When to move them to a different facility — recognizing poor care
This article is for informational purposes only and does not constitute medical, legal, or financial advice. Please consult appropriate professionals for guidance specific to your situation.
Sometimes the facility your parent is in is not good. Not just "adjusted to some degree" and "settling in," but genuinely not providing adequate care. Your parent is losing weight. They're developing pressure sores. They're not getting medications as prescribed. They're being treated roughly by staff. You notice bruises you can't explain. Your parent is withdrawn and scared. No matter what you say, things aren't improving. You've talked to the facility director. You've escalated concerns. Nothing changes. The facility is the problem, and your parent needs to move.
Moving your parent is disruptive. Another transition. Another loss. Another place to adjust to. Your parent might be reluctant. Moving costs money, time, and emotional energy. There's never a good time to move. But sometimes moving is the right choice. The facility doesn't have to be abusive for moving to be necessary. It just has to be failing your parent. It just has to be doing more harm than good.
Before you move someone, be clear about what the actual problems are and whether moving will fix them. Some problems are facility problems. Some problems are inherent to any facility because of your parent's condition or limitations. Moving won't fix the second kind of problem. But if your parent is actually being neglected or their medical needs aren't being met or the care is genuinely inadequate, another facility might be better.
Reality of Nursing Home Life
Understanding what nursing home life is actually like helps you assess whether the problems you're seeing are serious or whether they're just part of being in a facility. Nursing homes are institutions. They run on schedules. Your parent eats when the kitchen puts out meals, not when your parent wants to eat. Your parent showers on the schedule the staff sets. Privacy is limited. Your parent shares a room with a roommate. Staff come in at all hours. Noise is constant. The lights are controlled by the facility. The temperature is controlled by the facility.
This is genuinely uncomfortable and dehumanizing in ways that home never is. Your parent has no control over basic decisions about their own life. This creates a kind of institutional depression that's hard to address. Some people adapt. Some people never do. But this isn't abuse. It's the nature of institutional care.
Autonomy is limited in other ways too. Your parent might want to sleep until eight in the morning, but breakfast is at seven. Your parent might want to wear their favorite shirt, but maybe it's in the laundry and the timing doesn't work out. Your parent might want to spend time alone, but activities are encouraged for everyone. Your parent might not want to participate in group meals, but that's when food is available. Some facilities are more rigid about this than others. Some find ways to preserve individual preferences within the institutional structure. But no facility gives residents the complete autonomy they had at home.
Some of this is because of staffing. Nursing homes are understaffed. There aren't enough workers to accommodate individual schedules and preferences. There aren't enough people to check on residents individually or provide one-on-one attention. The staff is doing their best with limited resources. But the result is an impersonal system where residents are managed more than they're cared for.
Sometimes the rules are also arbitrary. Facilities have policies that don't have good reasons beyond "that's how we do it." Visiting hours. The amount of personal possessions your parent can have. Which family member is allowed to make decisions. Rules that protect the facility more than they protect the residents. A flexible facility works with families to make exceptions. A rigid facility enforces rules inflexibly. Both exist.
Maintaining Individuality and Dignity
A good facility tries to preserve your parent's identity and individuality despite the institutional structure. They ask about your parent's preferences. They use your parent's name. They allow your parent personal items from home. They encourage your parent to participate in activities your parent enjoys, not just whatever is being offered. They treat your parent like a person with a life and history and preferences, not just another body to manage.
Staff tone matters. Respectful staff speak to residents as adults. Dismissive staff use baby talk, talk about residents like they're not there, make decisions without asking the resident's input. Rough staff grab and move people without explanation. Gentle staff explain what they're doing and ask permission. The difference is visible.
Your parent's room and appearance matter. Is the room dignified or does it look like a hospital? Does your parent have personal items that remind them of who they are? Photos, books, favorite clothes, a comfortable chair? Or is the room bare and institutional? Is your parent clean and well-groomed, or do they look neglected? These things seem like details but they communicate whether the staff view your parent as a person worth honoring or as a task to complete.
Your role as a family member changes in a facility. You can't manage everything. But you can support your parent's autonomy where you can. You can encourage your parent to make choices about their own care. You can advocate for your parent's preferences. You can bring items from home that make the room feel more personal. You can treat your parent with respect and dignity that reinforces your parent's identity beyond the facility walls.
Sometimes this creates conflict with staff. Staff has systems and schedules. Your parent's preferences don't fit those systems. The facility wants to give your parent medication at nine in the morning. Your parent wants to take it after breakfast. The facility wants to shower your parent on Tuesday. Your parent wants to shower on Wednesday. These seem like small things. But small things add up. When your parent has no control over anything, small things matter enormously.
A good facility finds a way to accommodate these preferences when possible. An inflexible facility insists on their schedule and approach. Inflexibility isn't abuse. But it creates suffering and loss of dignity. Some people can tolerate it and move on. Some people can't. If your parent can't, another facility might be better.
Visits and Your Involvement
How you visit and interact with your parent and staff shapes what happens. If you visit and get angry with staff, blame them for your parent's suffering, criticize the facility, it poisons the relationship. Staff become defensive and resentful. The care doesn't improve. If you visit and are kind to staff, treat them with respect, thank them for their effort, they become more attentive to your parent. This isn't about accepting poor care to be nice. It's about creating an environment where staff are willing to go the extra mile.
When you visit, don't take over. Don't do things for your parent that your parent can do for themselves. Don't correct your parent in front of staff. Don't intervene in interactions unless your parent is actually being harmed. Step back and let your parent maintain their dignity and agency. Present without controlling.
Also don't undermine the facility's work. If your parent refuses to participate in therapy and you side with your parent, the facility gives up on recovery. If your parent wants to stay in bed all day and you validate that as an understandable response to loss, the staff stops encouraging your parent to get up and participate. Sometimes your parent needs to hear from you that they can do this, that recovery is hard but worth it, that you believe in them. Sometimes your parent needs to hear that you understand it's hard and it's okay to have days where things are difficult.
Be available but don't be omnipresent. If your parent can reach you by phone, they will call every time something is uncomfortable. If that's how your parent copes, that's okay. But recognize that your availability shapes whether your parent can develop independence at the facility. Some families set boundaries. "I can talk on Thursday evenings." Your parent has to manage between calls. Some families are always available. It depends on your parent's needs and your capacity.
Ultimately, whether you stay or move depends on whether the facility is meeting your parent's genuine needs, is treating them with dignity, and is providing adequate medical care. If those things are happening, the institutional nature of the place is just the trade-off you make for safety and supervision. If those things aren't happening, moving might be right.
How To Help Your Elders provides educational content for family caregivers. This is not a substitute for professional medical, legal, or financial advice. Every family situation is different; what works for one may not work for another.