Last year, employees at the apartment complex where her father, Stuart, lived informed Janice Walter that because of his deteriorating mental condition, she had 30 days to find him a new living arrangement.

Fortunately, Walters' daughter worked at a local nursing home, making her father's transition from independent life to assisted living a smooth one. Stuart, 85, now lives in Arden Court in Monroeville and his family is pleased. Emotionally, however, the move wasn't easy.

"It was a tough decision," says Walter, a school nurse from Export. "And this is happening to so many people in my generation."

Often, when an adult child is caring for a parent, there comes a point when 24-hour care is needed.

Paula Tchirkow, president of Allegheny Geriatric Consultants in Carnegie, which provides services for caregivers and their loved ones, says there are warning signs that a loved one needs formal care. They include: depression, poor judgment, loss of initiative, increased forgetfulness, poor grooming habits, falling, mishandling medication and change in eating habits.

"When I'm doing an assessment, if the person offers me a cup of coffee, I always say yes because it gets me in the kitchen," she says. "Then I can see if it's fully stocked."

The decision to place a loved one in a nursing or personal care home depends on many factors, such as how much family support there is, the family's financial situation and recommendations of the physician. Once it becomes clear that it's time, the first step is a visitation.

"Get recommendations from people you know who have placed parents somewhere," says Dr. Susanne Hartmann, medical director of geriatric medicine at UPMC St. Margaret in Aspinwall. "Talk to the staff. Talk to family members in the hallways."

During the screening process, it's important to keep expectations realistic.

"Realize that every facility has one problem or another," Hartmann says. "You're not going to find a perfect facility."

Tchirkow says when it comes to care facilities, the less institutional, the better.

"It shouldn't have a urine smell," she says. "Your nose shouldn't perk up and make you think 'nursing home.'"

She advises families to request a copy of the inspection, then simply observe the activity of the home and also assess if the residents have similar care needs of the loved one.

For example, placing someone with a hip problem in a home with all Alzheimer's patients can make the transition more stressful.

The best time to visit a facility, says Tchirkow, is during a meal. This way, guests can watch the staff and residents interact with each other and among themselves.

She also suggests showing up unannounced at about 10 a.m. to see how many residents are dressed.

No matter how suitable the facility where they plan to place their loved one, the transition often isn't easy for caregivers, who typically vacillate between relief and guilt.

"I don't know anyone who's put a loved one in a nursing home who didn't feel guilt," Tchirkow says.

To avoid this conflict, Tchirkow encourages loved ones to have a family meeting once the parents reach age 65 to discuss their wishes on the subject.

For Walter, even taking her father's driver's license away was a difficult experience. After he drove himself home one night, then couldn't remember how to get out of the car, she asked his doctor to suggest he stop driving.

Walter recommends people begin to research long-term care arrangements before it becomes an immediate need. Her mother-in-law, who also is in a nursing facility, did this, thus easing the pressure of the decision off her family.

She also urges family members to maintain their advocate roles, even after their loved one finds a satisfactory facility.

Walter visits her father nearly every day at Arden Court.

If an adult child cannot make frequent enough visits, services such as AgeWell Pittsburgh, an organization devoted to providing resources for a multitude of aging issues, can help. Clinical social workers are assigned to clients who need this kind of attention. "I get so concerned when I think about the people in such facilities who don't have advocates," Walter says.