In 2001, Gail Heimberg says she had to make one of the most
difficult decisions of her life. Her 88-year-old mother--a sharp,
independent woman who had lived alone in Brooklyn, New York, for
most of the latter part of her life--was quickly growing frail.
While she used to walk from her home to the neighborhood bakery
with ease, navigating the stairs of her circa-1920 apartment
building had become a daily battle. "She couldn't walk very well,"
remembers Heimberg. "And her emphysema had worsened."
Heimberg knew the discussion she needed to have with her mother,
yet like many adult children who were thinking of moving elderly
parents, the three words " assisted
living facility" seemed foreign, cold and impossible to
Time is of the Essence - Having That Tough Conversation
A few months passed, and Heimberg got a disturbing call. Her
mother had suffered a mild heart attack and had been taken to the
hospital. Heimberg used the opportunity to share her concerns with
her mother. But when the subject came to moving her mother away
from her home, she was met with sharp resistance. "No," said her
mother firmly. "I'm not moving."
Those can be the most difficult words a concerned child may hear
their elderly parent say. So how does a worried family member
convince a recalcitrant parent that moving to a long-term care
facility is in their best interest?
Tips From The Experts
When it comes to moving
and broaching the "nursing home
" or "assisted living"
conversation, experts like Stella Henry, R.N., author of The
(HarperCollins, 2006) say "this is probably
one of the hardest decisions a child will ever have to make."
Henry, an eldercare specialist who has been featured in Time, The
New York Times and The Wall Street Journal, says many seniors
"unrealistically believe they can take care of themselves for the
rest of their lives." And that's where their children or other
family members can be instrumental in identifying the problem and
No matter what the age of your parent, Henry and other experts
say now is the time to begin communicating about the future. If you
open the lines of communication early on, she says, words like
"nursing home" lose their sting later on. That's important,
considering that most of Henry's clients approach her with little
communication groundwork laid.
"Ninety-five percent of my clients come to me in crisis
situations," says Henry. The result? Confused elders, disorganized
yet well-meaning children, and a family in chaos.
The Importance of Regular Conversations
Avoid these unnecessary results by having regular conversations
with your parent about what the future holds. "Make it your problem
instead of your parent's problem," adds Henry. "If you say 'you
have to do this, or do that, 'you'll lose them. Instead say
something like, 'Mom, I'm concerned about you; it makes me worried
to see you like this.'"
That's the approach Heimberg ended up taking with her mother.
After sharing her serious concerns about her mother's health and
safety, the elderly woman slowly came around. "She finally said
yes," says Heimberg.
Nine out of ten parents, says Henry, don't want to burden their
children, and they will often respond to this sort of honest
communication. "Parents sometimes hide things from their adult
children because they don't want to scare them," she says. Yet, if
you show them that you are trying to be their advocate, adds Henry,
and that you are genuinely concerned about their wellbeing, it can
make all the difference.
The Resistant Parent - What to Do
Barry Jacobs, PsyD, a psychologist who has counseled many people
in the situation of moving elderly parents, knows how difficult it
can be when a parent in need of aging parent care refuses to leave
his or her home. While he's quick to say there are no magic
strategies or tricks for persuading an elder to move, he suggests
that adult children ask their parent to "indulge" them by visiting
an assisted living facility.
"Most of us are more likely to change our position and lifestyle
if such a transformation is of our own choosing," writes Jacobs in
his book, The Emotional Survival Guide for
Caregivers (Guilford Press, 2006). "Placed under duress
to change, we typically resist, regardless of the soundness of the
other person's arguments."
And when a parent continually refuses to entertain the idea of
moving? "The child needs to back off for the time being," advises
Jacobs. But don't give up, he adds, "seek other openings to raise
the issue again."
"What I tell adult children is that, unfortunately, sometimes
things have to get worse to get better," he says. "It may take
the parent falling or being spooked by burglars or having the
electricity turned off because he forgot to pay the bills for the
realization to dawn that the parent can no longer safely reside in
the home. Even then, it may take the strong urgings of health
care providers and extended family members for the parent to accept
If the parent begins to show signs of warming up to the topic,
"the child needs to emphasize the parent's right of
self-determination but also urge action," adds Jacobs. He suggests
structuring the conversation in the following way: "Tell your
parent: 'I can't make decisions about how you should run your
life. It would make me feel better, though, if we could go
together to look at some possible assisted living facilities so
that you're better informed about what choices are
available. Would you be willing to humor me in that way?'"
If there is a willingness on the parent's part to visit a senior
housing facility, says Jacobs, "the child should proceed
post-haste to set up visits at local facilities and point out that
most of these facilities will allow an aged individual to try
living in them for a week or a month before the person has to
decide whether to sell his house and stay in the facility or return
home." Experts say that can be the extra bit of comfort that can
make the difference for many hesitant seniors.
Forming a Caregiving Team
"Caregiving is a family affair," says Henry. That's even more
reason to gather your brothers, sisters, children and uncles and
aunts together to address an ailing loved ones needs. "Have a
meeting and discuss the problem, without the parent present," says
Power of Attorney
Important items to address include financial issues and who will
act as the elder's durable
power of attorney for health care. "One of the most
important things is to decide who will make the critical
decisions," says Henry. Though she recommends a family
approach to aging parent care, she recommends that one capable
person be appointed as the elder's primary advocate. This person,
whether a son or daughter or adult grandchild, should be in charge
of financial decisions and act as the elder's durable power of
attorney for health care.
Making Sure All Siblings Are On Same Page
When it comes to approaching a parent about making a move,
Jacobs says it's vital that all siblings and family members are on
the same page. "It's crucial that all the adult siblings are giving
their parent the same general message," he says. "It often
only takes one disgruntled child who urges the parent to stay in
his home to make placement nearly impossible."
Avoid Extraneous "Luggage"
"When families get together, there can sometimes be personal
"luggage" brought to the table," Henry cautions. She says it's best
to avoid unnecessary confrontation or sensitive family subjects,
for the good of the parent. "These can be emotionally charged
issues," she says. "But remember, it's not about your issue, it's
about what's best for your parent."
Get more tips on having the "tough conversation" with mom and
dad from A Place for Mom CEO, Sean Kell.
Dealing with the Guilt
No matter how smoothly the process goes, children often retain
guilt about moving elderly parents to a long-term
care facility. Jacobs cautions against that. "What I point out
to adult children is that, regardless of whether they promised to
never put a parent in a nursing home, the decision about placement
must be based on what's best for the parent at a given time," he
"Often, putting a parent in a nursing home is the most loving
act that a child can do because it improves the quality of the
parent's life from medical and social perspectives," Jacobs
continues. "Nursing homes vary in quality but are not snake
pits. Parents often thrive in them, to their great surprise."
While Heimberg admits she had moments when she questioned her
decision, she eventually felt peace about her mother's move,
knowing it was the right decision. After two and a half years in
the facility, her mother passed away at the age of 91. She credits
the residence for making her mother's final years the best they
could be. "I felt like it extended her life," she remembers. "She
was cared for and watched over. Finding the right facility is so
important, and we were lucky."