When To Put Elderly Parent In A Nursing Home

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Making the decision to put your elderly parent into a nursing home is not going to be an easy one.

And of course, there are many factors to consider such as cost, your parent’s wishes, and the impact on your parent(s) and your family to just name a few.

So, when do you know it’s time to put an elderly parent in a nursing home? The most common reason aging parents are admitted into a nursing home is because of severe cognitive and/or physical decline that requires them to need 24-hour care. A nursing home admission makes sense when private in-home care is unaffordable or if friends or family members are unable to care for them.

But that doesn’t mean that it will be an easy transition.

If your elderly parent is cognitively aware then moving to a nursing home can be a very difficult decision and an emotional event for family caregivers. After all, nursing homes do generally have a bad reputation.

Most people have never been to one so they have conjured up many horrible scenarios in their heads of what to expect.

I can tell you that as an OT (Occupational Therapist), I worked in over 20 different nursing homes in Florida, Georgia, and North Carolina and there definitely are good ones and bad ones out there.

So, don’t judge any facility based on what you may have seen at another place or perhaps have heard about from a close friend or relative.

I would urge you and your parent(s) if they are willing – to prepare beforehand for what may come as they age.

Later on in this article, we’ll talk about how to choose a nursing home that should alleviate some fears that you and/or your senior parent may have.

Why Do The Elderly Go To Nursing Homes?

Older adults often are admitted into nursing homes for a variety of reasons which I list below. But what I want to stress is that this type of placement is often the last resort for the senior and/or their adult children.

There are multiple care options that can be considered such as in-home care in their own home, an assisted living facility, villages, residential care homes, or moving in with a friend or family member.

One of the first things to consider when looking into care options for aging parents is their wishes on how they want to live out the rest of their lives. Families need to also consider if they can provide for an elderly relative’s emotional, mental and physical well-being.

Beaconjournal.com

What I want to stress to you is that there are options available.  For anyone growing older – I want to stress the importance of pre-planning and looking into these options to make a decision (as best as you can) before you HAVE to make this important decision.

For families – I also want to urge you to speak to everyone in the family (including your parents if they are cognitively aware) to make the decision (as a family) as to what options are viable for the older adults in the family unit.

Reasons For Putting Elderly Parents In A Nursing Home

Here is a table highlighting the reasons elderly persons go to nursing homes:

Please note that these are general reasons and the specific needs of an individual may vary.

When I was an Occupational Therapist working in nursing homes I saw that there were a large variety of reasons why people ended up coming to a nursing home.

Some of these reasons were very pragmatic, others were due to family dynamics and some were just due to the circumstances the person coming in found themselves in.

Some of the common reasons that elderly persons end up being put in a nursing home are:

1) The senior is alone, with no family or friends that are able to care for him or her.

This is a very common scenario and one that I’ve seen many times when I worked in nursing homes.  I suppose if you live long enough, you end up outliving everyone!

2) The person’s physical and/or cognitive disabilities are too difficult for a family or friend to manage.

Many families do their very best to care for their aging parents. Some purchase new homes or add to their existing homes so that their parent(s) can move in with them. They hire care providers and of course, do some of the work themselves.

But people may not have realistic expectations of the work involved in caring for an older person. As Jessica Horak and her husband soon found out, it’s not always as easy as they hoped it would be.

But their seemingly easy decision became complicated very quickly. While the caretakers looked after Horak’s father until she and her husband returned home from work at 5:30 p.m., they were responsible for him in the evenings….“We were up every couple of hours with him,” Horak said. “It got to the point where we were pretty much 100 percent sleep deprived, and it was lasting longer than the newborn phase.”

Chicagotribune.com

3) They do not have the funds to pay for a private caretaker to come to their current home part-time or full-time.

Caregivers can provide so much personal care for your elderly loved one.  A general list of their daily tasks can include:

• administer medication
• drive the older adult they are caring for to appointments, events, etc.
• pay bills and track finances
• provide company and companionship
• prepare food
• housekeeping and maintenance
• perform or assist with activities of daily living, such as dressing, eating, and taking care of hygienic responsibilities (showering, toileting, etc.)
• assessing overall health

But the cost of hiring a caretaker can be prohibitive for some families.  It can range anywhere from $21.00 per hour to $80.00 per day. 

Prices depend on your geographic location, the type of skilled (or unskilled) person you are hiring, the duties asked of them, and how many hours you will be hiring them for.

