Nursing Home Decision: General Considerations and My Story
Why Consider Professional Help?
If you are worn-out with caring for your loved one, you are not alone. Some caregivers end up having worse health issues than the ones they are caring for. When I was caring for both of my in-laws, my cousin, who had been a geriatric nurse for many years advised me to get professional help so that I could be sure to do a good job loving them as only a family can.
Let the professionals do what they can, so you can do what only you can.— Renee, experienced hospice nurse
Types of Care Facilities
Professional service can help you be a better caregiver. There are many types of services available, including:
- Respite care in your home.
- Daycare outside your home.
- Independent living with some daily needs support.
- Assisted living care.
- Combination care facilities which have graduated care from independent living to assisted living to nursing care.
- Long-term care nursing homes.
- Specialized Alzheimer's Units in Long Term Care Facilities.
- Memory Care homes.
The type of facility and care you choose will depend on your loved one's needs. However, it is important to consider not only the immediate care the person needs, but also to plan for the future. When a person with memory issues moves, they tend to lose their orientation and often decline more rapidly. Therefore, it is helpful to choose a place where the person can be cared for even as they move towards an advanced stage.
Long Term Care Poll
What is your interest in Alzheimer's facilities?
When to Seek Help
Many times, families feel guilty about not being able to care for their loved one with dementia. Often, when a person is in the early stages, changing schedules and reducing work can allow families to provide the assistance their relative needs to continue to stay in their home. However, as a person enters middle and late stages, caring for a person can be overwhelming. Long-term care should be considered when:
- The elderly loved one needs 24-hour supervision.
- The individual needs more medical monitoring and nursing care than can be provided in a home setting.
- The main caregiver is facing health problems, feels overwhelmed, doesn't get enough sleep, feels isolated or becomes depressed. If the main care provider is a spouse, other relatives need to watch for these signs. The caregiver may feel guilty and reluctant to admit they can't cope.
- Caregiver and patient are having difficulty in their relationship.
- Safety of the loved one with Alzheimer's is a concern because of falling, wandering or other behaviors.
- If the person lives alone, are they becoming unable to continue daily living tasks, feed themselves, and take medicines appropriately?
- Doctors and other professionals recommend considering it.
Alzheimer's Facility vs. Nursing Home
You may wonder if a person with memory loss needs to be in a facility which specializes in Alzheimer's patients. Here are some things to consider:
- Special Memory Care May Cost Much More: While many of these facilities might have resources which could help your loved one, the added cost of many of these types of long-term care homes may not be necessary. In our town, memory care homes cost 30% more.
- Most Long Term Care Facilities Have Patients with Dementia: A large majority of people in most nursing home facilities have some form of dementia, so staff is familiar with handling the different needs of memory challenged individuals. So even if the nursing home does not state a specialty in memory care, they may very well be quite competent to take care of your relative.
- Alzheimer's Patients are Difficult. No matter where your loved one stays, whether at home or in a care facility, they will probably encounter many difficult days as they struggle with continued declining abilities. Delusions, hallucinations, anger, sundowning (mixing up days and nights) and other behaviors make caring for a person very difficult. Even the best caregivers will sometimes be stumped at how to handle a behavior. No matter what facility you choose, you may be called upon (as we were) to be involved in helping devise strategies to handle different problems that arise.
Crisis Often Precipitates Care Decision
Like many people caring for loved ones with Alzheimer's, it took a crisis for us to consider long-term care. In our case, the problem was compounded by the fact that we were caring for two loved ones at once, Michael and Nicole, my husband's parents.
For two years, we managed to help them stay in their own home. I stopped working so I could be available for their emergency needs and medical care. We assisted in caring for them and changing their routines so that they could cope with their changing abilities. However, eventually, there came a medical crisis which put Nicole into the hospital. Within six months, both Michael and Nicole needed 24-hour care. Many of the items on the list above were true for us. We considered the special Alzheimer's facility in town, but they did not have beds at the time; moreover, as we investigated our choices in long-term care facilities, we realized that we needed to consider the different needs of each of them:
- Nicole needed 24-hour nursing and medical supervision of her condition. She needed people who were very compassionate but able to deal with her explosive anger.
- Michael needed to be assisted living services to help with daily living and activities to keep him busy. He also needed a locked facility that he could not leave. Furthermore, he also needed people who could re-direct his paranoia.
Which Option is Best?
The most important factor in choosing an Alzheimer's facility is determining what your loved one must have to be safe, emotionally stable and taken care of physically. What is important to you and your loved one may be different from what another family would need. However, here are some typical questions you might want to consider:
- Do they have locked doors and alarms?
- Are there cameras for monitoring patients?
- Are there lots of activities to keep them busy?
- How does the community encourage socialization?
- How are meals provided and are their choices about what to eat and where the individual can eat?
- Do they provide help with eating if necessary?
- What is the noise level?
- Is there a place where your loved one can have privacy?
- How do they handle incontinent care?
- What sort of personal care services do they provide and how often are showers, hair washing, and shaving done?
- What is the daily schedule and how can you find out about activities?
- What kind of therapy is available?
- Is there a doctor or nurse practitioner who visits? What is the schedule?
- Is the facility close enough for the family to easily visit?
- Do the staff seem to be compassionate and patient caregivers?
- Would your loved one have a consistent caregiver or a variety of different faces?
- Is there a 24-hour nurse on site?
- What provisions are made for moving from assisted living to nursing home care?
- Is there a place where your loved one can go outside, or at least look at the outdoors?
- Is this a physically attractive facility?
- Is this a place where family involvement is encouraged? Do they have activities to involve family members in special events?
- Are they adept at handling psychotic medications for individuals with difficult behaviors?
Red Flags to Watch For
Just as no one solution fits all needs, you may also find that one care solution may not be enough. In the end, we used three different long-term care facilities. Our problems came because:
- One facility was not able to handle the two of them together.
- Another facility had staff changes which made them unable to keep Michael safe.
- Michael initially needed the stimulation of assisted living, but as he declined he needed to have the medical services of a nursing home facility.
In the end, we found that caring staff made the biggest impact on how well Michael and Nicole adjusted to the facility and felt about their time living there. Caring and gracious staff would be the first thing I would look for while touring any facility in the future. In fact, our doctor told us that several of the homes that he felt provided the best care in our town were not particularly attractive in appearance, but had very experienced and caring staff.
Have you chosen a long-term care facility for your relative with Alzheimer's or dementia? Please share your stories and ideas for making the choice in the comments below.
Alzheimer's Caregiving Changes Family
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.