Dear Attorney Tully:  I thought this day would never come.  My siblings and I have to place Mom in a nursing home.  You cannot believe the guilt we feel about placing her there.  We feel as if we have let our mother down.  But we simply cannot provide 24/7 care anymore without destroying the lives my siblings and I have with our spouses and children.  I want to make sure Mom has the best care possible in the nursing home.  Where should I start?

ANSWER: I can understand the guilt and disappointment that you are currently feeling.  In over 30 years of practicing in the area of elder law, I see how badly caregiving relatives want to keep their loved ones home, but it can reach a point where it is not safe for anyone.  

Few decisions are more difficult than the one to place a spouse or parent in a nursing home.  Since nursing homes are seen as a last resort, the decision is generally overlaid by a sense of guilt.

Most families try to care for loved ones at home as long as (or longer than) possible, only accepting the inevitable when no other alternative is available.

The difficulty of making the decision can be compounded when family members disagree whether the step is necessary.  This is true whether the person disagreeing is the person who needs help, his or her spouse, or a child.

The placement decision can be less difficult if, to the extent possible, all family members are included in the process, including the senior in question, and if everyone is comfortable that all other options have been explored.  This won’t ensure unanimity in the decision, but it should help.  We recommend the following steps:

• Include all family members in the decision.  Let them know what is happening to the person who needs care and what providing that care involves.  If possible, have family meetings, whether with the family alone or with medical staff, where available.  If you cannot meet together, or in between meetings, use the telephone, the mail or the internet.

• Research other options.  Find out what care can be provided at home, what kind of day care options are available outside of the home and whether local agencies provide respite care to give the family care providers a much-needed rest.  Also, look into other residential care options, such as assisted living and congregate care facilities.  An experienced, certified elder law attorney can help answer these questions.  

Follow the steps above for finding the best nursing home placement available.  If you and your family members know you have done your homework, the guilt factor can be assuaged, at least to some extent.  These steps won’t make the decision easy, but they can help make it less difficult.