elderly man in need

How do I Know it is Time for Nursing Home Care?

It is not easy to watch a loved one experience the physical and mental decline accompanying aging. It is even more difficult to decide when it is time for nursing home care. The decision is different for every person and every family but what it all comes down to is quality of life.

This blog is for educational purposes only and should not be considered legal advice. The use of the Paths Law Firm website does not constitute a client-lawyer relationship.

Signs it is Time for Nursing Home Care

You can define the quality of life based on the quality of health, happiness, and comfort a person enjoys. Quality of life affects both the person in need of care and the caregiver. Suppose the quality of life of either is negatively affected. In that case, it may be time to consider the following factors in deciding whether or not a nursing home is the best solution.

Physical Health Conditions

If a loved one suffers from a medical health condition preventing them from performing basic daily tasks, they need care. When the health condition reaches a stage where at-home care becomes difficult, it may be time to consider care in a nursing home.

A caregiver can look for the following signs when caring for a physical health condition having  become unmanageable:

  • The need for medical equipment or specialized care and treatments the caregiver is unable to administer.
  • Administering medications by the caregiver is no longer possible.
  • You have suffered an injury as a result of delivering care. For example, a back injury from lifting a physically challenged loved one.
  • Your health is at risk.
  • You are physically tired and drained from the effort you are putting into caring for a loved one.
  • The health of the person requiring care is at risk by remaining at home.

Whether your loved one will receive better medical care for a physical health condition than you can provide for them at home is the question. It is important to remember your loved one’s physical health will continue to deteriorate as they age, and the illness, disease, or other health condition is going to keep taking its toll on you and your loved one. If you feel caring for your loved one’s physical health needs has become a challenge, it may be time to start looking at nursing home options.

nursing home care

Mental Health Conditions

Dementia, Alzheimer’s Disease, Parkinson’s disease, and cognitive deterioration are mental health conditions most effecting the elderly. While at-home care is possible and recommended mainly in the early stages of these conditions, there comes a time when nursing home care will become necessary. 

Mental Health Deterioration of The Care Recipient

Noticing the following signs may be an indication your loved one’s mental health is deteriorating to the extent a nursing home may be better suited to their needs. Some indications:

  • Forgetting medication schedule.
  • Reporting they are eating, however, there is no sign of meal preparation, and there is spoiled food in the refrigerator.
  • Wandering off and increased periods of disorientation and confusion.
  • Difficulty managing their hygiene, including bathing, changing clothes, and using the toilet.
  • Difficulty remembering or recognizing loved ones and friends.
  • Disorientation as to their surroundings.
  • Confusion as to date or time.
  • Increasing signs of agitation and aggression.

Few caregivers are aware agitation and increased aggression are symptoms of cognitive decline. A formerly placid person can become quite aggressive and even physically assault another person. Aggression from individuals with mental health issues is partially due to cognitive regression and frustration that comes with difficulty recognizing people and their surroundings. It is essential to keep in mind the above signs put your loved one at risk and you and your family.

forgetting medications

Mental Health Impacts on the Caregiver 

Signs your mental health may be affected by caring for an aging loved one include:

  • Chronic fatigue and difficulty focusing and concentrating.
  • Irritable and experiencing mood swings.
  • Failing to meet your own physical and emotional needs and those of your loved one and other family members.
  • Work is suffering.
  • Increased anger toward the person you are caring for or other family members.
  • Symptoms of anxiety and or depression.
  • Decreased interest in social interactions and activities.
  • Trouble sleeping.

It is common for caregivers of loved ones to be in denial regarding the cognitive decline they are witnessing in a loved one. This denial, combined with guilt, may prevent the caregiver from seeing their loved one (and the caregiver) may be better off receiving professional nursing care for their mental health disorder in a nursing home environment. It is critical to realize, the state of one’s mental and emotional wellbeing can significantly affect their ability to provide the care a loved one needs.

It is also important to realize a loved one may resist going to a nursing home, especially if they suffer from cognitive decline. We need to remember; cognitive decline means their ability to make decisions is impaired. It is the caregiver’s responsibility to do what is best for them when their mental health deteriorates to the stage where caring at home is no longer the best option.

caregiver anxiety depression

Accidents and Injuries

As we age, we become less physically capable. Muscles and bone health deteriorate, and combined with physical or mental illness, the risk of accidents, falls, and injuries become more likely. The severity of injuries from an accident or fall in seniors is also greater. For example, a fall is more likely to result in broken bones than usual.

