Ellen’s father had been living with her and her family for a few years after his wife died. He had severe depression and some mild dementia. Her family wanted him to be with them rather than in assisted living as he was no longer able to live on his own.

Over the years, his symptoms increased, and the caregiver tasks became more intense. Ellen did most of the caregiving as she was not working. The family helped, yet due to her father’s dementia, the routine was strictly scheduled, leaving little time for Ellen. She would frequently bring up the topic of moving him to a care residence and each time it was with such pain and emotion, and huge feelings of guilt.

I recently got an email from her saying that after two hospital visits and two stays in rehab she had made the decision to move her father to a care residence. It was no longer safe for him to be in her house and for her family to continue with his care.

This is a decision that comes to many family caregivers. As is often the case, it comes after or during a crisis. There is a rush to find a qualified residence, many residences have waiting lists. There are conflicting emotions and overriding guilt associated with the move. Other family members are brought into the decision often creating conflict or shifting the caregiver role.

There is a way to prevent this last-minute rush and roller coaster of emotions. That is to plan for this event. Many caregivers feel unrelenting guilt about this decision, as if they have failed. Most frequently they say, “I promised my parent I would NEVER put them in a home.” The only failure is that they didn’t plan for it. The residence they had hoped for did not have a bed. Other residences were not satisfactory or out of state. Someone else in the family would have to step in as the primary caregiver. Someone who perhaps was also not prepared.

In many cases the caregiver is not able to have a conversation about the decision with their parent. Because of dementia or other forms of cognitive dysfunction, it is a decision that is made alone or with other family members. This brings on even more guilt and emotion.

When a caregiver can have a conversation with their parents about a move there are some important steps to keep in mind.

Choose the Right setting: Find a comfortable space and time for people to express their thoughts and feelings openly. If the conversation gets tense, back off. Come back to another time.

Empathetic Listening: Begin by listening to your parents’ perspective. Their fears, desires and reservations need to be acknowledged and respected.

Share Your Concerns: Express your concerns from a place of love and care. Use “I” statements to convey your feelings without being accusatory or making the decision for them. Share examples of their friends who may have moved.

It is important to remember the intention behind the decision. Its ultimate outcome is for the best care of one’s parent and yourself. Acknowledging the emotions and the reasons can help open a constructive dialogue.

The decision to move your parents to a level of care and away from their home of many years is a difficult one for the whole family. It takes pre-planning and preparation. It calls for compassion, empathy, and an understanding of all the family emotions. You are not alone on this journey.