How To Know When Its Time To Move To Memory Care
Its difficult to know when your loved one needs to change living situations, because the disease progresses so slowly. Alzheimers takes years to transition from early to mid and late stages, so even if your gut says its getting worse, your mind and heart might argue otherwise. Add the guilt and emotion that can come with putting a loved one in memory care and the decision becomes even more difficult.
Did You Know?
1. When you cant keep them safe at homeA decline in overall health for someone with dementia can be a major sign of trouble. Watch for unexplained weight loss, hunched posture, and bruises. Difficulty standing and walking without assistance is something that can lead to falls and broken bones, which are very common for people with Alzheimers disease. On the opposite end of that spectrum, sitting for too long is another dementia-related behavior that has been shown to be unhealthy. Wandering and becoming lost can be mediated with technology but are also incredibly serious and dangerous behaviors.
4. When social life shrinks to isolationSomeone with dementia will become less social as their world becomes more confusing. The mental impacts of Alzheimers cause a person to retreat inwards and living at home makes it so much easier to be alone even if someone else is in the house. As the disease progresses, more confusion, less stimulation and inward retreat can become a self-reinforcing circle.
Crowded Nursing Homes In The Bay Area
Theres another factor, as well, that correlates with cost. California and the Bay Area are on the verge of what could fairly be described as an Alzheimers epidemic.
- The population of the state with Alzheimers will double to nearly 1.1 million.
- 1 in 8 Californians over the age of 65 will be afflicted.
- There will be a 100% increase for African-Americans and a 200% increase for Asians and Latinos.
In San Francisco alone by 2050, there will be nearly 55,000 Alzheimers patients, 56,000 in Almeda County, 59,000 in Santa Clara, 42,000 in Contra Costa, 38,500 in San Mateo, and on and on. There will need to be massive investment in facilities in the Bay Area, but even with that, costs will increase and the laws of supply and demand take a hideous toll.
How Can I Support Someone As Their Dementia Progresses
As a person’s dementia reaches its later stages, they become increasingly dependent on others for their care.
They may have severe memory loss and no longer recognise those close to them. They may lose weight , lose their ability to walk, become incontinent, and behave in unusual ways.
Not everyone will show all these signs, and some people may show them earlier on in the illness.
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Permanent Placement In Residential Care
It was also on bringing my husband home from hospital, that I decided I needed to get my applications and choices for permanent placement organised. I had already done a lot of looking around and had all the paperwork at home, but I just had not been ready to send them off, but now I felt I was ready. I had found a facility that was appropriate and close to home, so I submitted the paperwork.
As time went on, I decided to go further away from home to have more opportunities for placement, so have now submitted applications to six facilities, and I just play the waiting game. It has been 5 months now since I lodged the first application, and each day since then my caring role has just got harder and harder, some days I just do not know how I can keep doing this. I keep ringing the agencies week after week advising them of my urgency.
I have been told right from the very beginning that availability goes on need. These agencies have never seen or met my husband and so I questioned them, How do they understand our need when they have never met us? And the answer is always we go by the ACAT.
As our ACAT was done 18 months ago and the dementia has declined to a point where the ACAT does not reflect our true current urgent need, how can we be assessed correctly!!! I am also aware that if a bed becomes available, if there is someone in hospital or living at home on their own, they will go in before us, as their need is higher.
Tips For Dementia Care
Dementia can be challenging for both patients and caregivers but knowing what to expect can help ease the journey. Caregivers may not be able to anticipate the level of dementia on a daily basis, but they can be prepared to manage the varying symptoms of dementia as they progress.
The different stages of dementia require different degrees of caregiving. 2 With mild dementia, people may still be able to function independently, however, theyll experience memory lapses that affect daily life, such as forgetting words or where things are located.
People experiencing moderate dementia will likely need more assistance in their daily lives as it becomes harder for them to perform daily activities and self-care. They may hallucinate, get lost easily and forget where they are, and not remember what day of the week it is.
Someone with severe dementia will likely lose their ability to communicate and need full-time daily assistance with tasks such as eating and dressing. They may not remember their own name or the names of others. Physical activity and ability may be seriously impaired and they may be more susceptible to infections, such as pneumonia.
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Who Makes The Decision
In some cases the person with dementia will be able to decide for themselves whether or not they need to move into a care home. If this is the case, then they should make their own decision and be offered any help they need to do so. However, often by the time the person with dementia needs the level of care that a care home provides, they have lost the ability to make this decision for themselves.