Be aware of the following signs and symptoms that your aged loved one is at greater risk of a fall or accident in the home:

  • Difficulty sitting or standing from a sitting position
  • Shuffling feet or difficulty walking
  • Difficulty grasping or holding objects
  • Problems with balance and gross motor coordination
  • Hiding accidents and injuries

If your loved one has fallen in the past, they are at a greater risk of falling again.  Even if you are around 24 hours a day, there is only so much you can do to prevent a fall or accident from occurring. Nursing home care provides a safer environment for the elderly who are at a greater risk of a fall. The staff understand the increased risk and provide the necessary care to prevent falls and accidents. 

elderly man falling

Planning Ahead for Nursing Home Care

Sometimes, life throws us a curveball, and a sudden event or illness can leave us in a position where we need to provide care for a loved one. However, in most cases, simple aging is the primary cause of requiring care in later life. If possible, it is vital to plan for when nursing home care may become a necessity.

We should have discussions with parents or other loved ones in advance regarding the need for ongoing care.  These discussions may be based on certain life events or stages of physical or mental illness. Decide at which point physical deterioration or cognitive decline will progress far enough for your loved one to require care in a nursing home.  Planning will relieve you of the burden of responsibility and guilt you may feel towards caring for your loved one.

Keep in mind there is rarely a specific timeline attached to these decisions. Diseases, illnesses, and aging progress at varying rates and affect people differently. Planning is not about deciding to send a loved one to a nursing home six months, a year, or five years down the line. Instead, it is about determining when the challenge of caring will become significant for both the caregiver and the person in need of care.

care in nursing home

In Closing

Visiting nursing homes as early as possible and deciding the best facility for future needs allows the care recipient to choose their future arrangements. It is essential to consider any special needs and personal preferences when choosing a nursing home. Also, ensure the facility is close to family and friends to make visits easier.

You can start planning for nursing home care at any time. However, if a loved one has been diagnosed with a severe illness or a degenerative cognitive disorder, planning should become a priority. It is preferable to make decisions about future care before a disease has progressed or mental health deteriorates to the extent your loved ones can no longer make decisions for themselves.

At Paths Elder Law, we are dedicated to serving seniors and their families through legal representation and support.  Our dedicated and caring staff will listen to your unique story and assist you in planning for the future.  Whether this includes assistance with planning for nursing home care, estate planning, asset protection, or any other elder care issues you may experience, we are here to help.  If you or a loved one need assistance, contact Paths Elder Law to schedule a consultation.  Peace of mind is only a phone call away. 

Educational Seminar at Paths Law Firm

Paths Law Firm provides a Free Educational Elder Law Seminar every month to help you plan for your future.

Administrative Assistant

Ryan D. Foley

Ryan Foley at Paths Law

Administrative Assistant

Ryan D. Foley

Ryan graduated from the UMKC School of Law in 2018 and passed the Missouri Bar that year. Prior to law school, Ryan attended the University of Missouri – Columbia where he attained a degree in Business. He is a Kansas City native, growing up in the Northland where he achieved his Eagle Scout rank by doing a project for his high school. During his time in law school, Ryan was introduced to the practice area of Elder Law by one of his professors and has been

Ryan enjoys working with and educating clients to provide advocacy and support during the unfamiliar and often overwhelming probate process. Ryan understands the challenges faced by individuals when faced by the uncertainty and complexity of government systems or even handling a Trust during a time of grief, and he strives to make the process as easy as possible.

Administrative Assistant

Makaylee A. Morelli

administrative assistant at Paths Law

Administrative Assistant

Makaylee A. Morelli

Makaylee is currently working on her bachelor’s in political science and hopes to soon start law school as an aspiring attorney. In her free time, she loves to spend time with her friends and family but most importantly her dogs Taffyta, Tallulah Belle, and Harry. Their favorite thing to do is go on coffee dates and get pup cups.


Kathleen E. Overton

Kathleen Overton, attorney at Paths Law


Kathleen E. Overton

After starting her career as a disability attorney, Kathleen transitioned into estate planning at a mid-sized regional law firm. Kathleen joined Paths Law Firm in 2021 when she decided to return to a boutique law firm that provides excellent service and quality to clients. Because of her background as a disability attorney, she brings a thorough understanding of public benefits to each client meeting. At Paths Law FIrm, Kathleen focuses on traditional estate planning and business entity formation, providing tailored advice unique to each client’s situation.

Public Benefits Assistant

Tena K. Dooley

Public Benefits Assistant

Amanda D. Martin

I have my Associates in Applied Science and have over 20 years of office management experience. I have two daughters and one grandson.

During my time away from the office I enjoy spending time with my family.  I enjoy almost everything outdoors and my hobbies include fishing and gardening.


Sydney R. Morris

Paths Law elder law in Kansas City



Sydney is currently enrolled at the University of Missouri-Kansas City pursuing an accounting degree and plans to later attend law school.

In her free time, Sydney enjoys spending time with her nephews and volunteering at her local church.



Christy L. Phillips

client service manager at Paths Law


Christy L. Phillips

Phone: 816-640-8635
Email: [email protected]

Christy has 3 years of experience in Elder Law working for seniors and their families as a Benefits Coordinator processing Medicaid and VA applications. Prior to joining Paths Law Firm Christy worked in the finance industry for over 10 years.


