How to tell your parent they need to go to a nursing home

In 2019, nearly 53 million Americans were aged 65 and older, according to the United States Census Bureau. With so many adults reaching the age of 65, 1 in 5 U.S. residents will be of retirement age by 2030. If you have an aging parent, grandparent or other loved one, it’s likely they’ll need some form of senior care in the future, and now is the time to start discussions about what their desires and options are. These conversations can be difficult, but they’re necessary to plan for the future and give your family peace of mind.

Lisa Owens, a registered nurse with years of experience as a senior care provider, explains, “It’s not unusual for a person to be resistant to discussing senior care. Oftentimes, there is grief associated with losing one’s independence, and in general, throughout the aging process.” Some older adults also feel that they’ve lost their sense of purpose, especially if they have trouble performing activities of daily living. Instead of caring for others as they have done for most of their lives, they’re suddenly reliant on children, grandchildren and other caregivers for help with bathing, getting dressed or cooking.

This guide will help you determine the right time to talk to your parents about senior care. It also includes tips for having tough conversations in a respectful way that ensures your parent’s well-being.

Signs Your Aging Parent Needs Help

Dr. Michelle Feng, Ph.D., a licensed psychologist with specialty training in geriatric psychology and medicine and Chief Clinical Officer at Executive Mental Health, recommends having an open conversation as early as possible before physical and cognitive changes make it difficult for your parent to perform activities of daily living without assistance. She explains, “Ideally you should initiate the conversation before something occurs so that you have some roadmap which isn’t created in the middle of a crisis. The conversation doesn’t have to happen in a scary way: It helps when the adult child connects it with a positive event in their own lives (buying a house, having grandchildren, making a move, doing their own will). In this sense, it’s just another conversation about life put into context.” 

While you plan for your conversation, watch for these signs that your parent needs help.

Increased Forgetfulness

As people age, changes in the brain make it more difficult to remember things. Forgetfulness is also a symptom of some medical and psychological conditions. It’s time to have a conversation about senior care when a parent’s forgetfulness starts to get out of hand. Losing keys is one thing; forgetting to turn off the stove is another. If your parent’s forgetfulness puts their safety at risk, start exploring senior care options right away.

Signs of Depression

According to the National Institute on Aging, depression isn’t a normal part of getting older; however, it’s relatively common among older adults. For some people, getting older comes with many transitions in a short amount of time: retiring from work, developing chronic health conditions or even giving up enjoyable hobbies due to difficulty getting around.

Although sadness is a common sign of depression in young people, older adults often have different symptoms. Your parent may be moody, irritable or grumpy when you talk on the phone or visit in person. Fatigue and insomnia are also possible signs of depression in older adults. If your parent has heart disease or another chronic medical condition, the condition or the medications used to treat it can worsen the symptoms of depression, so be on the lookout for any sudden changes.

Recent Falls, Injuries or Other Incidents in the Home

More than 3 million adults aged 65 and older visit the emergency room for injuries sustained in falls every year. Fall-related injuries also account for around 800,000 hospitalizations each year. If you’re concerned about an aging parent, watch for signs of recent falls, such as broken bones, bruises and head injuries. You may also notice that your parent cuts back on regular activities due to a fear of falling again.

Some medical conditions make older adults even more vulnerable to falls, including vitamin D deficiency, vision problems and health issues that cause a loss of balance or weakness in the lower body. Pay close attention to signs of falls if you know your parent has one of these conditions.

Noticeable, Sudden Weight Loss

Older people tend to need fewer calories as they age due to decreased physical activity levels, but noticeable, sudden weight loss may be a cause for concern. If your parent loses a lot of weight in a short amount of time, it could be a sign of gastrointestinal disease, cancer or a psychiatric disorder.

Noticeable Lack of Hygiene

Physical and mental health problems can make it difficult for an older person to keep up with daily hygiene activities, including bathing, shampooing hair, brushing teeth and changing into clean clothes. Watch for signs of poor hygiene, such as body odor, bad breath, tangled hair or ragged nails. When you visit, keep an eye out for unwashed dishes, spoiled food, insect activity and other signs that your parent cannot keep up with regular housekeeping activities.

Unexplained Bruises or Injuries

Falls aren’t the only cause of injuries in older adults. In 2018, unintentional poisonings and burns accounted for more than 4,600 deaths among adults 65 and older. When you see your loved one, look for visible signs of burns, such as red skin, scarring, blisters and peeling skin. If you’re concerned about unintentional poisoning, ask your parent about abdominal pain, nausea, trouble breathing, vomiting and other possible poisoning symptoms.

