She was making her way from the hall bathroom to her bedroom when it happened. She slipped and fell backwards, landing flat on her back. She says she wasn’t down very long. She managed to crawl to the nearest phone and call for help.

Grandma was lucky — lucky that my aunt was available and lucky that her injury wasn’t too severe. But there’s a lesson here for my family and others who are dealing with aging parents. Grandma, who is well into her 80s and becoming frailer every day, is no longer able to do household chores, such as cleaning or laundry, and the steps around her home have turned into a major hazard. The reality that she can no longer care for a spouse who suffers from senility has also been a tough thing for her to accept.

Neither is keen on the idea of relocating to the local nursing home, and I don’t blame them. The very idea of sorting through and consolidating one’s possessions in transitioning from a house to a small room or smaller living space is overwhelming in itself. Imagine how leaving behind familiar surroundings to go live among strangers can increase that.

My associations with nursing homes conjure up nothing but negative images. As a small child, I can remember dreading going to the nursing home to visit my great-grandparents, where they eventually died. Conditions were grim with overworked, underpaid staff. Senior citizens were slumped in wheelchairs lining the dingy hallways, some drooling, others statue-like with unfocused stares and still others groaning sporadically. And the smell was horrible — a nauseating mix of soiled bedding, urine and body odor. Obviously, conditions have changed since the early 1980s. I hope.

In this culture, nursing homes carry a stigma. They are the beginning of the end.

Regardless of the quality of care, most seniors resist the move as long as they possibly can because they’re desperate to maintain some degree of dignity. When you require round-the-clock nursing care, when you lose control of your bladder and other bodily functions, when you can’t climb out of the bathtub, when the hearing aids and eyeglasses just aren’t enough, what kind of quality life is that?

Some families have to deal with aging parents who either refuse to accept their physical limitations or are simply unaware of the extent to which their abilities have deteriorated. It’s not easy to accept one’s limitations in a culture that worships youth and values independence.

What is the most humane, compassionate thing to do when the care of an aging loved one becomes too overwhelming for the adult children? There are no easy answers and each family is different.

Iowa lawmakers are drafting policies and pouring millions into improving the quality of care for senior citizens. One example of this is the “Green House Project.” The project, conceived and developed by Dr. William Thomas, attempts to design, build and test a radically new approach to residential long-term care for the elderly. Thomas wants to create a cozy, warm atmosphere that will resemble a lounge or living room rather than long hallways and nurses’ stations.

Someone would be hired to assume the paid position of the “Shahbaz,” or elder assistant. The Shahbaz would be responsible for some cooking, cleaning and laundry. Registered nurses would then check in every day as well and their work areas will be constructed in a concealed area.

This plan sounds intriguing. It sounds compassionate, even innovative. However, some argue that there are too many seniors. Are Iowans just living too darn long and sucking up our tax money? Get out the shotguns, kids. Line them up in a row, it’s time for target practice. What if it was your grandmother or grandfather, or a senior whom you are close to in that row?

In other cultures, including some Asian countries, aging parents live with their adult children and grandchildren until they die. There are no such things as nursing homes and assisted living facilities. Group elder care is not an issue.

From outward appearances, that arrangement could be the most mutually beneficial for all parties in this country as well.

Where do we get the idea that all the aging, frail and elderly need to be institutionalized, set apart or separated from the rest of society? The mentally ill or physically handicapped are often institutionalized for similar reasons. Their needs simply surpass their family’s capabilities and resources.

Making decisions for or helping aging parents make decisions concerning long-term care is not always easy. Dignity, pride and money are usually at stake.

Who knows what the future holds for quality elder care? The issue doesn’t often hit home until it’s your grandmother or grandfather.