I predict I will get some mean messages over this one. Some of you will message me and say that you hope my kids put me in a nursing home.

Well, the joke is on you. I don’t have kids.

Here goes.

Placing your loved one in a memory community, assisted living, or nursing home is often an act of love.

It is rare for a someone living with Alzheimer’s or another dementia to stay home through the end stage of dementia. And, when they do, it is generally because the family can afford extensive amounts of paid in home care or the family is large, flexible, and committed enough to provide 24/7 care.

But let’s talk about when there is one primary caregiver who does not have paid in-home help and has family and friends who, even though they can provide occasional respite, are not able to provide day-to-day care.

Maybe they live far away. Maybe they live close and have time commitments such as kids and work. Perhaps there are emotional or physical reasons they can’t step in to provide day-to-day help. Or, there might be four sons who live within a mile that are just unwilling to stop by and stay with their mom while their dad goes to the grocery store.

Most of our homes are not designed for someone living with dementia…most of us are not trained to provide extensive medical care…maybe you are at risk of an injury in providing physical care to your loved one…(maybe your husband weighs 230 pounds and you barely hit 120)…I could go on.

There is a point where someone living with dementia should not be left home alone. There’s no universal rule for when this occurs, but I would argue that if someone could not pick up the phone to call 911, you should strongly consider whether or not they should be home by themselves.

What are the requirements you might use to determine if a child is able to stay home alone? Can they use the phone? Would they wander away from the home and not find their way back? Will they have substantial panic when you leave or when they remember you aren’t there?

And when someone with dementia is unable to be home alone, caregiving needs are substantial and (I would argue) impossible to meet if there is one caregiver without support.

There are times in life when the optimal decision doesn’t seem that great. Sometimes the best decision is the least bad of a bunch of options. Making a decision for someone to move to a nursing home or assisted living? Perhaps it’s one of those times.

Of course, you might hear that people move to facilities and immediately the progress of of their disease quickens. Sure, that happens, but there is a bit of error in thinking here. You usually place someone because they are declining, and when they continue to decline, we blame the facility. Maybe they are declining because this is a progressive disease process.

Trauma can exacerbate the disease progress, and we often wait until a trauma (a fall, getting lost, etc.) happens to place someone in a facility. Then the change in environment happens in the center of a trauma, and the dementia brain struggles more than it would have with this change of environment.

There should be no shame in placing your loved one in a facility. My dad was in a nursing home in at the end of his life. In fact, he was in 5-6 of them (some bad and some better) over his final six months. He was not thrilled to be there.

“Shoot me before you put me in one of those places,” he used to tell me. I’d tell him I didn’t love him enough to spend the rest of my life in prison. That, my friend, is the extent of a heartfelt conversation among the Eshbaughs. Maybe you can relate.

There were a lot of reasons he could not have lived with me at the end of his life. Physically, it would have not been possible. He was about 6′ 4”. I have chronic nerve pain in my back and have a spinal cord stimulator. I would have been useless in trying to help him move and transfer. My husband is strong, but he’s not a big guy, and there’s no way he could have moved my dad around without help.

We could not have afforded significant hours of in-home care, even if we could have found someone for the job, which is unlikely. And there’s this small detail of us having jobs. I don’t know how we’d pay for the house if one of us didn’t work…and there’s that health insurance thing. Neither of us could quit our jobs to provide care.

I haven’t even talked about relationship dynamics here–which is another issue entirely.

Whenever I hear someone say, “I could never put someone I loved in a place like THAT” I cringe. It’s a really insensitive and ignorant statement. And I won’t just smile and change the subject when someone says it. I am going to point out the reasons why people have to make this choice because I am not okay with how society shames those who place their loved ones in a facility.

Sometimes people thrive in facilities. Sometimes their quality of life improves.

Wives can be wives again–rather than just caregivers. Sons can stop arguing with their moms about bathing. Family can be family. Professional caregivers can take on some of the battles. Family can be the good guy in that whole good guy/bad guy dynamic.

If you have to make the choice to place a loved one in a facility, my heart is with you. It’s not easy. And you will feel…..everything. You will grieve. You may feel relief. And you may feel tired—because you’ve given every bit of energy you’ve had to keeping someone at home–and when they are no longer at home, you crash. You need to rest. That’s normal.

It’s also normal to feel like you betrayed someone. You didn’t.

Sometimes the caregiver dies before the person living with dementia. And sometimes that is indirectly attributed to costs of caregiving–stress, poor diet, compromised sleep.

I know a man with Alzheimer’s who told his wife after his diagnosis that knew he’d die from Alzheimer’s but they couldn’t let his Alzheimer’s kill her as well. He didn’t want them to give his Alzheimer’s any more power than it had. And she kept that in mind when it was time for him to move to memory care.

I have to say this…sometimes getting someone to a facility isn’t easy. Maybe you fib to get them there. Perhaps they are angry and don’t talk to you for a few weeks. I know of situations where law enforcement was involved. It may not be pretty. I’d tell you not to take it personally but that’s easier said than done. So I’ll just tell you that you’ll get through it.

Stop feeling shame. Stop feeling guilt. You are doing the best that you can. You kept your loved one at home as long as possible, and now it’s not possible.

And in this strange world of dementia, you sometimes have to make choices that wouldn’t have made sense to you previously.

You aren’t a bad person. You are just trying to love someone through a set of pretty challenging circumstances.