In my experience working as a Certified Nurse’s Assistant in skilled nursing facilities for over a decade, I found that placing a loved one into a facility is not only challenging, but also riddled with guilt, loss, and worry. It need not be to such extremes, and it is my hope that by sharing my experiences with you that you will be better able to facilitate placement without all of the guilt, loss, or worry.

Don't Wait Until The Last Minute

A major problem that families face is the lack of time. In many cases, people wait until it becomes so obvious that a senior member of the family cannot live alone that the family loses the option of choosing the perfect facility.

Understand What You Face

Another major problem is that people do not consider how deeply this process will affect both the senior and those who care. Placement is not always a pleasant task. Not every senior wants to leave their home. There is a process that older folk go through was they become more dependent upon others. That process involves a clutching of things that mean a lot to them. They may not see their grown children enough. There is often a strong feeling of guilt over being a burden to their family. Many of us plan out our end years. The problem is life; life does not always follow our planning. There is regret. All of these emotions manifest themselves in different ways. Take the time to discuss this as a family. Lay the foundation early about what happens if X occurs.

When families wait until there are not options, the situation is ugly. Moving is traumatic for seniors. So traumatic that average emotions become almost manic. This can be avoided in many cases simply by talking and planning.

You Affect the Outcome

A huge problem is that people do not fully realize how their actions or inaction affect the outcome. There are disorders such as failure to thrive, depression, and grief that seniors go through when the planning for placement is not well thought out. These are all valid reasons to be proactive earlier rather than later.

Over the ten years that I worked with seniors in senior facilities there have been numerous cases that still stick in my mind twenty years later. One case involved an elderly gentleman whose family tricked him into coming to the facility. The family had power-of-attorney, and the man could not live by himself. Rather than tell him they were placing him in a facility, they suggested that he come visit a friend who lived there. Sadly, there was no friend. While he was eating lunch, they left and did not say goodbye. The burden of explaining to the man fell upon the staff of the facility. It was one of the most horrible situations that occurred in my career. It is the perfect example of how not to place someone.

Most of the problems that occur are due to poor planning. Some people do not take enough time to prepare the senior or the entire family for placement. Placement does not have to traumatic, but when there is little preparation the results rarely show the positive side of assisted living. Most people who have been through this process wish they could take more time to set up placement. What happens after placement is that family comes to visit, and the senior just wants to know when they can go home. The level of guilt and hurt on both sides is extreme. This is not the way to live for either the senior or the family. The emotional burden is deadly. It is also mostly unnecessary. Planning makes the difference. Take the time to plan out placement.

How Do You Plan a Placement?

First, it is important to discuss what options are available. Some seniors want to move in with their adult children. Sometimes that is possible and sometimes it's not. Set clear expectations from the start. There may be some guilt issued, but it will be a lot less in volume if you address it early.

Second, involve the senior in the decision making process. One of the problems is that seniors feel they have lost control over their lives. Involving them helps to overcome that reality. A good tip is to first choose 3-5 facilities and then ask the senior to pick a few in which they would consider living. Once that process is complete, take the senior to visit the facilities. When a senior can see for themselves that the place is not all bad, they may be more willing to accept change. If they find one that they like, take them to lunch there as often as possible. This process allows them to make friends, and that is a powerful tool for both you and the senior.

Third, be clear about visiting. People who feel "dumped" have a difficult time adjusting to their new life. This is a commitment that should involve the entire family. If you are an adult child who lives far away, your commitment can be to call or write letters often. Send a care-package now and then. These little actions make the feeling of being alone diminish. They also decrease guilt, worry, and loss.

Tools That Empower the Positive Side of a Placement

Laws vary from state to state, but the federal government offers nationally recognized standards for senior care facilities. There are many opportunities for you to research facilities. Take the time early to do so. It is always better to be prepared rather than being thrown into action because of a crisis.

Here are a few resources that can help you research and find a great facility for your loved one:

• National Center on Elder Abuse by the Administration on Aging - Here you can find a ton of information aimed at all levels of senior care, including placement. They have a library for research, information on abuse, and resources that can help you make placement a win, win situation for everyone involved.

• ALFA Creating the Future of Senior Living offers a valuable Assisted Living Community Evaluation Checklist that is free and comprehensive. This is also an excellent place to find information and resources.

• CANHR California Advocates for Nursing Home Reform is another outstanding resource. This site serves as an example of what is likely available in your state. It offers a lot of tools for those who live in California.

Involve outside resources when you need support. Clergy can make a difference; your aunts and uncles, and even your senior's doctor can be important. You can always divulge information to your senior's doctor, just don't expect them to give you information in return without written consent from your senior. It is perfectly ethical to provide information and ask for help if you need assistance. Sometimes the professional approach works best.

Even with planning, this process is not always easy. There is work involved in making this a better situation. Invest the energy and do the work before it needs doing. You will thank yourself, and your investment should result in a more positive outcome for your loved one.