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April 12, 2016

How to know it’s time to place a parent in nursing care

Caregiving Nursing Homes

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Woman with nurse in assisted living Halfpoint/

It’s a fact of life – there comes a time when we are faced with the reality that we may not be able to provide our parents with the care they need. But what are the signs you should be looking for, and how do you know that the time has come for you to look into skilled-nursing care or assisted-living?

Here are some guidelines to consider before you have a discussion with your parents and other family members:

The escalating need for care

Many adult children of aging parents find that they can care for their elderly parents at home – either in their parent’s home or their own – for a surprisingly long time. However, there will come a day when they simply can’t provide the care required because of a parent’s decreasing mobility, trouble with standing, difficulty bathing or getting to the bathroom, or other age-related challenges. This becomes the moment of decision-making for many – when the demand for care has escalated past a region of comfort.

The onset of Alzheimer’s

It’s by no means a given, but Alzheimer’s disease often greatly expands the demands of caregiving at home, and can tip the decision in favor of a nursing or assisted-living facility. Wandering, aggression, anger and the disruption of household routines are all characteristics of dementia. These symptoms have a negative impact on caregivers and their families, and elders suffering from dementia can often be better served by an experienced, competent nursing staff.

A precipitous decline

Has a recent injury or illness suddenly “aged” your parent dramatically, so much so that you notice a marked decline? A watershed event such as a major surgery or a fall that results in a broken hip is often the moment of truth, when the need for skilled nursing care becomes imperative.


This is a phenomenon that anybody who has worked in geriatric medicine is familiar with – the tendency of aging elders with dementia to have a dramatic increase in the severity of symptoms such as agitation later in the day – i.e., at sundown. If your aging parent is suffering from sundowning, caregiving duties can become doubly challenging, calling into question the need for professional nursing care rather than at-home caregiving.

Home safety

One of the primary reasons to consider moving your aging parent to a nursing or assisted living facility is, simply, safety. Is he or she truly safe living at home? Are they in danger of falling, getting burned or wandering outside into traffic or getting lost? Remember that an elder’s basic safety and security come before all else.

Caregiver burnout

This is a real phenomenon, and it is a legitimate reason to consider nursing care. Devoted sons, daughters, and grandchildren of aging elders can only do so much before the emotional, mental, and physical demands of caregiving kick in and they reach their limit. Geriatric-care professionals see it all the time: there comes a point at which a loved one needs more care than a caregiver is able to give.

If, as a caregiver, you find that friendships and activities are suffering, you’re dropping the ball with other things in your life or your own health is being affected, it may be time to admit the need for professional help.

Despite all this, of course, there are many reasons to conclude that it’s not the time for a nursing home.

If your aging parent knows his or her home well, is comfortable and mobile there, can walk without help and feels safe at home, there’s no need to consider making a move. Similarly, if your parent, despite his or her age, is “aging well” and is in relatively good health, it’s unnecessary to consider nursing care or assisted living simply because they reached a certain age.

On the other hand, your parent may need nursing care, but there may be enough funds to hire nursing staff to come into the home to give you respite. For many, this solution is preferable to moving to a facility – particularly if the elder in question has a good relationship with a local, long-trusted physician.

Virtually all adults say that the decision to place a loved one in a nursing home is one of the most difficult decisions they ever make. However, it can be the correct one, both for you and for your elder. In fact, being in an environment where they are surrounded by peers may ultimately make this difficult process a positive experience for your parent. Considering a few of the above points can make this decision-making process clearer for you both.

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