In 2011, it has been estimated by the Alzheimer’s Association that 5.4 million people have Alzheimer’s Disease and other forms of dementia. Dementia is a multi-faceted disease with no real cause, and unfortunately in most cases, no cure either. The burden of caring for a loved one with dementia often falls on the shoulders of an unpaid, untrained care giver trying to do their best to provide the care needed for the patient and in some cases for themselves.
Is it Dementia?
Forgetfulness is often a normal part of aging. Misplacing reading glasses, forgetting names or having a lot of “senior moments” is nothing more than an annoyance for many aging adults. However, this is not the case of everyone. If your loved one’s forgetfulness is compounded with such things as complications completing mundane tasks, problem solving, understanding spatial relationships or change in mood and behavior then it may be a more serious form of memory impairment. If you suspect that someone you love is suffering from a form of dementia, contact your primary care physician for a screening. Medication is available to help with the symptoms and may slow the progression of the disease.
With the disease becoming more prevalent, many senior living settings are dedicated resources to caring for individuals with poor cognition. From Assisted Living Facilities to Adult Day Care Programs, there are several options to provide safe, secure and nurturing environments for adults with memory impairments.
If you are helping to care for someone with memory deficits this guide is intended to help inform you of the options that may be available for someone with dementia
When is it time for long-term care?
Although many are able to care for someone suffering from Alzheimer’s or other forms of dementia at home, it may come to a point in the disease process that makes home care unmanageable. With the variety of home health services that are available, this may be delayed; but in some instance, placement is warranted. Some questions to consider when deciding if long-term placement is right for your loved one include:
- Have any accidents occurred recently with appliances in home such as the stove or forgetting to turn it off properly?
- In the event of a fire, do you feel your loved one would follow appropriate emergency measures including calling 911 and leaving the premises?
- Has your loved one become progressively dependent with more ADLs recently? (eating, dressing, bathing)
- Has he or she or become easily threatened or suspicious of others, taking medications, or eating certain foods?
- Is your loved one taking medications on schedule, following correct dosages, and willing to use an organizer/reminder device if necessary?
- Has your loved one gotten lost or unable to remember personal information such as address, phone number, contacts that enable them to return home? Has he/she gotten lost while on a walk or running errands?
- As the caregiver, is your health at risk, are you missing a lot of work or are unable to manage other responsibilities? Do you have additional support to care for your loved one
- Is the amount of home care assistance needed likely to become so great that it is not an affordable option for your family?
MEMORY CARE SETTINGS
Adult Foster Homes
With only up to 5 people to look after, an Adult Care Home operator with help as needed, can provide close supervision and support. Many dementia care residents plateau with their care needs and can live in the Adult Foster Homes for relatively long periods of time in a happy and caring environment. In fact, often the smaller, homelike environment around them is much easier for them to adapt to rather than larger institutions. Mild, moderate to severe dementia can often be handled very well here. Typically there is a system of security in place. Cost is typically calculated to be a product of the needs of a resident. If residents become violent or develop various anti-social activities where they might be a danger to themselves or others, then it may be appropriate to seek a full Alzheimer’s care facility. We have some good ones in the Portland metro area. Please ask.
Assisted Living Facilities
Assisted Living Facilities (AL) are designed to assist individuals who may need help with their day to day tasks, but do not need the extensive nursing care provided by skilled nursing facilities or nursing homes. Many ALs consist of small, efficiency apartments and some are larger double-occupied rooms. They are staffed with nursing aides who are able to help in bathing, dressing and grooming and medication management. Facilities also offer structured socialization opportunities. This may also be a good choice for couples who want to remain together but simply cannot care for each other because of health limitations.
For those with mild to moderate dementia, assisted living facilities may be a good choice for individuals with memory impairment without fully relinquishing independence. When choosing an assisted living facility for someone with dementia, be sure to identify some important factors:
Secure Areas: Some assisted living facilities are designed with the mild dementia patient in mind. Entire wings or even buildings may be designated for individuals suffering from memory impairment. They often provide more supervision and security than the rest of the facility. These communities are staffed with caregivers who are accustomed to the impulsivity and poor safety awareness exhibited by many who suffer. The staff is trained in how to respectfully and humanely redirect the resident back to the appropriate activity or location.
Rehabilitation Programs: Many memory centers will also offer programs designed to slow the progression of this degenerative disease or alleviate symptoms associated with dementia like agitation and aggression. Sensory stimulation, cognitive therapies, physical and occupational therapies are all included in these types of programs. There has been a lot of positive research regarding alternative therapies such as music, art therapies which tend to help reduce agitation, although no long term benefits have been identified. Most therapies and programs are performed in group settings which allows for greater supervision of the residents as well as the socialization that is needed.
Cost: Most assisted living facilities are paid for with private funds. The average cost of assisted living varies from state to state and depends upon the service selected by the resident. Medicare does not cover the cost of assisted living facilities and rarely does Medicaid. There may be some state programs or even federal programs, like the Veteran’s Aid and Attendance benefits that can help cover the cost.
Specialized Alzheimer’s Facilities
These facilities have nurses on staff and may actually provide hard-core care when Alzheimer’s gets really difficult. This is a much improved social environment over the typical Skilled Nursing Facility. Specialized activities and a thorough understanding of safety and needs are usually obvious. Alzheimer’s Facilities usually have a much higher staff ratio than a typical assisted living and feeding the residents, wheeling them in wheelchairs, full incontinence and other difficult issues can be handled here. Ask us about costs.
Skilled Nursing Facilities
Skilled Nursing Facilities, also known as nursing homes, are often the choice of last resort. Usually, if a person needs permanent placement in a nursing home, the supervisory care needed exceeds that which can be offered elsewhere. Many of these patients are exit-seeking or are more difficult to redirect. Some people with dementia may also develop aggressive behaviors which can pose a threat to themselves or those around them. Others simply are no longer able to perform most or all of their activities of daily living and need a higher level of care.
If you are considering placing a loved one with dementia into a skilled nursing facility, there are several factors to consider, including:
Secured Unit: With exit-seeking behaviors being one of the biggest threats to a patient with dementia, many facilities offer secure units that are kept locked 24/7.These units are generally smaller in nature and are accessed by staff and visitors with authorization. They should be inclusive areas with their living areas, activities and dining all within the secured areas. Some facilities also offer secure courtyards or outside areas in order to give their residents the opportunity to spend time in the fresh air while maintaining their safety.
Day Programming: Many skilled nursing facilities will provide patients with dementia programming throughout the day designed to help keep their minds active, lessening the symptoms of sun downing and hopefully slowing the progression of the disease. If you are considering placement in a skilled nursing facility, be sure to find out if they have structured daily activities for their patients with dementia.
Psychiatry/Psychology Services: Many facilities will have visiting specialists who are trained in caring for the psychological needs of those suffering with dementia. Because dementia and Alzheimer’s is such an individualized disease, it is often trial and error before the right medication regimen is established. It is important to have the advice of specialized caregivers available to help develop and maintain such programs.
Cost: The cost of care in a skilled nursing facility is expensive. Unfortunately, most residents with dementia do not qualify for Medicare or insurance benefits. Medicare guidelines require a 3-midnight hospital stay in order for a benefit period to begin and then patients must meet certain criteria such as a need for intensive nursing care or rehabilitation in order for the federal program to continue paying. Some dementia patients may initially qualify upon admission, but quickly become what is known as custodial care. If a resident is in a skilled nursing facility under custodial care, private funds or medical assistance will most likely be required to pay for outstanding balances.