Caring for someone with Alzheimer’s is not just exhausting; it is emotionally disorienting. You lose pieces of someone you love, slowly, in a thousand small ways. And while books, doctors, and websites talk about the medical side of Alzheimer’s, there are things they do not prepare you for like the guilt, the grief, the unexpected laughter, and how much it can break your heart. If you are in this role or about to be, this article is for you. Below are seven things most people do not say out loud, but every Alzheimer’s caregiver deserves to know.

1. You will grieve while they are still alive. Alzheimer’s is often called “the long goodbye,” and for good reason. As the disease progresses, the person you love may still look the same, but their memory, personality, and sense of time begin to fade. This creates something called ambiguous loss, the grief that happens when someone is physically present but psychologically absent. And it is real grief. You might feel sadness, anger, even guilt for mourning someone who is still technically “here.” That is normal and it is OK to talk about it.

2. You will constantly question yourself. Should I have handled that differently? Am I doing enough? What if they forget me? These questions can haunt caregivers, especially adult children. It is easy to feel like you are doing it all wrong especially when the person you are caring for cannot reassure you. But the very fact that you are showing up, reading this, and trying to do better says a lot. One of the hardest parts of caregiving is the emotional guessing game. Alzheimer’s does not come with a clear playbook, and every day can feel different. You will make mistakes. Everyone does. Self-compassion is part of survival.

3. The small wins matter more than you would expect. When a loved one remembers your name or smiles at you after a string of hard days, it can feel like a tiny miracle. And it is. These small wins might seem insignificant to others, but to caregivers, they are golden. Holding their hand, helping them dress, getting through dinner without confusion or distress, these are victories. Recognize them. Celebrating small moments keeps you grounded, especially when progress is not part of the journey.

4. You will need to set boundaries, even with family. One of the most invisible stressors for caregivers? The family dynamics. You may feel like you are carrying the emotional and physical load alone, while siblings or other relatives stay on the sidelines. And you may be tempted to take on everything to keep the peace. But you cannot pour from an empty cup. It is OK to say no. It is OK to ask for help. And it is OK to step away when you need to recharge. Boundaries are not just healthy; they are essential for long-term caregiving. If others are not stepping up, have honest conversations or delegate what you can. You deserve support, too.

5. Your loved one might say things that hurt. There may come a day when the person you are caring for does not recognize you, or worse, says something unkind or frightening. This can be one of the most painful parts of the journey. Alzheimer’s affects the brain in ways that alter behavior and personality. A once-kind parent may become suspicious, withdrawn, or even aggressive. These moments are deeply painful, but they are not personal. Remind yourself: It is the disease, not the person. Create distance when you need to. Talk to a therapist or support group. You are allowed to feel hurt and you are not alone.

6. Caregiving might isolate you, if you let it. The daily responsibilities of caregiving can quietly pull you away from your own life, friends, hobbies, even your job. Before you know it, your world shrinks to one person, one routine, and one endless to-do list. Isolation is a serious risk, both emotionally and mentally. Caregivers are significantly more likely to experience depression, anxiety, and burnout. That is why staying connected even in small ways is vital. Can you schedule one coffee with a friend a week? Join an online support group? Talk to a counselor once a month? These small steps help protect your mental health and remind you: you are still your own person.

7. It is OK to feel relief, and to still love them deeply. If you have been caregiving for months or years, there may come a time especially near the end when you feel a strange, unexpected sense of relief. Not because you did not love them, but because you are exhausted. Because the hard part is over. This feeling often comes with guilt. Do not let it. You are human. Loving someone through Alzheimer’s is one of the most difficult emotional tasks a person can face. Feeling relief does not mean you did not care; it means you gave everything you had. You can love someone completely… and still feel ready to rest.

Final thoughts

Being a caregiver for someone with Alzheimer’s is a kind of love that most people do not understand until they have lived it. It is not just about keeping someone safe. It is about learning to let go, little by little, while still showing up with patience and compassion. And it is not something anyone should have to do alone. Talk to a therapist. Join a support group. Take the break. Ask for help. You deserve care, too, not just as a caregiver, but as a person navigating deep emotional terrain.

What can you do next?

If you are currently caregiving:

• Make a list of people you can reach out to for help even small tasks matter.
• Look into local respite care options so you can take a proper break.
• Find one resource (a book, podcast, or support group) just for you.

If you are preparing to care for someone:

• Start conversations early about medical, legal, and financial planning.
• Read firsthand caregiver stories to emotionally prepare.
• Get organized: medications, appointments, and emergency contacts in one place.

Andrew Gulbis is a family physician.