If the person is not able to make this decision, someone else will need to make this decision for them. This would usually be the persons attorney under a health and welfare Lasting power of attorney, or their personal welfare deputy, if they have one. Any attorney or deputy must make decisions in the best interests of the person. An attorney or deputy for property and financial affairs is often able to make this decision for the person with dementia. This is because they have the legal power to arrange the finances to pay for this care. However, professionals or members of the persons family can challenge this decision.
For more about mental capacity in England and Wales, and how to know if someone is able to make decisions for themselves, see our page on the Mental Capacity Act. For more information on attorneys and deputies see Lasting power of attorney and Becoming a deputy for a person with dementia.
Differences Between Memory Care And Nursing Homes & Assisted Living
Memory care is not the same as assisted living or a nursing home. The difference between memory care and assisted living is that memory care is specifically for people with Alzheimers disease, or related dementia, because they require a higher level of skilled care and supervision. Also called Special Care Units or Alzheimers Care Units, memory care communities usually offer shared and private spaces. Sometimes memory care exists as a wing within assisted living communities or nursing homes.
When compared to memory care, nursing homes are more expensive, more restrictive to the individual and provide a higher level of care. Nursing home candidates are typically accessed and found to require a nursing home level of care, which is a formal designation. Not all, not even close to all, persons with Alzheimers disease require nursing home level of care at the early or middles stages of the disease.
Memory care has more frequent safety checks than assisted living , and staff is specially trained to meet the needs and demands of residents who have difficulty with basic tasks because of dementia symptoms, from early to mid and late stages. Memory care units, therefore, offer most of the same services as assisted living, but with increased supervision and more routine, including structured activities to stimulate memory and hopefully slow the diseases progression. These activities might involve music or pet therapy, games, arts and crafts, etc.
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Agreeing The Right Care Home
Most care homes will visit your relative at home, or in hospital, or invite them to view the care home before agreeing that they can meet their needs. It is beneficial to make contact with the member of staff who does this, give them as much information and tips on your loved one with dementia as possible. This will help the staff at the care home to settle the relative into their new home. Share your relatives life story as a tool of support for the staff. To learn more about my life story read the blog post: How to create a life story.
If possible, aim to have the same member of staff available when the move actually takes place, providing a familiar and welcoming face. They can then share the tips of engagement with other staff.
The Use Of Dementia Medication In Aged Care Homes
As Alzheimers disease progresses, your loved ones ability to perform activities of daily living decreases, and behavioural and psychiatric difficulties are experienced more often. Common behaviour symptoms include apathy, low mood, delusions, agitation, irritability and other behaviours . This means your loved one will require a considerable amount of staff assistance in the aged care home .
Commencing or continuing medical treatment to reduce difficult behaviours can reduce health care costs and improve your loved ones wellbeing. Current medications used for Alzheimers disease are cholinesterase inhibitors, including donepezil , rivastigmine , galantamine and tacrine . Chalinesterase inhibitors have been shown to have beneficial effects on hallucinations, delusions, agitation, anxiety, depression and apathy.
Studies have shown that up to 47% of patients living in aged care homes had their cholinesterase inhibitors discontinued over a period of one year. Furthermore, the move into an aged care home can be associated with a decrease in cognitive function and a more rapid rate of progress. Therefore, it is important for you to liaise with the doctor and staff at the aged care home to discuss the continued use of cholinesterase inhibitors and include their use in your loved ones care plan.
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Caring For Dementia Patients At Home Vs A Nursing Home
A new dementia diagnosis in your family can have a significant impact on everyone involved. You and your loved one may have difficulty coming to terms with the emotions, lifestyle adjustments, and expectations that come along with that type of diagnosis.
Dementia also presents your family with a number of decisions regarding treatment and location of care. Usually caretakers have one of two options, both with advantages and disadvantages, for long-term care. You can care for your loved one at home or make arrangements for care at a nursing facility.
When Should An Alzheimers Patient Go To A Nursing Home Making The Case For Home Care
Where do we go when our mind betrays us and when the person that we have been our whole lives gets lost in the recesses of our brain? Its a question with deep and often terrible philosophical, moral, and emotional implications, and the lack of an answer is one of the crueler parts of dementia and Alzheimers for a sufferers loved ones. But there is also a more tangible, though no-less-difficult, question: Where should they go?
The question of home care vs. nursing home for an Alzheimers patient is a difficult and challenging one. It ties in questions of cost, quality of care, and quality of life. It is about what a family can sacrifice, personally and financially. It is a question of what is best for the patient, but also what is best for the family, especially when the patient might be unaware of what is happening.
