 | When is it Time to Place a Loved One with Dementia? |
One of the most frequent questions we get on Memory People is, "How do I know when it's time to place my loved one?" This, of course, is different for every patient, but it is also different for every caregiver. My rule of thumb is, and always has been, that there is no downside to placing a loved one in a facility too soon.
There are many drawbacks to waiting too long, and none of them are good. The number of things that can potentially go wrong in waiting too long to place a loved one are endless. Here are a few examples:
Medications In a facility, the medications are regulated and can be changed, usually within the hour for whatever reason. When your loved one is living at home, try getting them to the doctor for an evaluation to change their meds. This in itself can be a disaster, and is unnecessary once you have placed them.
Mobility Toward the end stages of dementia and Alzheimer's, patients have extremely limited mobility. Take a 70 year old spouse, weighing in at about 90 lbs. soaking wet, trying to get her 180-pound husband to the bathroom two or three times each night. All this does is put both of them in danger of falling. The end result could be a broken hip which, in some elderly people, is in itself a death sentence. Bathing, toileting, dressing, and other activities of daily living all come with risks, but a facility is better equipped to safely handle all of these. Then there's the fear of them getting out of the house without you knowing. Wandering can (and does) happen in a facility, but the chances of your loved one wandering there are a lot slimmer. The response time when someone does wander is greatly increased as well, due to the number of employees available to look for them.
Stress Anyone who cares for a loved one knows what I am talking about here. 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. If you are in your seventies, you are more likely to have several medical conditions of your own to contend with. Stress can quickly manifest itself in people of any age, and is known to exacerbate even minor ailments. Sometimes placement in a facility is best for both the caregiver and the loved one’s overall health and wellbeing.
Long-distance caregiving This rarely works. How could it? Some dementia patients have the help of local family members, but they still struggle to stay on top of the care and assistance that their loved ones require. Some try to do this from hundreds or thousands of miles away, but adequate supervision and care can't be provided from afar. If you are a caregiver who is doing this, you know what I am talking about.
Have a plan The most important reason to have a plan way before it comes time to even think about placement is because you said you would. What does that mean, "You said you would"? It means that somewhere along the line you probably promised to take care of your parents, your spouse, your siblings, whomever. You may have said that you would never place them in a nursing home for any reason. Well, never sometimes arrives before we know it. I am telling you this as a patient who knows his destiny. I know what is coming. In a year or two, I may not understand. But right now I do, and I do not want to put my wife or our daughter through that. Period. 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. My daily care should not be substandard simply because of a promise you made some 20 or 30 years ago. Chances are, 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. Dignity also plays a huge role in this. We all want to be cared for with dignity. 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. It tends to be a matter of pride for their caregivers as well, believe it or not. One doesn't want their family to know they can no longer take care of their Dad, so they do the best they can, not even realizing that the care they are trying to provide is substandard at best. Every patient deserves to be taken care of. That should never even be up for debate, but it often is. In closing, I want to tell you something, and you need to think about this. Placing your loved one in a facility needn't be the dramatizing thing it is portrayed to be. The nursing homes these days are nothing like they were 30 years ago when you made that promise to never place them. Chances are neither the patient nor the caregiver have ever been in a facility that cares for dementia patients. Why is that? Because no one has a plan. Some think that one day they will decide they can no longer handle being a caregiver, just drive up to a facility with their loved one in the back seat, and tell the nurse at the desk you have arrived and you can't do this anymore. This only happens in movies. The only person who can place your loved one is their doctor. You, as their caregiver, can and should acknowledge when you can no longer handle these responsibilities, but it is only by doctor’s orders that a patient can be placed in facility. It is imperative to have some sort of long-term care insurance in place, which has to be purchased before your loved one was even diagnosed way back when. But this rarely happens. So you have to depend on what money your parents have, and it’s likely you have no idea where or how much that is. Another issue is whether the facility you are looking at has room for your loved one. Again, you can't just drive up and expect the facility of your choice to have a vacant room waiting for you. This post could be twice as long, and I still would have just grazed the surface on why you need to have a plan when it comes to placement. 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.
