Purpose: Few interpretive studies on adult children making care decisions for cognitively impaired parents limits our understanding of this important healthcare issue as the population ages. An informed understanding of this phenomenon would help to establish a foundation for: determining the assistance these families need, informing policy decisions about the fragmented care system for the cognitively impaired older adult, and decreasing the cost to society in lost productivity.

Question: What is the experience of making care decisions for cognitively impaired parents?

Method: Qualitative, Hermeneutic Phenomenology

Sample: Purposeful sample; 22 adult offspring who self-identified as primary decision-makers for cognitively impaired parents, including 14 daughters, six sons and two daughters-in-law ranging in age from 35 to 64 years who were making decisions for parents 73 to 91 years of age.

Procedure: Respondents were interviewed in their homes resulting in 35 hours of data. The use of ATLAS.ti software helped to organize data and audit decision making about themes. Saturation of themes assured trustworthiness.

Findings: A reiterative decision-making process emerged with five phases, which participants would revisit in varying order when confronted with the need to make a care decision: Finding a Voice; Professing Fidelity; Speaking for the Speechless; Correcting Course; and Expressing Gratitude. Nineteen categories informed various themes <>Significance: It is vital to help families through “Finding a Voice” so that their parents can benefit from early treatment. Providing easy access via the Internet to support and information, especially during the Professing Fidelity and Speaking for the Speechless phases, might help this population deal with time constraints that often interfere with using conventional resources. Supporting public policy changes about accessible, reliable, affordable day and respite care would sustain them through the “Correcting Course” phase. Finally, helping them to acknowledge their decision-making abilities under difficult circumstances would help prolong the “Expressing Gratitude” phase.