Placing a Parent in a Nursing Home: How to Make It Easier

Should I Put My Parents in a Nursing Home? (When Is It Time? What Are the Signs?)

In some cases, these questions are easy to answer. For example, some people are forced into long-term residential care by a sudden injury or the unexpected onset of a debilitating medical illness. Their conditions make it impossible (or too costly) for their loved ones to provide the 24/7 care they need at home, even if it's just for a temporary period of time.

But knowing when to put mom in a nursing home isn't always so straightforward. That's because many seniors have chronic health conditions that impact their functional abilities more slowly over time, making it more difficult to recognize the point when long-term caregiving in a residential facility is necessary. In those cases, it's essential to pay attention to various physical, mental, and behavioral signs. Parents need assisted living or residential nursing care when they pose a danger to themselves or others, when they can't function independently, or when their current caregivers can no longer provide the level of day-to-day support that's required.

In reality, a lot of families end up waiting too long—delaying the decision until something tragic happens that forces the issue. By that point, it is often too late to explore all the options in search of the best possible caregiving arrangement. Action may have to be taken immediately, which amplifies the stress on everyone involved. That's why right now is a great time to be asking these questions—before an accident or sudden medical event makes the decision for you.

Of course, it's also essential for family caregivers to take their own well-being into account. Adult children of sick, disabled, or terminally ill seniors frequently have other major responsibilities such as young kids and full-time jobs. As their parents' conditions deteriorate, family caregivers can find it increasingly difficult to juggle caregiving duties with everything else, which can lead to burnout, health problems, financial troubles, or relationship conflicts.

So, when is it time to put your parent in a nursing home? You may want to seriously consider assisted living or nursing home care if you recognize any combination of the following signs:

• Your mom or dad has fallen down multiple times, resulting in bruises, broken bones, or other injuries.
• Your parent frequently needs to visit the emergency room or be hospitalized due to unstable health.
• Your mom or dad's ability to perform basic day-to-day activities is declining because of cognitive or physical impairment.
• Your parent has gotten lost or confused after wandering away from home. (This sign is especially relevant to knowing when to put someone with dementia in a nursing home.)
• Your parent suffers from severe bladder and/or bowel incontinence.
• Your mom or dad is becoming more and more socially withdrawn or becoming less and less interested in doing fun activities.
• Your parent's physician has said it's time for nursing home care.
• You've injured yourself while caring for your parent.
• Caregiving is taking a toll on your own physical or mental health.
• The time you're spending as a caregiver is straining your other important relationships.
• You're starting to skip essential caregiving tasks because they've become too challenging.
• You're developing a quicker temper, and you're often feeling irritated or frustrated, even over minor things.
• Caregiving consumes your mind, making it difficult to focus on other responsibilities.
• You don't have enough financial support or help from other family members to continue caregiving on your own, and you can't afford more hours of professional in-home care.
• Your friends or colleagues are worried about your well-being, and they are urging you to explore other long-term care options.

Many family caregivers have trouble figuring out the best way to deal with parents who have Alzheimer's disease or other forms of dementia. When is it time for a nursing home in that type of situation? Generally speaking, the signs are pretty much the same as those already listed. If your parent has dementia and needs care that requires skills you don't have, then it's probably time for long-term residential care. If your own health is declining as a result of your caregiving, or if you need more assistance and can't get it, then it is probably time. And if your parent is displaying hard-to-handle behaviors that pose a real danger to himself or herself (or others), then it is definitely time. An article in International Psychogeriatrics says that, sooner or later, most Americans who have dementia are placed in nursing homes.

