One of the hardest decisions a family member – typically a spouse or an adult child – can make is putting a loved one in a nursing home. It's a huge emotional decision that's often accompanied by a mix of guilt, anxiety and relief.

There is no perfect time to make this life-altering decision. Harder still, the burden of the decision typically falls on just one, or possibly two, close family members.

No matter when it's done, and even though we go out of our way to provide the best possible advice to families faced with this decision, it's always heart-wrenching for everyone concerned.

Even though many families refuse to consider placing a parent or spouse in a nursing facility, we caution them that not doing so could have devastating consequences.

When is the right time to put a loved one in a nursing home? Our experts offer these signals:

• Your loved one can no longer care for him- or herself. If your family member has a stroke or breaks a hip, for example, the family is caught unprepared to handle the emergency.
• Caregivers display signs of burnout. Some common signs of caregiver stress associated with dementia or Alzheimer's disease include denial ("I know Dad will get better"); anger (frustration or irritability because your loved one can't do the things he or she used to do); withdrawal from friends and activities you once enjoyed; anxiety about the future or facing another day; and depression, which breaks your spirit and affects your ability to cope.
• You've hurt your back or fallen while trying to lift or move your loved one. Back injuries are very common among caregivers with bedridden elderly family members.
• Your loved one wanders outside and becomes lost. Caregivers describe this as a terrifying experience that triggers immobilizing panic.
• Family relationships are strained, causing dissension. Anger often occurs among caregivers who feel that they're stuck with the burden of caregiving. This is common among family members who are spread out geographically.
• Your physician recommends nursing home placement.
• Your loved one's Alzheimer's has progressed to the point where home care isn't possible. For example, the loved one demonstrates symptoms such as hostility or rage, incontinence and self-destructive behavior.

If one or several of these symptoms are prevalent, indicating nursing care is necessary, highly trained professionals can guide you through every stage of the nursing home placement process.

In sum, even though you've thoroughly researched local nursing homes, expect to experience a cascade of emotions when you decide to place your loved one in a facility. And despite the fact that you did everything humanly possible to provide the very best home care, it's perfectly normal to feel that you could have done more.

While a large proportion of caregivers want to care for their loved ones as long as possible, it's not always in everyone's best interest. That's a fact of life that's hard to accept, but it is essential to acknowledge for everyone's benefit.