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Once the need becomes obvious, have your relative participate in the decision making and plans – if possible, visiting prospective homes and making the final decision about where to go (when the person is competent to do so). Many families wait until the last minute to break the news, reasoning: “What possible good would the extra months of worry do Mom?” However, consider the pitfalls of waiting: you increase the shock of the move by adding the element of surprise; you add the pain of betrayal. The truth is you have been “putting one over,” plotting behind the person’s back. And you rob the elderly person of any chance of control.

Even if your relative has no choice about where to go, breaking the news as soon as possible means choices can be made around the decision. Your mother may be able to arrange to keep her doctor or have her long-standing attendant be there for the first few weeks to make the transition less difficult (it may be psychologically worth the extra expense). She may be able to choose her room or floor, arrange what belongings to take, decide who will come when moving day arrives. Be guided by your knowledge of your relative in following this advice, but also be aware of the research on learned helplessness. In this difficult situation, enhancing control can be lifesaving.

A main fear about nursing homes is the terror of being abandoned, left alone and unloved in an alien place. So as moving day draws near and in the first few weeks, have family and friends make a special effort to rally around. Unless you find that visiting is deeply upsetting, take pains to show your family member you are there. And be as involved as you can for as long as you can.

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GENERAL HEALTH