How do you know when the time has come to move your loved one with Alzheimer’s from the home setting to a long-term care facility? Dr. Peter V Rabins, medical editor of the Johns Hopkins Memory Bulletin, offers this advice.
If you are a caregiver struggling with the question of when to place your loved one with Alzheimer’s in a residential care facility, the questions you’re likely to ask are numerous, complex, and fraught with emotion. How long should I hold out? Can I afford a decent facility? What options do I have? How can I possibly get my loved one to understand this decision? These and a hundred other questions are as difficult as they are vital.
There really is not one answer to question of the "right” time to transition to a residential care facility; any answer is different for each person with the illness and for each family. Everything depends on the symptoms the Alzheimer’s patient has -- the degree of the impairment in his/her cognitive skills -- and on what other kinds of associated problems he/she is having in behavior and activity.
The decision to move the Alzheimer’s patient also depends on the ability of the caregiver to adequately meet the person’s needs. For example, a relatively frail spouse who’s trying to look after someone who needs a lot of physical help getting out of bed or even getting out of a chair just may not be able to provide that kind of care anymore. So there’s a level of physical strength and stamina that needs to be considered.
Perhaps the most important question is whether it would be dangerous to continue the current situation. If the Alzheimer’s patient needs more physical care than can be provided at home, wanders away in spite of attempts to prevent it, has become aggressive towards others and has not responded to care, or has dangerous medical conditions that need more monitoring than can be provided, then moving to a place where these needs can be better met is the right thing to do.
It is important to consider, as well, the emotional well-being of the caregiver. How overwhelmed is that person? And have they been able to use the resources that are available in the community? After weighing the pros and cons of each factor, you can better make a decision.
Long-term care for the Alzheimer’s patient: Questions to ask and things to look for
What should you look for when you visit a nursing home or assisted-care facility you’re considering for an Alzheimer’s patient? It all starts with a phone call.
Before you visit any facility, talk to the person in charge there. He or she can tell you if a place is available for your loved one, if there’s a special care unit for Alzheimer’s patients, and if the facility accepts the funding sources you’re planning to use, including Medicaid or Medicare.
Once those issues are settled, be sure to allow plenty of time for your inspection. If possible, take a friend or family member with you or an objective third party, such as a social worker or a member of your local Alzheimer’s Association. Having a backup person along gives you another set of eyes and ears that will catch things you miss. Repeat visits are encouraged for the same reason.
Once on site, talk to members of the staff and to any residents who are alert enough to converse. Try to picture how your loved one will fit in. Don’t be fooled by a fancy lobby. Other things -- such as food quality and staff competence and level of caring -- are more important.
Here are key things to look for:
- Be sure the physical plant is clean and safe. Check especially the kitchen and the bathrooms.
- Find out if staff members understand Alzheimer’s and how they care for people like your loved one.
- Is there adequate staff to supervise the residents, including at night?
- What sorts of recreation and social programs are in place?
- Is transportation available for going to church, shopping trips, or appropriate field trips?
- Are meals nutritious and appetizing? Are servings adequate? Is the menu varied?
- What day-to-day medical support is available?
- What procedures are in place in case of a medical emergency?
- Who is responsible for supervising the Alzheimer’s patient’s medications?
- Is help available for residents who are depressed?
- Review the requirements for licensure, and find out how often inspections are carried out and by whom.
- Find out what fire alarms and evacuation plans are in place.
- Use the “nose test”: Strong smells of urine and other odors often indicate substandard care.
- Ask for printed copies of any financial arrangements and other provisions of care.
- Nursing-home residents have rights that are protected under the law. Ask if the facility you’re visiting keeps a copy of those rights handy, and if it adheres to them.
Once you’ve decided on a facility or narrowed the choices down to one or two, there are a number of specifics to go over before you sign any papers. Here is a list of questions that need to be answered:
- Will the patient or resident receive a refund of advance payments if he has to leave the facility?
- How does the home protect cash and assets that have been entrusted to it? Is a receipt given to you or the patient? Are withdrawals noted by signed receipt, so that you can keep track of the account?
- Are the agreed date of admission and the care to be furnished set forth in the written agreement?
- Under what circumstances can the facility discharge a person, and how much notice must it give you?
- If your loved one’s condition changes, will the home move him or her? If so, will it be to another unit in the same facility?
- What charges are extra (television, telephone, laundry, personal care supplies)?
- Last, make sure that you get a copy of the final contract and that it includes all financial agreements. Do not take anything for granted.
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Posted in Memory on May 14, 2007
