Making the Decision

Nursing Home, Assisted Living, or Care at Home?

Frank & Martha have been married for 57 years. Frank was declining in physical health. He weighs 235 and is 6’3”. Martha tops out at 110 lbs and is 5’4”. This has never been a problem until now. Despite Frank’s mobility issues and the body-size difference between Frank & Martha, Martha was attempting to help Frank move around the house without falling. Frank & Martha had made the decision to take care of each other ‘in sickness and in health’. They were going to uphold that decision!

However, Martha began to sense that her own health was at risk. She knew that things had to change. Martha was worried about Frank falling and injuring himself. She realized the growing fear of a fall injury if she continued as Frank’s sole caregiver. Martha knew that with Frank’s ever-increasing needs, she was no longer able to serve as Frank’s sole caregiver.

The Decisions

Martha decided it was important to take action. She did what she thought she would never do – she called the kids and asked for help making her decision!

Plan A – Non-Medical Home Care Decision

Frank & Martha had promised each other that neither one would ever go to the nursing home. Martha had worked valiantly to keep her end of the deal. Sadly, things deteriorated much more than either one could ever have imagined when the first made the no-nursing-home-ever decision. Frank needed help. Martha knew that if things didn’t change quickly, that both she and Frank would suffer the consequences.

At the Family Meeting, the family decided to try non-medical Home Care. They interviewed a few companies and picked two caregivers (each from a different company) to help. After a brief experiment with this, it was obvious that Frank was going to need much more care than could be provided at home. It would take two caregivers most of the time to provide the needed care. The cost of this would be way more than Frank and Martha could afford to pay and it would not provide the safety or stability that Frank & Martha needed in their lives at their stage of the journey.

Additionally despite the presence of the non-medical caregivers, Martha felt the need to continue to personally provide care for Frank -she just couldn’t help herself. Fortunately the family had also crafted a Pivot Plan complete with a Plan B option.

Plan B – Assisted Living Care Decision

When the kids flew home and assessed the situation, they realized that attempting to provide care at home may not work. They knew their Mom – and they knew that even with the addition of capable non-medical caregivers in the house, that she would continue to try to care for her husband. They were extremely worried about her health so they decided to come up with a viable option.

Fortunately a new Assisted Living Facility had just been built in their home town, so the kids scheduled a tour and took Mom and Dad to the facility to check it out. With the lifting of some of the Covid restrictions, Frank & Martha and the kids were able to walk around the facility (Frank was wheeled around on the tour) and even have lunch in the facility dining room. Both Frank & Martha admitted that this was way different than they had imagined. This visit was making their decision making efforts much easier!

Assisted living facility was very nice, appeared to have capable staff and supplied the level of care that Frank & Martha needed. Frank & Martha were able to provide for most of their own needs, they just needed some assistance.

With the additional help provided, much of the load that had been shouldered by Martha at home would be taken care of by other caregivers. Given the fact that this facility was local, Frank & Martha could continue to visit with their friends and could go out of the facility anytime they wanted for a visit.

Plan C – Skilled Nursing Facility Decision

While they were in town, the kids we’re also able to visit a local Skilled Nursing Facility (aka Nursing Home). The nursing home provided a much higher level of skilled nursing care than was provided at the Assisted Living Facility (ALF). The cost of care at skilled nursing facilities was higher because the focus at nursing homes is to provide needed medical care for individuals who have declined to the point where they need 24 X 7 professional nursing care. After visiting with Frank’s doctor while home, the decision was made that he did not yet need this level of skilled care.

The Tipping Points

Several factors tipped in favor of the decision to go with care at an ALF at the present time.

  1. Because of Martha’s insistence to continue to do everything at home, despite the presence of qualified non-medical caregivers, an alternative living arrangements such as provided at an ALF was necessary. Additionally Frank was requiring an ever-increasing level of care that was very difficult to provide at home.
  2. Neither Frank nor Martha needed skilled level of care at this time
  3. The ALF provided room cleaning, personal assistance as needed with tasks such as showering or toileting (for an additional fee) and meal preparation.
  4. Frank & Martha were allowed to enjoy meals in their apartment OR they could enjoy meals in a nice dining room with their new friends. The food was much better than they were getting at home.
  5. The ALF provided a more home-like environment
  6. Frank & Martha were able to afford to pay the cost of care at the ALF out of their current income without dipping significantly into their principal (which was very important to them).

If your parents are declining, what is the best Future Care option for them? Then when things change even more, what’s next?

Best wishes as you work to help your declining parents with these difficult life changing decisions.

Strength is Found in the Decision to Work Together!

We know how much stronger all of us are when we bind together. We fully understand the stress and turmoil that you are facing as Family Caregiver – including personal experiences with burnout.

In our time as caregivers, we have amassed a wealth of knowledge that we desire to pass on. Likewise, we have met many professional caregivers, as well as other family members who were thrust into lives as Family Caregivers. All caregivers have shared the same stress management advice – Join a community!

We have since created Caregiver Connection. Caregiver Connection is a newsletter that we write personally and send to fellow Caregivers. It is full of tips, tricks, and even professional advice. If you would like to sign up, click the button below.

Please Invite Someone to Our Newsletter

Being an Adult Kid who is helping mom as she is declining can be a scary, frustrating and lonely place lacking stability. You feel like you are solely responsible for solving Mom’s problems while managing yours. Some occasional input and a community to plug into would help, especially when facing burnout! This is a way that all of us can be working together as caregivers!

Many others that you may personally know are having to figure it all out by themselves. Most of them have no community. Please take a minute and do them a favor. Copy this link – – and send it to them in an email or private message. They can click on it and subscribe to our newsletter for free. Encourage them to make the decision to join!

Then they can enjoy weekly stress management tips and encouragement. They no longer have to feel so alone in their family caregiver journey. They will appreciate the favor! Thank you for thinking of them!

Thank You for being a Caregiver for Your Loved One – you are making a huge difference in their life!

About the Author

Doug & his wife Cindy have not only helped hundreds of families with their estate planning and elder law needs over the years, but have personal experience as caregivers and advocates for their Loved Ones as well.

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