Mobility Problems

Arthritis, vision problems and other medical conditions may make it difficult for older adults to move around. If you’re concerned about a loss of mobility, watch for signs that your parent is having difficulty walking, climbing stairs and performing other movements.

Frequently Missing Appointments or Social Plans

If your parent has started missing appointments or canceling social plans, the behavior could be a sign of depression or mobility problems. Depression may cause some older adults to isolate themselves, damage their social relationships, and increase feelings of loneliness. Adults with mobility problems may have the desire to socialize, but difficulty walking or maintaining normal balance can make it hard to get out of the house and meet with friends.

Common Tough Conversations About Senior Care

Talking about aging with an elderly loved one can be intense and multi-faceted, and the list of hot-button topics of conversation can seem overwhelming. It’s understandable that you may be anxious about having some awkward discussions, which can include everything from your parents’ ability to continue driving to the challenges of estate planning, long-term care and even end-of-life plans. Though it’s impossible to cover all of the different subjects you may face when talking to your elderly loved ones, we’ve highlighted these common topics below to give you valuable insight on how to tackle these difficult conversations with an aging parent.

Senior Driving

In the United States, more than 700 older adults (65+) are injured in car crashes every day, according to the Centers for Disease Control and Prevention. Several changes that come with aging can make it more difficult for an older person to drive safely, which is why the topic of driving is such a sensitive one for older parents and their adult children. For example, many older people develop vision impairments that can make it difficult to see traffic lights, warning signs, pedestrians, cyclists and even other vehicles. Some older people also experience cognitive decline, impairing their ability to make quick decisions when faced with hazardous driving conditions.

Older adults also tend to have slower reaction times and medical conditions that can make it difficult to respond quickly to traffic hazards. For example, muscle weakness in the legs may make it harder to slam on the brakes if a child runs into the road. Slow reaction times may also make it difficult to pull into highway traffic without getting into an accident. Your parent may even take medications that cause drowsiness or confusion, making it even more dangerous to drive.

If you’re concerned about your parent’s safety, look for signs of unsafe driving habits, such as sudden lane changes, speeding, driving too slowly, tailgating other vehicles and getting into near misses on the road. You should also check your parent’s vehicle for dents, scratches and other damage that could have been caused by a recent accident. If you don’t have many opportunities to ride with your loved one, ask friends and neighbors if they’ve noticed anything concerning about your parent’s driving habits. Finally, if you handle your parent’s finances, watch for a sudden increase in car insurance premiums.

Trusts and Wills

Estate planning is an important aspect of aging, but 60% of Americans don’t have a will or a living trust. People may hesitate to engage in estate planning because they don’t like to think about what will happen when they die or may believe they don’t have enough assets to make estate planning worthwhile. They need to know if they die without a plan in place, their assets will be distributed by a court. Estate planning ensures that a person’s assets are distributed according to their wishes, rather than the whims of a judge or appointed executor.

Whether your parent needs a will or a living trust depends on several factors, such as the value of their assets and whether they want to distribute property before or after their death. A will is a legal document that specifies who will receive property in the event of a person’s death, while a trust can be used to distribute a person’s assets before death, immediately after death or even years in the future. If you’re not sure your parent would benefit more from a will or a trust, schedule a consultation with an attorney who has extensive experience in estate planning.

Long-Term Care Planning

According to ACSIA Partners, an insurance company based in California, 70% of Americans over the age of 65 will need long-term care at some point in their lives. Women need an average of 3.7 years of care, while men need an average of 2.2 years of care. Despite the high likelihood that they’ll need long-term care when they get older, many adults don’t plan for their future needs, perhaps because they don’t like to think about losing their independence or developing health problems as they get older. 

You may want your parent to live with you at some point, but it’s important to remember that some older adults develop medical or psychological problems that make it unsafe to live in a family home without health professionals on hand to assist. If you think your parent will need to move to assisted living or a nursing home, it’s best to start planning early. 

It’s also important to know that many insurance companies, including Medicare, only pay for long-term care for a set number of days, after which, the expense is out-of-pocket. Having a challenging conversation now can give you time to set up long-term care coverage or find a suitable facility before your parent needs long-term care. 