You can read more about the duties of a caregiver – click here.

4) They require 24-hour care due to their cognitive and/or physical disabilities.

Sometimes, the list of cognitive and/or physical complications are simply too long to be managed in a home environment.

Certain health conditions may require a higher level of care than what a family member can provide.

Cognitive decline and dementia or Alzheimer’s disease eventually may mean there are new safety concerns if the aging person stays in their current living situation.

Depending on the senior’s health conditions, skilled nurses may be needed to provide around-the-clock care. 

For these reasons, moving into a nursing home environment is often the best choice.

5) Family dynamics are too dysfunctional to provide care for the older adult.

Many times I saw seniors admitted to nursing homes not because they didn’t have family, but because the family members were at war with each other and they were simply unable to work together to care for the aging individual. 

Honestly, this was a common problem and was some of the saddest cases that I saw.

6) It’s a temporary placement into a SNF (Skilled Nursing Facility) for rehabilitation.

This basically means it’s a nursing home setting with a rehabilitation unit in it.

Many seniors recovering from a physical injury (i.e. hip fracture, etc.) or an accident go into SNF’s for a few weeks or less simply for the rehabilitation process before they return home. 

The intention is to get the patient’s strength and health back to where they can return home and care for themselves again.

If your parent is going to a rehabilitation center in a nursing home setting, I would recommend that you check out the facility first before they are admitted. 

Even though it’s a temporary situation, the reality is that the impression they get from that nursing home will stay with them. 

And if, for whatever reason, they eventually have to be placed into a nursing home in years to come – the sting won’t be so difficult if they had a good experience the first time around.

Some parents will find it difficult no matter what.  My mother (who was a very headstrong type of person) was admitted to a rehab clinic in a SNF (skilled nursing facility) where she probably would have spent less than a week but she was convinced that she was being placed there permanently. 

She spent the entire first night screaming and moaning and in the morning, the rehab physician sent her back to the hospital where she sat quietly in her bed and refused to eat or talk to anyone for the next 4 days.

Obviously, my sister and I knew that if the time came that my mother needed 24-hour care – a nursing home placement would simply not work unless she was suffering from severe dementia (which was not her case at all).

By the way – my sister and I checked that nursing home before she went in and I can honestly tell you that it was one of the cleanest and nicest ones I have ever been in (and as an OT – I have been in many!).

So yes – I understand completely if your elderly parent refuses to even set foot in a nursing home environment – even if it’s just temporary.

Can An Elderly Person Be Forced Into A Nursing Home?

Not every (or many) seniors will willingly be admitted into a nursing home without some convincing that it’s the best solution for them.

Many families struggle with this.  But when all the signs point to the nursing home as the only option, there may be no other viable choice for the family to make. 

Yet, the senior individual who is being placed may still not agree with the move so then what?

Can you force your senior loved one into a nursing home?

Legally, yes – you can.  The only way to do that is to obtain guardianship of that person. 

The guardianship of an elderly parent is a legal relationship created by the court. It gives an individual the right to care for a person who is unable to care for themselves.

The guardian is responsible for the welfare and safety of the senior.

But be aware that this is not easy nor is it inexpensive.  You will need the help of an elder law attorney and it may take some time to complete.

You may be wondering if a Power Of Attorney is sufficient to force an older adult into a nursing home.

The simple answer is it depends – a medical power of attorney must be written specifically to allow you to make that type of decision for your senior loved one.  

Again, go over your documentation with an elder law attorney.

You can read more about guardianship and power of attorney in our article What Is Guardianship Of An Elderly Parent?

Can A Doctor Put Someone In A Nursing Home?

The only legal way a physician can force someone to be admitted to a nursing home is if that person has been deemed legally incapacitated which is the legal term used by most states to describe someone who is mentally incapacitated or incompetent.

By definition, to be incapacitated means to lack the mental or physical capacity to sufficiently care for person and property whether temporarily, intermittently or permanently.

Legalbeagle.com

I would highly recommend that all families who have aging parents to spend some time and go over the legal checklist that we wrote about BEFORE any cognitive or physical decline occurs.  It may not ever happen, but IF it does, as a family unit you will be prepared.

How To Choose A Nursing Home?

About 1% of seniors aged 65 to 74 move into nursing homes and about 15% aged 85 years and older are moved into nursing homes. 

