The conversation between adult children and their aging parents about the possibility of moving into an assisted-living facility or nursing home can be tough and change family dynamics, but it needs to be happen.

“Children can generally see clear warning signs when it is time for their parent to enter an assisted living home or a nursing home,” says Kevin Flynn, president of Healthcare Advocates. “The sad reality is that it often takes an adverse event to make the elderly parent realize that such a placement is needed.”

The earlier you can react to warnings signs the easier the transition can be on parents, so it’s important to know what signs to look out for and address.

According to health experts, signs include forgetfulness when it comes to basic daily events like leaving the stove on, a lack of appetite or ability to eat, inability to food shop and constantly forgetting to take medication.

“When a parent is unable to care for himself/herself and needs help with everyday things like bathing, dressing and making meals, it may be time to consider a nursing home or an assisted living facility,” says Martin Rosen, executive vice president and cofounder of Health Advocate. “Other reasons for considering professional help for parent include if he/she has memory problems, has physical limitations and is prone to falls, and/ or has side effects from multiple medications.”

If warning signs are present, the next step is to figure the level of care options and approach your parents and family members about moving into a facility. According to Rosen, you’ll have to determine if it’s better to move the parent to a place or have a live-in nurse provide care in the current residence.

Costs will be a major factor as will insurance coverage and how much the family has to cover the expenses.  “It’s important that family members agree before making the decision,” says Rosen. “If there are some disagreements, a geriatric case manager can help with the situation.”

When it comes to starting the conversation with parents, Flynn advises being as direct as possible. The main reason people resist the idea of a nursing home or assisted living is over fear of losing their independence. Some parents are also in denial about needing care and help, which can also make the conversation tough.  Flynn says when talking about care options, you should provide parents evidence of why they need help: Point out aimless wondering, forgetting to turn off the stove and the dangers that came with these actions.

It’s also important to make it clear to parents they are not a burden and that you are not trying pass off their care and simply want them to have the best options and lifestyle. Children should put forth a well-discussed and thorough plan to their parents that covers financials.  

If possible, Rosen suggests asking parents what they want from a facility, including location and amenities, to get them involved in the decision. Same goes with at-home care. If they can, have them discuss who they would want to be the caregiver whether it’s a relative, friend or professional.

If possible, Flynn says it’s a good idea to take the parent to visit possible places to talk to the staff and residents.

“If they say no at first, continue the conversation in a kind way,” says Flynn. “After an adverse event occurs, they will either be willing or be forced into such a situation.”