The Mindful Caregiver: Making the Hard Decision

The Mindful Caregiver: Making the Hard Decision

When Your Loved One Needs a Nursing Home

By Nancy Kriseman, LCSW


Nancy Kriseman

“Promise me you’ll never put me in a nursing home,” is a common statement heard by many adult children. Mix that in with the Commandment to “Honor thy father and mother,” and you have a recipe for guilt and angst. How can you think of placing your parent in a nursing home if you “Honor thy father and mother?”

Caring for elder parents is no easy task. Elders are living longer, with greater dependency and with more physical and cognitive fragility than ever before. Countless family caregivers have come to me completely overwhelmed and fraught with guilt when having to face the nursing home decision. I am always amazed at how caregivers have sacrificed much of their lives trying to keep their parent out of a nursing home. By the time caregivers consider placing a loved one in a nursing home, they have exhausted all their resources, often to the detriment of their own health and well-being.  By the time an elder needs a nursing home, he or she may have significant medical problems, and/or cognitive impairment, and therefore may need more care and supervision than can be provided for at home or in an assisted living community.

Outside of a hospital, nursing homes provide the highest level of medical care, which includes two types: custodial and skilled nursing care. All nursing homes provide custodial care, but not all provide skilled nursing care.Custodial care offers services that assist in what is known as activities of daily living: feeding, dressing, toileting and bathing.

Skilled nursing care offers a range of services beyond activities of daily living. This includes skilled nursing services, which can be important if your loved one needs specialized medical care such as catheter insertions, intravenous injections, other procedures, or complicated medication management. So if your loved one needs skilled nursing care, make sure the nursing home is licensed for skilled care.

Having to make the decision to place a loved one in a nursing home is one of the most difficult decisions faced by caregivers. There is no getting around it, nursing homes are institutional and are not like being at home. Should you be faced with this difficult decision, there are a few important considerations to keep in mind.

• Be mindful of what you can realistically provide. I have found that caregivers sometimes struggle to separate out the care needs of their elder loved one from what is realistic.  What can you provide physically and emotionally without placing your health and safety in harms way?

• Be objective about what your elder loved one needs and consider hiring a professional.I have found that a caregivers’ guilt and emotions can get in the way of assessing the situation. A professional, such as a geriatric social worker, can objectively evaluate the social, emotional and physical needs of your loved one and potentially bring more clarity to your situation.

• Recognize that placing your loved one into a nursing home doesn’t mean you won’t be involved in his or her care. While the nursing home is responsible for the nursing care, you can partner in your loved one’s care as well. Become a vital part of the care team, provide helpful information about your loved one and advocate for the best possible care.

• Develop a circle of loving support around your loved one. Get to know the staff and let them know you appreciate all they are doing. Remember, in a nursing home, the staff can become like family.

I know first-hand about having to make the difficult decision placing a parent in a nursing home. And being a Geriatric Social worker didn’t make it one bit easier. I placed my mother who had Alzheimer’s disease in the William Breman Jewish Home, where she lived for over 10 years. I found relief and comfort knowing that she was in a place that could take care of her properly and where she was surrounded by a circle of loving support. I felt blessed that she was able to end her life well, loved and cared for by all that she touched and who touched her.


Nancy Kriseman is an author and licensed clinical social worker who specializes in working with older people and their families.  This column is about helping families make the best decisions possible and be proactive when supporting and caring for elder family members. To contact Nancy, you can visit her website at, or her Facebook page, or twitter feed @GeriatricMSW.



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