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Coping with the “Transfer Trauma” of Moving a Loved One

Rachel, a caregiver for her mother who is in the early to mid-stages of dementia, is on the emotional roller coaster of moving her mom to an assisted living facility. It’s taking quite a toll on her and her mother, because Rachel’s mom has strongly expressed that she would much rather live in her own home.

Recently, Rachel’s mother’s functioning has declined to the point that she fell several times, leading to multiple trips to the emergency room. Rachel initially fretted over the decision to look for another living arrangement for her mom, but it’s what is best for her safety and to ensure she gets the care that she needs. Rachel is hoping to make the transition as easy as possible for her mother, while minimizing the trauma.

What Is “Transfer Trauma” or “Relocation Stress Syndrome”?

Changing your living environment can be difficult for seniors, especially when that person has a complicated medical condition, such as dementia. Often called “transfer trauma” or “relocation stress syndrome,” extreme stress can occur when an individual moves from one location to another, and even more so when the move is from home to a facility that will be providing daily assistance, such as an assisted-living facility or nursing home. The transition is often perceived by the senior as ending their independence and losing control. Among elderly adults, it can lead to a decline in their physical and emotional well-being that can lead to significant health complications. It can also trigger depression, psychological distress, and withdrawal from social activities.

Some individuals are at greater risk of experiencing transfer trauma, such as those with mobility limitations or those who have difficulty moving around on their own. Individuals who live alone may be set in their ways. When established routines are disrupted, feelings can range from mild discomfort to feeling unsafe and even physically ill. Women and widows of both sexes and those who suffer from a cognitive condition, such as dementia, are even more susceptible to transfer trauma.

But transfer trauma is not something that happens to everyone. According to Dr. Nicholas Carte, Faculty Lead and Team Lead of Nursing at Southern New Hampshire University, only between 20 percent and 30 percent of older adults relocating to assisted living or nursing homes show symptoms of transfer trauma. “This change is often difficult for several reasons,” says Carte. Some older adults may have deep emotional bonds with their homes, which often represent security, comfort, and identity sources. “So, leaving their home can be very unsettling for them. They often feel the loss of independence,” he adds.

Transfer Trauma and Dementia

Transfer trauma is common with early-stage dementia sufferers who are moving into a care facility from their lifelong residence. For some early-stage dementia patients, the stress associated with a move can be significant, while others may experience mild effects or no effects of transfer trauma at all.

One difficulty that often arises with early-stage dementia sufferers is that they do not recognize their own deficits and believe they are more than capable of taking care of themselves in their own home. This lack of awareness and recognition of deficits by dementia sufferers can put added stress on the family during an already stressful time.

If transfer trauma occurs in a loved one who suffers from dementia, it’s important that it is identified and reduced quickly, or there can be negative consequences such as depression, anxiety, resistance to care, and behavior troubles. In some cases, the person may attempt to leave on their own and without warning. Almost all assisted living facilities in the DMV, and a growing number of nursing homes, have so-called “memory care” floors or entire buildings that are locked to prevent residents from leaving/wandering away from the facility.

Although transfer trauma may not always be preventable, you can help turn this challenging transition into a fresh start for your aging loved one.

Turning Transfer Trauma into a Fresh Start

You can take meaningful steps to ease the transition and mitigate the negative impact of transfer trauma. Here are some tips on how caregivers and loved ones can help reduce the risk of a loved one experiencing transfer trauma:

