Columbia, S.C. ? Slaine Hayes woke in the middle of a February night to the sound of the closet door shutting.

Sleep had been hard to come by since Slaine’s 87-year-old mother, afflicted with Alzheimer’s disease, moved in the week before. Cora Rafferty’s nighttime activities were already starting to become routine, and her daughter was feeling the strain of sleeping with one ear cocked open.

Slaine walked to the next room and found her mother piling clothes on the bed. Cora was packing because she wanted to go home, but the home she wanted to go to had been torn down years ago.

It’s 3 a.m., Slaine said, pointing to the alarm clock and reminding Cora she was staying at Slaine’s house now.

Cora apologized for waking her daughter, and Slaine moved the folded clothes to the floor so her mother could go back to bed.

This wasn’t the first time her mother had awoken in the middle of the night, and these episodes didn’t only affect her sleep. Her teen-age son had to get up for school, her husband for work.

“I knew the family would suffer to try to keep this going,” said Slaine, 49. “Within the first week I realized this was going to be a constant ritual, or we’d have to put her into assisted living.”

That decision is playing out in households across America as families must choose whether home care or assisted living is best for their loved ones.

More than a million people live in assisted living facilities in this country. With the number of people over age 85 expected to double in the next 20 years, the situation is expected to become even more common.

Even after a family decides assisted living is the best option, the emotional journey is just beginning. Feelings of guilt are typical, said Josetta Smalls, a social worker at Carroll Campbell Place, a facility for people with Alzheimer’s, where Cora Rafferty moved in April.

“The families know it’s the best decision, but they’re still cursing themselves,” Smalls said. “They’re asking themselves what they could have done differently, and I try to assure them that they’ve done their best.”

Slaine’s husband, George, 51, knew his wife was doing everything she could to care for her mother and saw the toll it was taking. She stopped meeting friends for lunch, and George could see she was sleep-deprived.

“I tried to help out, but Slaine took on most of the burden,” he said. “I was really worried about her.”

And just as George worried about his wife, Slaine worried about her mother.

When Cora moved in with the Hayeses in February, Slaine had no idea that her mother’s mental state had deteriorated so much. With no family history of Alzheimer’s, the concept of the disease never entered her mind.