When It’s Time to Let Go : Aging: The decision to place a parent or spouse in an institution can be gut-wrenching. But sometimes, there’s no choice.

After Marion Albert’s husband was admitted to a nursing home, she went home and looked at his old room and cried.

For 10 years she had nursed Ken Albert and watched as symptoms of Alzheimer’s disease increased to the point that he sometimes didn’t even recognize her or their children.

Finally, after she suffered a heart attack last month, she gave up her fight and turned over the care of her husband of 53 years to professionals at a long-term care facility.

“I went upstairs and I looked at the bath where I had shaved him every morning, and I got real blue,” says the 79-year-old woman. “I’m still not used to the idea of sleeping the whole night and not having to get up at 2 or 3 in the morning.”

The sense of loss is inevitable, says Elizabeth Isenhart, a psychiatric nurse at Keswick nursing home in Baltimore, who with social worker Sally Smith regularly counsels people who are in the process of admitting family members to institutions.

About once a month the two professionals invite spouses and children of people newly admitted to the home to a dinner to share their feelings.

The dinner gives families an opportunity to talk about the emotional toll their loved one’s illness has taken on them and to get some sound advice on handling the problems that come with this major change.

When placing a loved one in an institution, the family goes through a range of emotions, not unlike the grief one feels when a death occurs, says Isenhart, a clinical specialist in dementia and its related problems.

While the family feels the loss of a person’s presence in the home, the person is grieving the loss of his vitality and his independence.

There is almost always some guilt on the part of a spouse or child who may feel she has “failed” the loved one, says Smith.

Some people even feel guilty because they experience relief at having made the right decision, knowing their loved one was overdue for professional care.

“You are taking on the decision-making, the parenting role of people who may be your parents. And that doesn’t feel right,” Smith told guests at the most recent admissions dinner. “But you have to do it. You have to look at the bottom line and not get caught in details.”

Spouses and children at the round-table discussion nodded in agreement as Isenhart and Smith suggested the scenarios that might be playing out at home.

“It’s difficult when you see your father, who used to play ball and such, go through this deterioration process,” said Joseph Albert, who attended the dinner with his older brother, Charles, and their mother. “It’s hard for me to adjust, but I knew he needed to be in a place where he would get good care and be happy.”

Their mother, however, was less easily convinced that her 78-year-old husband should leave home.

“I would say, ‘Mom, you know this is gonna kill you.’ She would shave him, clothe him, do the wash, do it all. We would offer to help, but every time we went over there, there would be a lot of hollering and screaming. She was like a time bomb, she was wound so tight.”

Last month, Marion was hospitalized with a heart attack, and Ken, robbed of his care-giver, was admitted to Keswick. Joseph attributes his mother’s heart attack, at least in part, to the years of stress.

“Female care-givers can operate on guilt a long time,” Isenhart says. Often, she says, a family member’s guilt is compounded by a promise once made, “such as ‘I’ll never put you in a nursing home, Mom or Dad or whoever.’

“Well, none of us grows up wanting to go to a nursing home when we get older. But you can’t make a commitment to something that you’re not going to have control over,” she says.

Part of Isenhart’s job is to visit potential patients at home or in the hospital for an evaluation before admission. The majority of families she sees want to keep an elder in the family home as long as possible, despite the person’s deteriorating condition and the stress of care.

Avoiding institutionalization is not necessarily a financial decision, she says; it can cost a family more to hire around-the-clock nurses to come into the home or to forfeit income potential in order to stay home with a loved one.

It is more often an emotional decision, says Isenhart. People just can’t let go.

“I felt like the bottom dropped out, and I haven’t got over it yet,” said one dinner guest in his 80s whose wife had been admitted to a nursing home less than a month before. “I was going to go up (to see her) every day, but now I find I can’t go. It’s just too emotional.

“I know (moving her to a home) is the right thing to do,” he said of his wife of 54 years, who is suffering severe dementia and is unaware of her surroundings. “But, here I am in my nice house and she’s up there. Of course I feel guilty.”

The man, who asked that his name not be used, said the loneliness is overwhelming. He characterized his latest conversations with his wife as “just a pack of lies.”

“When I go up there, I don’t know whether to go on with the charade or not. You know, she thinks she’s in a hotel.”

“That’s right; they are lies,” Smith agreed. “But they’re aimed at helping her. You have to say whatever you can to keep her from being anxious. Arguing with her about reality is not going to help her.”

Isenhart reassures families about patients suffering the severe mental impairment of dementia: “These people have no control over their illusions. Some people think they’re on a cruise. You cannot talk them out of it. And they won’t remember this, so you’re not hurting them by going along with the charade.”

The institutionalization of a person whose perception, memory and judgment are intact causes somewhat different emotional reactions on the part of the patient and the family, says Smith, who often finds herself playing the go-between with patient and family.

“What the person who has been admitted is doing is grieving a loss and going through depression. Family members have to support them through this,” she says.

“Sometimes people don’t recognize displacement as a loss, but it is. The new patient is losing a lot--his belongings, home, surroundings, church, affiliations. He is being transplanted for good.

“A lot of family members, when they start getting this reaction, overcompensate,” says Smith. “They try to make everything right. They try to make the nursing home not a nursing home; they try to correct every complaint. And as a result, they kind of thwart the grieving process.”

“The vast majority of nursing home patients thrive once they have adjusted,” Isenhart says. In a good nursing home, they get stimulation, they eat regular meals and they are no longer socially isolated.

“It’s your adjustment that is tougher,” she tells family members, particularly if the loved one has dementia. “Someone with a cognitive deficit does not recognize the difference in their surroundings,” she explains. “The recent changes in their lives are forgotten very quickly.

“After a while, you’ll find yourself saying, ‘How come she’s doing so well, and I still feel so bad.’ ” It’s an unfortunate feeling, but it may be one of the first signs of recovery for everyone involved.