How to Place a Parent Into a Nursing Home: Step-By-Step

Author: Amanda Lambert, MS, CMC, ALCP

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. 

Families tend to take care of a loved one long beyond the time a nursing home may have been the best option. This 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 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.  

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 Siblings or Other Loved Ones About Moving a Parent to a Nursing Home

The idea of moving a parent into a nursing home may be met with resistance, anger, and outrage by your siblings and other loved ones. Often the family members least involved in care tend to object to the idea of a nursing home. They haven’t seen the day-to-day decline and may not have an understanding of the constraints of care in assisted living or at home. Here are some steps to take to get your siblings and other loved ones on board.

Listen first

A sibling or other loved one has legitimate feelings, and it is appropriate to let them express those. Listen to their concerns and acknowledge them. Show that you understand and have had the same misgivings and doubts, but remain firm in your decision.

Describe your parent’s condition in detail

One of the reasons it is so hard for a sibling to accept that a parent is ready for a nursing home is that they may not understand or see why. Explain your parent’s condition in detail, in particular their difficulties with daily living activities and any specific medical needs that you and they can no longer manage. 

Explain your rationale

If your parent is at home, you may be the primary caregiver and can no longer manage their needs. Be honest about the toll that caregiving takes on you and the rest of your family. If care costs escalate to the point where they are no longer sustainable, talk about that issue.

Bring your siblings or other loved ones into the discussion in a way that invites them to be active participants. You may find that a sibling may resist the idea of nursing home placement but is unwilling to give more of their time to caregiving. 

Be flexible

Discuss the fact that nursing home placement could be a temporary solution. With enough care in a nursing home, perhaps your parent can recover to the point where assisted living placement is an option. Or that nursing home placement gives you all time to come up with a plan for your parent to return home. Invite siblings and other loved ones to propose any alternative ideas for care.

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 examined 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.

How to Deal With Guilt or Negative Emotions After Moving a Parent to a Nursing Home

In all the upheaval of moving your parent into a nursing home, you may not have had time to process your feelings. After the move, you may be surprised by a flood of guilt or negative emotions. You might even second guess yourself or feel like you made the wrong decision. Your siblings or other loved ones may continue to criticize your decision. These emotions are not unusual. With that said, there are some ways to deal with them. 

Acknowledge your feelings

The more you fight against your negative feelings, the more difficult it will be to manage them. Feeling guilt means you are human and compassionate. Moving a parent into a nursing home is a loss. Your parent is now dependent and in decline, and the grief you feel about this process is normal. 

Express your feelings

Talk to other people about what you are going through. Keeping negative emotions locked away is not healthy. Reach out to friends, family, clergy or even some caregiving support groups. If you start to suffer from unrelenting feelings of depression and anxiety, don’t hesitate to seek out counseling. Some people find solace in keeping a journal where they can express emotions without judgment. 

Revisit your reasons

You will inevitably second guess your decision. Try writing down all the reasons you made the decision, to begin with, and refer back to those. You had solid, legitimate concerns about safety and your parents well-being. There were consequences to keeping your parent in their current environment, and reminding yourself of those can help.

Focus on your needs

Guilt and negative emotions can be damaging to your mental and physical health. Focusing on your needs and self-care can make a positive difference. Remember and emphasize the activities that bring you joy. Make sure you eat well, get enough sleep, and exercise. Even taking a walk can provide significant relief from negative emotions. 

Accept that you made the best decision

There is rarely the perfect or “right” decision. There is only the best decision at the time. You are not responsible for the conditions that led to placing your parent in a nursing home. Accept that you don’t have control over your parent’s aging process. You can only make the best decision at the time based on the current situation. 

How to Ensure a Smooth Transition and Support Parents Moving to a Nursing Home

The transition to nursing home placement can be rocky. If you plan ahead as best as you can and prepare to make the move as smooth as possible, you will have the best chance of a positive transition. It is worth noting that despite all of your efforts, the process may still be challenging. Do everything you can to ensure a smooth transition and provide all the support you can. 

Include your parents in decisions

To the extent that you can, include your parents in decisions. Although the decision to move is made, pay attention to important items they might want to bring with them. Most nursing homes have very limited space for personal items, so reassure your parent that you will store or take care of what they can’t bring. Make their room as comfortable and home-like as possible. 

Listen to your parent’s concerns

Prepare for the fact that your parent may be angry and ask to go home. Try to listen and keep calm. If they express concerns about care at the nursing home, take those seriously. It might seem as though your parent is complaining all the time, but realize that this is a significant transition, and it will take time to adjust. 

Visit often

As hard as it might be, visit as often as you can, even if your parents are angry at you. By visiting, you show you care, and besides, you can advocate on their behalf if you are there to see first-hand what kind of care they are receiving. 

Also, encourage your siblings and any other family members to visit when they can. Bring small gifts like fresh flowers or their favorite baked goods. 

Advocate

If you see something that you don’t like or have questions about the care your parent receives, go to the appropriate manager to voice your concern. Nursing homes require quarterly care plan meetings and, if possible, attend in person or ask to reschedule if you can’t make it. Families involved in their loved one’s care can make a big difference in the quality of that care. 

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. 

About the Author: Amanda Lambert is a Certified Care Manager and Aging Life Care Professional with over 20 years of experience in mental health, home health, guardianship, and care management. She is the co-author of Choose Your Place: Rethinking Home as You Age and Aging with Care: Your Guide to Hiring and Managing Caregivers at Home. Amanda specializes in long-term care planning and care management, helping families navigate the senior care landscape. Learn more about her work at Mindful Aging.