Deciding when it’s time to move a loved one into a nursing home is one of the most challenging situations a family can face. It’s a decision filled with complex emotions as you navigate your growing concerns while trying to balance your loved one’s independence and safety. Whether due to aging, health complications or a combination of both, there comes a time when at-home care or assisted living is no longer sufficient to meet the needs of your loved one.
Dr. Gerda Maissel a board-certified physician in physical medicine, rehabilitation and patient advocacy in Pleasant Valley, New York and president of My MD Advisor says the question about nursing home placement comes up regularly among her clients. She notes that typically it’s the adult children who begin to worry for their parent’s safety. “Frequent falls, a kitchen fire from a forgotten pot on the stove or a marked change in personal or household cleanliness can all be signs of concern that should be discussed with a physician,” says Maissel.
Here experts point to signs that it may be time to consider a nursing home, as well as what factors to consider to ensure your loved one receives the best possible care.
Is it time for a nursing home? Questions to consider
If concerned, experts recommend observing your loved one and asking yourself the following questions:
Are they falling often?
Yelena Sokolsky, a registered nurse and director of patient services at Galaxy Home Care in New York, says, “Falls are among the most common and costly causes of injury for seniors and could indicate the need for more support.”
Are they showing signs of memory loss?
If an older adult is forgetting to turn off the stove or lock the door it may mean home is no longer a safe place without someone present to reduce risks.
Are they neglecting important documents or bills?
If your loved one was previously very conscientious about sorting their mail or paying their bills, seeing unopened mail or unpaid bills could signal cognitive, physical or emotional impairment that needs attention.
Are they isolating?
If you notice distancing from family, friends or community, this could indicate a risk of social isolation. Sokolsky states this is another leading health concern for seniors but that it can be addressed with professional help.
Are they neglecting self-care?
“If they appear to have lost or gained weight, if they seem to be wearing the same clothes day after day, or if they look more tired or stressed than usual, they may be struggling with depression, chronic pain or loss of mobility, all of which require treatment,” says Sokolsky.
Are they showing a pattern of incontinence?
Maissel says one issue that often tips the balance in the decision on whether or not someone should be placed in a nursing home is incontinence. “Many times, the family can manage someone in the home until bowel (and bladder) incontinence becomes overwhelming.”
Are they recovering well enough to go home?
If your loved one is too frail after a hospitalization, they may not be able to return to their previous home at their current level of function. “In that case, the physician will recommend a rehab stay in a subacute section of a nursing home,” says Maissel.
Will they require short-term or long-term care?
If your loved one shows promise that they could return to activities of daily life without supervision after a medical procedure, they may require a short-term stay in a nursing home. However, if the loved one experiences memory loss or has total care needs, they will need a long-term care option.
How to assess if a nursing home meets your loved one’s needs
If it comes down to choosing a nursing home or another care option, the experts recommend keeping your loved one’s preferences in mind.
When her mother suffered memory loss and a decline in her executive functioning, Dr. Sabrine Simeon — a surgeon in Miami, Florida, and her mother’s health proxy — thought first of what her mother would want. She knew her mother would not choose to stay in a nursing home, but when her mother’s needs increased, she had to consider other care options.
Simeon worked with her siblings to come up with an arbitrary marker: “Only when she does not recognize us, can we consider putting her in a memory care or nursing home.” They agreed and began searching for options.
Simeon says selecting a nursing home is a difficult decision that requires weighing many factors, including the following:
- Is it secure, supervised and safe?
- Will medical needs be met?
- Is the place properly staffed?
- Can I afford it?
- Is it close to home?
- Are the staff culturally and linguistically competent enough to match my needs?
Since her mother is not a native English speaker, cultural competency was a big factor for Simeon. “I didn’t want her to feel isolated,” she says.
What to look for in a facility
“If someone is looking for a long-term nursing home, I recommend they go in at different hours, listen for noise, talk to families and residents and look for appropriate programs and staffing,” says Maissel.
Simeon recommends reading the reviews of the facility and evaluating staff credentials, as well as taking note of the cleanliness and patient-to-staff ratio.
The National Institute on Aging also recommends visiting the nursing home to speak with staff.
Costs and financial assistance
If a loved one doesn’t have long-term care insurance, care can get too expensive for families. However, seniors may be eligible for Medicaid or Medicare, which has its own eligibility guidelines that differ from state to state. Medicaid will cover the total cost of a nursing home if determined total care is needed.
Simeon says memory care centers are not always covered by insurance, that Medicaid will cover some memory care as well as hospice or palliative care.
Alternatives to a nursing home
If you know your loved one needs specialized or one-on-one care support but aren’t convinced a nursing home is the right fit, there are other options to consider.
Assisted living vs. nursing homes
Depending on your loved one’s needs, you may want to compare assisted living facilities to nursing homes, to see if it might be a good fit. Assisted living facilities can provide help with daily care but not as much as a nursing home can. Nursing homes provide comprehensive care and are equipped similarly to hospitals.
Review the costs and insurance guidelines associated with them as well as the specific needs of your loved one.
Home care and respite care options
Another possibility is securing in-home support. After finding the right memory care center for her mother, Simeon ultimately decided on a home care option for her mother. “We decided to keep her at home and elected for hospice care.”
She explains hospice care is a good option for loved ones with total care needs because it provides daily assistance (and is completely covered by Medicaid). “A nurse comes three times a week,” as well as another person who provides daily care, she says.
For those who need support at home, respite care or adult day care may bridge the gap for some primary caregivers.
Benefits of nursing home care
Nursing home care have certain advantages, according to the experts:
Specialized medical care
Nursing home care includes access to registered nurses, therapists and other specialists. Sokolsky says that with increasing awareness of mental health among seniors, nursing homes are incorporating more mental health services. These may include counseling and therapy sessions that address common issues like depression and anxiety.
Social and recreational opportunities
Sokolsky says daily life in a nursing home is structured “to enhance both the physical and emotional well-being of residents.” She adds that many nursing homes include activities designed to cater to various interests and capabilities. “These activities range from arts and crafts to more physical options like light exercise classes, helping residents maintain their physical abilities and engage with their community.”
Peace of mind for families
You might worry for your loved one’s safety, especially if they’re showing signs of memory loss or at risk of falling and getting hurt. Total care facilities include around-the-clock supervision, which can give families the reassurance they need that their loved one is safe.
A final word on knowing when it’s time for a nursing home
Deciding when it’s time to move a loved one into a nursing home is never an easy decision, but recognizing the signs that additional care is needed can help guide you through the process of making the right choice. From frequent falls and neglected personal care to isolation and cognitive decline, these indicators often point to the need for more comprehensive support. If your loved one’s home environment is no longer safe, or if their physical, emotional or medical needs exceed what you can provide at home, it may be time to consider professional care.
The decision to move a loved one into a nursing home is deeply personal, requiring careful consideration of their unique needs, preferences and dignity. It’s important to weigh factors like safety concerns and medical care challenges, as each situation is different. Involving your loved one in the conversation, when possible, and ensuring they feel supported can help make the transition smoother, easing emotional strain and fostering a sense of comfort in their new environment.
