"Oh, this place again," my mother says, as if somewhere in her memory, where most things are forgotten, this building, with its enormous orange and yellow Senior Living sign, clicks a normal synaptic reaction.

"Yes," I say. "That's right. Let's go inside and have some lunch."

It all seems so innocent, a dutiful son taking his elderly mother out for a meal. She doesn't know how I've struggled with the decision I've made, how it tears me apart. She doesn't know that today isn't just lunch. And she doesn't know that my heart is broken again because I've done this before—struggled and ultimately removed another family member from a comfortable home without consent.

Twelve years ago, I paid two men to come to my house in the early hours of the morning and take my eldest son to a therapeutic wilderness program in North Carolina. With my wife standing beside me, I grabbed his shoulder as he slept. "Wake up. These men are here for you. We love you," I said, before I calmly walked away.

It seemed so utterly heartless, but the truly difficult part—making the decision to send him away—was done. The wringing of hands and the endless debating was over. His situation, of course, was hugely different from my mother's, but the agonizing process of getting from what should we do? to actually doing it was eerily the same.

At 14, my son had remained impervious to all the help we'd given him. Medication didn't help. Therapy had little impact. Love was…