When is it time to consider care outside the home?

Although many are able to care for someone suffering from Alzheimer’s or other forms of dementia at home, it may come to a point in the disease process that makes home care unmanageable. With the variety of home health services that are available, this may be delayed; but in some instance, placement is warranted. Some questions to consider when deciding for long-term placement is right for your loved one include:
  • Have any accidents occurred recently with appliances in home such as the stove or forgetting to turn it off properly?
  • In the event of a fire, do you feel your loved one would follow appropriate emergency measures including calling 911 and leaving premises?
  • Has your loved one become progressively dependent with more ADLs recently? (Eating, dressing, bathing)
  • Has he or she or become easily threatened or suspicious of others, taking medications, or eating certain foods?
  • Is your loved one taking medications on schedule, following correct dosages, and willing to use an organizer/reminder device if necessary?
  • Has your loved one gotten lost or unable to remember personal information such as address, phone number, contacts that enable them to return home? Has he/she gotten lost while on a walk or running errands?
  • As the caregiver, is your health at risk, are you missing a lot of work or are unable to manage other responsibilities?
  • Do you have additional support to care for your loved one?
  • Is the amount of home care assistance needed likely to become so great that it is not an affordable option for your family?

Consider an Assisted Living Facility

As the name implies, assisted living facilities (AL) are designed to assist individuals who may need help with their day to day tasks, but do not need the extensive nursing care provided by skilled nursing facilities or nursing homes. Most ALs are set up a small, efficiency apartments and are staffed with nursing assistants and aides who are able to help in bathing, dressing and grooming. In some state’s medication administration is also a benefit for residents in an assisted living. Most facilities also offer dining programs and structured socialization opportunities. Assisted livings may also be a good choice for couples who want to remain together but simply cannot care for each other because of health limitations.
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For those with mild to moderate dementia, assisted living facilities are a great choice for individuals with memory impairment without fully relinquishing independence.

Consider a Skilled Nursing Facility

These are also known as nursing homes and are often the choice of last resort. Usually, if a person needs permanent placement in a nursing home, the supervisory care needed exceeds that which can be offered at home or in an assisted living. Many of these patients are exit-seeking or are more difficult to redirect. Some people with dementia may also develop aggressive behaviors which can pose a threat to themselves or those around them. Others simply are no longer able to perform most or all of their activities of daily living and need a higher level of care.
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Cost: The cost of care in a skilled nursing facility is expensive. Unfortunately, most residents with dementia do not qualify for Medicare or insurance benefits. Medicare guidelines require a 3-midnight hospital stay in order for a benefit period to begin and then patients must meet certain criteria, such as a need for intensive nursing care or rehabilitation in order for the federal program to continue paying. Some dementia patients may initially qualify upon admission, but quickly become what is known as custodial care. If a resident is in a skilled nursing facility under custodial care, private funds or medical assistance will most likely be required to pay for outstanding balances.
The transition from home to either an assisted living facility or a skilled nursing facility is difficult. Do not be surprised if your loved one is agitated, confused and persistent about returning home. This is common and will most likely subside as they become acclimated to their surroundings. Speak with the nurse or administrator about visitation guidelines or suggestions during those first few days. You may find that some facilities will ask that you not visit until the resident has had the opportunity to adjust to his/her new surroundings.

This information was provided in part by Assisted Living Today, an online resource dedicated to providing valuable information about various aspects of elderly living and elderly care.
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