Unfortunately, there are no easy or simple answers to this question. A family can best make this decision considering the following questions:

• Does your loved one have nursing or physical care needs that require 24-hour attention? Does his or her ability to remember to eat or to use the stove cause you concern?
• Are you and your family members able to manage all or a part of your parent or spouse's care needs?
• How much care can be provided by family members?
• Can you and your family afford home care to keep your parent or spouse in their home? Do you want to invite your parent to move in with you? If so, what effect do you see the new living arrangement having on your immediate family, both positive and negative?

Ultimately, the decision to choose nursing home care will be based on a delicate balance of addressing the physical, mental and social needs of your loved one. Seek counsel from friends who have been faced with similar decisions, your family physician, social service professionals and clergy.

Most professionals suggest that families begin the discussion about care decisions before a significant health problem occurs or at the first signs of dementia. Ideally, the parent or spouse involved will be able to participate in this early decision-making to ensure that their wishes are considered. In addition, the siblings and/or the spouse can come together and discuss their perceived limitations in a loving and supportive forum. In this way, decisions can be made before a crisis occurs that requires immediate action. The decisions that emerge from pre-planning will be realistic markers, not heated decisions fueled by a crisis. Pre-planning also helps to minimize turmoil and disagreement among family members at an already difficult time.

As your family discusses options, be sure to talk about what goals and expectations each of you may have. Of course, each family is unique, so your discussions and decisions won't follow a formula of any kind; instead, the resulting decisions you make will reflect your family's personal journey to arriving at the decision that is right for you.