Question: Over the past 18 months, my father has been failing steadily, falling frequently, wandering at night, and disrupting my mother's sleep. In my view, although she does not want to admit it, my mother can no longer take care of him by herself.

She is 77, has become very depressed, has no appetite, and is also beginning to go down rapidly. I live out of state and find myself going to their home almost every weekend at quite a cost, both economically and emotionally. My mother has it in her mind that she does not want Dad admitted to a nursing facility, but I don't think there is any other solution. How do I go about convincing my mother and then choosing a nursing facility?

Answer: Not unlike most family members who provide care for other family members within the home, it appears that your mother is suffering not only from burn out, but also guilt feelings about not being able to continue your father's care. Your first order of business is to seek professional assistance from a geriatric care manager or other health professional your mother trusts who will be able to assure her that she has done all that can be done and, without some immediate help, she may also need long-term care. If properly handled, this should be very doable. And by including your mother in the selection process, she will feel better about the entire process. If you continue to have problems, we suggest that you take your mother to a psychologist or counselor who is experienced in dealing with these issues.

When it comes to choosing a long-term care facility, there are many variables that should be considered. But first and foremost, a determination of the level of care your father needs should be made. We suggest that you have your your father fully evaluated and assessed by an experienced geriatric care manager who then will be able to not only determine the type care he needs, but also help you find a suitable facility.

In a perfect world, the long-term care facility should be chosen based on the preferences of the elderly person, the proximity of the facility to family, staffing, recommendations from others, and financial arrangements. But since there may be shortages of beds in some areas, some people find themselves grabbing the first bed available - which can be a big mistake.

Since this is an multidisciplinary process, we strongly suggest not only geriatric care manager, but also an elder law attorney to assist in the financial and other aspects of the application process, including a comprehensive review of financial and other planning issues.

While you can do some searching on your own, we think that since you live out of town and your mother will be of little help, you should hire a care manager who will provide you with a list of options that are economically and emotionally feasible to your situation.

Either way, you should a) find out what facilities are in your area and the type of care each provides; b) be sensitive to your mother's preferences; c) learn about how long-term care is paid for, that is, by Medicare (only limited periods and amounts), long term care insurance, private pay, or Medicaid. Remember that assisted living is generally paid for privately. d) seek direction from your parent's physician, friends, and relatives who have placed a family member in a long-term care facility; e) be sure to understand exactly what kind of care your father needs and whether a facility has the capacity to allow him to move from one level to another as his condition worsens; f) find out if the facility is approved for participation in Medicare or Medicaid or both; g) determine each facility's admission requirements; h) visit the facility personally and meet with the staff including the administrator, the director of nursing, and the social worker; I) find out about staff turnover; j) determine who owns the facility and whether it is operated on a for profit or not for profit basis; k) and find out from the appropriate agency in your state if the facility is licensed and whether there are pending investigations.