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When your family disagrees about a parent's care

Most families do not start out agreeing about this, and the disagreement is not a sign that something has gone wrong with yours. In one study that followed 22 older adults and their family members through an assisted living decision, 15 of the 22 pairs held conflicting or differing views about the move. The research reviews on how these decisions actually get made list intensifying family conflict as an ordinary feature of the point families reach before they start looking — named in the same breath as exhaustion and not knowing where to turn.

Almost everything else written about this is published by a company that is paid when your parent moves in. That is not an accusation about the advice, much of which is kind and sound. It is a note about which direction it is free to point. No community pays to be listed here. Nothing on this page is worth more to us if your mother moves than if she stays exactly where she is, so this page is allowed to end in not yet, and sometimes it does.

The argument is usually five arguments

Should Mom move? is not one question, and families get stuck because they answer it as though it were. Underneath it there are usually five, they belong to different people, and they have different kinds of answer.

  • Is she safe where she is?
  • Who is doing the work, and what is it costing that person?
  • What would it cost, and who pays?
  • What does she want?
  • What do we owe her, and what would we not forgive ourselves for?

Two of those have answers you can go and look up. One has an answer only your parent can give. One is a question about a person you both live with and see differently. And the last one has no answer at all — which is exactly why it is the one everybody ends up arguing about at eleven at night. Getting them apart is most of the work.

The parts that are a matter of record

Three of the things families argue hardest about are not opinions, and looking them up ends the argument faster than another phone call does.

What a place is licensed to do

A license category decides what staff may legally do for your parent and what they may not — it is not a quality rating, and the two get confused constantly.

What the levels of care actually mean

What it costs, and what the alternative costs

Published regional medians, each one carrying the survey it came from, set against the cost of keeping her at home with help — priced the same way, on the same page, because that is the comparison the argument is usually missing. We do not publish a price for a named community, and neither can anybody else honestly.

The cost stack

What the state already knows

Inspections, substantiated findings and license status are public where we cover, and they are the part a tour cannot show you.

Find care · What to ask, and what to check yourself

Bring the link, not the recollection. A disagreement about a fact stops being a disagreement the moment somebody opens the record; a disagreement conducted from memory can run for weeks.

The part only one person can answer

There is one piece of advice the rest of this industry gives over and over, and it is worth carrying forward with its provenance attached: involve your parent early, and keep her the person deciding. We cannot point you to a study that measures it. The material that says it is published by the companies paid when she moves in, and they do not cite one either. What we will say is that it is the one recommendation in that corpus that costs its publishers something, which is a weak reason to believe a thing and a better one than none.

If her answer is no, that is an answer. Unless she genuinely cannot weigh the decision, it is the answer, and what changes it is not a better argument from her children — it is a clinical judgment about capacity, made by someone qualified to make it. That is a real thing with a real process behind it, and it is not one a family settles at a kitchen table or that a website can settle for you.

Powers of attorney, capacity and who is allowed to decide

The part that has no answer

Guilt is the thing most people are carrying when they get here. The reviews of this literature name avoiding the guilt of abandonment as one of five things families are doing while they choose — the others being keeping her safe, reaching the end of what one person can do, not knowing where to turn, and wanting to be told afterwards that they got it right. It is a described feature of this decision, not a flaw in you, and no conversation with a sibling resolves it, because it is not an argument and cannot be won.

We are not going to tell you that you have nothing to feel guilty about. We do not know that, and you would not believe it from a website. The narrower thing that is true and checkable is this: the average family caregiver in the United States is already doing about 27 hours a week of this before they ever start looking for help. Reaching the end of what one person can do is one of the five things the reviews find families weighing, alongside safety, not knowing where to turn, wanting reassurance, and the guilt itself.

Four questions, in writing, before the next call

Write these down and answer them in writing. Not because writing is nicer, but because a written worry can be answered and a spoken one escalates. Print this page and bring the sheet.

  1. 1. What is each of us actually worried about?

    One sentence each, in that person's own words, including yours. Most families discover here that they have been arguing about two different things.

  2. 2. Which of these is a matter of record?

    Mark them. Go and look those up before anybody says anything else. This is usually two of the five.

  3. 3. What would change my mind?

    Ask yourself before you ask your brother. If the honest answer is nothing, then the disagreement is not about the facts, and no amount of evidence will end it — which is worth knowing before you spend a fortnight gathering more.

  4. 4. Who decides, and by when?

    Name the person. Name the date. Most family stalemates are not disagreements about the right answer; they are disagreements where nobody has been given permission to end them.

If the answer to the fourth question is that nobody is ready to decide yet, that is a legitimate place to stop, and it still has a next step: what would have to be true four weeks from now for the question to be answerable? Write that down too, and put the date on it.

Someone in the room with no stake in it

If you want a third party in this conversation who gains nothing either way, there is a federal one. The Eldercare Locator will name the publicly funded agency that covers your parent's county — every state has one, though not every state calls it the same thing — or call 1-800-677-1116. The advice is free, and it is a different thing from the advisors who offer to help you choose a community.

Where this comes from

Every figure on this page is a paraphrase of one of these, read on the date shown. Two things on this page are ours rather than findings, and we would rather say so than let them borrow the authority of the list below: splitting the decision into five arguments, and the four questions to write down. The five recurring themes further up are from the review, and are the only "five" here that is research.