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For many seniors, home represents autonomy and belonging. Unfortunately, sometimes declining health and cognition function shut the door on independent living, and talking to your aging parents about moving into assisted living or a nursing home isn’t easy. Thankfully, it is possible to have the conversation while simultaneously empowering your loved one.
“They need to have a voice,” says Dr. June McKoy, a board-certified geriatrician at Northwestern Memorial Hospital in Chicago. “They need to know they have control.” And they need to know that you’re facilitating their move out of love, adds McKoy.
So what do you do when you’re concerned that your aging parent is no longer safe living at home? Below, experts offer their perspectives.
Key takeaways
- It can be an awkward topic, but ultimately, it’s never too early to discuss with older loved ones where they envision living out their golden years.
- There are a number of things you can do in order to have the most productive conversation, including doing research on the front end and taking their feelings and viewpoint into consideration.
- When in doubt during the conversation, always go back to something along the lines of “what do you think?” By doing this, you’re ensuring them that their opinion matters.
When to discuss moving into assisted living or a nursing home
According to a 2021 AARP survey, 77% of adults over the age of 50 hope to age in place. So if you suspect a move to assisted living or a nursing home may be on the horizon for your aging parents, you may want to start having that conversation sooner, rather than later.
In fact, McKoy recommends that people discuss assisted living or nursing home care options long before a move is deemed necessary. While not every senior needs to move into assisted living or a nursing home, finding out your aging loved ones’ wishes ASAP — or simply well before the day comes that a move is necessary — prepares the whole family in case independent living ever becomes unsafe.
How to talk to parents about assisted living
Telling your aging parent that you think it’s time to move into assisted living or nursing home care can unleash a host of emotions: sadness, guilt and even fear of being brushed off. “You have to remember that your mom and dad are adults,” says McKoy. “They’re older, they’re a little bit more frail, but you’re not the parent. Approach it with great respect and love.”
She and Weinstein walk you through how to prepare for the conversation, as well as some statements and questions to jumpstart the conversation:
Do your research
McKoy suggests preemptively taking stock of the senior communities and senior care centers in your area: What are the living arrangements? The levels of care available? The costs? Narrowing down local communities to what’s realistic helps prepare you to present practical options.
“You have to remember that your mom and dad are adults. They’re older, they’re a little bit more frail, but you’re not the parent. Approach it with great respect and love.”
— Dr. June McKoy, board-certified geriatrician
Take your loved one’s individual situation into consideration
It’s important to assess for any signs your loved one may need additional assistance, says Dana Parsons, vice president and legislative counsel for LeadingAge Virginia, a non-profit aging services organization. This could include “frequent falls, medication mishaps, memory lapses, withdrawal from social activities or challenges with daily tasks like bathing or cooking,” she says. Having these examples at the forefront “can help frame the conversation around safety, health and quality of life,” she adds.
However, “If both parents are living together and one is able to assist the other, then minimal help could be needed,” adds Edie Weinstein, a Pennsylvania-based licensed social worker who works with seniors in nursing homes.
You’ll also want to think about any kind of financial prep that your older loved one has done that could help foot the bill for assisted living. “Some people have long-term care insurance that could pay for live-in caregivers,” notes Weinstein.
Aim to be respectful and empathetic
McKoy stresses that your aging parents are adults with thoughts and opinions that should be heard and considered. Also, consider these pointers:
- Try not to be reactive, as McKoy has found this behavior in particular can frighten older adults.
- Words matter. “Always go back to ‘What do you think?’” says McKoy.
- Avoid the word “facility.” For her patients, this conjures images of room-bound seniors who could not receive visitors during the pandemic.
Start the conversation
If you’re unsure of how to even begin these conversations, McKoy and Weinstein share some prompts to get you going.
- “How do you feel about your current living situation? Are you able to keep up with all your needs?” Sometimes family members notice a downturn in self-care before the senior has acknowledged it internally, says Weinstein. This opener invites the parent to reflect on potential concerns.
- “Have you seen any commercials about assisted living? I’d like to hear your opinion on that.” Broaching the topic with curiosity can set the tone for an open, respectful conversation.
- “We know you’re attached to the house, but what would you do if something happened and it became too difficult to care for?” This approach invites responsible, practical parents to consider the possibility of moving.
- “I’ve heard that some of the senior communities in this area are reasonably priced. Can we look at some places online together?” It’s common for seniors to worry about the financial cost of assisted living, says McKoy. This opener acknowledges the concern while assuring a parent that you’re on their team.
