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It’s difficult to see an aging father reach a point where full independence is impossible. Helping Dad transition from a role of caregiver to that of someone who needs care can be just as difficult—and can begin to feel like an exercise in walking on eggshells. Polite offers of help can be met with stern rebuffs, leaving you feeling helpless.

No one is ever fully ready for the tough, but necessary, conversations with a father who is clinging to his former way of life, but prolonging his struggles could have serious consequences in the long run.

To help prepare you to approach these tough conversations and difficult transition, we’ve come up with a list of five crucial questions to ponder. We’ve contacted elder care experts to provide valuable insights on each of these core, complex issues. It’s our hope that, as you answer these questions for yourself, you can more confidently help your loved one transition to the next stage of life with dignity, compassion and a clear path to personal fulfillment.

Navigate to specific questions using these links, or simply scroll down for the entire piece:

  1. Is Dad still able to live alone?
  2. How do we start the conversation with Dad about moving to senior care?
  3. How do we pay for this?
  4. What do we do if Dad needs to sell the house?
  5. How do we make sure Dad always feels included?

 

1. Is Dad still able to live alone?

It can be difficult to recognize that an elder parent is no longer able to live independently. Most likely, Dad won’t admit he needs help. But there are certain financial, emotional, hygienic and mental signs children can look for to determine whether or not Dad needs regular assistance:

  • Dad’s house has become messy. “You may remember a parent who enjoyed a house that was spotless and things were organized, clean and in the right place,” writes St. Louis Post-Dispatch columnist Aisha Sultan. “However, upon visiting with Mom or Dad now, the home is cluttered and not nearly as clean as normal. This could be a sign that your parent is having a difficult time keeping up with all the chores.”
  • Dad’s refrigerator is bare. The team at eCaregivers says checking the refrigerator can tell you a lot about how your father is living. Too little food could indicate Dad is having trouble cooking, driving to the grocery store, or even carrying groceries inside from the car. eCaregivers also advises to check for spoiled food, which could indicate increasing forgetfulness or even a decreased sense of smell.
  • Dad’s hygiene is beginning to suffer. “If you notice that your parent is wearing the same clothing day in and day out or that their hair or skin appears dirty on a fairly regular basis, they may have lost the motivation, ability or forethought to look after themselves,” Sultan writes. “They may have forgotten or simply no longer care that such personal hygiene and cleanliness is an important part of daily living and maintaining one’s good health.”
  • Dad no longer socializes. Paula Spencer Scott at com notes that elderly parents’ social circles do tend to shrink, but if Dad has stopped going to meet with friends or leaving the house to pursue hobbies, this could mean he feels afraid to go out alone, or even that he’s suffering from depression.
  • Dad’s bills and his other mail are piling up. “This may be another sign of memory issues or difficulty with simple math cognition,” Sultan writes. “It can also indicate a general apathy, a mindset that can be equally problematic for someone with the glut of responsibility required to effectively live alone.”
  • Dad has stopped being active. Again, this could be a sign of depression. “Feelings of loneliness are linked to cognitive decline and an increased risk of dementia, depression, and lower mobility,” eCaregivers writes. “[Seniors] can also lose interest in hobbies that they once found to be enjoyable. The lack of motivation can cause a decrease in appetite that may contribute to their declining physical condition.”

Taken alone, a single sign may not indicate that a parent needs outside care, but as the number of signs increases, so does the probability that assistance may be necessary.

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Could in-home care be the solution for Dad?

Most elderly people prefer to stay in their homes—even when it’s at the expense of their own well-being. One way many families accommodate this desire is through in-home care, whether  delivered by a professional or through the collective efforts of family members.

The former option can be expensive. Clare Absher, a registered nurse writing for CarePathways, calculates that an in-home caregiver who works 40 hours per week costs about $3,500 per month.

The other option—family members taking turns helping Dad—might save money, but it can also place an overwhelming emotional burden on families, especially when those caregivers also have their own children to care for.

