Did You Know

Some residential care facilities that have been specifically designed with the needs of Alzheimer's disease and dementia patients in mind. To learn more, read about the considerations that went into the planning and building of Woodside Place, one of the first dementia-specific care facilities in the United States.

Even with help from community and respite services, providing care for a loved one with Alzheimer's disease or dementia will become more difficult with time. In later stages, long-term care options may be able to provide best for the needs of the individual; however, these options are often considerations that caregivers and their families find difficult to plan for or to even discuss.

Long-term Residential Options

The two main long-term care available to seniors and to individuals with AD/dementia are assisted living facilities and nursing homes (also known as a skilled nursing facility).

Assisted living. An assisted living facility, such as a continuing care retirement community, is especially suited for those individuals in the earlier stages of Alzheimer's disease and dementia who do not have many medical problems but who do need more intensive support for Instrumental Activities of Daily Living (IADLs)Many people with dementia will need help with tasks that are called "Instrumental Activities of Daily Living," or IADLs. IADLs are activities that we perform from day to day that add to our quality of life, but are not as basic to self-care as ADLs or activities of daily living. The following tasks are considered to be IADLs:
  • Managing money (i.e., writing checks, handling cash, keeping a budget)
  • Managing medications(i.e., taking the appropriate dose of medication at the right time)
  • Cooking (i.e., preparing meals or snacks, microwave/stove usage)
  • Housekeeping (i.e., performing light and heavy chores such as dusting or mowing the lawn)
  • Using appliances (i.e., using the telephone, television, or vacuum appropriately)
  • Shopping (i.e., purchasing, discerning between items)
  • Extracurriculars (i.e., maintaining a hobby or some leisure activities)
Persons with dementia may be able to perform these tasks independently, with some difficulty, or with additional assistance. However, their performance might change over time as well. It is a good idea to take notes on the abilities of your loved ones and how they change. In this way, when you go to the physician, you can supply information that can help him or her better understand the progress of the disease.
or Activities of Daily Living (ADLs)Individuals with dementia may also need help with tasks that are called "Activities of Daily Living," or ADLs. ADLs are the basic activities that we must perform every day in order to take care of ourselves. Typically, ADLs refers to the following tasks:
  • Bathing (i.e., able to bathe without assistance in cleaning or getting into tub or shower)
  • Toilet Use (i.e., able to use the toilet and clean oneself afterwards)
  • Control or continence of urine and bowels (i.e., able to wait for the right time and the right place)
  • Dressing and grooming (i.e., able to button a shirt, choosing appropriate clothing)
  • Moving about (i.e., able to move in and out of a chair or bed, walking)
  • Eating (i.e., able to eat without having to be fed by another)
In this type of program, your loved one would be able to live and to interact in a more independent community where he or she still has the benefit of services such as security, transportation, personal care, socialization, and meals. You should begin to consider long-term care for your loved one if:
  • Your own health (physical, mental, and/or social), is being sacrificed and is failing due to providing care for your loved one.
  • You experience some sort of injury or onset of disease that would make it difficult to care for another person.
  • You are unable to provide your loved one with the sorts of care and activities that he or she would need to remain as healthy and active as possible.

Skilled nursing facility (Nursing home). A skilled nursing facility, also known as a nursing home, provides more extensive medical care. These facilities are best suited for individuals with AD/dementia who are in the later stages of the disease and who have more serious problems with their health or with daily living. In spite of your best efforts to support and to care for your loved one, you should consider long-term care for him or her in a skilled nursing facility if:

  • Your loved one needs more constant supervision than you are able to provide, whether for wandering or for other behaviors.
  • Your loved one is posing a danger to themselves or to others because of their behavior and actions.
  • Your loved one is becoming more difficult to keep adequately nourished, hydrated, and/or healthy.
  • Your loved one is no longer able carry out their activities of daily living.
Resources
Source: 
U.S. Department of Health and Human Services, Medicare
Description: 
This website allows caregivers to search for nursing homes by state, city, county, zip code, or name. The results of this search compare nursing homes. The website also includes advice on how to choose a nursing home and provides additional resources for caregivers.
Source: 
The Alzheimer’s Association-Greater Illinois Chapter
Description: 
This 21-page booklet available as a printable PDF offers insight into Alzheimer’s disease and related dementias, particularly care issues related to the late and final stages. The booklet is geared towards families so that they may make informed choices regarding medical decisions on topics such as nursing homes, assisted living facilities, and other types of care. It will also provide information for families to ask good questions with the goal of obtaining the best care. A checklist is provided of comfort care measures. Staff members of long-term care facilities will also find this guide useful, as an educational tool for families.