So, compared to the larger overall population of older adults in the United States, this is a small number but still – nursing homes can have a waiting list, especially if they are good ones.

If you (and hopefully your elderly parent was able to be involved) have decided that a nursing home placement is the best option then the next question is how do you choose one?

Here’s our list of steps that you can take to make the best possible decision.

1. Ask everyone you know if they have had any experiences with any local nursing homes.  And I mean everyone you know!  Friends, neighbors, co-workers, acquaintances, etc.  It’s not a topic that most people talk about so you may not be aware of someone’s experience with a particular facility.
2. Speak to a geriatric care manager.  These are “usually a licensed nurse or social worker who specializes in geriatrics…who can help you and your family to identify needs and find ways to meet your needs.”  nia.nih.gov
3. Make a physical list of the nursing homes in the area that you are considering.  APlaceformom.com has a wonderful list to help you with this project.  You can filter it to meet your budget and your needs.
4. Once you have narrowed down your list to a handful of facilities – begin the process of visiting them.  Meet with the director of the nursing home as well as the nursing director.  The kinds of things that you want to look out for are…
   • Is it Medicare / Medicaid certified?
   • Is there a room/bed available? (important if you need admission immediately)
   • Are there specialized services such as locked wards for seniors with dementia / Alzheimer’s?
   • Is the facility well-staffed?
   • Are there enough extracurricular activities for seniors to participate in?
   • Is it free from unpleasant odors?
   • Medicare.gov has a full checklist of questions that you can bring with you to your meeting
5. After your initial visit – make a second and possibly third visit but this time, without meeting anyone.  Simply go to the nursing home at varying times of the day so that you can see how the facility is run.  I recommend visiting early in the morning when the staff is busy providing assistance with meals and showering and dressing (this is often the time of day when you can see if the facility is staffed appropriately).  I would also recommend visiting during mealtime so that you can see how meals are prepared and presented and if the facility’s dining area is kept clean and well-maintained.
6. If possible, speaking to other family members who have loved ones in the facility is helpful to get a full picture of what you can expect.  No facility is going to be “perfect” – there will always be issues but the goal is to have as few issues as possible and hopefully very minimal ones.

Dealing With Guilt Over Putting A Parent In A Nursing Home

It’s inevitable that you will feel some guilty over putting a parent into a nursing home or care facility, even if you know it is the best thing for them. There are many reasons for this, including:

• Feeling like you broke an unspoken promise (or an actual promise) that you wouldn’t do so.
• Judging yourself (or having other judge you) because you “should have” taken care of them until the end.
• Worrying that your parent is unhappy in the nursing home or care facility.
• Guilt over being able to relax now that you are not responsible for  taking care of them.

Grief is also not uncommon after moving a parent to a care facility. You mourn the loss of what was and have to accept the changes that have occurred in your life and your parent’s life.

To help you through the emotions of moving your parent to a nursing home:

• Know that it is common to feel grief and guilt.
• Reach out to other loved ones, your spiritual leader, or to friends for support.
• Try keeping a journal of the stressful events that led up to this change. How did you feel? Worried? Scared? Acknowledge these emotions and write something positive daily – about either yourself or how your parent is doing now.
• Consider joining a support group for caregivers.

A book that might help is Living Well in a Nursing Home: Everything You and Your Folks Need to Know by Lynn Dickson, Xenia Vosen, and Serverine Biederman.

Frequently Asked Questions

Conclusion

I want you to know that these days, there are many options for senior housing, depending on the type of care they need.

Seniors can choose to live in active senior communities, all in one type of facilities where you can move from independent living to assisted living and on to memory care (if needed), co-op communities, villages and many more.

The reason most seniors and their families choose one over the other usually boils down to cost, the older adult’s mental / physical condition and proximity to family.

Here’s a table that will give you an idea of the differences between your options…

These prices will vary depending on where you live.  So I urge you to seek out the costs in your specific location.

Again, the decision to choose a nursing home placement is dictated by the amount of care that your elderly parent needs AND the amount of caregiving that you and/or your family are able to provide.

This is one of the hardest decisions to make where older people are concerned. Expect some feelings of guilt to creep in. But know that, if it’s the right time to move your parent and you’re doing it in their best interest, then it’s absolutely the right thing to do.

So, take your time to make your decision, and hopefully, your aging parent will be able to work with you during this process.

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