Challenging Health Issues

Chronic health issues are common during seniors’ retirement years. According to the Centers for Disease Control and Prevention, the following medical conditions are among the most common causes of death for adults aged 65 and older:

• Heart disease
• Cancerous tumors
• Chronic lower respiratory disease
• Cerebrovascular accidents
• Alzheimer’s disease
• Diabetes
• Influenza and pneumonia
• Nephritis (inflammation in part of the kidneys)
• Parkinson’s disease

These conditions result in various physical and mental changes, such as fatigue, confusion, incontinence, difficulty breathing and limited mobility. It can be difficult to think about what will happen when a condition worsens, but it’s important to be prepared for significant changes. Here are a few things you can do when handling this sensitive topic:

• Learn as much as you can about the condition, including the signs and symptoms, treatment options and expected prognosis. Knowing what to expect makes the condition less frightening, and it can also help you be more effective in communicating with your parent’s health care professionals and any paid caregivers.
• Discuss the medications your loved one is taking, including dosages and side effects. Make sure you and your parent know the plan for medication management. It’s not uncommon for the elderly to unintentionally overdose on prescription medication or conversely, to miss doses, leading to medical emergencies.
• Discuss what your parent wants to do if the condition worsens. Some people want to try as many treatments as they can, while others prefer to focus on living their lives without having surgery or taking medications that can cause serious side effects.
• Discuss what kind of care your parent would like if it becomes too difficult to live independently. Some older adults stay in their homes with the help of family members and home health services, while others need 24/7 care in a skilled nursing facility. Discuss your parent’s preferences and have an honest conversation about how much care is likely to cost.
• If your loved one has incontinence, choose your words carefully. Mention that you’ve seen absorbent underwear that can prevent leaks, and ask your parent if you should get some the next time you go shopping. Be careful not to use the word “diaper” or suggest that someone who’s incontinent has to move into a nursing home.

How to Help Aging Parents

Nobody wants to think about losing their independence or having to leave a home they’ve lived in for many years, but it’s critical that you have these important conversations with your parent as early as possible. The first step in helping an aging loved one is having open discussions about their health, safety, and challenges they may be facing.  When you start early, you have the opportunity to include your parent in all aspects of planning, ensuring that you carry out their wishes regarding medical treatment, long-term care and financial decisions. 

Because these are such emotional topics, the way you frame each conversation matters. Below, we offer some tips on how to approach these topics in a way that best serves both you and your loved one.  

Do Your Homework Before the Conversation

Don’t go into one of these conversations unprepared. Speak with medical professionals or conduct online research to gather the information you need to have a productive discussion. Dr. Feng suggests, “When looking for some simple ways to get that conversation started, consider sending them this article or any article related to senior care as a conversation starter. Open the conversation with ‘I just read this article in Caring.com about senior care. I’ve been thinking about it, and I want to make sure I know what matters to you so that I can respect your wishes. What do you think?’” Make it clear that you have your parent’s best interests in mind and want to honor their wishes rather than making decisions on your own.

Be Patient

It’s difficult to have a productive conversation if you’re impatient and frustrated. Remember that the physical and mental changes that occur with aging may cause confusion, forgetfulness and other problems that make it difficult for older adults to have in-depth conversations about their needs.

One way to stay patient is to put yourself in your parent’s shoes. You would probably have a tough time if you were starting to lose your independence or struggling with health problems. Showing empathy can help you maintain your patience during tough conversations. If you get frustrated, take a step back and try to have the discussion when you’re more level-headed.

Let Your Loved One Take the Lead

Even if you have your parent’s best wishes in mind, you shouldn’t take charge and try to make all the decisions yourself. Including older adults in every important decision preserves their independence and makes it more likely that they’ll be open to discussing things like long-term care and estate planning.

Lisa Owens, RN recommends that you “Give them as much control in the situation as possible. Don’t simply make decisions for them; rather, provide choices, and let them make decisions. Explain that the reason for the discussions is to ensure they can be as healthy and independent as possible, for as long as possible. And preparation is key — have a plan that enables you to stay as healthy as possible, rather than being unprepared when problems arise.”

Make It Clear That Their Well-Being Is Your Priority

When you’re ready to have a tough conversation, let your parent know that you are concerned with their well-being, not with making your own life easier. According to Dr. Feng, “You can also let them know you care by saying, ‘Mom, Dad, I love you. I want you around for as long as possible. I want to learn about what’s important to you, both now, when we get older, and toward the end of life. I want to make sure I can support your wishes and speak about them if I ever need to.'”

