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It's a question that almost everyone who is caring for a person with dementia has asked:
How will I know
when it's time to place my loved one in a facility?
Caring for a family member is an act of love. But even the best-intentioned caregivers can get in over their heads as their loved ones' health declines. Caregivers are often heard to say, "Oh, Mom's not ready for Assisted Living yet." What they don't realize is that Mom's already IN Assisted Living - because they're providing it.
The reality of dementia is that it is progressive, so that many of those diagnosed with it will eventually need more care than can be provided at home. Families can sometimes lose sight of the fact that the demands of full-time caregiving may be more than any one person can realistically manage, yet they are reluctant to move a loved one to a care facility. "We promised Mom we'd never put her in a nursing home" is an all-too-common dilemma for families who are struggling with guilt.
While there's no clear answer - every situation is unique - there are a few guidelines to consider in determining when it might time for someone to be cared for a professional setting. Common reasons that families decide to move their loved one may include one or more of the following:
Symptoms of the disease are becoming too difficult to manage at home (incontinence, falling, aggressive or violent behavior, wandering, etc.)
The person is no longer able to walk.
The caregiver's health is being compromised (lack of sleep, not enough respite support, or physical injury from lifting)
The person can no longer be left unsupervised.
The caregiver must work and cannot remain home to provide care.
The home environment isn't safe for the older person (stairs, narrow doorways, bathrooms that are not handicapped-accessible).
Having the person with dementia in the home is creating stress for other family members living there.
The person has had an acute episode (stroke, heart attack, or injury) that requires more medical care.
Ultimately, the two most important questions a family should take into account are: 1. Is our loved one's safety at issue? 2. Is the primary caregiver's health at risk? Begin reviewing your options early, before a crisis occurs that will necessitate a sudden move under stressful conditions. Talk to family, friends, and health professionals about their recommendations. It's good to visit a few facilities now, get to know the admissions staff, find out about amenities, philosophies, and financial requirements, and allow yourself to get used to the idea in small stages. Remember, your loved one isn't the only person who will have to adjust to this move. Perhaps the most important thing you can do is to begin preparing your loved one for a change. Again, this should be done in small increments, not all at once. Although they cannot remember many details or facts, people with mild to moderate memory loss still have the same concerns and fears as people whose memories are intact. Acknowledging their feelings, recognizing their need to express them, and conveying to them your love and support will go a long way in helping to smooth the transition. Many families, when asked what would have made the move easier, admit that they probably waited too long to begin the process. Accepting the move seems to be less painful for everyone when families take the time to explore options rather than having to make immediate choices. Consider taking your loved one to lunch at the facility, maybe with another trusted friend or family member along for reassurance. Ask about the possibility of short-term respite stays, which allow the person to become familiar with the staff and surroundings. Although there may be resistance to it the first time, it will likely take some of the fear and anxiety out of a permanent move down the road. Even after a thoughtful decision is made to move a loved one, it is normal for caregivers to feel sadness, grief, and plenty of guilt. Know that the promise to always keep Mom at home was made with the best of intentions, but that breaking this promise may now be in her best interest. Although it's often difficult to accept, keeping her at home may no longer be the best thing for her. Keep in mind that the role of caregiver doesn't end once a loved one moves to a facility. You now become your family member's advocate, helping the staff to provide the best care plan possible, offering personal background information that only you can give, and helping to create a comforting, familiar setting in a new environment. And you are now free to resume the role of devoted daughter, son, spouse, or partner, without the constant worry and strain of 24/7 responsibility. Finally, try to understand that taking care of yourself is a gift to your loved one as well as yourself. You may have promised to always take care of them - but you never promised you'd do it alone. 
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