No one wants to face relocation to an assisted living or long-term care facility and no one wants to be in the position of making such a decision for a loved one.

Ultimately, though, for elders with dementia, most families face the same question: "How will I know when it's time to place an elderly family member in long-term care?" The answer is not simple. Research shows there are a number of reasons that people with dementia must be moved from their homes, but the main reason is the burden that the caregiver perceives.

The truth is caregiver burden is a concept that everyone can identify with, but the specific idea of what constitutes "burden" are different for everyone. What about the person with dementia who is compliant with care but who has to wear diapers, needs to be fed, and has to be bathed? Is that person less, or more, of a burden than the person who fights and hits whenever personal care is attempted, but is otherwise good natured, eats well, and can hold a conversation?

To make things even more complicated, research also reveals that placement of a loved one in a facility really does not reduce the sense of caregiver burden. It seems as if one set of worries is traded for another, whether real or anticipated. So, if you think that placing your relative in a facility will solve all the problems and eliminate stress, that may not be the case – at least not entirely.

So what do you do when you have to think about finding a secure dementia unit for a father who was a world traveler and ran his own successful multi-million dollar business? Or when you are in the heartbreaking position of providing full-time care for a mother who always cared for you?

Well, you might start by looking at Web sites and brochures for long-term care communities. You will likely find key words such as "safe," "trust," "compassionate," "trained, professional staff," and "around-the-clock." When you read these words (as was the marketing intention) you experience a level of cautious relief, easing the transition to the new lifestyle.

Messages such as the ones above reach out in an extraordinarily powerful way and directly engage the emotions of desperate families in need of solutions in their time of crisis. However, as comforting as these messages are for families who are hurting, they have repeatedly told us that they really need a way to reliably compare the services offered by various facilities.

In looking for ways to compare facility offerings, it is very important to try to separate actual facts and figures from your emotional reaction to a facility. In order to do this, we must first ask ourselves what does assisted living really sell? To answer that question, we must first recognize that the commodity sold by assisted living and the services sought by consumers might be different.

Lovely decor, good food, and a central location might be less important to consumers than knowledgeable staff. So what does assisted living really sell? Expertise? Compassionate care? Safety? Wellness? Maybe all of those, but what is really for sale is trust, and since families are in crisis, and since they need to believe they have chosen the "right" facility for a loved one, their expectations are high, and the consequences of misplaced trust can be tragic.

How do you respond to the inevitable problems that can crop up after the transition to long-term care has been made?

After the move – Beliefs that stop us in our tracks.

If things go badly after having moved into a facility, "buyer's remorse" takes on a whole new meaning. Unfortunately, good money is paid for high levels of care, but many deficiencies in care are rationalized and accepted by both providers and families. Let's look at some faulty beliefs as well as legitimate fears that we have seen become obstacles to better care.

Belief No.1: If I or my loved one is a compliant, friendly resident, then the staff will provide better care and lots more attention. What really happens is the resident who yells, hits, wanders, argues with staff, or is found crying is the resident who receives lots of attention (even though not all positive), more family communication by staff (to report all the behaviors and problems), and more consults from mental health care providers. It is the quiet, friendly resident who is left alone, because he or she seems" obedient" and fairly self-sufficient.

Obviously, we are not advocating that residents and families should cause problems to get attention, but residents and families should make needs known to the appropriate staff members, going up the management chain if necessary. It is critically important once you have made needs known that you request an action plan and accountability.

Belief No. 2: If I am friendly and compliant, my loved one will get better care. Yes, the staff is friendly to compliant residents and families and is glad to see them, but their friendly behavior is most likely because the staff don't perceive compliant consumers as being demanding.

Too often staff becomes defensive if questions are asked, even if those questions are genuine and not posed in a confrontational way. Even so, it is important to continue to ask questions, participate in care plans, keep an open line of communication with caregivers, social workers, and administrators and attend family or resident council meetings. Of course, it goes without saying that threats, bribes, and temper tantrums do not constitute open lines of communication.

Belief No. 3: If my loved one causes too much work for the staff (or if I complain), we will be asked to find another facility. Sadly, once a facility decides you or your loved one is no longer appropriate to stay there, there is usually little you can do.

The best thing to do is to make sure that as soon as problems arise, you take steps to address them and reassure the facility that you are not looking to start a legal battle. If a loved one develops behavioral problems spend more time with him or her quietly observing so that you have real information to discuss with staff rather than relying on second-hand reports.

Often behavior problems blamed on a resident are actually behavior management problems which should be rectified by the facility. If there is a sympathetic nurse, aide, or social worker enlist his or her help in rectifying the situation. Urge consultation with a psychiatrist or psychologist experienced in dealing with dementia. Finally, be open to the idea that this might not be the best place for your loved one. The facility might honestly be telling you that despite their best efforts, they are unable to provide your loved one with the care he or she needs. Wouldn't you rather have your loved one in a safe place that is qualified to care for him or her appropriately?

Belief No. 4: If I complain or make a fuss, the staff will take it out on my loved one. We are certain that if training and family-resident-staff communication were improved, not only would families' fear of retribution be diminished, but also staff would feel less frustrated and angry, and be less likely to take out that frustration on residents.

However, if you are in a situation where you are concerned about retribution, here are a few things you can do. Stay with your loved one or hire a sitter. Document any threats and any changes in appearance, nutrition, or demeanor of your loved one. If you think there has been retribution, report it to the state regulatory agency.

We have provided some information for families facing life transitions. There are really no easy answers. Elder care is complex, and the very nature of aging ensures that as soon as you have one hurdle cleared, there will be another.

We discuss this and other issues more fully in our book, "The Insider's Guide to Dementia Care: What You Should Know About Assisted Living, Alzheimer's, and Dementia Care" available at www.amazon.com.