Planning Ahead, Convincing Your Parent, and Working With Your Siblings

It pays to be proactive. The more research and planning you do now, the more positive the outcome is likely to be in the future. By planning well ahead of time, you'll be better prepared if an emergency occurs that requires you to make quick decisions. When it comes to putting a parent in a nursing home, decision-making shouldn't feel rushed. The best outcomes are usually the result of advanced collaboration between parents and all of their adult children. Here's how to develop your family plan:

• Learn about the differences between assisted living and nursing home care. Many people confuse the two options, but it's important that you have a solid understanding of how they differ. Among other factors, these living options can be very different when it comes to cost, the types of residents they serve, and the level of caregiving they offer.
• Enlist your parent's input as early as possible. When an elderly parent refuses assisted living or nursing home care, it's often because he or she feels backed into a corner. That's why it's a good idea to stay sensitive to your mom or dad's feelings. Many seniors have a difficult time imagining their lives in a different place, without all the possessions they've acquired over their lifetimes. So if your parent still has the cognitive ability to contribute to the planning and decision-making, then make sure he or she feels like a leader in this process. Start discussing the realistic options for future caregiving arrangements. Have a discussion about all available resources.
• Avoid making promises you can't keep. When your parents are still relatively healthy, it's tempting to say that you'll never place them in a nursing home. It feels like a noble gesture. But, realistically, it might not be a promise you can keep. Long-term, it may cause more harm than good. You don't want your parent to feel betrayed, and you certainly don't want to carry around any extra guilt. Even if you only think your parent needs assisted living, there's a good chance that he or she will need nursing home care in the future.
• Get your siblings involved right away. Family harmony makes this whole process much easier. But in many families, conflicts between siblings can undermine good planning. So if you have any siblings, it's best to contact them early in the process and invite them to work with you for the benefit of your parent. You and your siblings may need plenty of time to overcome disagreements or long-held resentments—with you, with your parent, or with each other. All of you will need to lay your cards on the table and decide what you're able to contribute going forward. Each of you will also need to discuss your expectations for inheritance and how you will reconcile those expectations with the need to care for your aging parent. (In many families, some siblings worry about "spending away their inheritance.") Inevitably, one sibling will end up taking on more responsibility than the others, but try to get everyone's involvement and buy-in before moving forward. Seek family counseling if necessary.
• Get input from outside your family. It's hard to be objective about your loved ones. As you get into this process, you may be so involved in the situation that you overlook critical information. By enlisting help from a social worker, geriatric specialist, or independent senior care advisor, you can ensure that you and your family get an unbiased assessment of your parent's current and future needs. With expert recommendations, you may be able to settle disputes more easily and arrive at a plan that everyone agrees on more quickly.
• Start selling your parent on the benefits of long-term residential care. Learning how to convince a parent to go to assisted living or into a nursing home is an essential part of the process if you want a successful outcome. The key is to make your mom or dad feel like it isn't already a foregone conclusion. Let your parent warm up to the idea instead of coming across as too pushy. Express the concerns you have about being able to provide good care, reminding your parent that you want him or her to be as safe, comfortable, and happy as possible. Use any falls or accidents as examples of the need for added care. Talk about the challenges you and your siblings face. And emphasize the benefits of modern residential care, keeping in mind that your parent may have an outdated perception of nursing homes and assisted living facilities. For example, some of the potential benefits include:
