Housing Options for People with Dementia Need Careful Consideration
Recently I went to visit an elder who is in a rehabilitation center recovering from surgery. The center is on the third floor of a retirement community; the bottom two floors are assisted living. (Another set of buildings nearby offers independent living for seniors.) As I got ready to pull into the parking lot, I slowed to let a couple go by who were carrying a piece of furniture to their truck. I went on and parked, entered the building, signed the visitor’s log, and headed to the elevator. When I got there, I was joined by the couple who had been carrying the furniture. The lady joined me in the elevator while the man went to help move another load to the truck.
Seeing that I was wearing a Walk to End Alzheimer’s t-shirt, the lady told me that they were in the process of moving their grandmother out of the assisted living portion of the building. The reason – the grandmother, who has mild cognitive impairment, has been wandering at night. In fact, during the middle of the previous night she wandered outside and couldn’t find her way back into the building. Her family realized at that point that she no longer could reside in the assisted living facility.
That’s a sad – and scary – way to learn that a loved one with memory loss is living in the wrong place. It’s also a good reason to realize that you probably will need to reevaluate living options as your love one’s dementia progresses. Therefore, I thought it would be good to provide a primer on living options.
There are three levels of care to consider as a loved one's battle with dementia continues. These are:
- Custodial care, which involves assisting with activities of daily living (bathing/showering, dressing, eating/feeding (including chewing and swallowing), functional mobility, personal hygiene/grooming, and toilet hygiene). This type of care can be provided in many settings, such as the home, an assisted living facility or a nursing facility. Custodial care does not require services from a skilled professional such as registered nurses, physical therapists, speech therapists and occupational therapists.
- Intermediate care. This type of care offers assistance with activities of daily living and some health services. It also offers some nursing supervision, but does not include constant nursing care. Intermediate care can include periodic health monitoring for issues such as blood pressure as well as medication reminders.
- Skilled care. This type of care is designed for people who need 24-hour medical supervision, skilled nursing care or rehabilitation. To qualify for this level of care, a person needs to have a physician’s order.
There also are various options of where the care is provided. One, obviously, is in-home care in which the services are provided in the individual’s home. These individuals also may want to take part in adult day programs. These community-based programs allow individuals to live at home but offer supervision and activities during the day. These programs also offer assistance with activities of daily living, meals, medical services and transportation.
Another option is continuing care retirement centers, much like the one that I described in the opening paragraph. These facilities offer a continuum of living options, including independent living, personal care and nursing services. Some also provide dementia care. The benefit of these centers is that they offer a consistent and growing support system as the loved one’s needs change.
A third option is an assisted living facility, which also is known as board and care, adult living and supported care. This type of facility is for people who need additional support with completing activities of daily living. These arrangements are designed for people who are unable to live independently but who don’t need the intensive medical care of a nursing home. Some of these facilities do have dementia-specific units. If the facility you are considering does not have dementia-specific units, then I’d really recommend you watch the Frontline documentary concerning having a loved one with dementia live in these types of facilities.
A fourth option is an adult-family home that provides 24-hour care. These homes are private residential homes and are licensed and inspected by the state.
The last option is nursing facilities, which can be known as nursing homes or long-term care facilities. The level of care is based on an evaluation of the person’s physical, medical and emotional needs. Some facilities also provide dementia units that are secure and that have increased supervision and activities specifically for people who have dementia.
If you have a loved one with dementia, it’s important to evaluate their abilities continually. That way, you can help them make an informed decision about where they should live. Obviously, the main goal is to help them live as independently as possible for as long as possible, but make sure that their current abilities, health and well-being are the primary determining factors in making all decisions about where your loved one lives.
Primary Sources for This Sharepost:
AARP. (ND). Care and housing options for people with dementia.
Alzheimer’s Association. (ND). Residential care.