When Is It Time for a Nursing Home?

        Caring’s Editor in Chief Elizabeth Galik, PhD, CRNP, helps family members navigate tough decisions about a loved one’s need for nursing home care.
        Guilt. Anxiety. Concerns. Questions. Regrets. These are feelings family members often experience when their loved one moves into a nursing home. Yet there are times when this setting is the best and safest place. Your practitioner can help you make these difficult decisions, answer your questions, and help identify resources useful during the decision-making and transition.
        Some signs that it may not be safe for a loved one to live alone or even with other family members include:
        • Physical aggression against family members or others that has not been responsive to interventions
        • Growing care needs, including the inability of a loved one to bathe, get dressed, or use a bathroom independently
        • Safety concerns, such as putting a pot on the stove and forgetting about it, leaving doors unlocked or letting strangers into the house, hoarding, or experiencing frequent falls or issues with medications
        • Restlessness, agitation, irritability, or confusion that starts or gets worse as the sun goes downand results in safety risks
        • Particularly for some people with Alzheimer’s disease or other dementias, wandering away from home or other locations and getting lost or confused, especially when it becomes common and potentially dangerous
        • Lack of access to resources, such as transportation to the store or doctors’ appointments, which can put your loved one at risk for illness, poor nutrition/dehydration, and accidents.
        • Lack of supervision/assistance of a caregiver when care or treatments are required
        More specifically, consider some of these situations:
        • You visit mom for the holidays, and she is surprised, even though you discussed the visit with her several times. The house is a mess, the refrigerator is empty, and you notice she’s lost weight.
        • Your dad’s neighbor calls to tell you that your father was walking down the street in his bathrobe and didn’t seem to know where he lives.
        • You discover that your mother hasn’t filled her prescriptions for over a month.
        When one of these or a similar situation occurs, don’t panic, but at the same time don’t ignore it. Instead, take the time for an open and honest discussion with your loved one and other family members. Talk about your concerns and listen to theirs. Be prepared to discuss what type of care, services, and supports are needed and your finances, lifestyle issues, and preferences (including desired location and amenities). Then you can discuss all the possible options (including but not limited to nursing homes).
        Here are some tips to make these conversations easier:
        • Be realistic about what this move will mean to your loved one, other family members, and anyone else involved, such as friends and neighbors. Seek input from others, and consider their concerns and feelings.
        • Come to a realistic agreement with siblings, spouses, and others about what financial support and time commitment they are able or willing to make to help your loved one.
        • Focus on your loved one and the need to balance what he or she wants with what is needed.
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        Take the time for an open and honest discussion with your loved one and other family members.
        Photo by Joshua Hoehne on Unsplash
        It is important to consider the practical aspects as well as needs and limitations, including finances and proximity to family. Before making any final decisions, find out exactly how much a nursing home will charge for care and exactly what is involved. Find out how much Medicare, Medicaid, or private insurance will cover and what out-of-pocket expenses your loved one or you will be responsible for.
        The good news is that your physician or other practitioner can help. You don’t have to make any decisions in isolation.

        Questions to Ask Your Practitioner

        • How do I know when/if my loved one can come home from a nursing home?
        • What if I move my loved one into a nursing home and it turns out not to be a good fit?
        • What’s the different between a nursing home and an assisted living facility?

        What You Can Do

        • Visit (virtually if necessary) possible nursing homes. Talk to staff. Prepare questions to ask.
        • Get finances in order before making any decisions.
        • Find out what amenities your loved one wants (such as pet visits, gardens, or walking paths).

        For More Information

        • Carol Bradley Bursack, “Moving Into a Nursing Home: A Checklist,” AgingCare, Jan. 30, 2018;
        • Focus on the Family, “When a Nursing Home Must Be Considered,” from Complete Guide to Caring for Aging Loved Ones (Tyndale House, 2002);
        This column originally appeared online and in print in Caring for the Ages (
        Caring for the Ages is the official newspaper of AMDA – The Society for Post-Acute and Long-Term Care Medicine and provides post-acute and long-term care professionals with timely and relevant news and commentary about clinical developments and about the impact of health care policy on long-term care. Content for Caring for the Ages is provided by writers, reporters, columnists, and Editorial Advisory Board members under the editorial direction of Elsevier and AMDA.
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