Christy’s experience in the finance industry has been extremely beneficial to her role as Benefits Coordinator. There have been many influences that went into her decision to select the field of Elder Law. Christy has a special place in her heart for the elderly and attributes this to her relationship with her grandparents.

When asked why she loves what she does, Christy said that at Paths Elder law, she gets the opportunity to help clients in more ways than one. Her favorite part of her job is getting clients approved for Medicaid or VA benefits as it is a huge relief for them and their loved ones.

Christy was raised in Ogden, Utah, and moved to Independence, MO, when she was ten years old. She has two children that keep her busy and fill her life with joy! Christy’s daughter cheers for Avila University, and her son plays competitive baseball for the Bucks and races BMX locally for the Motorcycle Closeout Team.

When Christy is not working, she enjoys crafting and making homemade gifts for her loved ones and raising her kids to be healthy, happy, and positive humans.


Practice Areas

  • Medicaid Benefits
  • VA Benefits


Professionalc Memberships and Affiliations

  • Missouri Notary


René A. Fracassa

Rene A. Fracassa, Paths Law



René has worked along side Rusty for 35 years. Not only is she part of the Paths team, she is also his wife. René spends her time working with the accountant to keep all of the finances in order, as well as general office management.

In addition to helping run the office, she helps manage the family and grandkids, tries to keep everyone fed, and has a passion to teach Bible Studies. Her former career in Event Planning trained her to juggle all the activity. She understands Rusty’s passion to serve people from the first mention of law school. It is a great pleasure for her to be an important part of every area of his life.



Hilary R. Tichota

Hillary at Paths Law



Hilary plays a vital role in the daily operations of the office. In addition to her regular office duties, Hilary has a heart of gold.

For more than 5 years, Hilary has operated the front desk at Paths, running the office and catering to clients. Hilary recently moved into the role of Community Relations Coordinator. She has a passion for people and a focus to share our business practices with the community’s seniors, businesses, and clients. She especially has a heart for seniors, showing they are loved through her visits, treats, the “Pen to Pal” program, and volunteering services at various senior living communities. She is a wonderful wife and mother of two. Most activities with seniors involve her great talent for any type of craft.



Jennifer A. Bronson

Jennifer, senior paralegal



Jennifer has been in the legal field for over 25 years and considers Paths her second home.

When she’s not running the office or working for our clients, she’s spending time with her first passion – her children.


Russell A. Fracassa (Rusty)

attorney at Paths Law elder law


Russell A. Fracassa (Rusty)

Phone: 816-640-8635

When asked what he wants to do, his reply was “I just want to sit at the kitchen table and work directly with people.” Rusty enjoys working with clients providing experienced advocacy and supporting them through their unfamiliar and overwhelming situations. Due to all the challenges faced by seniors, it is essential to work with an experienced elder law attorney who has expertise in the law, issues, and concerns affecting seniors and their families.

Rusty brings nearly 30 years legal experience and expertise working for seniors and their families as an elder law attorney in Kansas City and surrounding. Prior to law school, Rusty was a practicing accountant. This provides invaluable experience in his current practice of law. Rusty decided to put his focus on helping the elderly, vulnerable adults, and their families navigate challenging life, end of life, and death events.

Rusty understands the challenges faced by individuals whose capacity is declining and how upsetting the loss of a loved one can be. He understands he may not be able to eliminate his client’s grief from loss, but he strives to provide clients with peace of mind. Rusty works directly with client’s long term care issues, including Medicaid, Veteran’s Benefits, Estate Planning, Asset Protection, and Special Needs Planning.

In 2010, Rusty’s faith and love led him and part of his family to China as Christian missionaries. He and his wife, went permanently, but ended up dedicating 3 years to that ministry. They returned to Missouri to help with grandchildren after a family tragedy and later began anew with Paths Elder Law. The goal is providing compassionate care through legal advocacy.

When Rusty is not practicing law, he enjoys spending time with his family, grandchildren, and excessive eating at local restaurants.


Practice Areas


  • Wills and Trusts
  • Estate Planning
  • Asset Protection
  • Medicaid Benefits
  • VA Benefits
  • Probate
  • Guardianship and Conservatorships
  • Education


BSBA and Master’s in Accounting, Master’s in Inter-Cultural Studies, and Doctorate in Juris Prudence

  • Rockhurst University
  • Liberty University
  • University of Missouri – Kansas City

Admissions to Practice

  • Missouri

Professional Memberships and Affiliations

  • State Bar of Missouri
  • National Academy of Elder Law Attorneys (long-time Member)
  • Elder Counsel (Charter and Ongoing Member)
  • Missouri Association of Trial Attorneys (Past Member)
  • Kansas City Metropolitan Bar Association
  • Missouri State Bar Committees – Elder Law, Estate Planning, Probate