Coping with Sadness, Guilt after Nursing Home Placement

Discussing the Guilt of Placing a Loved One in a Nursing Home
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If you've made the difficult decision to move your loved one to a nursing home or another facility, it's possible you're struggling with guilt about this change. You also may be grieving several losses that resulted from this decision or struggling to adjust to the changes in your lifestyle.

No doubt your decision to place your family member in a facility was not made lightly. You likely took into account many factors.

Sometimes, these decisions are taken out of our hands by emergent situations or health concerns. Other times, the decision to admit your loved one to a nursing home is an inch by inch one, with multiple family members weighing in, physicians giving advice and warnings, and neighbors encouraging you to take the next step.

While there’s turmoil as the decision is made, it doesn’t always stop just because someone is admitted into a facility. In fact, it can continue or even increase as the caregiver has to learn to loosen her hold on the minute details that she’s so used to taking care of for her loved one.

Recognizing Symptoms of Guilt, Grief and Adjustment

While it may seem like it should be obvious, not all feelings of guilt or grief look alike. Here are a few ways difficult emotions can emerge after nursing home placement of a loved one:

  • You may feel guilt when you have an enjoyable experience.
  • You might experience a cycle of guilt, then relief, then guilt.
  • You may find yourself dissatisfied with the care of facility staff.
  • You may feel the need to constantly be present in the facility.
  • You might feel feel depressed or anxious.
  • You may not want to consider making medical directives, such as a DNR order.

    Contributors to Feelings of Guilt and Grief

    Some factors that can increase difficult feelings after nursing home placement might include the disappointment of not being able to care for a spouse at home as originally planned, the perception (accurate or not) that others expect you to have been able to care for the person at home, and the acknowledgement that the person's disease is advancing.

    Sometimes, the person may have even said to you, "Please don't put me in a nursing home!" Yet, her needs may have made that request impossible.

    How to Help Yourself Adjust to this Change

    • First, acknowledge that you’re coping with a significant adjustment. While this doesn’t change the situation, it can help to give yourself permission to pause and understand the challenge you’re facing.

      One study found that caregivers, particularly spouses of nursing home residents, experienced just as much depression and anxiety after nursing home placement as before nursing home placement. This demonstrates that although the placement may have been necessary for the care of the loved one, it won't automatically "fix" the primary caregiver and make everything okay.

    • Find little, and perhaps new, ways to express your care and love. Maybe you can bring the newspaper or a flower every day to your loved one.

    • Identify someone to whom you can express your concerns, both outside of the facility and within it. Communication is important, and most facilities want to know what your concerns are. Learning how to advocate for your loved one is important and necessary, especially when he has dementia.

    • Acknowledge that even though your loved one may not have wanted to live in a facility, there could be some benefits to nursing home care. Although you may feel that nothing can compare with the level of care you gave your loved one at home, keep in mind that the care at a facility may still be good, quality care, and it’s available 24 hours a day. Some people find that their loved one actually improves in a facility because she's getting the care consistently that family members wanted to provide but just couldn't maintain effectively at home.

    • Help your loved one adjust to the facility. Work together to identify meaningful activities and routines for him to help facilitate the adjustment.

    • Consider developing a life story to share important people, events and information with the staff about your loved one.

    • Remind yourself of the ability now to focus, not only on your loved one's physical care needs, but also on visiting and building your relationship with him.

    • Most caregivers feel it's a privilege to care for their loved one, and don't want to be relieved of the job of providing the care, even if it's physically and emotionally taxing. Acknowledging the possible mix of emotions including grief, loss, guilt and relief, may allow for a healthier adjustment after nursing home placement of a loved one.


    Family Caregiving Alliance. National Center on Caregiving. Life after Placement. Accessed March 27, 2013.

    JAMA. August 25, 2004—Vol 292, No. 8. Long-term Care Placement of Dementia. Patients and Caregiver Health and Well-being.

    Journal of Advanced Nursing. 2000 Nov;32(5):1187-95. Nursing home placement: an exploration of the experiences of family carers.

    Journal of Gerontological Nursing. 2001. 27(8), 44-50. Family caregivers' attitudes towards aging, care-giving, and nursing home placement.

    Ohio State University Extension. Senior Series. Moving Your Loved One to a Nursing Home: What Can You Do? Accessed March 27, 2013.

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