Putting a loved one in a nursing home is a difficult decision regardless of the circumstances. In the case of Alzheimer's, most research shows that at some point in the progression of the disease a nursing home becomes the right decision for the family. According to the US Department of Health and Human Services, there are nearly 2 million people currently living in some form of nursing home. Over 90% of these residents are over 65 years old and most require 24 hour supervision due to some physical limitation or dementia. However, due to the increase in "familial Alzheimer's", aka Early On-Set Alzheimer's, there are many people in their 40's and 50's that are now requiring long term care.
A memory care facility is a specialized nursing home that provides - in addition to a room and food - full time medical (nursing) care and in-house rehabilitative services, along with close supervision to provide some measure of physical protection for the residents. The home will not be designed as an acute care facility, but the goal at an Alzheimer's care facility should be to help people maintain, as much as possible, their daily independent functioning.
It is obvious that when choosing a care facility or nursing home it is first necessary to consider the needs of the individual for whom you are providing Alzheimer's care. You must determine what special care needs the facility can provide. What type of therapy is available. Ask if these needs and therapy are handled by in-house staff or outside care. What are the qualifications of the individuals who provide these.
If you are choosing a nursing facility for someone who is presently at home, ask for referrals from your physician, Area Agency on Aging, Alzheimer's support group, friends, and family. Other factors such as location, cost, the quality of care, services, activities, size, religious and cultural preferences, and accommodations also need to be considered. Above all else discuss this with your family. Most families will not all agree on a place or the costs, but get a majority consensus as this will ease the burdens later on when you, the primary caregiver, need to time off an want someone else that is willing to help step in for a while.
When you've located a few facilities that you'd like to consider more thoroughly, plan on visiting each one, both with scheduled and unscheduled visits, and at different times and on different days of the week. As you walk around, take note of what you see, hear and smell.
* Is it a peaceful atmosphere or does there seem to be an underlying level of chaos?
* Do you hear residents crying out or moaning very loudly for more than a minute or two? (Some of this is the disease and to be expected.)
* Do you notice call lights continually flashing or bells dinging where residents are asking for help their room?
* Do the caregivers and nurses respond quickly to aid the residents or do they ignore the calls for help?
* Are there scheduled activities for the residents?
* Is there an activities staff or do the caregivers hand them puzzles and cards?
* Do you see staff members interacting with residents or do they leave them in their rooms or parked in wheelchairs in the hall without paying much attention to them?
* Do the common areas and bathrooms look and smell clean?
* Are the residents rooms and bath areas clean?
* Are the residents dressed appropriately for the season?
* Do they look clean and is there any sign of an untreated cut or bruise?
* At mealtimes, do you notice caregivers helping residents who have difficulty feeding themselves?
* Do they stay with them until they've eaten most of their meal or do they stop after only a few bites and move on to someone or something else?
* What is the quality of the food and do the residents appear to enjoy it?
* When residents become agitated, how does the staff respond?
* What security does the home provide to protect residents?
* Is there a numbered keypad to enter and exit? Does everyone coming and going seem to know the code?
* What systems or physical barriers are around the facility to make sure no resident wanders away?
* Is the overall atmosphere similar to a homelike environment or more like an institution?
* If your family member is still coherent and able to converse, are there other residents with whom they may socialize?
* What is the staff turnover rate?
* What is the ratio of nurses to residents and caregivers to residents?
* Do they work 8 or 12 hour shifts? This is an important point since familiarity and routine is a key element to your loved ones comfort level.
Before signing a contract for care at a specific facility you should fully review the contract and know your rights and responsibilities as the family and also those of your loved one as the resident. Review the admissions agreement carefully and have anything explained in detail that is not fully understood. Spend $150 or so to have an attorney review this for you if necessary. Do not sign any paperwork that has not been fully explained. The admissions contract should, at a minimum, contain the daily or monthly room and meals rate, any specific reasons for discharge or transfer from the facility (these items should apply to your family member if they do them or to anyone else in the facility if done to your loved one), and the policy regarding payment of the daily room rate if the resident goes to the hospital or the family brings the resident home for a short period of time. Is there a reduced or prorated rate or do you continue to pay full price to keep the room/space available?
You may question if you're really making the right decision to place your loved one in a facility at all. This is an agonizing decision that you will routinely question, but remember, you can do no more than your best. If you have done that, then you should not continue to ask more of yourself and know that you have done the best, as an Alzheimer's caregiver, for your family member.
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