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Long-Term Care Options
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:
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. 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:
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.
Picking the Right Facility for Your Loved One
When choosing a facility for your loved one, there are several issues that you should address in order to make sure that the location would be both appropriate and beneficial to your loved one and their needs.
Familiarity with AD/Dementia
When you visit, try to get a sense for how familiar the facility and the staff are with the needs and care of persons with Alzheimer's Disease or dementia. Do they have special measures for security or supervision in place to prevent wandering or other behaviors? Do they offer rehabilitative or therapeutic support for AD/dementia individuals and how active do they encourage these individuals to be? Some facilities may have specialized dementia care units or, in larger metropolitan areas, facilities might exist whose specific purpose is to care for AD/dementia individuals.
Quality of Care
Part of the anxiety that is associated with long-term care comes from wondering what quality of care your loved one would have at a facility. When you visit, be sure to not only talk to the administration and the staff, but also try to talk with some of the residents and their family members. Also, remember to try to get a sense for how things operate when you are not around. What kinds of staff or health professionals are available on a daily or semi-daily basis?
Practical Matters
Remember to ask the purely practical questions. What is the current availability of rooms within the facility? If there is a waiting list, how soon would your loved one be able to gain entrance? Finally, ask about how much placement would cost and what kinds of payment they take. Medicare and Medigap (supplemental Medicare insurance) will not pay for extended stays in nursing facilities, so discuss with the facility what payment options are available. State-run Medicaid or long-term care insurance may be able to help finance your loved one's stay.
Family Involvement
Finally, when talking to residents and their families, find out whether they are satisfied with the level of involvement and interaction in the facility. How open is the facility to visits from family members and friends? Are there certain hours when you can or can't visit your loved one? Do appointments need to be made for visitations? Does the facility ask for or allow the input of family members in designing the care plan and activities for their loved ones? As a caregiver, you have a lot of knowledge and experience that is valuable to the continued care of your loved one, even in a long-term care facility.
Hospice
In the end-stages of Alzheimer's disease or dementia or if your loved one is terminally ill, hospice care can ensure that your loved one is receiving the best care possible at all times. Visit the AlzInfo.org page below to learn more about this option.
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Resources
Source:
Virginia Department of Aging
Description:
This brochure from the Virginia Department on Aging provides specific resources and recommendations for placing a person with Alzheimer's disease or dementia into long-term care, including questions that should be asked and documents that should be considered before placement.
Source:
National Institute on Aging (NIA)
Description:
This brouchure contains a list of resources that can help you make an informed decision about a long-term care facility for your loved one.
Source:
American Health Care Association
Description:
This resource provides information on how to find and choose an appropriate a long-term care facility for your loved one. It discusses the issues to consider when making a long-term care decision, such as finances and personnel at the facility, and includes tools such as a cost calculator and a consumer checklist.
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. 