Overcoming Resistance to Nursing Home Care: Tips for Families

For family members and loved ones, there's nothing harder or more frustrating than convincing a parent to move to an assisted living community - especially if they are resistant. The complex dance between acknowledging their autonomy and agency, and ensuring their well-being can be emotionally charged. When the need for assisted living is clear, yet a parent vehemently refuses, it poses a unique set of hurdles.

The short answer is no - in most cases you cannot legally force a family member to move to assisted living communities or nursing homes if they don't want to. Forcing someone to move into a nursing home is a complex and ethically charged matter. Generally, adults have the right to make decisions about their own living arrangements, even if family members don't agree with their choices or lifestyle.

However, the long answer is somewhat more complicated. There are some extreme cases in which it may be justifiable to force an elderly parent to move into a nursing home or a supportive care environment, such as when the senior has severe cognitive impairment. But even in the most extreme cases, compelling an adult to do something against their will is a strategy that should be explored as a last alternative.

For most of us, and especially for older adults, the concept of autonomy and agency in decision-making is highly valued. As a result, any attempts to intervene or circumvent that agency should seriously consider whether or not there are documented cognitive issues that would prevent someone's ability to decide what's best for themselves.

From a desire to preserve independence to emotional ties to their home and concerns about financial implications, there are some perfectly valid reasons why your loved one might refuse to move to a nursing home - even if you think they should.

• Holding on to independence: Many older adults may resist moving to a nursing home out of a desire to maintain their independence. There may be fear of losing autonomy in decision-making and daily activities, such as cooking or managing personal schedules, which has some basis in reality - as senior communities often focus on routine.  
• Emotional attachment to home: A deep emotional connection to one's home, filled with memories and familiarity, often acts as a powerful deterrent. The prospect of leaving behind a lifetime of experiences and sentimental attachments can lead older adults to resist moving to an unfamiliar environment.
• Concerns about loss of community: Older adults may fear losing their existing social connections and sense of community. This is especially true if they have a familiar neighborhood and have established a supportive network over the years. After all, a new support network takes time to build.
• Stigma associated with assisted living: The perceived social stigma attached to a nursing home may also deter older adults from considering such a move. The reluctance could stem from concerns about perceived dependency or the societal stigma surrounding aging and residential care.
• Financial worries: Economic considerations can be a significant barrier. Older adults may refuse the move to a nursing home due to worries about the associated costs, even if their financial situation indicates the necessity of such a move. Addressing these concerns is vital in navigating a smooth transition while respecting the individual's perspective and priorities.

In certain circumstances, it may be crucial to make the difficult decision of moving a loved one into a skilled nursing care or home against their will. The following list highlights situations where a move may be essential for the well-being and safety of the individual:

• Substance abuse: When a loved one struggles with substance abuse, and their addiction poses a direct threat to their health and safety (or the health and safety of others), intervention in the form of relocating to a nursing home may be essential to provide specialized care and supervision.
• Dementia: In cases of progressive dementia, where the individual's cognitive abilities significantly decline, the move to a nursing home or specialized memory care facility may be necessary to ensure their safety and access to specialized memory care. This is most significant in the later stages of dementia, where a person can no longer safely care for themselves.
• Intellectual disability: Individuals with intellectual disabilities may face challenges in managing daily living tasks independently. If their condition reaches a point where their safety is compromised, a nursing home with appropriate support may become a necessary option.
• Brain injury or cognitive impairment: Severe brain injuries or other cognitive impairments may lead to an inability to make sound decisions for one's well-being. In such cases, the move to a nursing home is a protective measure to address immediate health risks and provide comprehensive care.
• Mental disorder: Instances of severe mental disorders may result in behavior that puts the individual or others at risk. When conventional support systems prove insufficient, relocation to a nursing home or other supportive environment may be considered for specialized care and supervision.

Balancing the safety and well-being of a loved one with their right to make choices requires careful consideration, open communication, and, when necessary, seeking professional guidance or legal counsel. If you have reason to suspect that your elderly parent's decision-making capacity is diminished, it may be necessary to engage an elder law attorney or even adult protective services, who can navigate the legal landscape, assess the appropriateness of legal intervention, and help family members understand their options.

Talk it out - again and again

The initial and perhaps most crucial option in encouraging an elderly person to move into an assisted living facility is through simple conversation. It's imperative to take a step back and evaluate the dynamics of these discussions. As adult children, are we allowing our parents to feel in charge of the decision-making process, or are we inadvertently imposing our preferences? Assessing whether the conversation aligns with their timeline and desires, rather than forcing a decision on our terms, is key. Importantly, reflecting on our motivations is essential— are we pushing the issue for our convenience or genuinely seeking to enhance their quality of life? 

Relationship dynamics and power imbalances in families can often derail the conversations about moving to a nursing home. Exploring alternative approaches or engaging other family members, such as siblings or a spouse, may provide a fresh perspective and change the dynamics of the conversation.