The burden on caregivers and families

Families taking on the role of caregiver creates what’s known as the “Sandwich Generation effect,” which the University of Michigan’s Depression Center touches on at its DepressionToolkit.org site.

“The scientific literature confirms what many sandwich generation caregivers know all too well: the burden of caregiving is significant,” UM researchers write. “Although both men and women may assume caregiving responsibilities, statistics show that women bear the brunt of that responsibility.

“And societal expectations and current economic realities can combine to make that burden even heavier. In many, indeed in most cultures, women are expected to assume caretaking responsibilities for children and other relatives.

“Coupling that expectation with the increased pressures today’s economy places on household finances, more and more women find themselves returning to work or increasing their working hours, in some cases compensating for a spouse’s job loss, with no corresponding relief in their caregiving duties. The result can mean stress, anxiety and depression for the caregiver and the entire family.”

Caregiver guilt

“Guilt often plays a big role in caregiving,” says Patricia Smith, founder of the Compassion Fatigue Awareness Project. “Guilt was most likely created early on with patterning or modeling by parents, other family members, teachers, etc. These patterns of being guilt-ridden are very difficult to overcome. They run very deep within the caregiver’s psyche.

“Overcoming feelings of guilt can be diminished or even alleviated with professional help and a commitment to care for oneself first in order to have something left to give others. Guilt should play no part in caregiving, but unfortunately, it does.”

If there are family members who have the skills, patience and time to be effective caregivers, Dad might do very well at home. But few families are so lucky. As Dad ages, what’s required to provide in-home care can become too much to bear, and those families will once again need to revisit options for care outside of the home.

Senior living facilities: Know your options

Though most of us lump living options for elder people under the term “retirement home,” there are a large variety of living arrangements available to seniors, each with different types and degrees of care. It’s important to understand the characteristics of each when weighing options for Dad.

Retirement communities

Retirement communities allow residents to live independently. These communities provide social benefits—Dad would live alongside numerous other seniors, for whom the community’s staff would organize activities, provide housekeeping services and prepare meals.

Retirement living could be a good fit for Dad if his needs are social, and his health doesn’t require regular monitoring. Expect to pay anywhere from $1,500 to $4,000 per month for most retirement communities.

Assisted living

Assisted living communities have staff on hand to provide residents more comprehensive care with day-to-day living, and those services can grow as a resident’s needs change.

“A key benefit of an assisted-living community is that, should your loved one’s health deteriorate, services are already in place to provide extra care in the same facility,” Ilana Polyak writes at Health.com. “He or she can start with a basic apartment and live independently, with services such as cleaning, meals, and transportation taken care of. If additional assistance is needed—with dressing, bathing, or walking, for example—that help is available.”

Polyak says to expect to pay about $3,000 per month for assisted living. This cost might be at least partially offset by Medicaid, for seniors who qualify.

Nursing homes

Nursing homes have medical professionals on hand to monitor residents’ health around the clock, so these are best-suited for seniors who have complex, long-term medical issues. These issues include:

  • Seniors with dementia, Alzheimer’s, and other severe cognitive impairment or behavioral problems
  • Seniors with “complicated medical conditions that require regular monitoring—for instance, those whose use of blood thinners involves regular testing to adjust the dosage,” per author and journalist Paula Span at The New York Times’ The New Old Age

The second point is an important distinction, Span points out, because, unlike at a nursing home, staff at an assisted living facility cannot legally administer medication in most states. “So someone who stuffs pills into her purse, or whose dementia means that moments later she won’t remember to swallow them, may easily fall off her drug regimen.”

Nursing homes are the best option if Dad requires constant medical attention. Expect to pay at least $4,000 per month, and possibly even double that, for nursing home care. Some of that cost should be covered by Medicare, as well as Medicaid for seniors who qualify.

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2. How do we start the conversation with Dad about moving to senior care?

