weight during this last year while Nonno Mario keeps plugging on...Today was his fourth week in a "casa serena"(nursing home) and for him everything is the same...We should be relieved and looking forward to getting back to a normal routine but it's difficult when the neighbors 'tsk-tsk' over the fact that we weren't up to the task of caring for a loved one in the house(up to 75% of Italian families do this). For myself, I can't wait to visit him tomorrow...just to see if there is a glint of recognition in his eyes and maybe if I'm lucky I'll capture one of his toothless smiles.I'm on a major guilt trip in spite of all the research we've done on his illness..It's a disease that I think I'll never really come to terms with.For this reason, I'll be volunteering time to help out in the local daycare for the 'anziani' now that I've been graciously 'let go' from my teaching job. It's time for me to learn more even at the ripe old age of 52.
- marisa
September 22, 2009 11:58 a.m.
My 85 year old father is caring for my 89 year old stepmother at home. Her dementia or Alzheimer's has greatly progressed this year. This summer he finally consented to have a caregiver two afternoons a week. His health is suffering, since he insists on doing everything himself--including all the yard work! She really needs more care, because she has fallen several times, and will leave or try to get out of the house whenever she sees a chance. My father is convinced she wouldn't survive in a care facility. As an only child, I'm caught in a bad situation. She is not my mother and has no children, only nieces and nephews. One of her nieces and I have teamed up and have become close friends, too. I'm very concerned about my father's physical health and he is beginning to make decisions that aren't well thought out. He's very strong minded and my input doesn't have too much influence. Not only am I his child, but I am a woman. Unfortunately, I see nothing changing until something disasterous happens. I have so much empathy for other families in this position. This disease sucks the life out of family members too.
- Jenny
August 19, 2009 12:03 p.m.
In July I put my husband of 24 years in a memory unit, then I went off on a much needed vacation. When I returned I thought I would be bringing him back home, but his doctor and the unit felt he needed more care than I could give him. (he's diabetic as well as 3rd state AZ) I have watched him deterioate fro the past ten years. I know my health has suffered as well, but the guilt and the questioning is so overwhelming sometimes. Other times I feel amazingly free, alone but not really lonely. Able to eat or sleep when I want is an amazing gift. I don't visit him much yet, it only upsets him and when he sees me he kicks and screams that he wants to come home. I hope I'm doing the right thing.
- anna
August 15, 2009 2:44 a.m.
My husband and I have moved his mother in a year and a half ago. We are now researching nursing homes close to our house so one of us can stop by on a daily basis.(We work opposite shifts). Just changed our todddlers crappy diaper and hers. Shes 82 he is almost 3. Haven't been able to leave overnight since she moved in. There is guilt and reality. She needs more than we can give her. We serve her every meal in her bedroom because she won't come and dine with family. She is very frail and needs help with everything from dressing to showering. A place for mom is a good non profit organization if anybody needs help to place a loved one. There are insurance issues and asset issues that need to be handled if you are not able to help with the monthly expense of a home.Research them and show up unexpected before you pick one out. We still have her at our house until we are 110% comfortable with our decision. Good luck to all.
- Kerry
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47 comments posted