There are many drawbacks to waiting too long, and none of them are good. The number of things that can potentially go wrong in waiting too long to place a loved one are endless. Here are a few examples:
Medications In a facility, the medications are regulated and can be changed, usually within the hour for whatever reason. When your loved one is living at home, try getting them to the doctor for an evaluation to change their meds. This in itself can be a disaster, and is unnecessary once you have placed them.
Mobility Toward the end stages of dementia and Alzheimer's, patients have extremely limited mobility. Take a 70 year old spouse, weighing in at about 90 lbs. soaking wet, trying to get her 180-pound husband to the bathroom two or three times each night. All this does is put both of them in danger of falling. The end result could be a broken hip which, in some elderly people, is in itself a death sentence. Bathing, toileting, dressing, and other activities of daily living all come with risks, but a facility is better equipped to safely handle all of these. Then there's the fear of them getting out of the house without you knowing. Wandering can (and does) happen in a facility, but the chances of your loved one wandering there are a lot slimmer. The response time when someone does wander is greatly increased as well, due to the number of employees available to look for them.
Stress Anyone who cares for a loved one knows what I am talking about here. 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. If you are in your seventies, you are more likely to have several medical conditions of your own to contend with. Stress can quickly manifest itself in people of any age, and is known to exacerbate even minor ailments. Sometimes placement in a facility is best for both the caregiver and the loved one’s overall health and wellbeing.
Long-distance caregiving This rarely works. How could it? Some dementia patients have the help of local family members, but they still struggle to stay on top of the care and assistance that their loved ones require. Some try to do this from hundreds or thousands of miles away, but adequate supervision and care can't be provided from afar. If you are a caregiver who is doing this, you know what I am talking about.
Have a plan The most important reason to have a plan way before it comes time to even think about placement is because you said you would. What does that mean, "You said you would"? It means that somewhere along the line you probably promised to take care of your parents, your spouse, your siblings, whomever. You may have said that you would never place them in a nursing home for any reason. Well, never sometimes arrives before we know it. I am telling you this as a patient who knows his destiny. I know what is coming. In a year or two, I may not understand. But right now I do, and I do not want to put my wife or our daughter through that. Period. 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. My daily care should not be substandard simply because of a promise you made some 20 or 30 years ago. Chances are, 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. Dignity also plays a huge role in this. We all want to be cared for with dignity. 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. It tends to be a matter of pride for their caregivers as well, believe it or not. One doesn't want their family to know they can no longer take care of their Dad, so they do the best they can, not even realizing that the care they are trying to provide is substandard at best. Every patient deserves to be taken care of. That should never even be up for debate, but it often is. In closing, I want to tell you something, and you need to think about this. Placing your loved one in a facility needn't be the dramatizing thing it is portrayed to be. The nursing homes these days are nothing like they were 30 years ago when you made that promise to never place them. Chances are neither the patient nor the caregiver have ever been in a facility that cares for dementia patients. Why is that? Because no one has a plan. Some think that one day they will decide they can no longer handle being a caregiver, just drive up to a facility with their loved one in the back seat, and tell the nurse at the desk you have arrived and you can't do this anymore. This only happens in movies. The only person who can place your loved one is their doctor. You, as their caregiver, can and should acknowledge when you can no longer handle these responsibilities, but it is only by doctor’s orders that a patient can be placed in facility. It is imperative to have some sort of long-term care insurance in place, which has to be purchased before your loved one was even diagnosed way back when. But this rarely happens. So you have to depend on what money your parents have, and it’s likely you have no idea where or how much that is. Another issue is whether the facility you are looking at has room for your loved one. Again, you can't just drive up and expect the facility of your choice to have a vacant room waiting for you. This post could be twice as long, and I still would have just grazed the surface on why you need to have a plan when it comes to placement. 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.
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