Most caregivers experience a twinge of guilt when the time comes for their loved one to be placed in a nursing home or assisted living community. The transition is difficult for the caregiver and the affected person, and both often experience anxiety and sadness among other strong emotions.

After a period of time and with some adjustments, however, both parties can become acclimated with the new care setting and move forward in the new environment.

Your concern for quality care in this new environment is understandable. In the home setting, you and your loved one were care partners. You cared for just one person.

In a long-term care setting, the ratio is different, usually one nursing assistants to six or eight residents. So, instead of one-on-one care, your loved one will will now be among seven or so others being cared for by one person, a stark contrast to the level of care he or she had received.

This does not mean the nursing assistants and staff are not sensitive or meeting your loved one's needs. It just means their time with each person is limited.

The staff may need more training in how to accommodate the needs of residents with Alzheimer's and dementia, and, as a caregiver, you could share tips and strategies which helped you. This also will help in building relationships with the staff, especially if you build trust and acknowledge the work they are doing, treating the staff with consideration and respect.

When care falls short of your expectations, talk to staff members in a calm and concerting way. Be positive and encouraging; let them know you are on their team; and discuss your concerns over specific needs. Give precise examples of things you would like to see done and be clear about your goals. If your expectations are not met, meet with the administrator.

A person with Alzheimer's disease or dementia is often paranoid and will accuse staff of taking his or her things. This is common, yet upsetting for the affected person and the staff. It's important to validate the feelings of the affected person while showing concern for the staff and quietly working things out. Keep in mind that it is best to leave valuables, such as jewelry and other keepsakes, at home as your loved one might misplace them or another resident might take them. And always label personal items such as dentures, eyeglasses and hearing aids.

While abuse in the nursing home and assisted living communities is much less common than abuse at home, it can happen. If you sense a problem with your loved one or witness any form of abuse with the residents, contact the administrator immediately and your local adult protective services agency.

Questions about Alzheimer's disease or related disorders can be sent to Dana Territo, the Memory Whisperer, a volunteer ambassador with Alzheimer's Services of the Capital Area, at, or visit the organization at 3772 North Blvd., Baton Rouge.