In 2010, advice columnist Amy Dickinson was interviewed on NPR’s Talk of the Nation and spoke to the challenges her family had in helping their ailing mother understand her need for senior care.

Those family conversations got off to a few false starts, she said. “With us—I think this is very typical—you start crying in the snow, in the parking lot of the hospital because your frail, elderly family member is falling or, you know, ill—so these conversations usually start among, you know, younger family members when everyone is under duress, and it’s an emergency and everybody flies into action.

“And then nothing really happens because … your parent recovers enough to get back home. They’re like: ‘That’ll never happen again. I’m good.'”

Many times, though, that elderly parent isn’t so good, and it falls to loved ones to recognize it. This is what Dickinson’s family did, and she said it brought them closer together.

“We started to talk about things we had never talked about, and we became intimate in a way that we never had been. … Part of the intimacy was the realization that we had to face this as adults and as daughters, and that we had to do the really hard stuff.

“And we started talking to my mother about this about 18 months ago. Remember when your kids were young, and I remember thinking, oh, the sex talk. It’s just the one talk. Well, it’s not … this took a really long time.

“Our mother was very resistant, and we had to keep talking to her about it, opening up as a conversation, not pressuring her…It’s like you can’t force—it is very, very challenging to force someone to do this. And you don’t want to force someone.”

Dickinson’s last point is key: It’s important to not force an elderly parent to do anything. Convincing a parent to move to a senior care facility instead requires persistence, patience and empathy. Below are some sage bits of wisdom to help guide these conversations with your parent.

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The earlier you can begin the conversation, the better

What Dickinson described about her own family is rather typical. It often takes an accident or a medical emergency before children of an elder parent begin to think about senior care options.

But this timing is less than ideal, as elderly loved ones can feel especially vulnerable in the days and weeks after they leave the hospital. It’s better to begin the conversation well before long-term care becomes a pressing need.

“A good time for this is around an aging parent’s annual medical physical or birthday,” says Barry J. Jacobs, PsyD, co-author of AARP Meditations for Caregivers: Practical, Emotional, and Spiritual Support for You and Your Family.

“Adult children should use these opportunities to ask the parent how he ideally would like to live as he becomes older and more physically limited. The children should reassure the parent that this isn’t a ploy to take over his life; instead it is a strategy session to ensure that the parent’s wishes are upheld (e.g., to continue to live independently as possible).”

Framing the conversation this way gives your family an opportunity to explore options as eventualities, not as looming, dramatic life changes. Dr. Jacobs says this is the time to begin thinking about downsizing homes or considering retirement communities.

“Moves such as these shouldn’t be framed as catastrophic losses for the parent (‘being put out to pasture’) so much as new means for them to live as independently and as well as possible in an environment with built-in supports to foster increased functioning and safety.

“Family members tend to avoid discussions about making age-related changes for two reasons:

  • They don’t want to upset and possibly insult their older member; and
  • They have a magical belief that if they don’t think about a person’s possible decline then it will be less likely to happen.

“I try to assure family members that having open and honest conversations about creating contingency plans—including the prospect of moving into an assisted living facility or retirement community—to deal with aging is actually the more prudent and caring approach.”

Handling pushback

No matter when you broach the subject, Dad will likely resist the notion at first. Now is the time for patience—if you’ve started the conversation early, time is on your side.

Be prepared to meet your father’s objections with thoughtful, caring reasons why a senior living facility is the best option for him. In an excellent piece at AgingCare.com, Lori Johnston recommends firm-but-empathic rebuttals to the most common objections Dad might have. Her advice can serve as a rebuttals cheat sheet:

  • Rebut any “Oh, don’t worry about me” responses with an affirmation that, yes, you do care, and it’s your job to do so.
  • Rebut any hesitation or “I’m not ready yet” responses with an invitation to move the conversation forward so you’ll all be prepared when Dad is
  • Rebut any concerns about moving being too much effort by pointing out how many daily tasks such as housekeeping or yard work can become someone else’s responsibility, giving Dad more time to enjoy life.

