You know the moment is approaching. A hundred times the notion has crossed your mind. You have always let it pass -- until now. Your loved one's medical condition has gotten worse in spite of your best efforts. His or her personal care needs and need for supervision have increased. You may feel exhausted. Your own health may be failing. The need for relief is growing and the help you have arranged at home is no longer sufficient. Feelings of guilt and despair may seem overwhelming. These are some of the mixed thoughts and feelings involved in considering whether to move a loved one into a residential care setting.

Although some families are able to keep their chronically ill relatives at home, placement in a long-term care facility may become necessary -- especially in cases of Alzheimer's disease or a related dementia. Placement is usually considered a last resort after other options have been tried. Though this decision is rarely made with ease and confidence, proper planning can make the transition less burdensome. The following suggestions may be in making this most difficult decision:

Take an inventory

First, ask yourself if you have the personal resources needed to continue to provide home care? Is your physical, mental, and spiritual well-being at risk? Is your loved one's well-being at risk? Second, do you have the social resources to continue in this role? Are other people willing and able to provide practical help and emotional support on an ongoing basis? Have you explored using community resources such as adult day services, home care agencies or hospice care? Identifying what and who is available is essential. Third, do you have the financial resources to pay for services at home or in a care facility? The availability of personal funds or eligibility for government-subsidized programs can make the difference between home care and care in a facility. Consultation with a social worker about community resources or with an attorney about legal and financial planning may clarify these issues. Contact the Eldercare Locator Resource Center at http://www.eldercare.gov or (800) 677-1116.

Examine care needs

Care needs often get more complicated as a chronic illness worsens over time. Symptoms can become too physically and emotionally demanding for the caregiver. A realistic assessment of the care needs can help determine if those needs would be better met at home or in a long-term facility. A consultation with one's medical provider can shed light on the medical outlook.

Achieve a consensus

Allowing trusted family members and friends to share the burden of decision-making for their loved one can be invaluable. Communicating facts about the medical condition and feelings it brings out may enable all concerned to accept a measure of responsibility for the person's care. A unanimous decision should not be the goal. The opinion of the primary caregiver must carry more weight than others, due to his or her unique role with the care receiver. A consensus takes time to develop but is worth the effort.

Explore facilities

Get to know the difference between types of residential care facilities available locally: supportive living, assisted living, nursing home, and continuing care retirement community. Visiting a few places can provide a frame of reference in determining the best option. Visits should be made with someone who can assist in making an objective evaluation. The quality of facilities varies depending on many different factors such as staff ratios for all shifts, physical environment, the schedule of daily activities, the food, the costs, etc. Checklists are also available online to help guide this decision. AARP has an excellent, free booklet, Prepare to Care, available at www.aarp.org

The decision to move a loved one into a care facility is usually quite complicated and always highly personal. The above ideas are intended to serve as a beginning guide in deciding whether this option is appropriate. If indeed this option is chosen, your caregiving role will continue, but with the help of professional staff. Both you and your loved one may ultimately benefit from this change.

Daniel Kuhn, LCSW, is a Community Educator for Rainbow Hospice and Palliative Care, Mount Prospect, IL

The views and opinions expressed in these blogs do not necessarily represent those of CMSS or its affiliates.