- “I’ve noticed that it’s tough for you to get around. I’m afraid I might not always be nearby to help. Maybe we should consider a community with more support. What do you think?” This opens the door to tell a parent why you are concerned for their safety.
Notice that these conversation-starters all invite feedback from the loved one. Regardless of how the conversation unfolds, let them know their voice is heard, says McKoy.
Things to avoid when you talk to your parents about assisted living
It can be hard to know how to talk to parents about assisted living; it can be awkward at best and heated at worst. But it is possible for everyone to come out on the other side of the conversation relatively unscathed. Here is some advice from the experts on what to avoid to ensure peaceful discussions.
Rushing the process
Barring urgent medical needs, your family does not need to decide between staying home, assisted living or nursing home care in a single conversation. That’s why McKoy urges adult children to talk about parent living arrangements as soon as possible.
Once the decision is made, transitioning to assisted living can happen in days, she says. Whenever possible, she prefers a prolonged approach — one in which you can truthfully say, “We’re just talking. We’ll look at this now so you can think about it in the next few weeks.”
Neglecting their desires
“Ask them about the amenities that are important to them, including meals, recreational activities, nursing care,” recommends Weinstein.
Tina J., who lives in Indiana with her husband, also emphasizes how important it was to prepare a “homey” environment for her mother-in-law. Show curiosity about what makes your loved one feel comfortable. This can turn worries into anticipation and excitement over decorating or sharing holiday meals.
“Always go back to ‘What do you think? How do you feel? Is this something you would consider?'”
— Dr. June McKoy
Excluding them from the search
As much as possible, include your loved one in the housing selection process.
Suggest scheduling a lunch or outing together, followed by sitting down at the computer to look at pictures or take virtual tours of local assisted living communities, suggests McKoy. Infuse the day with quality time instead of focusing solely on the conversation about moving.
Weinstein suggests physically visiting facilities together when possible. “Go on tours and interview the intake coordinator or social worker. Walk around and get a sense of how staff interact with the residents,” she says.
Ignoring the alternatives
If a parent pushes back on your suggestion, listen to their concerns. Not every aging adult needs assisted living or nursing home care.
“A step prior to assisted living is home care,” explains Weinstein. “Continuing care retirement communities may also fit the bill since initially, people can live independently and then move to a higher level of care if the situation warrants it.”
What to do if safety has become an issue
As important as it is to respect your loved one’s wishes, sometimes independent living is no longer safe — and safety is the most important consideration, says McKoy
You are right to be concerned if a parent has repeatedly left the stove on, flooded the bathroom or forgotten daily living activities like eating and personal hygiene, she notes. But forgetfulness does not always equal dementia, and memory loss isn’t always a sign it’s time for your parent to move into assisted living or a nursing home.
Consult a medical professional.
If an aging loved one refuses to listen to your concerns, seek help from their primary care provider who can determine their level of functionality, says Weinstein.
Talk it over, even once a decision has been made.
According to McKoy, even in severe cognitive decline, it’s vital to talk through the decision. “You don’t know how much they understand,” she says. “Say, ‘Dad, you seem to need help. I’m going to take you to see this community where people can help you.’”
That’s what Tina had to do when her mother-in-law fell and ended up in the hospital. “The conversation we had with her then was that she had to go into assisted living because she had trouble walking,” says Tina. “She’d say ‘I want to go home,’ and we always kind of blamed the doctors: ‘The doctors say you can’t go home until you can walk.’”
The next steps after you talk about assisted living
Starting a conversation with a parent or loved one about moving to assisted living is never easy. “It’s an emotional topic that touches on independence, identity and long-standing routines,” says Parsons. “But when health, safety or quality of life becomes a concern, having this conversation isn’t just important — it’s an act of care and compassion.”
So even if the discussion was emotional, or it ended without any concrete decisions or plans, try not to be discouraged. “With empathy, preparation and a thoughtful approach, you can help guide your loved one toward a supportive environment that truly meets their needs,” says Parsons.
And, if you’re unsure of where to go next, McKoy advises coming back to the basics of conversation with your loved ones: “Always go back to ‘What do you think? How do you feel? Is this something you would consider?’” If they’re open to it, you might start small with researching options online or touring a community in person together.
The most important thing is to include your senior loved one in the process, says Melissa Andrews, president and chief executive officer of LeadingAge Virginia. “Empowering them to participate in the decision helps ease the transition and fosters acceptance,” she concludes.
With additional reporting by Elise Ramsbottom.
