Does any parent ever decide on their own to move into assisted living? I told myself that my mother-in-law made this decision when she purchased long term care insurance. Her brother lost his home and ended up in a trailer on his son’s property, dependent on the care of his overworked children. She did not want that for herself, or for us.

Knowing this, why was I tossing in bed at 3am, feeling intense pain in my muscles? Why did my heart break and my brain accuse me of callous selfishness? Because my husband and I had to make the call for her, and it felt like we were torturing a puppy.

Many of us will have to make this call for our parents. This is the first is a series of blogs on what to expect when you are expelling grandma from her cherished home.

Our culture does not make this an easy conversation.

“No, grandma, we are not putting you in a nursing home. You are going to an, um…residential care facility. You won’t exactly have an apartment, it’s a, uh, single unit.” I search for words that do not sound like institution.

How did we know it was time? Professionals say that older people stay on a plateau for years and then experience a sudden drop. That triggers the need for a level of care that can only be provided by family or paid staff.

As in so many cases, it was a fall. She injured herself and was slow to recover. It came to her neighbors’ attention and they called us. We flew from California to Arkansas to assess the situation and within hours determined that she could no longer manage on her own. That seems to be the pattern: an incident, a flurry of phone calls, an assessment that clearly shows the family that mom or dad can no longer manage their own care, despite their insistence to the contrary.

Like heartless storm troopers we move in and condemn a living situation they have been content with for years.  How do you make a decision like this? Consider these three factors:

Safety – Someone finally noticed that grandma wasn’t coming out of her apartment and found her in bed because she hurt so badly from the fall. (No, of course she didn’t call us.  She didn’t want us to know.)

State of mind – “She is getting very forgetful,” neighbors called repeatedly to tell us. She was depressed over losing a good friend and neighbor. She stopped fixing her hair and rarely left her apartment. She was often confused.

Can’t manage – Because she was no longer getting to the senior center or the store, we arranged for home health care visits and meals on wheels. She dismissed the visiting nurse and barely touched food piled up in the frig. She hurt her back trying to wrestle an ancient vacuum cleaner through a high pile carpet.

Rocking on the porch at the RCF

Clearly she wasn’t safe and needed a level of care she couldn’t get in her apartment. Her doctor, her pastor, her friends and neighbors all confirmed our decision to move her. We had two choices. A rare opening came available at the residential care facility (known by all in town as the RCF). We could move her a few blocks over to a place with a good reputation, surrounded by people she knew. Or we could take her back to California to live with us. Isn’t that what a good son would do? Not necessarily.

We tried that once. The cultural difference between California and the Ozarks is immense. She was brave, but she wasn’t happy. We’d had her in our home at the holidays just two years ago. She wandered around in a state of confusion.

Without giving away details that I will share in future blogs, we are convinced we made the right decision to let her stay in her home town. After a roller coaster of emotions– frustration, anger, and tears–we saw a transformation. She turned into a girl again; a new hair-do, freshly laundered clothes, chatting at the dinner table and eating full meals, choosing to walk down the hall to join the hymn sing or rock on the porch with old friends.

She is well cared for and happy, and we are at peace.