Above all, ensure you’re keeping Dad’s best interests in mind, that you’re clear and transparent with him,  and that you’re not forcing the issue.

“It would be a shame to let the struggle for control eclipse your well-intended efforts,” writes Jody Gastfriend, VP of care management at Care.com. “It may be painful to bear witness to your parents’ bad decisions. But they have the right to make them, unless they are deemed medically incompetent or a danger to others (with, for example, unsafe driving). Resistance is common, and the best way to address it is through understanding, patience, and even humor!”

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Dealing with feelings of guilt or doubt

“Preparing to move our loved ones into an assisted living or senior care facility is, arguably, the most difficult thing we are asked to do,” Smith from the Compassion Fatigue Awareness Project says. “While working or volunteering in a caregiving environment in general is stressful and difficult, nothing compares to the family caregiver. This is due to the intense emotional levels we experience when caring for a loved one.

“Often, the person being cared for becomes angry and combative, especially if he or she doesn’t have an awareness of how dire the situation is. The best way to approach this challenge is to accept that the loved one being helped is not the loved one you knew in the past. Illness or disease has changed that person, particularly if Alzheimer’s or dementia is present.

“The emotions of the caregiver at this time can range from guilt to relief to fear to profound sadness. It is simply a roller coaster ride. If a caregiver doesn’t practice authentic, sustainable self care daily, a secondary traumatic stress syndrome can surface. It is called compassion fatigue, and it can devastate the life of a caregiver.”

Taking steps to ensure quality of life and dignity

Remember, the purpose of helping Dad transition to a retirement community or to assisted living is so he can find fulfillment and a better quality of life. Keep this at the forefront of your thoughts as you speak with him about moving.

“Prior to moving an elder loved one, family members can encourage sense of fulfillment at this stage in the elder’s life through active involvement in the placement and transition process, helping to ease psychosocial stress,” says Crystal McGaha, graduate student of gerontology at Nova Southeastern University in Jacksonville, Florida.

“Family members play an important role throughout the process of relocating an older loved one; assisting in creating a vision; providing support, guidance, and direction; seeking to meet needs and preferences; handling safety concerns; attempting to eliminate fears and drama; and encouraging open communication.”

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3. How do we pay for this?

This is the biggest question most families must face when preparing to move Dad to a senior care facility. Virtually all options will cost in the thousands of dollars each month—even with Medicare coverage. Your family will need to work out a budget to ensure Dad gets the best care that’s financially possible.

Your options for financial assistance

The team at PayingForSeniorCare.com has some of the best resources for understanding elder care financing options.

Begin with the site’s financial assistance locator. After you enter information about Dad’s assets, insurance coverage, current health and senior care needs, the calculator will return any available options for financial assistance.

Depending on Dad’s circumstances, these could include:

  • Medicare
  • Medicaid
  • Social Security programs
  • Veteran pension and benefits
  • Public programs and tax credits
  • Home equity
  • Private loans

Note that Medicare only pays for medical care, which excludes any assistance with things such as bathing, grooming and mobility. “Medicare does not pay for home care or assisted living,” writes the Paying For Senior Care team. “Medicare does cover nursing home care and some personal care is provided in nursing homes. However, Medicare does not cover nursing home care at 100% and Medicare only pays for a limited period of time.”

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Deciding on the right facility for Dad

According to Patricia Smith at the Compassion Fatigue Awareness Project, doing your homework ahead of time will pay dividends later.

“Talk to friends and colleagues about their experience in finding compassionate, quality care,” she says. “Get a list together of possibilities and go visit each site. Talk to the people who manage the facility and ask targeted questions with specific references to your loved one (e.g., ‘My mother values socializing with others. Does your program provide opportunities for social events?’).

“Figure out the finances. Nothing creates more stress in caregivers than not having the resources to pay for the care.