  • Increased safety
  • Better physical care
  • Fewer responsibilities
  • Greater social vitality
  • More opportunities to make new friends
  • Closer access to fun activities
  • More meaningful and enjoyable family interactions
• Visit and evaluate several local care facilities. Take your parent along for as many facility tours as he or she is willing to go on. Try to keep the vibe light, fun, and adventurous. As you visit each nursing home or assisted living center, try to:
  • Observe how staff members interact with residents.
  • Determine how long physically or cognitively impaired residents are left alone at any one time.
  • Pay attention to how quickly staff members respond to urgent situations.
  • Figure out if the facility provides adequate care to residents in your parent's particular condition.
  • Spend time with other residents, participating in a few activities if possible.
  • Ask visiting family members of current residents for their opinions of the facility.
  • Sit down for one of the facility's meals and ask how the kitchen handles special dietary needs.
  • Inquire about security and whether the facility has a special section for residents with dementia.
  • Check out the living quarters and visualize how your parent's room might be furnished and decorated.
  • Find out if any of your parent's friends or acquaintances are residents of the facility.
  • Inquire about the facility's procedures for handling medical emergencies.
  • Talk with the facility's administrator about cost, funding options, availability, and what steps are required in order to admit your parent.
• Get your parent on the waiting lists of facilities that meet your family's requirements. Without advanced research and planning, it can be very hard to know how to get parents into assisting living or nursing home care. The best facilities are often full, meaning that rooms only become available as existing residents leave or pass away. By putting your parent on the waiting lists of your favorite facilities, you'll stand a better chance of achieving the outcome you want when it's time to make the move. Plus, if your parent isn't ready to move when a room becomes available, many facilities will allow you to turn it down without losing your spot on the waiting list. That way, your parent can enjoy living at home for as long as possible and take advantage of a future opening when the time is right.
• Look into Medicaid funding (if necessary). Many Americans don't have the financial resources to pay for assisted living or nursing home care out of their own pockets. However, most people without financial means can get coverage for long-term care in a nursing home through Medicaid. And some states now provide Medicaid coverage for assisted living facilities or in-home care. Your parent may even be able to keep his or her home as a protected asset. But it's a good idea to apply for Medicaid funding before your parent actually needs it since it can take a long time to get approved.
• Let everything sink in. It's normal to feel a little overwhelmed throughout this process. Your mom or dad may feel especially overwhelmed. Change is hard. It may take your parent a long time to get used to the idea of living in a residence for seniors. So try to be patient. Maintain a gentle attitude. Let everyone process all the information you've gathered. Your parent may eventually become enthusiastic about moving to a facility, especially if you and your siblings present a positive, unified front. However, for some seniors, it takes an injury, medical emergency, or other brush with danger to finally be convinced.
• Agree on a final plan. If possible, meet with everyone in person to go over all the details. Work together to decide how responsibilities will be divided before, during, and after your parent's transition to a care facility. Keep in mind that each of you may have different resources, capabilities, and local availability. (Those who live out of town probably won't be able to provide the same type of support as those who live nearby.) Even if you can't all provide equal support, try to make sure that everyone is still contributing something meaningful to the effort.
• Have regular meetings to go over any changes or updates. Stuff happens. Life gets messy. So your plans may have to change at least once, if not multiple times. Stay flexible by gathering new information as necessary and adapting your plans to the current circumstances and future potential needs.

