Our parents cared for us and now, as they age, it's natural that we want to care for them. At first, we figure we'll stop over at their home and do what they need us to do. That can work for while, when all that's needed is some help with errands, the lawn or fixing a meal now and then. It's kind of a pleasant way to help out and show our love for our parents.

However as care needs increase, we are faced with more decisions. Many of us promised in good faith, back when our parents were healthy, that we wouldn't ever put them in a nursing home. That would be abandoning them. We aim to care for them ourselves until they die.

Admirable thinking. However, as years go by and care needs mount, we find ourselves faced with the fact that we can't raise our families, work our jobs and run to Mom and Dad's condo three times a day.

So, with some guilt, we start looking at other options. For some people, this means having your parents move in with you. If there is enough room so everyone has privacy and the personalities blend, this can work. However, before making such a move, make sure your head is as engaged as your heart. While you are considering this option, you also may want to read "Living With Elderly Parents: Do You Regret the Decision?"

Another option, though there is some guilt attached, is getting some in-home agency help. Why the guilt? Because you are now sharing the caregiving with someone else. Someone who is not a family member. You are hiring help for your parents. That isn't what you had in mind for them, but they are not safe alone all day, and you can't be there all the time. You have to do something.

The same guilty feelings are often attached to adult day care. Adult day care can be a wonderful choice for many seniors, as they get care and supervision, plus peer interaction and activities more stimulating than watching TV all day. But, this too means you are turning over some of the care to strangers. You were going to handle it all yourself. You told them you would. And now? You can't. You need help.

Then the day comes where in-home care can't handle all of their needs. Adult day care can't take care of them. Only one choice remains, and that is a nursing home.

How to Research Nursing Homes to Find The Right One

Cheryl E. Woodson, MD (and caregiving daughter) wrote a wonderful book titled "To Survive Caregiving." One of the most important things Woodson says is that, while you may have to "break your promise" – you know, the one you should never have made – and put your parent in a nursing home, you have still honored the spirit of the promise.

I loved the way she put that. None of us knows the future. Our healthy parents have visions of nursing homes decades ago, and the very idea of living in one is unthinkable to them. You tend to agree. Yet, now the day has come where Mom is incontinent, confused and paranoid. She has wandered away from home twice, and once you had to call the police. Dad had a stroke and needs a lift to get him out of bed and two strong people to get him into his wheelchair. You've run up against a brick wall. There is no choice but a nursing home.

When the guilt starts to overwhelm you, stop it. Adjust your attitude. You have done all you can. You have honored the spirit of your promise. People live longer now, in far worse condition, than they did in the past. You know that both of your parents would be dead, had this been the 1970s. Because of medical advances, their hearts are still ticking. However, they are in such frail health that there is no way you can care for them alone. No one could have foreseen this way back when they were younger and healthy.

There are still some bad nursing homes. So, be proactive and tour the ones in your parent's area long before the need arises. Be realistic but be aware. Find the best one you can. Hang around and you're likely to find family members visiting their loved ones. Ask them what they think of the home.

Elderly Parents in a Nursing Home? You are Still a Caregiver

Then, if it's good, get your parents names on the list. The good homes are often full and hard to get into. You can always say no if they call with a room and you aren't ready. But when you hit that brick wall of reality and know you must, for your elders' safety and your health and sanity, put them in a nursing home, you have done your best. You cared for them in every way possible before turning to this last option. You have found the best home available. Now, you are ready to really share the care.

Even when your elders are in a nursing home, you are still a caregiver. I had a time when I had three people in a home (plus two others in separate apartments) and I was at everyone's place every day. It wasn't a cakewalk, by any means. I was still a caregiver.

If you put your parents in a nursing home, they still need you, the primary caregiver. They need you as an advocate. They need you to put the personal touches on their rooms and to be visible to the home staff and the other residents. They need you to help them settle in and make friends. The best part of this, if you will let the guilt go and think for a moment, is that you now can enjoy them again. You aren't tied to doing everything for them, so when you visit, you can do extra little things. You aren't too worn out to be pleasant. You can surprise them by bringing the children. You can bring their favorite chocolates or wine. You can make this their new home, and be the person who visits, without all of the exhaustion that used to make you crabby. And you can do it without guilt.

Caregivers can be dedicated, but that dedication can turn into martyrdom, and frankly, martyrs aren't good caregivers. Using the help of a good facility, while keeping an eye on things and continuing to care for your elders in this new role, allows you to take off your martyr hat. You can do it without guilt because you have done your best. You are still doing your best. You are providing them with the best care humanly possible. Accept your humanity without guilt. Honor the spirit of your promises by being the best caregiver you can be. Be a caregiver who knows when to say when.