“And finally, sit down with your loved one and explain the situation in a compassionate, empathetic way. Bring your loved one to the site and tour the facility to be sure you have located a good match.”

Once you’ve found the right match for Dad’s needs, you can get a clear idea of the costs and start preparing a budget.

And if your budget is a little short for Dad’s preferred facility, there are ways to bring the monthly price down, the Paying For Senior Care team points out:

  • Go for a smaller apartment or room. “Modern communities typically offer enough public spaces and activity rooms that residents often find they don’t require a large private room,” they point out. “Renting a studio instead of a one-bedroom apartment can reduce monthly payments by 15%–20%.”
  • Negotiate fee waivers by strategically timing Dad’s move-in date. “Residences are often willing to give price breaks at the end of month, end of the calendar quarter or their financial quarter. … While most communities resist negotiating on the monthly rent, they will often waive the ‘community fee,’ which can equal several months rent or offer ‘move-in credits.'”
  • Understand the level of care Dad requires. “The service contract with an assisted living community stipulates the ‘level of care’ required by the resident. The level of care specifically lists the services required by the resident and the cost of those services. Some communities offer both an all-inclusive package and care on an as-needed basis. Choosing the correct right level of care can save families hundreds of dollars [each] month.”

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What you should know about long-term care insurance

Long-term care insurance helps seniors pay what Medicare doesn’t cover. Policy costs, and what they cover, vary depending on your coverage needs and your age when you take out the policy. AARP recommends that late-middle-age adults look into long-term care insurance—unless they already have money set aside to cover these costs.

Long-term care insurance isn’t a catch-all, however:

  • It’s expensive. The sticker shock from this kind of insurance, AARP notes, creates tension because the normal person is unable to imagine needing assistance in their everyday lives, and instead desires a nest egg to pass on to their children.
  • Not everyone qualifies. The U.S. Department of Health’s gov site lists a few common reasons people do not qualify for long-term care insurance:
    • They already need the daily assistance this insurance provides
    • They have AIDS
    • They have dementia, Alzheimer’s or another severe cognitive impairment
    • They have a history of strokes
    • They have a progressive neurological condition
    • They have metastatic cancer

Though long-term care insurance works best when invested in long before it is needed, it’s still worth exploring even if Dad’s needs are imminent.

“The conventional wisdom has been that if you have limited income and resources (defined by many experts as having assets, including your home, that total $50,000 or less) or you are very rich, you can forgo this insurance,” the AARP writes. “In the former case, the government—i.e., Medicaid—will pay for your care, and in the latter you’ll have sufficient resources to pay for it yourself.

“But if you’re somewhere in the middle, [long-term care insurance] is probably the best way to preserve your assets for your heirs, spare them a large portion of the physical and financial burdens of your care, and enhance your chances of getting your personal choices of care met.”

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Options available to homeowners

If Dad owns his home, there are ways he can use that asset to pay for care without having to sell the house outright. There are two primary options:

  • Reverse mortgages
  • Home equity loans and home equity lines of credit (HELOCs)

Reverse mortgages

A reverse mortgage essentially promises Dad’s home to a lender, who would pay him for it in regular installments, in one lump sum, or in a line of credit. “The most popular choice is the line of credit because it allows a borrower to decide when he or she needs the money and how much,” the team at Elder Law Answers writes. “Moreover, no interest is charged on the untapped balance of the loan.”

Note that this isn’t the same as Dad selling his home. “Borrowers who take out a reverse mortgage still own their home,” Elder Law Answers writes. “What is owed to the lender—and usually paid by the borrower’s estate—is the money ultimately received over the course of the loan, plus interest. In addition, the repayment amount cannot exceed the value of the borrower’s home at the time the loan is repaid.”

As the team at Investopedia says, “In general, a reverse mortgage is considered a better choice if you are looking for a long-term income source and don’t mind that your home will not be part of your estate.”

To qualify for a reverse mortgage, Dad must be at least 62 years old, and he must not have other debt taken against his home.