Dealing With Nursing Home Guilt and Other Difficult Emotions

How do you put someone in a nursing home when you feel overcome with guilt, shame, anxiety, or a sense of loss? It's a question faced by many family caregivers. Guilt is incredibly common in this situation. It's natural to feel like you're letting your parent down, especially if you've been criticized or berated by your aging father or elderly mother. Guilt trip or no guilt trip, you may feel extra regret if you've made a promise that now must be broken. And, paradoxically, your guilt may be fueled by positive feelings, such as relief that you'll have more time for yourself or that your mom or dad will finally be in a safe place and receiving appropriate care. The whole process can feel like an emotional rollercoaster with confusing loops, uncomfortable turns, terrifying drops, and unexpected highs. Some people feel these emotions even when their parents are cooperative and enthusiastic.

But regardless of how common or normal these emotions are, they can also be harmful. They can zap you of energy, make you feel isolated, increase your stress, and make it hard to think clearly. In some people, they can even lead to depression. When you suffer from caregiver guilt, feelings can come on strong and last for a long time—unless you take healthy steps to cope with them. Here are some tips for dealing with guilt over nursing home placement:

• Give yourself time and permission to grieve.
• Acknowledge and accept your emotions for what they are.
• Seek reconciliation with your parent for unresolved conflicts or old resentments.
• Shift your focus away from feelings of obligation and toward feelings of unconditional love.
• Remind yourself frequently that your mom or dad is safer, less isolated, and better cared for.
• Take comfort in knowing that you did not cause your parent's physical or cognitive impairments.
• Remember that you're doing the best you can under difficult circumstances that are largely out of your control.
• Acknowledge the fact that nursing home care is a necessary reality for millions of people, including your parent.
• Give yourself permission to have a life that isn't totally focused on your parent.
• Establish healthy boundaries by steering conversations away from attempts to guilt-trip you.
• Make each visit with your mom or dad as fun or meaningful as you can.
• Recognize that you still get to be a caregiver, just in a different way.
• Set up new ways to connect with your parent when you can't be there (such as phone calls, texts, or video chats).
• Seek emotional support from your friends or close family members, your spiritual community, or groups such as the Family Caregiver Alliance.
• Consider one-on-one counseling or therapy if your guilt persists despite your best efforts to let it go.

Making the Transition to a Nursing Home Go as Smoothly as Possible

When the time finally comes to move your parent into long-term residential care, you may have a lot of intense emotions, such as fear, doubt, excitement, and guilt. After all, it will probably also be a highly emotional time for your mom or dad. Your parent may feel sad, angry, scared, or confused. He or she may lash out with harsh words or give you the silent treatment. So it's important to prepare yourself and your parent for what may be a stressful few days. The following tips can help you make the best of this challenging situation:

• Remember that the stress will be temporary.
• Plan something fun or relaxing for yourself that you can enjoy when the transition is over.
• Take care of as many details as you can prior to moving day.
• Review and organize all of your paperwork ahead of time.
• Make a final list of all furniture, clothing, and other parental possessions that will be moved.
• Hire a professional downsizing consultant if your family needs help planning what stays or goes.
• Write down some of the important events from your parent's life story. Include it with your mom or dad's medical history as something to give to the facility's staff.
• Remind yourself that it's normal to feel a little disoriented in this situation. Moving your parent into assisted living or nursing home care will require both of you to get to know a new environment with new people, new rules, and new ways of doing things.
• Find out if the care facility offers any kind of buddy system for new residents. Pairing your mom or dad with an existing resident can make the first few days feel less intimidating.
• Meet the facility's key administrators and caregivers, which might include a nursing director, activities director, social worker, case manager, on-site physician, nurses, or care aides and assistants.
• Discuss any concerns you have with the facility's senior staff members.
• Schedule follow-up meetings or conference calls with facility staff. (Aim for every few weeks, at least in the beginning.)
• Start keeping a list of your concerns or questions about the facility or your parent's life there. Discuss the items on your list in each meeting with staff and be sure to follow up often to make sure they are being addressed.
• Be patient with the facility's staff since it may take a while before everyone is up to speed on the best way to care for your parent. Early on, small mistakes are fairly normal. You may need to repeat yourself or provide information multiple times in order to get everyone on the same page.
• Spend time helping your mom or dad identify enjoyable activities or coming up with a satisfying new routine.
• Remind your parent often that he or she is loved and that you will continue to call or visit.
• Figure out how you'll respond if your parent complains about being unhappy or wanting to go home.
• When it's time for you to go home, try to ensure that your parent is settled into an engaging activity or has the company of a staff member or another resident.
• Schedule regular times to visit or call your parent. But follow up with staff to see how your parent reacts after your calls or visits. (Some nursing home residents become agitated after having visitors, and they have trouble adjusting to their new environments if they have too much interaction with family.) Adjust your approach accordingly.
• Talk to your siblings and other family members about visiting and calling your mom or dad. Work out a schedule that works best based on everyone's availability and feedback from staff.
• Make yourself or one of your responsible family members the main contact person for the facility to call in case of emergencies or other issues. Choose someone else to be the secondary point of contact.

Providing Ongoing Love, Care, and Support

As time goes on, your parent will probably feel more settled and at-home in the care facility. Both of you may begin to perceive the situation in a more positive light. That's especially likely if you and your siblings stay in touch with your parent, making each interaction as meaningful as possible. How often you call or visit should depend on how well your mom or dad has adjusted. Work with the care staff to determine how much family interaction may be beneficial. For some nursing home residents, daily calls or visits work well. For others, it may be more appropriate to have weekly or biweekly interactions. The important thing is to ensure that your parent doesn't feel ignored or forgotten.

