I am continually approached about putting my husband in an adult day care to get him out of the house, and give me more free time. My case manager, social workers, even some medical professionals bring it up. About a year ago I took my husband to one for a tour. Everyone we saw seemed somewhat medicated and unaware. The next morning my husband sat up in bed, and with more clarity than normal stated that he did not ever want to go back there. So we didn't. This last week we went to a different facility, highly recommended by his case manager. While there, my husband, being excited about the new surroundings, was quite chatty. The program manager said to me that although he knew I didn't medicate my husband, he would talk to someone to see if there was something he could give him so he wouldn't talk so much. Needless to say, we will not be going back.
I have repeatedly read that people with dementia can live anywhere from 2-20 years, and that the 2 year range is mainly for people put in nursing homes. I am concerned that those with dementia are being tolerated by medicating them, so that those caring for them in facilities don't have to interact with them as much, thus making their job much easier. I had hoped to find activities outside the home for my husband to enjoy with others in the same general condition. He is 54. And although I know most of the people in these places will be older, he needs more social interaction. If all he is going to do is sit around at the day care center, he can do that at home. I am very disappointed in what I am finding. Although medication has it's place, quality of Life doesn't seem to matter anymore. I want my husband to enjoy his life. I have found that since adding basketball 3 times a week at our church, he has become much more active and aware, as well as being happier. So why should we take that away from him by medicating and subduing him?

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Well you shouldn't take that away, of course, Rahtersassy. I am very sorry you had the experience you did at the Day Care places. The first place my husband attended was so-so, and the second was excellent. Neither suggested drugs.

The basketball you have found sounds like a life-enhancing activity. My husband loved the golf league a rehab place sponsored one a week in the (short) summer. And he also loved bowling with a senior league. They looked out for him and enjoyed his presence. These social and physical activities were wonderful for him and I encouraged and supported him in them as long as he was capable.

But I also needed the respite of the 9 to 3 day care a couple days a week. I think what I would have said to that program manager would have been along the lines of "Oh, he is particularly excited about the new surroundings today. He isn't always this talkative and I don't think you will find him disruptive after he settles in. And of course you do not give out drugs without the caregiver's consent, right?"

"If all he is going to do is sit around at the day care center, he can do that at home." Well, yes, sort of. But then you won't have a day to take care of your appointments and your needs. And "just sitting around" probably would not be what he was doing the entire day. There are programs and activities he could participate in. And it is nice to hear another adult say, "Is that a new shirt? It is a very good color for you!" My husband loved the sessions where a staff member read a book, a chapter at each session. And he really liked when they had travel programs, often based on participants trips. He was so proud and excited to bring in his vacation pictures and they did a wonderful job of making a program out of them.

If the social worker is recommending this place, I wonder if you should give it a second look.

Medication has its place, and for dementia I think that place is in enhancing/preserving quality of life. For example, my husband took a drug to help overcome excessive daytime sleepiness and help him stay alert! Drugs don't necessarily mean sedating or making someone easier to "tolerate."

As you know, dementia can last many years. Remember that you are in this for the long haul, and you need to pace yourself and avoid caregiver burnout. Finding a regular way to obtain respite for yourself while you husband is safe and entertained is worthwhile, even if program is not ideal in every way.

Your needs deserve consideration, too.

Rahter, perhaps your husband was too talkative during the tour? What did you think? Was he talking much more than is normal for him? Excessive talking is a symptom of anxiety and this may be what the director was noticing and identifying. He has seen many new participants and is probably knowledgeable about what someone is feeling. This was also an interview for him so the director would be able to accurately assess whether your husband was a suitable candidate to attend this center. Do you think that the anxiety is going to intensify if you are not there? I would think probably so. I would like to think that the director was being proactive in assessing a behavior that could become problematic or even disruptive.

The care ratio at the day care my mom attended was 8 or 10:1 which is sufficient in most cases for a day program. These centers provide a service for a fee that is determined the center can continue to operate efficiently and safely. Staffing levels are determined on the basis of the needs of all of their participants. Also these centers are responsible for keeping our loved ones safe. If a new participant requires more care, this needs to be a consideration as to whether someone is accepted into the program or not. Some participants I'm sure require medication to reduce anxiety making a safer environment for all, there are others that do not. My mom was one that did not. Some did. As my mom's disease progressed medications increased for her sundowning behaviors which is often the case. The purpose was to make my mom more comfortable, one of the side benefits was that it made it easier for me to provide for her care at home.

If you liked this center, I think you should give it a try. There will be an adjustment period. Have the doctor prescribe something for the anxiety, just in case it is needed. You need the time that day care will allow you to get a break to care for yourself. You are going to have to let go just a little bit so others can provide care for him.

I am very impressed by your loving care for your husband and excellent question. It is very difficult to make an informed decision when you have multiple professionals advocating for something i.e. medication, and your instinct is telling you otherwise. Your husband is such a young man, and I am very sorry to learn about his diagnosis. Did a Neurologist provide this diagnosis? I ask this because my husband could have been diagnosed with Dementia, however we discovered his presentation was an adverse side effect of a statin medication. Fortunately, I have a clinical background, and after working with my husband's primary MD, she removed the statin and my husband's cognition returned to normal levels. I support your assessment and concerns of introducing medication at this stage, based on your info. Medications have side effects, and can introduce new problems into the equation. However, there are appropriate times for medications, under the supervision of an excellent medical team. I don't know the entirety of your husband's situation, so it will be wonderful if you can find a great clinical team dedicated to Dementia Care. Evidenced-based research recommends daily exercise, valued activity engagement, etc. vs. sitting at home. Continue to follow your instincts, and find an excellent team that will provide Best-Practice treatments. I believe that there is an OT and other specialist affiliated with Aging Care (check their home page). Perhaps a specialist with cognitive diagnosis expertise can provide some excellent resources in your area. I wish you and your husband the very best!

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