Home equity loans

A home equity loan allows Dad to use his house as collateral in exchange for cash or a line of credit. A home equity loan would not affect ownership of the house or his estate, provided he is able to pay back the loan plus interest.

“A home-equity loan or HELOC is considered a better option if you need short-term cash, will be able to make monthly repayments and prefer to keep your home,” Investopedia says. “Both [reverse mortgages and home equity loans] bring considerable risk along with their benefits, so review the options thoroughly before taking either action.”

As the Federal Trade Commission (FTC) reminds us, the United States has a law in place—the Federal Truth in Lending Act—that requires lenders to disclose APR, payment terms, and any upfront charges. It also provides a legal way to get back any fees paid if contract terms change and you decide to back out of a plan.

“Once your home equity plan is opened, if you pay as agreed, the lender, generally, may not terminate your plan, accelerate payment of your outstanding balance, or change the terms of your account,” the FTC writes. “The lender may halt credit advances on your account during any period in which interest rates exceed the maximum rate cap in your agreement, if your contract permits this practice.

“Before you sign, read the loan closing papers carefully. If the HELOC isn’t what you expected or wanted, don’t sign the loan. Either negotiate changes or walk away.”

Other options for homeowners

If a loan or a reverse mortgage isn’t the right fit, this might be a good time to bring up the idea of selling Dad’s home to pay for long-term care.

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4. What do we do if Dad needs to sell the house?

Many families ultimately decide that the best way to pay for long-term care is by selling an elder parent’s home. This decision is a tough one for several reasons:

  • It could mean parting with the home you grew up in. For Dad, for you, and for everyone else in the family, that could be a deeply emotional experience.
  • It means you’ll need to contact financial planners, real estate agents and attorneys to handle the details of the property sale. Significant work goes into the transactional facet of selling a home.
  • It means Dad and the rest of the family will have to go through his things to decide what he should keep, what he should sell, and what he should pass on to younger family members.

Budget plenty of time to go through Dad’s things

“What most need to remember is that it has taken years to accumulate the belongings of the house, and it will take time to go through things,” says Susan Danick, owner of senior relocation service TAD Relocation in Washington, DC, and a member of the National Association of Senior Move Managers.

“It is impossible to realistically think you can downsize in a matter of a few weeks what took 30, 40 or 50 years to accumulate. Many items in the home have been collected over time from travels they took as a family, all bringing back memories of good times together. There are often collections through the family generations that have accumulated in the house. They may have their things, their parents’ things, their grandparents’ things and their kids’ items that got left behind once they moved out.”

Danick recommends downsizing Dad’s home well before moving even becomes a question.

She says one of her clients kept a box in the trunk of her car, and each time she went for a visit would fill it with items her parents no longer wanted. On the drive home, she’d donate what she could and recycle the rest.

“Start now by going through closets, basements and attics so that when you do decide to move you will be ready and not overwhelmed with 40 years of stuff,” Danick says.

Gillian Carty-Roper agrees. A professional organizer, National Association of Professional Organizers member, and psychologist at DC-area senior living facilities, Carty-Roper has seen first-hand how chaotic downsizing can be when done in a hurry.

“My sense from working with older adults is that they have mixed feelings about having to part with possessions acquired over the years,” she says. “This process is easier if it is done with their input and over time, versus when there is a crisis and others make the decisions in a rush.

“All this is to say that in my opinion we are better off downsizing in place beginning somewhere in our 60s, when we may not as yet have health problems that limit our ability to participate in the process.”

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Understand how much Dad can bring to his new home

Danick says many of her clients are pleasantly surprised to see how well their furniture, family photos and other cherished belongings fit into their new homes.

“Most communities offer a floor plan, and we can scale out the plan to show how those pieces most important to them will fit in their new space,” she says. “Most of our families/clients are spending the majority of their time in 2 or 3 rooms of their home, so reducing their space to accommodate what they use on an everyday basis is not a difficult process. It is finding the right size space for this time of their lives.”

