How to Have the Placement Conversation Without Destroying Your Relationship

By Kari Baker, CDP | High Country Senior Advisors | Flagstaff, AZ Category: Family Caregiving | Read time: ~4 min

There is a conversation that almost every caregiving family eventually has to have. It goes something like this:

Mom, we've been talking — and we think it might be time to look at some other options for your care.

And then one of two things happens. Either the conversation goes better than expected, or it goes so badly that the family doesn't try again for six months — while the situation at home continues to deteriorate.

I have sat with enough families through this moment to know that how you have this conversation matters almost as much as what you say. Here is what I have learned.

Start with curiosity, not conclusions

The conversation fails most often when a family member comes to it with a decision already made. We've decided you need to move. Even when that is said with love, it lands as an ambush. The person with dementia — or without — hears: you have lost control of your life and we are here to take more of it.

Start instead with a question that invites their perspective. Mom, I want to talk about how things are going for you at home. Can you tell me what feels hard right now? You may be surprised by what they say. And even if the conversation goes where you expected, starting with curiosity rather than conclusions gives the other person dignity — which is the whole point.

Separate the conversation from the decision

Families often try to have the placement conversation and make the placement decision in the same sitting. That is almost always a mistake. The conversation is about understanding. The decision comes later, after everyone has had time to process.

Give yourself at least two conversations. The first one plants the idea and gathers information. I've been thinking about what would make things easier for you, and I want to understand what matters most to you about where you live. The second one is where options are discussed and preferences are heard. The decision, if it comes, is the third conversation.

This feels slower. It is also much less likely to produce a rupture.

Name what you are trying to protect, not what you are afraid of

Families often frame the placement conversation around fear. We're worried you're going to fall. We're worried you're going to leave the stove on. We're worried something is going to happen. All of that is real and valid — but leading with fear makes the other person feel like a liability rather than a person.

Try framing it around what you want for them instead. I want you to have people around you. I want you to have someone who can help you with the things that have gotten harder. I want you to be somewhere you feel safe and connected. That is a very different conversation — and it is the one your loved one is more likely to actually hear.

Let them grieve

Even when a placement is clearly the right decision, it is a loss. A loss of home, of independence, of the life someone imagined for themselves. Families sometimes try to rush past the grief — but you'll love it there, it's really nice, you'll make friends — because sitting with the grief is painful for everyone.

Don't rush past it. I know this is hard. I know this isn't what you imagined. I'm sad about it too. Those sentences do more to preserve the relationship than any amount of reassurance.

You don't have to do this alone

This is one of the most delicate conversations a family can have — and it is made harder when the person delivering the message is also exhausted, guilty, and emotionally depleted. Which describes most caregivers.

Sometimes having a neutral third party present changes everything. Not to make the decision for the family, but to help the conversation stay on track, to reflect what is being said, and to offer a professional perspective that takes some of the weight off the family member who has been carrying it all.

This is part of what I do. If your family is approaching this conversation and you are not sure how to start — or you have tried once and it went badly — I am glad to help you think through how to approach it.

The relationship you are trying to protect is worth the extra care it takes to do this right.

Call or text: 480.789.1058 Email: kari.baker@highcountryseniors.com Web: highcountryseniors.com