A while back, 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 utter.
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. I’m sure she now understands that she has to move someplace where she can be taken care of, thought Heimberg. 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?
Having the Conversation
When it comes to moving elderly parents and broaching the “nursing home” or “assisted living” conversation, experts like Stella Henry, R.N., author of The Eldercare Handbook (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 instigating change.
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.
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
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 . “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 the inevitable.”
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 Henry.
Important items to address include financial issues and who will act as the elder’s durable power of attorney for health care (someone who is in charge of making medical decisions for a loved one when he or she is incapacitated). “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.
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.”
“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.”
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 says.
“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.”