Engage a geriatric care manager

Engaging the expertise of a professional geriatric care manager can often influence the decision-making dynamics in difficult situations. These skilled professionals bring a comprehensive understanding of the aging process, health care systems, and available resources. A geriatric care manager can conduct a thorough assessment of the parent's physical, mental, and emotional well-being, helping to create a personalized care plan that aligns with their unique needs and preferences.

In some cases, the geriatric care manager may even be able to present a better alternative to a nursing home, or create a plan that mitigates the concerns about independent living, such as by providing in-home medical care and support for your family member. Their neutral perspective often improves communication within the family, addressing any concerns or disagreements. By tapping into their wealth of knowledge, a geriatric care manager can present viable alternatives to a nursing home, explore various care options, and ultimately empower elderly parents to make informed decisions about their future living arrangements with a sense of confidence and control.

Work with a senior living advisor

Professional senior living advisors are market experts who have an in-depth knowledge of communities in your area and can reshape the conversation from one in which the battle for control is replaced by an exploration of possibilities in your area.

These advisors approach the search as a collaborative effort, with your loved one as the valued client. By engaging with your parent, the advisor can tailor their recommendations to align with personal preferences, fostering a sense of excitement about the possibilities. Going beyond mere information dissemination, a senior living advisor can orchestrate community tours, allowing your parent to explore potential living spaces firsthand.

Use in-home support to meet senior needs

If you sense that the conversations about nursing homes are going nowhere, perhaps it's time to rethink what you see as the solution. Perhaps a structured senior living environment isn't the only way to go. Start by listing out the specific concerns related to health problems, physical care medication management, socialization, household management or mobility.

In today's rapidly burgeoning senior care economy, many solutions can now be provided in the home and managed remotely. From companionship services to medical care to household maintenance, it's easier than ever to create a network of care and support that allows an elderly parent to remain living in their home. Perhaps the answer doesn't lie in a senior living community after all, but in an approach to care that is sourced from various organizations.

Create a plan for the transition to senior living

If a nursing home or similar facility is truly the best solution, and your elderly parent is resolute in their resistance to a nursing home, it may help to work together on a transition plan. This will allow them to feel in control and still address your specific concerns about care and safety. Begin by incorporating in-home care solutions over time to provide targeted support for specific needs, ensuring a smooth adjustment.

During this period of home care support for your family member, try using respite care programs offered by assisted living facilities, which allow your loved one to experience the community on a temporary basis for a week or two. This "try out" period provides insights into the lifestyle and services offered, as well as the sense of community created by other residents and staff.

Simultaneously, have conversations to set agreed-upon "triggers" or milestones that signal when the transition to assisted living becomes necessary. These triggers could be practical markers, such as difficulty walking to the mailbox or challenges with independent bathroom use. They could also be social markers, like no longer attending church, decreased participation in social activities, or not walking with friends reguarly. Establishing a shared understanding of these criteria ensures a collaborative decision-making process, promoting a sense of control and involvement for your loved one as they gradually transition to assisted living.

Legal guardianship

Pursuing guardianship over an older adult or family member is a significant decision that should be considered as a last resort, only when the individual is unable to make sound financial or medical decisions about their personal or financial affairs, often due to cognitive decline or mental incapacity.

Before pursuing any kind of action, it's important to weigh the pros and cons, particularly in balancing potential benefits to their health against the potential strain on the parent-child relationship. On one hand, guardianship may provide a structured and protective environment, ensuring necessary decisions are made in the best interest of the parent's health and safety. However, the process may also strain the relationship, potentially causing emotional distress.

From a practical perspective, it may become necessary to obtain guardianship when the safety and well-being or mental health of the older adult are at risk, and you and your loved one simply cannot reconcile your desires. When exploring this option, engaging in open communication with family members, healthcare professionals, a even legal advisors is crucial to assess the appropriateness of guardianship and ensure it aligns with the older adult's best interests.

From a procedural standpoint, obtaining guardianship involves several key steps:

• File a petition: Initiate the guardianship process by submitting a formal petition to the local court. Clearly outline the reasons for seeking guardianship and provide evidence demonstrating the older adult's incapacity. It’s also important to notify any relevant parties, including family, of your intentions and motivations.
• Medical evaluation: As part of the process, a medical evaluation may be required to assess the mental and physical condition of the older adult. This evaluation helps establish the extent of their incapacity and informs the court's decision-making.
• Court hearing: After filing the petition and completing the medical evaluation, a court hearing will be scheduled. During this hearing, the petitioner must present compelling evidence and arguments to demonstrate the necessity of guardianship, and highlighting the risks and challenges faced by the older adult.
• Granting of guardianship: If the court is convinced of the necessity, they may grant guardianship. The appointed guardian assumes the responsibility for making decisions on behalf of the older adult, encompassing both personal and financial matters.
• Respect dignity and preferences: Throughout the guardianship proceedings, it is paramount to approach the process with sensitivity and a clear understanding of the responsibilities involved. Ensuring that the older adult's dignity and preferences are respected remains a central focus, even as decisions are made on their behalf. Providing updates and soliciting their input throughout the process is helpful to coming close to an arrangement that will be well-received by all.