How to Decide If Your Parent’s Ready for a Nursing Home: Step-By-Step

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Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Any decision involving care for an aging adult can be difficult at times. You may be concerned about the cost, the quality of care, and also how to have a conversation with your parent about care. 

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Families tend to take care of a loved one long beyond the time a nursing home may have been the best option. Our step-by-step guide can help you make this difficult decision by focusing on specific care needs and how best to discuss this very challenging transition.

How Do You Know If Your Parent’s Ready for a Nursing Home?

If you are considering whether your parent is ready for a nursing home, they are most likely either at home or in an assisted living facility. Most assisted living communities can help you discuss the option of nursing home care with your parent, especially because they may be unable to provide all the care necessary to keep your parent safe. 

For a parent at home, the process is more challenging. You and your family may be providing care, along with paid caregivers. The emotional burden of these decisions can be enormous. 

The difference between assisted living and a nursing home as an option for your parent might not be obvious. One way to clarify this decision is to ask for a nursing evaluation from an assisted living facility. But, keep this in mind, even if your parent is accepted into assisted living, how long can they stay there? Will this decision make the transition to a nursing home easier?

Let’s examine the most common reasons families and assisted living communities decide it is time for nursing home care.

Loss of mobility

Loss of mobility can happen for a variety of reasons. Some people have a slow decline in physical functioning after a fall, for example. A broken hip and or ribs can contribute to decreased strength and balance, which leads to more falls. It is a vicious cycle that is hard to break.

Others have neurological conditions that cause weakness and balance problems. In time, these people may need help with walking and transferring. 

Regardless of the reason, when your parent can no longer get to the bathroom or get up out of bed or a chair without substantial help, a nursing home may be the only option. Most assisted living residences do not have the staff availability, and may not want to incur the liability of lifting or transferring someone. Many communities also prohibit mechanical lift devices. If a resident needs that level of assistance, they are not appropriate or safe in assisted living.

States determine assisted living rules and regulations, and they are cautious about accepting or keeping people who need advanced care. The care lines between assisted living and nursing home care have gradually blurred as assisted living communities have found financial incentives to fill their beds.

Increasing care needs

With enough money, it is possible to cobble together the medical care that a nursing home can provide. But it can also be enormously expensive and difficult to manage.

Nursing homes are set up like hospitals. In situations where someone doesn’t qualify to be in the hospital, turning to a nursing home can make sense because they can offer a full range of medical intervention that includes the following:

  • Injections and IV medications
  • Catheter care
  • Wound care
  • 24-hour nursing
  • Supervised eating in case of swallowing issues
  • Modified diets 
  • Two-person transfers and the availability of lift devices

The bottom line is that if your parent is not safe at any other lower level of care, it might be time for a nursing home.

Aggression or acting out

Late-stage Alzheimer’s or other types of dementia can cause aggressive and inappropriate behavior. If your parent is at home or in assisted living, these behaviors may be too challenging to manage.

In some states, a diagnosis of dementia or a mental health diagnosis alone may not be enough to qualify someone for nursing home care unless there is a co-occurring medical need. Nursing homes can handle patients that have behavioral problems. 

Cost

Unfortunately, the cost of care is often a driving factor about whether it is time for a nursing home. Families can and do run out of funds to pay for care.

When this happens, qualifying for Medicaid is the only solution to cover costs. Medicaid covers the full cost of care for someone in a nursing home for as long as they are there. Your parent must meet Medicaid criteria for admission to a nursing home. 

Caregiver burnout

For a family caregiver, things can reach a critical point where something has to give. Caregiver burnout can lead to stress, loss of income, and mental and physical health problems. As hard as it is to do, there comes the point at which your parent’s care has to be turned over to someone else.

Hands-on care and medical interventions are exhausting, and sometimes not safe for either of you. It might be time for a nursing home if assisted living is not an option.  

ยป MORE: Don't skip these commonly forgotten post loss tasks. View our post loss checklist.

 

Can You Force a Parent to Move to a Nursing Home?

Unless you are the legal guardian, you or a doctor can’t force someone into a nursing home. Even as the guardian, there are ethical and legal issues around physically forcing or tricking someone into moving to a nursing home.

A far better approach is to convince your parent to move to a nursing home. Sometimes when there is a medical crisis and a hospitalization, the medical treatment staff will recommend nursing home care, and the transition can happen then.

Otherwise, you will need to talk with your parent about moving to a nursing home and hope you can convince them it is the right thing to do.

How to Talk to Your Parent About Moving to a Nursing Home

Your parent may have said to you at some point, “Promise you won’t ever put me in a nursing home!”

No one wants to go to a nursing home because of the impression that it is where people go to die. Indeed, many people do, but it can be a place to recover to the point of moving to a lower level of care. Let’s look at some tips on the best ways to talk to your parent about going to a nursing home.

1. Find a good nursing home

If you take the time to investigate nursing homes and find a good one, this can make all the difference. Visiting is the best way to determine cleanliness, staff interactions, and general ambiance. Meet with the nursing and therapy staff. Talk with the administrator about lines of communication and regular care planning meetings. 

Contact the state ombudsman to inquire about complaints and reports. Narrow your search to the top three and suggest to your parent that you visit together. A visit can dispel some misconceptions and make your job of convincing easier. Ask your parent their preference and include them in the decision making process.

2. Be transparent

These conversations will be hard. Be transparent and honest about the reasons you are considering nursing home placement. It is very common for older adults to minimize or deny their physical disabilities and the need for help. Gently explain and detail exactly what is done each day, from help with bathing to assistance with dressing and transferring.

If your parent has dementia, this can be much harder to do because they may forget what you tell them. Your parent may get angry and resentful. Stay as calm, reassuring, and centered as you can.

3. Show compassion

Imagine how frightened your parent may be at the thought of moving to a nursing home. There are feelings of loss of independence and control, as well as the inevitable end-of-life emotions. Be open to discussing these feelings, and if it helps, bring someone else into the conversion. Perhaps clergy, friends, or other family members can provide comfort during this stressful time.

Reassure your parent that you and your family will visit weekly. Talk about important personal items and what to bring and what to store. Personal mementos are significant to older adults, so honor your parent’s wishes as much as you can. 

4. Be willing to accept defeat, but come back another day

As mentioned earlier, you can’t physically force your parent to move to a nursing home. An assisted living community has every right to require your parent to move. In this case, moving them to a nursing home may be easier because there is no other alternative.

If your parent is at home and refuses to go to a nursing home, try to make sure and make a plan for both of you. Meet with a financial planner if you haven’t already to examine the big picture moving forward. There may be financial resources you and your parent could tap into or state and local assistance to help.

Take care of yourself through this process as the stress can be overwhelming. It is easy to forget your needs as you continue to try and keep your parent safe. Come back to the subject of moving to a nursing home another day when you might have better luck.

Putting a Parent into a Nursing Home

Putting a parent into a nursing home may be one of the hardest things you will ever do. Reach out to other family members and friends for support and guidance. Be sensitive to feelings of abandonment and loneliness by focusing on what is important: your love and care for your parent. 

If you're looking for more help with your aging parents, read our picks for the best caregiver books and how to start advance care planning.

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