For many seniors, there is no place like home, a familiar place that simultaneously represents autonomy and belonging. Perhaps that’s why 77% of adults over 50 hope to age in place, according to a recent AARP survey. Unfortunately, sometimes declining health and cognition function shut the door on independent living.
But 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 as much as possible.
“They need to have a voice,” says Dr. June McKoy, a board-certified geriatrician at Northwestern Memorial Hospital in Chicago, Illinois. “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, McKoy and Edie Weinstein, a Pennsylvania-based licensed social worker who works with seniors in nursing homes, offer their perspectives.
When to discuss moving into assisted living or a nursing home
It’s never too soon to ask your loved ones where they envision spending their golden years.
McKoy recommends that people “think ahead.” She says assisted living or nursing home care options are best brought up long before a move is deemed necessary. That said, not every senior needs to move into assisted living or a nursing home, she notes.
Think of it this way: 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 prepare for a discussion about long-term care
If you think it’s time to tell your aging parent that it’s time to move to assisted living, get ready to take notes.
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.
Take your loved one’s individual situation into consideration.
“If both parents are living together and one is able to assist the other, then minimal help could be needed,” says Weinstein.
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 parent is an adult 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.
“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, A BOARD-CERTIFIED GERIATRICIAN
How to begin the conversation about moving to 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 offer a few statements and questions to jumpstart the conversation:
“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.
Tips for a successful conversation
Remember that this is a new discussion.
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.”
Ask them what makes a place feel like home.
“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.
Suggest researching options together.
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 interacts with the residents,” she says.
Be open to 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.
“Always go back to ‘What do you think? How do you feel? Is this something you would consider?'”
— DR. JUNE MCKOY
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 main takeaway on telling your parent it’s time for a move
Whether your aging parent has experienced a sudden change in cognition or a gradual loss of physical strength, Weinstein says this is a difficult conversation for everyone. The key is respectful, empathetic communication.
As McKoy advises, “Always go back to ‘What do you think? How do you feel? Is this something you would consider?'”
