Caregiving: – Choosing a full time care facility

One of the hardest decisions caregivers have to face, and probably one of the most difficult issues we have to deal with in our entire lives, is when to place a parent or loved one into a residential care facility. We may feel like we are abandoning our relative to a miserable and lonely existence in their last years and we have to struggle with half-remembered news reports of neglect and isolation.

Emotional Dilemma

Despite all of the emotions involved, at some point we may realize we can no longer provide the full-time care needed and feel worn out by the burden of dealing with the medical and emotional difficulties of simply helping the person with daily living. When caregivers reach this point, part of the dilemma usually involves having to choose from a myriad of residential care options; however, this need not be as overwhelming as it can initially seem.

Common Considerations

If you check into some of the most common considerations when deciding which facility is best for your relative, it will ease the transition. First check to see if the staff at the facility specializes in dementia care issues. Find out what kind of programs are available and how the staff address all the daily living activities such as bathing, dressing, eating and so on.

To get a better idea of how the staff would handle different behaviors, you may wish to give examples of specific difficulties you have had at home and see what solutions the staff have to offer.


Safety is of course, very important, so don’t forget to inquire about the facility’s plans in case of accident, fire, or other emergency, as well as daily safety concerns such as getting in and out of the bathtub, climbing the stairs etc.

Another useful way to evaluate a place you are considering is to visit during the day and chat with some of the residents’ visitors. Most of them will be thrilled to have someone to share their experiences with and will be only too happy to give their opinions on the level of care and comfort their relatives are receiving.

Ask to sit in on a program to see how the staff interacts with the residents. Check to see if there are any special rules the facility has regarding visiting hours. Do these hours fit your particular schedule?

Seemingly small matters can take on greater significance in a care home; for example, if your relative prefers staying up late or eating at a particular time, you will need to find our how the staff accommodates such personal likes and dislikes. Otherwise, being forced to change the habits of a lifetime can be quite stressful and depressing.

Types of Residential Care Facilities

There are different kinds of care facilities to consider. First of all, what is meant by a residential care facility? This usually refers to a place that provides a combination of housing, supportive, personalized assistance and medical care services for people with Alzheimer’s. According to the Alzheimer’s Disease and Education Referral center (ADEAR) there are about 1.8 million residents in over 18,000 nursing homes in the United States today. They offer 24-hour care and supervision by registered nurses and certified nursing assistants and are designed to care for people with chronic conditions, including dementia.

Nursing Homes

It’s true that the even the phrase ‘nursing home’ can be very off-putting to many people, but as Peter Rabins and Nancy Mace comment in their book The 36-hour Day, “often nursing homes give good care and are the best alternative for the ill person. Some nursing homes do not give adequate care, and there has been much publicity about them. Not all homes, however, deserve a bad reputation, and this publicity has brought about needed changes that have improved the quality of nursing home care.”

Assisted Living Facilities

Nursing homes are not the only type of full-time care facilities. There are also assisted living facilities, sometimes referred to as board and care homes. This type of care aims to ease the transition between independent living and living in a nursing home. Assisted living facilities usually provide housing, personal assistance and support and health care.

They often have specialized care for people with Alzheimer’s and dementia. Some people consider them to be more like home and less like a hospital. However, standards will vary as the regulations governing the quality of care vary from state to state. You will need to determine if such a care facility is really offering a unique service and if that service is worth any additional costs. Authors Mace and Rabins note that “many of the recently developed special dementia programs have a more social approach to care and are excellent alternatives for people with dementia.”


There are many outstanding resources available to help you care for your family and to assist you with these challenging decisions. The Alzheimer Association has several free pamphlets available, including Residential Care: A Guide for Choosing a New Home. Call 1-800-272-3900 to order. There are also several books with extensive information on this subject including The 36-Hour Day by Nancy Mace M.A. and Peter Rabins, M.D. and also How to Care for Aging Parents by Virginia Morris.

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