Carty-Roper says that in her experience, and depending on the size of their rooms or apartments, elder parents have been able to bring

  • 1 or 2 pieces of furniture they especially love
  • Wedding photos and family photos that can be put in frames
  • Reading material
  • Throws, blankets and bedspreads

“Of course, clothing also has to be downsized, and it is a time when one may have to part with some dressier or fancier items,” she says. “Based on what some residents have shared with me, if they have children or close friends they try to get them to take treasured items for which they will not have space, and sell/donate the more common everyday stuff.”

This process will get emotional for you and Dad

The things in our homes can evoke strong memories, and sorting through Dad’s belongings will likely raise intense emotions and give you both a chance to reminisce.

“When working together with their kids, parents might be ready to let go easier than the kids, throwing out old photos and other items where the kids might all of a sudden question, ‘How can you throw that out?'” Danick says. “The kids do not necessarily want the items but are not ready to see their parents let go of them.

“On the other hand, the parents could be resistant to let go of certain things, but if they knew that these things had a good home to go to and were not just going to be thrown away, it makes parting with them a bit easier. We tell kids if their parents offer them something, say ‘Thank you’ and take it out of the house with them as they leave to help with the letting-go process. It is then up to the kids at this point to decide if they would like to keep, donate or sell these things.”

A realtor’s advice

Nancy Sorg, a realtor with Virginia Beach-based Rose & Womble, says the most emotional home sales are those where an elder parent sells the home in which they’ve raised a family.

“[It’s a] very emotional decision, and many times there are also health issues present and a feeling of loss of control over their life,” she says. Sorg is also a partner at Virginia Coastal Connections, which recently launched a collaborative effort with local senior living community The Crossings at Independence to help residents and their families make the transition to senior living.

Sorg recognizes how overwhelming home sales can be for elder family members, so her company connects families with a variety of professionals to help with the sale:

  • Home stagers who can make a home more marketable
  • Law firms specializing in elder needs that can help with power of attorney, living wills and integrating a home sale within existing estate plans
  • Loan officers and financial planners
  • Contractors to make repairs or updates before the home goes to market

If Dad makes the decision to sell his home, it may be beneficial to find those who provide these services locally.

Sorg also advises having self-storage available during and after the sale. “Instead of selling all of the furniture and personal items immediately, storage could help with the emotional transition,” she says. “Storage could also be helpful because sometimes there may be more than one transition—independent to assisted/memory center, etc.—and often times there are wait lists.”

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5. How do we make sure Dad always feels included?

Once Dad is settled in his new home, active steps are needed to ensure he doesn’t feel alone. This goes beyond regular visits: Dad needs a clear role and responsibilities within the family so he continues to feel a part of everyone’s lives.

Below are some steps you can take to ensure he feels included.

Be there to offer support and care as needed

If a dedicated staff takes care of Dad’s day-to-day needs, you and the rest of the family can now focus your energies and attention on strengthening your bonds with him.

That said, adult children should still be involved with Dad’s care. Peter Robinson, vice president of marketing and public relations at LifeSpire of Virginia, says that for adult children with a parent in a nursing home, involvement is crucial and should include regular visits, getting to know the staff and attending care planning meetings. He also recommends family members stop in announced and unannounced—just as you would when he lived at his old home.

“Show up, involve them and seek their input and advice in family matters from education, health, business and finance to charity,” advises Paul Irving, Chairman of the Milken Institute’s Center for the Future of Aging. “Facilitate active and engaged grand-parenting. Give them an authentic reason to age as well as they can.

“Enabling them to define and realize purpose in their lives could not be more important for their health and well-being. All of us seek meaning and purpose, and older adults are no exception. They appreciate the opportunity to share the wisdom, experience and perspective that they’ve accumulated in their lives. And even those experiencing significant cognitive decline need and deserve company, connection and compassion.”

