For many caregivers, the time will come when they are no longer able to take care of their loved one at home. At this point the person with Alzheimer's will have to move to a place where care is available around the clock. There are two types of residential care: assisted living and skilled nursing facilities.
Assisted living arrangements are available in large apartment or hotel-like buildings or can be set up as a "board and care" home for a small number of people. They offer different levels of care, but often include meals, recreation, security and help with bathing, dressing, medication and housekeeping. Skilled nursing facilities – or nursing homes – provide 24-hour services and supervision. They provide medical care and rehabilitation for residents who are mostly very frail or suffer from the later stages of dementia.
Sometimes, health care providers offer different levels of care at one site. These "continuing care communities" often locate an assisted living facility next to a nursing home so that people can move from one type of care to another if necessary. Several offer programs for couples, trying to meet needs when one spouse is doing well but the other has become disabled.
Choosing a residential care facility – a nursing home or an assisted living facility – is a big decision, and it can be hard to know where to start. It's helpful to gather information about services and options before the need actually arises. This gives you time to explore fully all the possibilities before making a decision. The Administration on Aging (AOA) has a toll-free number for its Eldercare Locator: 1-800-677-1116.
Determine what facilities are in your area. Doctors, friends, relatives, hospital social workers, and religious organizations may be able to help you identify specific facilities.
Then make a list of questions you would like to ask the staff. Think about what is important to you, such as activity programs, transportation, or special units for people with Alzheimer's. Contact the places that interest you and make an appointment to visit. Talk to the administration, nursing staff and residents. Observe the way the facility runs and how residents are treated. You may want to drop by again unannounced to see if your impressions are the same.
Find out what kinds of programs and services are offered for people with Alzheimer's and their families. Ask about staff training in dementia care, and check to see what the policy is about family participation in planning personal care.
Check on room availability, cost and method of payment and participation in Medicare or Medicaid. You may want to place your name on a waiting list even if you are not ready to make an immediate decision about long-term care. Once you have made a decision, be sure you understand the terms of the contract and financial agreement. You may want to have a lawyer review the documents with you before signing.
Moving is a big change for both the person with Alzheimer's and the caregiver. A social worker may be able to help you plan for and adjust to the move. It is important to have support during this difficult transition.
Visitors are important to people with Alzheimer's. The person may not always remember who the visitors are, but just the human connection has value. Here are some ideas to share with someone who is planning to visit a person with Alzheimer's disease:
–Plan the visit at the time of the day when the person is at his or her best. Consider bringing along some kind of activity, such as something familiar to read or photo albums to look at, but be prepared to skip it if necessary.
–Be calm and quiet. Avoid using a loud tone of voice or talking to the person as if he or she were a child. Respect the person's personal space and don't get too close.
–Try to establish eye contact and call the person by name to get his or her attention. Remind the person who you are if he or she doesn't seem to recognize you.
–If the person is confused, don't argue. Respond to the feelings you hear being communicated, and distract the person to a different topic if necessary.
–If the person doesn't recognize you, is unkind, or responds angrily, remember not to take it personally. He or she is reacting out of confusion.