Explain that having an important discussion now can help you protect your parent’s health and finances in the future. For example, long-term care can cost anywhere from $19,500 to $102,200, depending on what type of care your loved one needs. Discussing long-term care insurance now can help you avoid having to sell your parent’s home or drain their bank accounts to pay for care later.

Frequently Asked Questions

How do you tell a parent it’s time for assisted living?

Be honest. Let your parent know that you’ve noticed signs that living alone isn’t safe. Some of the most common signs it’s time for assisted living include not remembering to take medications, an increase in falls, inability to perform activities of daily living, a noticeable change in weight and a lack of housekeeping or personal hygiene.

How do I talk to my elderly parent about not driving?

If you’re concerned about your parent’s driving, have a frank discussion. Mention any recent accidents, traffic tickets or unsafe driving behaviors that you’ve observed. If you can’t get your parent to listen, consult a Certified Driver Rehabilitation Specialist. A CDRS can assess your parent’s driving skills and make unbiased recommendations.

How can I help my elderly parent stay at home?

To help your elderly parent stay at home, pool as many resources as possible. If you have siblings, set up a schedule so that someone checks on your loved one daily. Be sure to designate which sibling will take your parent to medical appointments or social activities. If you’re an only child, look for companies that offer home-based health services or assistance with personal care.

Do I need to hire outside help to talk to my parents about senior care?

You don’t need to hire outside help if it’s not in your budget. Depending on where you live, you may be able to get free advice from an Area Agency on Aging, state agencies or nonprofit organizations. If you need to discuss estate planning, some attorneys offer free consultations. 

How do I help my parents adjust to needing senior care?

Give your parent a little time to adjust to the idea of moving to assisted living or a nursing facility. When it’s time to move, let your loved one be as involved as possible. For example, make sure your parent takes part in choosing which items to keep and which ones to sell or donate before moving. If you use a moving company, let your parent oversee the loading process. This can help your parent maintain a sense of control.

Works Cited

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“Older people expected to outnumber children for the first time in history.” United States Census Bureau, March 13, 2018, https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html. Accessed June 12, 2021.

“Do memory problems always mean Alzheimer’s disease?” National Institute on Aging, January 24, 2018, https://www.nia.nih.gov/health/do-memory-problems-always-mean-alzheimers-disease. Accessed June 12, 2021.

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“Facts about falls.” Centers for Disease Control and Prevention, February 10, 2017, https://www.cdc.gov/falls/facts.html. Accessed June 12, 2021.

“Nutrition for older adults.” MedlinePlus, April 6, 2021, https://medlineplus.gov/nutritionforolderadults.html. Accessed June 12, 2021.

“Unintentional weight loss in older adults.” American Academy of Family Physicians, May 1, 2014, https://www.aafp.org/afp/2014/0501/p718.html. Accessed June 12, 2021.

Pavlou, Maria P., & Lachs, Mark S. “Self-neglect in older adults: A primer for clinicians.” Journal of General Internal Medicine, November 23, 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585676/. Accessed June 12, 2021.

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“What is poisoning?” American Academy of Family Physicians, March 2021, https://familydoctor.org/condition/poisoning/. Accessed June 12, 2021.

Donovan, Nancy J., & Blazer, Dan. “Social isolation and loneliness in older adults: Review and commentary of a National Academies report.” The American Journal of Geriatric Psychiatry, December 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437541/. Accessed June 12, 2021.

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“Older drivers.” National Institute on Aging, December 12, 2018, https://www.nia.nih.gov/health/older-drivers. Accessed June 12, 2021.

Lumpkins Walls, Barbara. “Haven’t done a will yet?” AARP, February 24, 2017, https://www.aarp.org/money/investing/info-2017/half-of-adults-do-not-have-wills.html. Accessed June 12, 2021.

“What’s the difference between a will and a trust?” Los Angeles County Office of the Assessor, 2018, https://assessor.lacounty.gov/real-estate-professionals-toolkit/12-will-and-trust/. Accessed June 12, 2021.

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“10 leading causes of death by age group, United States – 2018.” Centers for Disease Control and Prevention, June 24, 2020, https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_by_age_group_2018_1100w850h.jpg. Accessed June 12, 2021.

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