Listen to his needs

Dad might be unwilling or unable to fully articulate his wishes and needs, so you might have to read between the lines. Being an attentive, patient listener can have a profound effect on his own quality of life.

“As an elder loved one begins to settle in a new living environment, family members can assist in helping to ensure sense of fulfillment by maintaining positivity; emphasizing and identifying that there are things to look forward to; following through with promises; encouraging the elder to embrace their new home; and demonstrating love, honor, and respect throughout the process,” McGaha at Nova Southeastern University says.

And if necessary, she says, pull out a pen and paper to help him plan big-picture goals and wishes. Whether by questionnaire or conversation, you can use this time to find out:

  • How happy Dad is
  • Where he finds hope and inspiration
  • His beliefs about his own life’s purposes
  • Whether he has a specific wish list or goals he’d like to achieve
  • Spiritual, physical or emotional elements he’d like to see brought into care practices
  • Whether he needs access to spiritual or religious materials
  • Whether he’d like an accountability partner

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Give Dad freedom to explore his sense of purpose

Whatever Dad’s physical limitations, he’ll still crave intellectual stimulation, good company and cheerful humor. Help him find ways to incorporate all of these into his life.

“When an elder expresses desire to be creative or to become involved with something, seek to make that possible for them, according to their abilities,” McGaha says. “Attempt to provide them the tools and extend belief in their talents and abilities. Brain exercise games are fantastic for building and maintaining cognitive function.”

She recommends the following activities, depending on Dad’s interests:

  • Lifelong learning programs
  • Scrapbooking or other arts and crafts
  • Animal visitation and interaction programs
  • Mentoring opportunities
  • Getting out in nature
  • Visits with grandchildren or even “step-grandparenting” programs
  • Board games or trivia
  • Life story and legacy building
  • Adult day programs
  • Any additional programs his new home offers
  • Telling stories over old photos or other cherished items
  • Reading
  • Prayer
  • Meditation
  • Any other reflective practice

“Family members can assist elders in finding fulfillment and purpose in life by identifying and incorporating activities that will nurture their physical, emotional, mental, and/or spiritual elements of life,” McGaha says.

One of the best ways to do this is to have Dad write down his bucket list with you. Not only will you have a plan of action for the next weeks, months and years, but you’ll likely develop new perspectives on him as a person.

“While older adults with physical and mental limitations, chronic illness and/or disease, and disabilities may not have the same possibilities as other individuals with full capacity, help them to identify what is possible,” McGaha says.

“Identify possibilities beyond their imagination that they are capable of. Extending life seems to be a common goal for researchers and medical providers, although just as important, if not more so, researchers and care providers should seek to improve the ‘life’ in those years.”

Case in point: Ann Lovell, the director of corporate communicates at LifeSpire of Virginia, told us the story of one centenarian, Buddy Hamilton, who spends time every single week volunteering at his church’s homeless ministry.

“[Buddy] told me recently that his role has shifted from envisioning the future to dreaming about the past,” Lovell says. “Rather than planning for the future and working hard to provide for the family, the role of an elderly parent shifts to offering advice and counsel to the younger generations, especially grandchildren. Their stories, experiences and wisdom are often untapped resources that can help younger generations avoid pitfalls, temptations and mistakes of past generations.

“While America is a youth-centered or youth-focused culture, cultures with oral traditions often look to the ‘village elders’ with great respect because of the wisdom these elders have gained through their life experiences.”

Give Dad new responsibilities within the family

Even without committing to volunteer work, Dad can embrace his role as a father, as a grandfather and as a friend.

Entrust him to help younger family members with homework, to call people on their birthdays, to tell stories and to help out anywhere he can.

McGaha says you just might be surprised by Dad once you assign him a role that respects his personal abilities and his comfort level. “It is incredible to see the excitement, personal fulfillment, and progress you can see from an elder when you allow them to take on some sort of responsibility, challenge, and/or opportunity to lead,” McGaha says.

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