One of the hardest decisions caregivers face is whether to keep a loved one living at home or move them into an extended care, nursing home or rehab facility. Just considering it as an option often brings up tremendous guilt, and actually taking steps toward invoking that option – researching facilities, getting advice and comparing costs and benefits…not to mention filling out paperwork – can result in feelings of failure and even betrayal.

Many times, family members make promises early in their caregiving role to keep their loved one at home…then over time find that keeping that promise requires more time, energy, attention, care, and sacrifice of the other important aspects of their own lives than they ever could have anticipated.

The challenge then begins of facing your own feelings about “breaking” a promise, and – just to add insult to injury – then having to also face non-caregiver family members’ negative judgments about this change (and sometimes about you for considering it!).

This is a time when you will most need family support and understanding! But, unfortunately, it could potentially be a time when you find yourself instead on the receiving end of emotional blackmail, resentment, and a fracturing of relationships. (There’s much more on this topic in Chapter 6 in Take Back Your Life: A Caregiver’s Guide to Finding Freedom in the Midst of Overwhelm.)


Many caregivers try desperately to keep their loved one at home, while placing their own health and wellbeing on a back burner (or ignoring them altogether). The initial decision to keep someone at home may stem from a very loving and caring intention, but it’s absolutely essential to remind oneself that the original intention was not based on the very different reality that caring commitment has become over time.

Facing these changes, you need support and compassion, not judgment or guilt. You must make the caring but rationalchoice that best represents achieving and outcome that’s for the greater good of all concerned, even if it means changing plans and expectations. And you have to keep in mind that that “greater good” includes yours!

There are some basic steps you can take as you begin to acknowledge that caring for your loved one at home is increasingly less realistic and less doable.

PLEASE NOTE: All too often this realization happens as a result of a crisis of some kind in your loved one’s life: a slip and fall, the shock of a first episode of wandering, another late night trip to the ER, or a sudden decrease in functional abilities. Equally frightening is when you have a health crisis or begin to experience physical challenges – you might even experience cognitive stresses from having taken on so much and your energy being so depleted.

Whatever the triggering event, awareness of this sudden need for a radical change is usually the catalyst in needing to make radically new decisions as a caregiver. It is far better to have considered your options well in advance of needing to make a change than to suddenly have to start at the beginning of the process while actively dealing with the crisis itself.


Keep the following self-calming practice handy for those moments when you start to feel anxious or overwhelmed when dealing with the prospect or implementation of transitioning your family member to someone else’s capable hands.

5 Steps to Support Your Serenity When Facing a New Care Plan Decision

  1. And we breathe…. Yes! This is the first step – as always – because the breath gives you space and the ability to face new possibilities and decisions with clarity.
  2. Share the situation. Don’t let fear of others’ reactions cause you to keep to yourself the news that a change is needed “until it’s all figured out.” Once you have achieved your own clarity about the overall circumstances and the likely best option, tell family members who are also involved, however peripherally, in your parent’s care what the situation is. Explain in detail the new reality you all face, and the resulting new non-negotiable requirements for both your loved one and yourself. State what you know with assertiveness and clarity – “just the facts, ma’am!” – keeping emotions to a minimum as much as possible.
  3. Keep your Desired Outcome clear in your mind as you explore options. It’s perfectly acceptable to explore all available options for ongoing care as long as you are clear that the ongoing care will have to be done differently than it has been up till now. You can be willing to help and support without providing the daily care that has so far been done by you, but you must also be ready to surrender whatever you cannot – and should not – continue to provide. Breathing is especially important during this step.
  4. Allow others to step up as you step back. If all the care has been on your shoulders, remind yourself often that it really is OK to step back and let others in the family take on more responsibility, as challenging as that may be at first. If the care has been divided between family members and the others involved are absolutely unwilling to explore the option of long term care facilities, delegate your responsibilities to others so that you can take care of your own needs respectfully and compassionately.
  5. Set and maintain healthy boundaries. You MUST avoid getting sucked into the emotional manipulation and blackmail that often occurs at this stage. Everyone may have differing ideas, and while it’s important to listen to others, that doesn’t mean it has to be done their way, or that your opinions don’t count!

Taking steps that change the dynamics of care for your loved one requires you to accept the reality that your needs and feelings MUST count. I can’t emphasize it strongly enough: When you allow your needs and feelings to be ignored (especially by you!), you will be unable to compassionately care for your loved one. This is about you taking as good care of yourself as you do of those you love, so you can continue to be a loving and caring presence in their life.


Download my Caregiver’s Step By Step Guide now for even more daily, moment-by-moment support, guidance and encouragement as make whatever changes are needed to take the best possible care of both your loved one and yourself.

And stay connected! Leave your comments or questions below.

And we breathe…
~ Loren


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