One of the most difficult challenges we face is the need to place our loved ones in an assisted living facility or a nursing home. The decision is probably one of the hardest ones we will ever face in our lifetime. One thought you must keep in mind is that there are many good nursing homes available. It is up to you to assist your loved one if they are coherent in discovering what is available to them should the need arise. This requires research and investigation from sites as to what is available in the local area.
If your put off investigating, you will find yourself in a difficult position, if you wait until the time arrives that you must place them immediately.

After my father passed, my mother had become critically ill. There was a possibility that she would have to be placed in a rehabilitation facility if she did not recover. Fortunately she healed well and there was no need for placement. Time passed and I explained to her what I was feeling. I assured her I would never place her in a facility unless it was absolutely necessary. However, I insisted that she visit one or two homes so we would be prepared if circumstances ever led to her requiring placement. My mother was so resistant. It was if her life caved in on her. I carefully explained that as I had been working with so many caregivers online, I heard many stories of placement that were horrific because there was no time to “research and investigate.” I lovingly discussed her last bout in the hospital. I asked her openly how I could have handled it if I were out of the country on business or even living out of the state. She couldn’t answer. She understood and agreed to look at one or two homes.

We went to one of the best homes outside the city. When we got out of the taxi, her first response was,” If you ever put me in here, I won’t leave you a cent! Your father would have loved it because it is rural but I want to die in New York City!” We both laughed out loud at her response.

We began to view the facility. It was magnificent. It was also huge. We opted to not take the tour and walked around on our own, observing as much as possible. We spoke with individuals who placed themselves into the home because they had no one to care for them. We learned that if you were really not able to care for yourself and incoherent, that a full time aid was needed to tend to the carerecipient as well. We had lunch and discussed our observations. On the ride back home my mom looked me straight in my eyes and said, “I am glad that we came. This is what I want to do should a catastrophe arise and I am in need of placement. If I have my faculties, I want you to hire to full time aids 24/7 to care for me in my own apartment. In this way you can still oversee my care. If I lose my faculties, I want you to put me in the home that Grandma was in. It was good enough for grandma. Your father and I had no guilt feelings about placing her, as that is what she needed. I have no need to check out any other places. This is my decision.”

And to this day, I respect her decision. It is her choice and I will accommodate her when and if the time arises. The most important issue is that we have clarity as to how to handle it should her situation ever require placement.

Most caregivers promise they will never place their loved one into a home. Unfortunately, in many situations, it becomes a necessity for many reasons. The two most important reasons is that the carerecipient can longer care for themselves, (they may in fact be a detriment to themselves); and the caregiver may burnout physically, mentally or emotionally, and no longer be able to care for themselves properly. However, because of the promise they may have made to their loved one, they are determined to keep them at home. It is because of their “promise” that most caregivers do burnout and in many cases, the care of their loved one is sacrificed.

One caregiver, Harriet, shared how her father who had Alzheimer’s and was living at home with her. Not only was he continent but also he had started fires unintentionally indicating that he was not able to care for himself. Being ill herself, Harriet was going to need surgery that meant placing her father in respite at a nursing home nearby. The guilt she suffered was unbearable because of the promise she had made to him to never put him in a nursing home. When the time came to place him for two weeks in respite, she observed how easily he took to the facility. He was with other people his age and there was a solid staff to care for him. Meals were prepared and served to him. There were daily activities that kept him involved. Harriet made the decision not to bring him home after she healed from her surgery. She let go of her guilt as she observed how much she tried to live up to a promise she could no longer keep. Harriet was able to regain her life and remain as the overseer of his care, visiting him daily without all the pressures.

Promises aren’t legally binding yet caregivers feel bound to them. In actuality, it is what binds them to the guilt they can suffer and their poor decisions that may arise while caring for their loved ones. A promise may have been made from their heart or dictated by the one they care for but situations change.

If your loved one has coerced you into promising never to place them in a home it can be for many reasons. Some may be:

  • They are afraid of being abandoned, unloved or taken advantage of.
  • They are afraid of being abused in the home as their loved one may have been at one time.
  • They may not trust you to care for them the way they think you should.
  • They are fearful, controlling, and manipulative.

Instead of making a promise that you are not able to keep, it is best to communicate with your loved one that you will do the following:

  • We will not abandon you no matter what situation arises.
  • We will always provide you with the best care we can afford.
  • We will always do what is for the highest good for you as well as the rest of the family.
  • We will always treat you with respect and dignity and see that others treat you in this fashion.

By talking these issues through with your loved one, you will be guided into making the right choices.

Richest Blessings,

Gail R. Mitchell


  • Ms. Mitchell began her full-time caregiving experience in the early eighties when her husband was diagnosed with cancer. Later on she became the primary caregiver for her father, along with her mother who had become critically ill from burnout prior to her dad’s passing. In recent years, she cared for several friends with AIDS while continuing to care for her mother and actively providing support, information, referrals and resources for caregivers.

    Gail's leadership on the Internet and her success with Empowering Caregivers led her to found National Organization For Empowering Caregivers (NOFEC) INC in 2001.

    Prior to founding NOFEC, she created the iVillageHealth Chat: Empowering Caregivers, which she hosted for over 5 years. Within a month of hosting she created Empowering Caregivers: in 1999 as a resource for caregivers around the globe. Over three million visitors have frequented the website.

    She has presented at national and international care-related conferences and programs and has been a keynote speaker for many programs as well.

    Ms Mitchell has assisted thousands of caregivers online and offline in ways to empower themselves in their roles in caring for loved ones.

    For a list of clients and/or her resume, please contact

    Gail's articles have been published in many venues nationally and in Canada. Presently, she is a member of American Society on Aging and National Quality Caregivers Coalition.

    Gail has discovered that there is life after caregiving: She has become a successful ceramic artist and installation artist. She created Crystal Illumination Art to bring the transformative quality of illumination, light and color to the human experience and celebrate its ability to inspire, heal and nourish our physical, mental, emotional and spiritual well being.