PLACEMENT OPTIONS

Waterman Lake“Dad has Alzheimer’s and I can’t take care of him any longer, I guess I’m going to have to put him in a nursing home,” says a daughter who is the primary person caring for her Dad.
There was a time when this might have been true. However, in 2014, we have options that didn’t exist a number of years ago.
During March 2014, I was a presenter at the Alzheimer’s Association ~ Rhode Island Chapter’s annual, state-wide conference. My topic was “Placement Options for those with Alzheimer’s or Dementia.” I want to share with you some of the information I prepared for that presentation.
There are six options to think about, depending on the stage of Alzheimer’s or dementia that your loved one is experiencing. Caregivers need to consider home care, adult day care, respite care, assisted living~memory care, nursing home and Hospice.
HOME CARE: There are home health care agencies that provide services that will allow your loved one to continue living in his/her own home or with a caregiver for an extended period of time. Agencies can provide companions who spend a few hours a day with your Dad, assisting him “around the house.” Companions can make beds, prepare meals, drive him to a doctor’s appointment, do laundry, get groceries or perhaps go for a walk with your Dad. However, they are not allowed to do personal care like showers and dressing. CNAs (Certified Nursing Assistants) are able to do what companions do, but additionally they are also able to provide personal care as well. Some families will choose to have someone come 2-3 days a week (day time or overnight), or depending on circumstances and need, they may choose 5-7 days a week.
ADULT DAY CARE: Some ADC programs are specifically for people with dementia and others are more generic. ADC programs generally run Monday through Friday during a normal work day hours. However, some may be open in the evening or on weekends. There is usually a 2 or 3 day minimum that you must commit to and many programs offer transportation, breakfast and lunch. Medical or clinical models will have a nurse on staff. Make sure you check to see what insurance programs are acceptable.
RESPITE PROGRAMS: Respite programs are usually located within assisted living communities, rehab facilities or nursing homes. They provide 24/7 temporary care which includes nursing services. Rooms are set aside so you can leave your loved one for brief periods of time while you are on a 2-3 week vacation, when your home is being painted or renovated, while you have surgery or if you just need a break, etc. Many times this is a good segway to placement if you think you will need to consider placement for your loved one within a short period of time.
ASSISTED LIVING ~MEMORY CARE COMMUNITIES: Memory care communities provide permanent, 24/7 care for your loved one. The community becomes their new home where their meals, laundry, personal care and medical needs are managed by a trained staff. Some memory care communities are in a stand-alone building, while most are located within a traditional assisted/independent living community. People may have the option of a private or shared room. There are activity programs scheduled daily including transportation to off-site restaurants and entertainment sites. These facilities are generally private pay, but do take VA benefits and long term health care insurance.
NURSING HOMES: Nursing home care is for individuals who have medical needs beyond what an assisted living community is able or licensed to provide. Generally rooms are shared between two patients. Services are similar to an assisted living program, but there is more emphasis on the medical needs of the patient. Some nursing homes also have memory care units for dementia patients. Most insurance plans are accepted and patients also have access to Medicaid if they quality.
HOSPICE: Many people don’t realize that Hospice offers two programs for their patients: palliative care and end-of-life care. Both programs provide on-going support through social workers, chaplains, doctors and regular visitations by nurses. Patients may receive services in their own homes, assisted living communities, nursing homes or hospitals. Palliative care provides care for individuals who are seriously ill, with any medical issue, who need their symptoms and pain to be monitored and managed. It may be long or short term. End-of-life care is for terminally ill patients, no matter what the cause, who are in the process of actively dying. Both programs in Hospice are able to provide specific medications that assist with pain management and keep the patient comfortable.
The main purpose for any one of these types of care options is to provide what is best for the patient AND the caregiver. Caregivers are at great risk because of the stress, frustration, frailty and exhaustion they experience. In some cases a placement decision might be more important for the life of the caregiver even though the patient isn’t quite ready for placement. Both individuals must be considered equally in the decision.
Costs will vary and need to be researched. You will also want to look on-line and visit potential communities.
When visiting be observant of odors and residents’ hair, nails and clothing. Be sure to get clarification of the type of training and in-services that are required of the staff, as well as the staff ratio.
Placement is never an easy decision, but for Alzheimer’s or dementia patients, there may come a point in time when that may be the only option you have. Spend as much time researching this option as you did when you were looking at colleges with your children.

Photo Credit:  The Village at Waterman Lake, Greenville, RI

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