Posted on: July 11, 2016 | 0 Comments |
When we toured the nursing home it was clean and the people who worked there were nice enough but the place felt institutional and sad. The walls were a pale green and the floor was a similar linoleum tile. There were people sitting in wheel chairs in the hallways talking to themselves or staring straight ahead with a blank look on their face. No one was screaming or filthy or being abused but Mom and I both walked out of there sad and scared. My Grandmother lived there peacefully for 2 years before she died and several years later my Grandfather moved in to live out the last 8 months of his life. Both of them received good care and were treated with kindness and respect. None the less, I was bound and determined to keep the promise I made to my Mom and never let her end up in a nursing home.
Fast forward 30 years and my Mother is diagnosed with Alzheimer’s and I am facing my 10 year old self and a promise made. I was able to keep that promise to some extent, Mom never did have to go to a skilled nursing home. However, she did move into assisted living and eventually a memory care facility. Thankfully there were major improvements made in the elder care industry in those 30 years and we had a lot more options to choose from. Ultimately my Mom lived in 4 different communities during her decline through Alzheimer’s and I can honestly say breaking my promise (even sort of) was in the best interest of her care and quality of life.
I know the current hue and cry is that the elderly should age in place and stay in there home. Let me be clear, I am a big supporter of home care and work with many great home care companies, however, in some cases home care is NOT the best option. Each situation is unique and in dementia cases in particular, facility care is often the best choice. Obviously financial resources are a determining factor but in general if a person needs 8 hours or more of custodial care per day it is less expensive to live in an assisted living or memory care community. Finances aside there are many benefits to living in a well run community such as:
- 24 hour care and security reducing wandering and other unsafe conditions
- 24 hour access to a nursing professional reducing falls, infections and hospitalizations
- Socialization and decreased depression
- Improved hydration and food intake
- Improved nutritional management
- Access and transportation to activities and events on and off site
- Smaller less confusing living quarters
- Daily routine which reduces confusion
- Supervised medication management
- On site services such as physician visits, salon, banking etc., reducing the need to leave the familiar setting
Over the years we have helped clients move many family members into communities and I can say that every one so far has resulted in an improved quality of life for both the person with dementia and the family caregivers. Of course, that does not mean that these moves were not without drama and emotion. I am also not saying all people with cognitive impairment should move to a facility. What I am saying is that family should not exclude this option due to social pressures, misconceptions, a promise made or ignorance of their options. That being said, how do you know when it is time to consider facility care?
- Is the person safe?
- Are they able to function alone safely? Will they wander out, open the door to a stranger, leave the stove on, etc.
- Can they recognize an emergency and respond appropriately? Will they know how to call 911 and exit the house if there is a fire?
- Is the current environment high risk for falls or infection? Is there clutter, stairs, hording, unsanitary conditions?
- If they fell could they get help?
- Are they able to manage meals, hydration and medications safely? Is there a risk of them eating spoiled food or missing critical medications?
- Are they lonely, depresses or socially isolated? One of the biggest benefits we see in facility care is the opportunity for friendships and healthy socialization with people who are experiencing the same issues.
- Do they have other medical issues in addition to dementia such as diabetes that requires oversight?
Any or all of the above situations are red flags that a person needs care. If these risks can be mitigated easily with family or home care that is great, if not, it is time to look at other options. So how do you know what to look for in a community? Here are a few tips:
- Have the person professionally assessed so you are clear on what the care needs really are. Family members are notorious for underestimating how advanced the dementia is and the extent of care needed. I was guilty of that!
- Research the different types of care available. It is important to know that this industry is NOT standardized so what one facility calls memory care another may call assisted living. It is NOT an apples to apples comparison most times.
- Research the types of facilities. There are large communities with a full breadth of services and there are small facilities with only a few residents. Each has pros and cons.
- Research the financial health of the organization, the staff make up and turn over and how much dementia training they are requiring.
- Tour a few different types of facilities without the person with dementia so you can get an idea of what options are available. Then narrow it down to 2 places if you are going to involve your loved one in the decision.
- Ask what the admission criteria are and what could constitute the need for a move or eviction.
- Try to choose someplace that is close enough for family or friends to visit regularly and oversee care. Every facility has its issues. The best way to ensure good care is to be there often!
- The apartments are small by design. A smaller and less cluttered environment has been proven to be safer and more calming for people with dementia. You don’t have to bring ALL of their belongings.
- Be prepared for resistance from your loved one and have a plan for how you are going to convince them to move.
- Be prepared for the first few weeks after the move to be difficult. Often it is best for family to stay away and let the staff do their job and help the new resident acclimate. It is often a good idea to request a mild anti-anxiety medication from the person’s physician to help reduce the stress of the change.
- If the transition has been difficult do not take the person out of the facility for a few weeks until they adjust. Do not take them back to their previous home – this is almost always a very bad idea.
- Finally, don’t beat yourself up. Many family members feel guilty when they have to move a loved one into a community. Remember you are doing this to improve their quality of life and keep them safe.
The dementia journey is difficult and there is no set methodology for how to manage the many different types of dementia. Each person and journey is unique. But there is help out there. Do your research, ask for help, try to be gentle with yourself. That is the best advice I can give.