I was a teenager in 2014 when my mom was the primary caregiver for my grandmother. Mom struggled emotionally after she moved her into a long-term-care facility, and I didn’t know how to support her. I still sometimes feel guilty about that. I’m writing this letter in 2025 as if I could mail it to my mom and she would receive it back in 2014. It’s a way for me to process the guilt, and I hope it provides some comfort to my mom when she reads it (in the present)—and to any caregivers who read it and see themselves reflected in her story.
Dear Mom,
As I write to you in 2025, I’m working as a clinical geropsychologist in dementia care. I imagine you in 2014, probably sitting in Grandma’s nursing home bedroom, feeding her a mango smoothie you just picked up from Burger King. You recently made the incredibly painful decision to move Grandma out of our home, where you were caring for her so lovingly, for so long, through her Alzheimer’s disease.
I am writing to you now because I want to tell you what my teenage self couldn’t. At this point, I have supported dozens of dementia caregivers who have made the same decision you have. That has given me some perspective that I wish I had been able to share in real time back in 2014.
There are many books, articles and blogs now about the challenges of caring for a loved one with dementia. What I see less of is acknowledgment of what happens for caregivers after that nursing-home move.
You told me that the time Grandma was living in the nursing home was the hardest part of caregiving for you. Back in 2014, after witnessing the stress that caring for Grandma and Grandpa at home put you under, I thought—mistakenly—that this transition would help.
You once told me about your drives to and from the nursing home, so I know that in the quiet of today’s drive, your mind raced, thinking about how Grandma was doing and about separating from her. When you were a caregiver at home, there was no separation.
It is OK that you are emotional. There is grief in acknowledging that Grandma needs a higher level of care. The nursing home is a symbol for her decline that is tangible and cannot be ignored.
Grief may have been there all along, but you were in survival mode. As you describe it, you were “go go go” while Grandma was living at home. No time or space to feel. Now, you have that time and space. Grief is a natural response to loss. Even when the person is still alive, loss exists, grief exists. You need to let it out and find the people, places or things that will bring you comfort.
There is so much that is no longer in your control. When Grandma was at home, you were the one who was organizing, shaping and carrying out her care plan. Now, a whole team of professionals is doing this for you. Let’s acknowledge the fact that you were one person, doing the job several professionals now do, and they have years of education and certifications in medical fields. They also do this in shifts, so they can leave to recharge their batteries. You were on shift 24/7.
Please try to release the guilt that you could no longer keep Grandma at home. Dementia caregiving often becomes impossible at some point for the caregiver to do alone. It requires more support, and our medical system often fails to offer adequate support at home.
You gave Grandma the privilege of living in our home for so many years. She got to sit at the dining room table with me as I curled my hair for prom. She got to sneak the dog treats under the dinner table. She got to sun herself outside in your beautiful garden. Just because this part of our lives has come to an end does not mean you have failed in any way.
Now that there are so many professionals helping with Grandma’s care, it might be hard to watch things done in ways that you would do differently. Imagine this on a spectrum: on one end, there are things you can lean into accepting. On the other end, you may want to advocate for changes. When each new situation arises, evaluate for yourself where it falls on the spectrum.
The team of professionals caring for Grandma should have her best interests in mind. If you don’t believe they do, there are steps we can take to move her to a different nursing home or report signs of abuse or neglect to the appropriate authorities. This is in our control.
Many caregivers I work with are ashamed of the relief they feel when a nursing home takes over. That shame may be one of many emotions you’re feeling. You love Grandma. You are not feeling relief because she is gone, but because you’re free of the dementia-related tasks, decisions and responsibilities that have overwhelmed your every day for the past five-plus years.
I know that, over time, you have found deep meaning in caring for your mother. It may feel like you have lost a part of yourself and a part of your identity now that she lives in a nursing home. But you are still a caregiver: you facilitate her doctor’s appointments, bring her meals and snacks she enjoys and give her emotional support.
I know this time is hard for you, Mom. I hope some of my words bring you comfort and help you to feel less alone. You have taught me a lot about strength: how vulnerability is strong, how resilience is strong, how caregiving makes you strong. I see your struggle and I see your new strength.
Caregiving does not end when nursing home care begins, it changes—and so do you.
With endless love and appreciation,
Your daughter,
Anastasia
Anastasia Canell has a PhD in clinical geropsychology, a specialty that focuses on understanding and helping older people and their families. As a postdoctoral fellow, she works in hospitals, skilled nursing facilities and elsewhere, providing psychotherapy for individuals and groups. She also does research and has written and spoken extensively about issues associated with aging, such as the way becoming an older person’s caregiver impacts young adults (18 to 25).
