Guest Author - Debra Stang

The woman in the admissions office of the nursing home was white and shaking as she mechanically signed the papers to admit her mother to our facility. "I promised her," she whispered, reaching for a tissue. "I promised her I would never, ever do this to her."

Meanwhile, as the daughter sat sobbing in the office, her mother, who suffered from dementia, had already been coaxed into a spirited game of Bingo and was having a fine time. During the two years she lived in the facility, she made friends, participated in every kind of activity imaginable, and never uttered one word of complaint about being in a nursing home. In fact, she referred to her new home as "the resort."

But her daughter was never able to let go of the guilt of breaking her promise to her mother. Even after her mother had peacefully passed away in her sleep, the daughter continued to torture herself daily with the broken promise. She died less than six months after her mother.

Let's face it, no one really wants to spend their last few years in a nursing home. We'd all rather live independently or at least in the home of a family member. The good news is that most people get their wish. Only a little over 4% of seniors live in nursing homes.

The bad news is that sometimes nursing home placement can't be avoided. If you're facing a situation where nursing home placement for a loved one is inevitable, these ideas may be of some comfort to you.

First, never promise a loved one not to place them in a nursing home.

Even if you fully intend to keep your promise, circumstances may change. Instead of making a promise you may not be able to keep, say something like, "I can't make that promise, Mom, because none of us ever knows for sure what the future will hold. I will promise to make every effort to avoid putting you in a nursing home. I also promise that if you do need to go to a nursing home, I will do my very best to find you the best facility possible."

If you have made the promise, and now must go back on it, apologize to your loved one (if appropriate).

Every time Mike (names and identifying details changed) visited his elderly father in our facility, his father would greet him with rage. "You swore you would never do this to me, son. You broke your promise." Mike fled from his father's words, and his visits became fewer and further apart. At last, during an emotional phone call, I counseled him about some possible ways to respond to his father's rage.

The next time his father accused him of breaking his promise, Mike responded: "Dad, you're right. I did break my promise to you, and I'm very sorry. There are reasons why I had to do it, and I think they're pretty good ones. Maybe someday you and I can talk about them. But in the meantime, I am very, very sorry that I made a promise to you and couldn't keep it. You have every right to be angry."

The stunned patient said nothing at first, but as Mike continued to visit, the two men slowly rebuilt their relationship. At last, Mike's father even conceded that the nursing home was "not so bad."

Even if you can't apologize to your loved one, find a way to forgive yourself.

Darla (names and identifying information changed) was a cheerful little resident with late stage dementia. She rarely spoke, and when she did, the words didn't make sense. She spent most of her days sitting in a rocking chair cradling a baby doll, firmly convinced she held a real baby in her arms. She was happy.

Her younger sister who had promised to care for her at home was miserable. When she and Darla were little, their favorite uncle had died in a filthy county facility. Right then, she and Darla had promised each other that they would never let the other go to a nursing home.

But now Darla's eighty year old sister found she was not able to manage Darla's care at home. Darla was way past being able to understand an apology, so we had her sister write her an "unsent letter." In the letter, the sister explained why she had made the decision she did and asked Darla's forgiveness. After writing the letter, the sister was able to acknowledge that her choices had been very limited and forgive herself for making the inevitable decision to place Darla.

Finally, never ask a loved one to promise not to put you in a nursing home. If a loved one has made a promise like that to you, release them from it. Trust that your loved ones will do their best to keep you at home, but don't increase their guilt at making a painful, but sometimes necessary, decision.