Two days before he was to visit his mother, Guillermo Goodman cried at the thought of her in the care of strangers.
Raised in a traditional Hispanic family, where his grandmother's every need was tended to by his father at home, Goodman, 59, never imagined making a different choice for his own mother.
But the effects of Herminia's Alzheimer's disease and Guillermo's own failing health took a toll.
Earlier this month, Goodman placed his mother in a private assisted-living home - an option that few Hispanic families pursue, sometimes to the detriment of the elder and the caretaker.
"I remember my grandmother living with us and the love that my father had for her," said Guillermo, a native of Nogales, Ariz. "I thought I, too, would take care of my mother her whole life and that's one of the reasons I didn't want to make this choice."
The Pima Council on Aging is reaching out to the Hispanic community with information on long-term care, hoping to remove cultural guilt from the decision.
Lupe Salas, an outreach coordinator with the council who works with the Hispanic community, said there's a lack of information about resources for elder care. She said many Hispanics frown upon government programs such as the Arizona Long Term Care System because of a long-held reluctance to place loved ones in the care of the government. The program offers in-home or nursing-home care assistance for Arizona seniors at no cost or reduced cost.
Guillermo's first visit
Upon entering the South Side assisted-living center Casa Theresita, Guillermo let out a sigh of relief and went to his mother's side.
He clung to her and repeatedly asked if she was OK.
Herminia, 80, didn't understand the fuss. She reassured her son that everything was fine and showed him around her new home.
Although Guillermo had visited the home before placing his mother there, he let her give him a tour. He saw the garden she waters every morning and the Catholic saints that adorn the house and her bedroom. Herminia's chores include washing the dishes, she told her son.
She had been there for two weeks and, on the advice of the home's owner, Guillermo had not visited in order to give his mother a chance to settle in.
"I'm so glad that you like it here," Guillermo told her. "I prayed and I prayed and God has answered my prayers."
For five years, Guillermo attempted to care for his mother himself. He moved in with her, leaving his wife at home, trying to juggle his responsibility to both.
But eventually she stopped eating. She grew tired and agitated and tried repeatedly to run away. She would water empty flower pots and run up $400 electric bills by turning on the air conditioner, even when it was cold outside.
After going to the hospital twice last year with blood-pressure problems, Guillermo realized he could no longer take care of his mother. He chose Casa Theresita because of the warmth he felt from the owner and employees, who all speak Spanish. He also liked the Catholic saints in the home because he knew they would comfort his mother.
"I felt so guilty," he said. "But I spent five years watching her deteriorate and I couldn't handle it anymore."
Overcoming guilt is vital
Breaking through the guilt associated with assisted living or nursing home care is crucial, said Yvette Jimenez, community liaison with Odyssey HealthCare, which helps people with referrals to hospices, nursing homes and assisted-living homes.
She said less than 10 percent of her clients are Hispanic.
"They don't realize that there's help out there; that they can get assistance 24 hours a day," she said.
Instead, many Hispanics feel a sense of duty to take care of their aging parents, sometimes while raising a young family and working full time.
The owner of Casa Theresita, Theresa Fernandez, said families often bring loved ones to her only after a medical or mental problem has become chronic.
"Once they've run out of options and are exhausted from the hassle, then they consider this option," she said.
Fernandez, who runs five assisted-living homes in Tucson, hopes the outreach changes that.
Once an older person begins to fall, lose memory, stops eating or tries to run away, people need to consider their safety, she said. "Assisted-living centers are equipped, for example, with alarms if anyone tries to leave," she said.
The Pima Council on Aging recommends that families have discussions about tough subjects, such as death and if an assisted-living or nursing-home situation would be acceptable, Salas said. "Everything should be discussed before memory loss sets in," she said.
Herminia's comfort a relief
Guillermo's first visit with his mother was brief, but it was enough to reassure him.
The home was cozy and clean and Herminia was obviously comfortable and well cared for, he said.
He would be able to sleep that night, he said.
"She looks good and she's gained back some weight," he said.
Memories of his mother are of an active, independent woman who attended church every day and socialized with friends. Six years ago, following hip surgery, doctors told Guillermo to consider nursing-home care.
He refused. Now he realizes it's OK to let others help with his mother's care.
As he prepared to leave, Guillermo promised to return the following day with chocolates.
"Everything looks fine," he said aloud, yet to himself, as he left. "It's not as if I abandoned her."