Alzheimer's: Variety of long-term care options are available

Alzheimer's caregivers often need help. What are your options for long-term care?

Every caregiver dreads the time when caring for a loved one with Alzheimer's disease becomes too difficult to do without help. It's often possible to postpone the decision to seek outside care for years, especially when the caregiver is the person's husband, wife or child.

Early on, many people with Alzheimer's do well at home. Eventually, though, even the most loving and accommodating family may be unable to meet the needs of a person with Alzheimer's and need to think about long-term care options for their loved one.

What is long-term care?

Long-term care may mean help from family and friends or a regular visit by a home health aide. Or it may mean moving your loved one into assisted living or a nursing home that can provide 24-hour medical attention. In fact, a variety of options are available, depending on where you live.

Selecting long-term care can be difficult, but determining your own needs and the needs of your loved one are the first steps in finding help.

Sharing the burden improves care

One obstacle you may need to overcome is your own reluctance to ask for help. You may be worried that your loved one won't feel comfortable with other caregivers. Maybe you think that no one else can provide care as well as you can. These reactions are common and, to some extent, may be valid.

But getting assistance can make caregiving less burdensome, both physically and emotionally. This assistance can provide other resources and skills that you may not possess and can give you a chance to rejuvenate your caregiving. Your loved one may actually improve with the help of such other resources. This improvement can lower your stress level as a caregiver.

Keeping your loved one at home

A continuum of options may be available in your community, including:

Respite care. Respite services offer care for your loved one, giving you occasional time off from your duties. Community organizations or residential facilities frequently offer these services. Respite care may be available through informal resources as well. For example, family, friends or neighbors may be available to help.
Adult day services. Also known as elder care programs, adult day services provide socialization and activities for adults in need of assistance. Some programs are specifically designed for people with Alzheimer's disease. These programs are generally available during daytime hours, usually weekdays only. Staff will lead various activities, such as music programs and support groups. Most will provide a lunchtime meal, and some will offer transportation to and from your home.
Home health services. The most common assistance involves personal care such as bathing, dressing and grooming and helping your loved one with eating and going to the bathroom. Some agencies also provide help with meal preparation and household chores. Most provide nursing care that may include injections of medications and assistance with wound care and medical equipment. Some agencies may also provide physical therapy.

Residential care options

As your loved one undergoes changes brought on by advancing Alzheimer's disease, he or she will require increasing amounts of assistance. At some point, you may decide to look into alternative housing options in your community.

You may find a wide range of residential care settings available in your community, but most fall into one of the following categories:

Retirement housing. These settings — also known as senior apartments or senior living — provide housing only. Residents usually have their own apartment or private room that includes a kitchen. This type of residential care setting may be appropriate for people in the early stages of Alzheimer's who can care for themselves independently and live alone safely but are unable to manage an entire house.
Assisted living. People who need help with personal care and require general guidance but don't need the specialized medical care of a nursing home may be well-suited for assisted living facilities. These facilities — also known as board and care, group homes, community-based residential facilities or foster homes — are best for those who have moderate functional impairment but who can still engage in such tasks as feeding themselves and getting in and out of chairs.
Specialized dementia care facilities. People who need more supervision and assistance than may be offered in assisted living may benefit from "memory care" assisted living. This model of care generally offers a greater number of staff per residents, specialized staff training and activity-based programming. The building or unit often includes secured exits and enhanced visual cues (like signs or pictures) to help residents feel more oriented in unfamiliar surroundings.
Nursing home. If your loved one needs medical care, a nursing home may be the preferred option. These facilities provide room and board with 24-hour skilled care — care provided by a licensed nurse. Some nursing homes have special units for people with Alzheimer's disease — designed so that the environment, activities, philosophy of care and staff training revolve around the special needs of people with Alzheimer's.

Choosing the type of care

To decide which type of care would work best for you, assess the needs of your loved one and your needs as a caregiver. Ask your doctor, social worker, members of your local Alzheimer's Association chapter or another community agency to help you determine your loved one's potential needs. Any new care arrangement you make will involve blending your capabilities as a caregiver with the needs of your loved one.

Keep in mind that some settings aren't designed for people with Alzheimer's. And as the needs of your loved one change, caregiving options may also change. Some settings may not be able to care for your loved one throughout the course of the disease. Most people require more support and help as the disease progresses.

To determine which type of care is best for your loved one, consider the following:

Is 24-hour supervision needed?
Does your loved one need special care? If so, what type of skills must a caregiver have to provide that care? For example, does your loved one have communication difficulties or unique behaviors, or does he or she need toileting and bathing assistance? Does your loved one want to walk or move around but needs direction and assistance?
Does your loved one need help in taking medications?
Does your loved one have complex medical problems, such as heart disease or diabetes?
What types of meals are needed? Do the meals need to be prepared by a caregiver?
Do you want a facility that specializes in Alzheimer's care?
How will the costs be covered?

Don't delay the decision

The amount of care needed and type of atmosphere preferred will influence your decision about the type of care setting you should visit. Keep in mind that most facilities have waiting lists, and it may be beneficial to explore your options early, before a crisis arises. This allows for a more thorough evaluation without additional pressure.