Sometimes you can no longer care for the person with Alzheimer’s disease or a related dementia at home. The person may need around-the-clock care. Or, he or she may be incontinent, aggressive, or wander a lot. It may not be possible for you to meet all of his or her needs at home anymore. When that happens, you may want to look for another place for the person to live. You may feel guilty or upset about this decision, but remember that many caregivers reach this point as the disease worsens. Moving the person to a care facility may give you greater peace of mind. You will know that the person is safe and getting good care.
Steps to Take
Choosing the right place is a big decision. It’s hard to know where to start. Below we list steps you can take to find the right place:
Gather Information – Talk with your support group members, social worker, doctor, family members, and friends about facilities in the area. When you find a facility that you think may be a good fit, make a list of questions to ask about the facility and call to set up a time to visit. You can also check the following resources for information about facilities:
- Centers for Medicare and Medicaid Services (CMS) – CMS has a guide to help older people and their caregivers choose a good nursing home. It describes types of long-term care, questions to ask the nursing home staff, and ways to pay for nursing home care. CMS also offers a service called Nursing Home Compare on its website. This service has information on nursing homes that are Medicare or Medicaid certified. These nursing homes provide skilled nursing care. Please note that there are many other places that provide different levels of health care and help with daily living. Many of these facilities are licensed only at the State level. CMS also has information about the rights of nursing home residents and their caregivers.
- Joint Commission – The Joint Commission evaluates nursing homes, home health care providers, hospitals, and assisted living facilities to determine whether or not they meet professional standards of care. Consumers can learn more about the quality of health care facilities through their online service at www.qualitycheck.org.
Other resources include:
- Assisted Living Federation of America
- National Center for Assisted Living
- National Clearinghouse for Long Term Care Information
- Senior Guidance
Visit Assisted Living Facilities and Nursing Homes – Make several visits at different times of the day and evening. Click here to see a checklist of questions to ask a facility. Talk with other caregivers who have a person they are caring for at the facility and find out what they think about the place. Ask yourself:
- How does the staff care for the residents?
- Is the staff friendly?
- Does the place feel comfortable?
- How do the people who live there look?
- Do they look clean and well cared for?
- Are mealtimes comfortable?
- Is the facility clean and well maintained?
- Does it smell bad?
- How do staff members speak to residents – with respect?
Ask the staff:
- What activities are planned for residents?
- How many staff members are at the facility? How many of them are trained to provide medical care if needed?
- How many people in the facility have Alzheimer’s or a related dementia?
- Does the facility have a special unit for people with dementia? If so, what kinds of services does it provide?
- What is a typical day like for the person with dementia?
- Is there a safe place for the person to go outside?
- What is included in the fee?
- How does the person get to medical appointments?
Find out about total costs of care. Each facility is different. You want to find out if long-term care insurance, Medicaid, or Medicare will pay for any of the costs. Remember that Medicare only covers nursing home costs for a short time after the person with AD has been in the hospital for a certain amount of time. If you're asked to sign a contract, make sure you understand what you are agreeing to.
Assisted Living Facilities
Assisted living facilities have rooms or apartments. They're for people who can mostly take care of themselves, but may need some help. Some assisted living facilities have special dementia units. These units have staff who check on and care for people with dementia. You will need to pay for the cost of the room or apartment, and you may need to pay extra for any special care. Some assisted living facilities are part of a larger organization that also offers other levels of care. For example, continuing care retirement communities also offer independent living and skilled nursing care.
A group home is a home for people who can no longer take care of themselves. Several people who can't care for themselves live in the home. At least one caregiver is onsite at all times. The staff takes care of the people living there: making meals, helping with grooming and medication, and providing other care. You will need to pay the costs of the person living in this kind of home. Remember that these homes may not be inspected or regulated, but may still provide good care.
Check out the home and the staff. Visit at different times of the day and evening to see how the staff takes care of the residents. Also check to see how clean and comfortable the home is. You'll want to look at how the residents get along with one another and with the staff.
Nursing homes are for people who can't care for themselves anymore. Some nursing homes have special dementia care units. These units are often in separate sections of the building where staff members have special training to care for people with dementia. Some units try to make the person feel more like he or she is at home. They provide special activities, meals, and medical care.
In many cases, you will have to pay for nursing home care. Most nursing homes accept Medicaid as payment. Also, long-term care insurance may cover some of the nursing home costs. Nursing homes are inspected and regulated by State governments.
How to Make Moving Day Easier
Moving is very stressful. Moving the person with Alzheimer’s or a related dementia to an assisted living facility, group home, or nursing home is a big change for both the person and the caregiver. You may feel many emotions, from a sense of loss to guilt and sadness. You also may feel relieved. It is okay to have all these feelings. A social worker may be able to help you plan for and adjust to moving day. It's important to have support during this difficult step. Here are some things that may help:
- Know that the day can be very stressful.
- Talk to a social worker about your feelings about moving the person into a new place. Find out how to help the person adjust.
- Get to know the staff before the person moves into a facility.
- Talk with the staff about ways to make the change to the assisted living facility or nursing home go better.
- Don’t argue with the person about why he or she needs to be there.
Be an Advocate
Once the person has moved to his or her new home, check and see how the person is doing. As the caregiver, you probably know the person best. Look for signs that the person may need more attention, is taking too much medication, or may not be getting the care they need. Build a relationship with staff so that you work together as partners.
Source: “Caring for a Person with Alzheimer’s Disease: Your Easy-to-Use Guide from The National Institute on Aging,” part of the National Institutes of Health.