There are no easy answers. But if a loved one of yours is suffering from dementia and Alzheimers, you need to ask yourself, your family, and professionals what the best course of action is. Very few people consider home care, but increasingly, it is a viable and popular option. It is a life-changing decision and should be met with the same gravity.
Here are a few things to consider when thinking about when an Alzheimers patient should go to a nursing home or if there is a case for home care.
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Planning For The Move
Once a place becomes available in a residential facility a decision may need to be made very quickly, so it is helpful to plan the move in advance. Many people with dementia can be disturbed by change. Explain simply and gently where and why they are moving. Emphasise the positive aspects such as new friends and enjoyable activities. If at all possible, introduce the person with dementia to the new facility gradually so that the place becomes a little more familiar and a little less confusing and frightening. Sometimes of course this is just not possible, especially if the move has to be made quickly.
Ensuring that their new room has as many familiar items as possible may help with the move. Family photos and familiar prints or paintings on the wall and familiar bed coverings can make the new room look a little like their own bedroom at home.
Label all personal items with large, easy to read identification. During this initial moving stage it will take time for both the person with dementia and their family and carers to adjust to the new situation. Expect a period of adjustment. People do settle. Many actually do better in a structured environment they feel more secure and get more stimulation.
There is no right number of times to visit or length of time to stay. Some people want to visit frequently during this time. Others will want to rest and recover from the strain of caregiving. The important thing is to make each visit as rewarding as possible.
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Forgetting to take prescription medication, or taking too much of it, can lead to serious side effects. Reminders, alerts, and pill separators may be effective for seniors with early-stage dementia, but those with significant cognitive decline need more intervention. Medication management is an important feature of memory care.
8. Is your loved one getting proper nutrition?
Seniors with dementia may require special diet plans to combat existing health conditions. Adults aging in place may forget to eat, or they may overeat after forgetting theyve recently had a meal, leading to significant weight changes.
9. Have you started to feel caregiver burnout?
Balancing your loved ones needs with your own is vital. Its normal for dementia caregivers to feel frustrated or overwhelmed sometimes. But if left untreated, those feelings can lead to caregiver burnout and negative consequences for the caregiver and their loved one. Teepa Snow, a noted dementia care specialist, recommends asking yourself the next four questions to determine if burnout is a problem.
10. What are two things that are going OK, and one thing you wish were different?
If your immediate answer is that nothing is going well, or you have to really think about it, its time to seek help when caring for someone with dementia.
11. What are some things you still like about your loved one?
13. Are you and your family safe?
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Setting Up Care At A Nursing Home
The decision to place a loved one in a nursing home often involves a lot of emotion and thought and it isn’t easy. However, in the later stages of dementia, the support provided by a nursing home can come as necessary relief to caregivers. If you’re considering a nursing home for your loved one, you likely want to weigh the advantages and disadvantages.
Pros: Once a person reaches the later stages of dementia, they may have trouble performing the most basic tasks and be at increased risk for medical complications. The extensive memory loss may necessitate 24-hour care. At a nursing home, staff with expertise in dementia is available at all times to provide a safe, supportive environment. If your loved one has a medical emergency at the facility, a medical provider is always there to intervene.
A nursing home also offers social and recreational benefits for older people who enjoy the activity and companionship. Most of their appointments can be arranged in one place, and their meals, medication, and living needs are all provided, alleviating those responsibilities from family members.
The advantages and disadvantages of both types of care can complicate your decision-making process, and no single approach works best for every family. However, the decision usually comes down to what’s best for your loved one. Many families choose a nursing home once the disease progresses.
When Should A Person Living With Dementia Go Into A Care Home
Making a judgment about when a person living with dementia is in need of residential care can be a difficult and emotional step for their loved ones, but understanding the factors which necessitate this move can enable more confident decision-making.
Many families are keen to keep their loved one at home in a familiar environment for as long as possible. However, as dementia progresses, it is likely that the person is going to need some kind of more specialist care.
It may become clear that someone living with dementia can no longer be safe and comfortable while living independently. For example, if they are struggling with everyday tasks such as cooking, cleaning or bathing and dressing themselves.
Since dementia most often effects older people, it may also be accompanied by other physical deteriorations, and incidents such as a hospital admission may create a compounded need for a higher level of care.
While it can be possible for loved ones to care for a person living with dementia, there are usually limits to how much family and friends are able to do, especially as the individuals symptoms worsen and their needs become more complex. When caring for someone at home starts to become unsustainable and too much for their loved ones to cope with, it is wise to begin considering professional care options such as a residential home.
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