When do my parents need to go to a nursing home?

As my father ages, my sisters and I are, once again, collaborating on how to “solve” the problems. When do we need to move him to a nursing home?

What to Evaluate?

The short answer is the existing dwelling and the person’s ability to perform activities of daily living (ADL’s). We can delay a move by making the home more accessible and talking dad into utilizing more services to maintain independence.  Most importantly, he needs to become more aware of his own limitations.

Dwelling Considerations

The obvious answer to this is having everything on one floor. Here is a short list of discussion points that we came up with:

  • Ease of getting in and out of the house.
    • Stairs?
    • Paved driveway? Don’t want gravel or mud/rough terrain.
    • Can a ramp be put in?
    • Are existing handrails sufficient?
    • Landings – level/sturdy – slip hazard?
  • What is the home’s footprint – does it have an easy, logical flow?
    • Clearance for walker?
    • Where are handrails and grab bars needed?
  • Flooring?
    • Any carpet?
    • Bathroom/kitchen tile – is there enough friction? Fall hazard?
  • Are there internal steps/stairs?
  • What about the contents of the house? Too much to maintain?
    • Hoard/pack-rat problems?
  • Landscaping/Snow Removal?
  • Kitchen – how is it setup? Are cabinets accessible?
  • Can the bathroom be made accessible?
    • Do a tub cutout or zero entry shower?
    • Transfer bench – short term.
    • Sufficient grab bars?
    • Toilet – full height
    • Vanity – sturdy?
      • Usually leans on it.
    • Floor drain?
  • Laundry? Is it on the first floor?
    • Can it be put there?
  • Cleaning needs?


The only way to really monitor this or find out about your parent’s ability to perform activities of daily life is to go spend time with your parent. If you ask questions in an interview style, you may find that your parent is not exactly the most accurate historian. Or while technically able to perform a given task, it isn’t done in a safe manner. Some folks have a hard time admitting to limitations.

Here were our talking points between my sisters and I:

  • Grocery Shopping?
    • Do it or not do it?
    • Will he use an app?
  • Can he drive?
    • Should he drive?
  • Appointments
    • Transportation
    • Accurate historian?
  • Medication compliance?
    • Taking meds as prescribed?
  • Cooking – can he cook for himself?
    • Is he just going to get takeout?
    • Is he eating anything with nutritional value?
    • Safely use a stove/oven?
    • microwave?
      • Does he need a turn dial?
  • Trash
    • Can he take it to can?
    • Can he get the cans to the curb?
    • Will he take trash out?
  • Bathroom
    • Use the bathroom independently?
    • Wash self independently?
  • Dressing
    • Can he do this independently?
    • Do we need to look at wardrobe/shoes to make this easier?
  • Phone – can he use one?
    • keep it on the charger?
  • Emergency system
    • Fall alarm
    • Alexa hack – is it working?
  • Laundry – Can he do it?
    • Carry baskets?
    • Operate the dials on machine?
  • Furniture – it accessible?
    • Height of seat
    • Table sturdy?
    • What needs to be eliminated?
  • Aware of limitations?
    • Insight/Situational awareness?

Other Challenges

Our biggest struggle is my father’s independent/rebellious streak, coupled with him being unaware of his limitations. He still does things like he is 30 years old. He doesn’t seem to be aware of all the unnecessary risk that he is taking or the potential consequences if things don’t go off as planned.

Two newspapers a day.

By way of example… The newspaper. My dad and I both get two newspapers a day. The first challenge of his day is physically retrieving the paper. He has a raised porch. When the paper is on the porch and within reach of the door, he leans out to pick it up. He is already unsteady on his feet and bending over is a challenge. To me, at this stage, this is an unnecessary risk.

Challenge Accepted.

The real problem comes when the paperboy throws the papers on the walk, at the end of the drive, or the papers errantly land in the bushes. Rather than abandon the paper, my father transforms into MacGyver or Ethan Hunt. I watched this weekend as he dangled out over the threshold, holding on to the door frame, other arm extended, holding a broom handle that had a scrub brush fashioned onto the end of it as a retrieval tool for the Sunday Edition of the Columbus Dispatch.

His mother used to do the same thing every morning until one day she lost her balance, fell, and broke her hip. She passed ten days later. I reminded my father of this, it didn’t seem to really compute to him that he is standing in her shoes.

Old values die hard.

But that’s not where the saga of the paper ends. My father hates waste and loves to recycle. These values become a perfect storm for a bad outcome.

If my dad hasn’t finished a paper, he puts it in a stack to read later. If it has been read, he puts it in a stack to recycle (his community didn’t have curbside recycling until recently). In either case, the newspapers are stacked, inside the home. Before long, we’ve got stacks, six feet high of the Wall Street Journal and Columbus Dispatch. He refuses to throw them out because he wants to recycle. But now, the task of recycling has gone from something small, to something enormous.

In any event, this is the conversation I was having with my sisters this weekend. Hopefully it provides a helpful framework to consider if you’re having the conversation for the first time.

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