Do whatever you can to make sure your parent remains comfortable. For example, add personal touches to your mom or dad's room, such as family photos, cherished keepsakes, or art from grandchildren. Or bring in some of your parent's favorite treats. All of those things will help you stay visible in the minds of your parent and his or her caregivers. It's also a good idea to show your gratitude when you observe those caregivers making an effort to provide great care. Don't be afraid to say thank you or send them small gifts as tokens of your appreciation.

Maintaining good communication with the facility's caregivers will be a major part of supporting your parent. But be prepared for some potential obstacles. Some of the issues that can hinder communication between families and professional caregivers include:

• Staffing turnover, understaffing, or insufficient training
• Family visits that don't align with caregivers' work schedules
• Poor communication between staff members, especially during shift rotations
• Unrealistic expectations among family members
• Miscommunication or infighting between family members
• Criticism of family members by caregivers
• Poor or less-than-timely access to essential information
• Ineffective procedures for consulting with each other on changes
• Non-constructive criticism of caregivers
• Lack of trust or respect for each other
• Cultural differences or non-shared values

Most professional caregivers are remarkable people. If you show them respect and acknowledge the good work they do, they will generally respond in kind. But it's always important to stay vigilant, watching for any signs of elder abuse or neglect. If at any point you observe a decline in conditions at the care facility or suspect abuse, don't hesitate to contact the region's long-term care ombudsman. Or if you need additional help in overseeing your parent's care, consider hiring a professional seniors' advocate.

Helpful Books and Other Resources

Putting a parent in a nursing home is clearly something that requires a lot of planning, communication, collaboration, and inner reflection. So give yourself permission to explore all the different angles of this subject, and consider a variety of recommendations from seasoned experts. You may be able to take advantage of personalized assistance from a professional senior care advisor or geriatric care manager in your area. And here are some good books that are worth checking out:

• A Bittersweet Season: Caring for Our Aging Parents—and Ourselves by Jane Gross
• Aging Is Living: Myth-Breaking Stories from Long-Term Care by Irene Borins Ash and Irv Ash
• Caring for Your Aging Parents: An Emotional Guide to Nurturing Your Loved Ones While Taking Care of Yourself by Raeann Berman and Bernard Shulman
• Coach Broyles' Playbook for Alzheimer's Caregivers: A Practical Tips Guide by Frank Broyles
• Doing the Right Thing: Taking Care of Your Elderly Parents, Even If They Didn't Take Care of You by Roberta Satow
• How to Protect Your Family's Assets from Devastating Nursing Home Costs: Medicaid Secrets by K. Gabriel Heiser
• Insider's Guide to Better Nursing Home Care: 75 Tips You Should Know by Donna M. Reed
• Living Well in a Nursing Home: Everything You and Your Folks Need to Know by Lynn Dickinson and Xenia Vosen
• Nursing Homes and Assisted Living: The Family's Guide to Making Decisions and Getting Good Care by Peter S. Silin
• Nursing Homes: Getting Good Care There by Virginia Fraser, Sara Hunt, and Barbara Frank
• Parenting Your Parents: Straight Talk About Aging in the Family by Bart J. Mindszenthy and Michael Gordon
• The 250 Eldercare Questions Everyone Should Ask by Lita Epstein
• The Parent Care Conversation: 6 Strategies for Dealing with the Emotional and Financial Challenges of Aging Parents by Dan Taylor
• There's No Place Like (a Nursing) Home: 4 Powerful Steps That Will Change Your Life by Karen Shoff
• They're Your Parents Too!: How Siblings Can Survive Their Parents' Aging Without Driving Each Other Crazy by Francine Russo
• When Love Gets Tough: The Nursing Home Decision by Doug Manning
• When the Time Comes: Families with Aging Parents Share Their Struggles and Solutions by Paula Span