What makes this conversation so difficult?

There may come a time when caregiving at home is no longer an option. Both caregiver and the senior inevitably have powerful feelings about this momentous life transition, and most caregivers experience a sense of dread when they think about initiating this heartbreaking conversation. Sadness, anger, guilt and grief are common.

Many families make this decision after years of heroic measures to keep the senior at home. They often fear they have failed as caregivers. The volatile mix of emotions can complicate efforts to hold a discussion on the subject and come to a resolution everyone feels comfortable with.

What is "the right to folly"?

No one can force someone else to move to a nursing home or any other kind of facility unless that person has been declared legally incompetent or has formally signed over decision-making authority. Moreover, once they move into an institution, they have the right to leave against all medical advice and reason. A person’s freedom to make bad personal choices is commonly called "the right to folly."

People can choose to do as they please — as long as it does not pose a real danger to themselves or others. One of the most frustrating aspects of caregiving is watching someone you care for make irrational decisions and refuse needed services no matter how much you cajole, beg, threaten and plead.

If you truly believe someone can no longer live safely at home and they will not comply with your suggestions, you may have no choice but to initiate arduous and emotionally wrenching legal proceedings to establish a conservatorship or guardianship over the person. It is far better, however, to develop skills in the arts of compromise and communication and resolve the problem without having to go to court.

Tips for caregivers

How you approach the discussion may well determine the outcome. The following suggestions might help:

• Be aware that all parties have an enormous stake in this decision. You don’t necessarily have to address and respond to every complicated feeling, but you must recognize their existence. You must be alert to how this combustible mix of emotions can quickly lead to tempers and raised voices. Be prepared. Make a commitment to yourself to remain calm no matter what ensues.

• Give seniors a chance to express their reaction to the move. Do not try to talk them out of their feelings. Do not tell them how many friends they will make or how much better life will be. Listen with patience, empathy and understanding. Allow them to grieve the loss of independence and experience the fear of what the changes will mean.

• Explain in practical rather than emotional terms why the move is necessary. For example, tell them you simply don’t have enough time anymore to make sure they are safe and comfortable at home, not that the current situation is ruining your life or making you and the rest of the family miserable.

• Do not make promises you cannot keep. Caregivers sometimes coax seniors into moving with an offer to return home if they don’t like the facility. Resist this urge; it could come back to haunt you. Assure them instead that you will remain involved in their life and will always keep their best interests, as well as your own, at heart.

• Have a script mentally prepared. Review in your mind what you would like to say and how you would like to say it. Keep your message clear and simple. Planning ahead for this conversation will allow you to deal with your own complex emotions beforehand so you can focus all your energy on being supportive and responsive to the person facing the move.

• Forgive yourself in advance for making this decision. Caregivers must make hard choices based on the realities of a senior’s condition, financial resources and the available support network. If you blame yourself for taking this step, it will be hard to contain your emotions enough to communicate with the senior in the gentlest and most effective manner possible.

• Leave room for the senior to make some decisions. Even if home care is no longer a viable option, offer them some level of choice about how to make the move. You might line up two or three different facilities and let them choose between them. Encourage them to take along favorite personal items like photographs, books and trinkets. Some facilities allow residents to bring their own furniture or personalize their rooms in other ways, such as repainting or selecting new curtains.