One of the most frequent questions I see in online support groups is, “How do I know when it’s time to place my loved one with dementia in a long-term care facility?”
This, of course, is different for every patient, but it is also different for every caregiver. My rule of thumb is that there is no downside to placing a loved one in a facility too soon. However, there are many drawbacks to waiting too long.
If your loved one requires a higher level of care, but you decide to wait, the number of things that can potentially go wrong are endless.
In a facility like a memory care unit, all medications are carefully regulated. They are administered on a strict schedule, the nursing staff looks for any indications that a resident’s regimen should be changed, and they can usually implement these changes quickly once the doctor has approved them.
When your loved one is living at home, all of the medication oversight falls to you. While many family caregivers learn a great deal while caring for their loved ones with dementia, there are certain signs and issues that only medical professionals can pick up on and address. Even if you do notice a problem, getting them to the doctor for an evaluation to change their meds can be a struggle.
Toward the end stages of dementia and Alzheimer’s disease, patients have extremely limited mobility. This is a serious hazard for both the patient and their caregiver. For example, a petite 70-year-old woman could easily get hurt trying to get her 180-pound husband to the bathroom two or three times each night. Continuing to care for him at home puts them both in danger of falling.
Bathing, toileting, dressing, and other activities of daily living all come with risks, but a facility is far better equipped to safely handle all of these. They have the proper equipment, training and manpower to assist residents and prevent accidents.
A loved one can easily get out of the house without their caregiver realizing, and this can be a life-threatening situation. Wandering can (and does) happen in facilities, but the residents are limited to spaces within the building and, in some cases, a secure area outside. This is why supervised memory care is so valuable for dementia patients and their family members. The residents are able to move about, but the premises are heavily monitored and often feature special security measures to prevent them from wandering away from the facility and getting lost or injured. The response time when someone does wander is greatly increased as well, due to the number of employees available to look for them.
It doesn’t matter if you are in your thirties or in your seventies; the stress that dementia puts on a caregiver is the same. If you are in your thirties, chances are you’re in reasonably good health, but older caregivers are more likely to have medical conditions of their own to contend with. Stress can quickly manifest itself in people of any age, and is known to exacerbate even minor ailments. Be honest with yourself about your emotional and physical limits while caregiving. Sometimes placement in a facility is best for both the caregiver and the loved one’s overall health and wellbeing.
Caregiving from afar rarely works, especially for loved ones with progressive illnesses like dementia. How could it? Some local family members can provide intermittent support, but they still struggle to stay on top of the level of care and assistance that their loved ones require. Adequate supervision and care can’t be provided from afar. The patient’s needs will continue to increase, and it will only put more strain on the caregiver and leave the person with dementia more vulnerable.
In a long-term care facility, yes, there are more patients, but there are also more caregivers. Unlike a family member who lives across town or across the country, nurses and aides are on duty around the clock to ensure residents are safe and their needs are met.
Rely on a Plan, Not a Promise
The most important reason to have a plan way before it is time to even think about placement is because you probably made a promise years ago that you would handle a loved one’s care yourself. It is common for people to promise to take care of their parents, spouse, siblings, whomever and pledge to never place a loved one in a nursing home for any reason.
Well, sometimes “never” arrives before we know it. I am telling you this as a man with dementia who knows his destiny. I am well aware of what is coming. In a year or two, I may not understand my situation, but right now I do. I do not want to put my wife or our daughter through the challenges of caring for me. I also don’t want them to struggle with the difficult decision of whether to place me. They have the right to not be burdened by my disease.
Then there’s the fact that, as a patient, I deserve and demand to be taken care of to the best of one’s ability. A dementia patient’s daily care should not be substandard simply because of a promise their family member made some 20 or 30 years ago. We all have made promises we haven’t kept for one reason or another. This thing about, “I promised my Mom I would never put her in a facility,” is noble, but that’s about it.
It tends to be a matter of pride for caregivers as well, believe it or not. A caregiver doesn’t want their family to know that they are struggling with Dad, so they do the best they can, not even realizing that the care they are trying to provide is substandard. Every patient deserves to be taken care of. A patient may not be able to communicate or have any idea what is going on around them, but they deserve to have their dignity remain intact.
Placing your loved one in a facility doesn’t have to be as dramatic as it is often portrayed to be. The nursing homes these days are nothing like they were 30 years ago. It’s highly likely that neither the patient nor the caregiver has ever been in a specialized facility that cares for dementia patients, because most people don’t have a plan in place.
There is research involved, an assessment of your loved one must be conducted, and there needs to be a financial plan in place to cover the costs of professional care. When you take your time to prepare, there is less drama and fewer surprises.
Do yourself and your loved one a favor and be prepared. To me, placing a loved one is one of the most loving things you will ever do for them. You are doing something your heart tells you not to, but you are doing something that your mind knows is the right thing to do.
This is exactly what you said you would do all those years ago: take care of them. When you can no longer manage, you seek out placement. This is, in fact, taking care of them.