  • Involve the senior loved one in the decision-making process, if they are capable of making a sound decision. Give them the opportunity to speak their mind and ask questions. Keep communication open, honest, and tailored to their level of understanding. Explain what is happening in a way that makes sense to them and make them understand that it is for their own benefit.
  • Keep the loved one informed of what is going on, and allow them to participate in the process. This could include touring facilities, talking to staff, and selecting their new living space. Take time to walk your loved one through the layout of their new residence. Show them where their things are located and how to navigate the space. If they feel like they are involved in the process, they may be more likely to accept the decision to relocate.
  • Get other family members or friends involved. If the person’s loved ones are collectively working together, the senior loved one may feel loved and supported knowing that everyone is working toward a common goal of doing what is best and helping them get adjusted.
  • Address concerns your loved one may have: Openly talking about concerns upfront can help fix problems early. Check in with your loved one about specific worries. Ask questions such as: “What are your concerns about the new facility?” Allowing your loved one to talk about their worries helps you avoid potential issues before the transition occurs. Proactive steps to address apprehensions can also smooth the adjustment process.
  • Capture the memories so your loved knows they won’t be lost. When getting ready for a move, going through a lifetime of possessions and memories can stir up a lot of emotions. Ask questions about the home, listen to their answers/stories, and record them for future generations to enjoy. Use your smartphone to video the questions and answers, or use the audio recording feature on your phone if your loved one is camera shy. Here are just a few sample questions you might want to ask to ensure that their memories about this home are captured for posterity and to remind them that life is full of transitions and that a house is just a place (be sure to use the word “house” in these questions, and not the word “home,” to subtly drive in the fact that a house is just a place):
    • When did you move into this house?
    • Why did you move into this house?
    • What was your prior house like?
    • What was this house like when you moved?
    • How old were you, and what was going on in your life at the time you moved into this house?
    • Do you remember how you felt when you first moved into this house?
    • Where did you live prior to moving into this house, and what was the reason for the move?
    • What are your memories about the moving process?
    • Why did you choose this particular house?
    • How much did you pay for this house?
    • What changes, if any, have you made to the house over the years?
    • What are some of your favorite memories of events that have happened in this house?
    • Do you have any negative memories of events that have happened in this house?
  • Be sure there is adequate time to reminisce. Sharing stories and memories can be a wonderful time to bond and look back at the time your loved one has spent in this house. It’s important to know that, ultimately, houses and possessions come and go, but memories can last forever. Sort possessions into items to keep, things to donate, and heirlooms to give to loved ones.
  • Set up their new space similar to the way their home was arranged. Putting up family photos and displaying cherished items can help a person feel more at home in their new setting. Before you begin the moving process, take photos of how things are arranged at the person’s home, and then replicate the look at their new space to the greatest extent possible. For example, take a photo of a shelf that has photos displayed, then put the images in the same order at the care facility. The familiarity will reduce stress and provide a heightened sense of comfort. If they are able, allow your loved one to personalize their new living space by bringing familiar items from home. Involve them in decorating and making the space their own for comfort.
  • Give your loved one as much autonomy as possible regarding their new daily life: Try to facilitate activities and routines tailored to their interests. If they appreciate fresh air, arrange for regular time outdoors. Connect them early with the facility’s card group if they like card games. Introduce them to the facility’s staff and residents with shared interests to build community.
  • Understand that it may take time for a loved one to get adjusted: Oftentimes, most of the stress associated with a move is short-lived once the loved one arrives, gets set up, builds friendships, and becomes acclimated to their new routine and surroundings. Each person deals with it differently, so it’s important to be conscious of the situation, and help alleviate concerns whenever you can.
  • Seek professional assistance, if necessary: If your loved one seems to be exhibiting symptoms of transfer trauma, such as depression, psychological distress, or a withdrawal from social activities, request help from medical and mental health professionals at your loved one’s new facility.

Similar to Rachel and her mother in our example, one of the main reasons family members choose to move their loved ones into a community is safety. It’s often the best thing for your loved one. However, relocating involves adjustments in environment, routine, and social connections that can be emotionally challenging. With care, understanding, and support, you can help your loved one experience a transition to an aging facility as hopeful new beginnings rather than a traumatic experience.

Plan in Advance for Yourself and Your Loved Ones

Here at the Farr Law Firm, we give our clients the peace of mind that comes from long-term care planning and protecting your assets and your legacy, all while preserving your dignity, quality of life, and financial security.

If you or a loved one are in the early stages of dementia, it is likely that you or your loved one will eventually need long-term care in a nursing home, which in the DC Metro area costs between $14,000–$17,000 a month, a catastrophic amount for most of us. With proper planning, Medicaid will pay for most or all of the nursing home expenses.

In cases where a family member is in the early stages of dementia, early planning is especially important. The family member needs to make decisions about financial matters while he or she still has the mental capacity to do so. If you have not started planning, or had your planning documents reviewed in the past several years, please call us to make an appointment:

Northern Virginia Elder Law Attorney: 703-691-1888
Fredericksburg, VA Elder Law Attorney: 540-479-1435
Rockville, MD Elder Law Attorney: 301-519-8041
Washington, DC Elder Law: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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