How do I Know When it is Time to Consider Placement in a Facility?
Placement in a memory care or skilled nursing unit is a very difficult and gut wrenching decision, one of the most stressful decisions I have ever seen anyone make. Most people suffering from a dementing condition are cared for at home by either their spouse or one of their children. However, there may come a time when a caregiver can no longer safely manage alone at home.
The most typical reasons for placement are behavioral problems (e.g., wandering, aggression, delusions, hallucinations), incontinence, refusal of personal care, and/or caregiver illness or stress. Unfortunately, placement is usually secondary to a crisis rather than a planned extension of care. Placement is better executed as part of a palliative and safe memory care plan rather than a reaction to a crisis. The objective is to continue to engage in a comfortable and stimulating life despite increasing loss of ability, as lost abilities can no longer be restored.
When I work with a couple early in the disease process (stage 2 or 3) we devise a long-term plan to pursue in case there is further decline. We devise a strategy for monitoring and adjusting care that gradually transfers decision making over the course of several years, as that is the typical course of dementias like Alzheimer’s disease. As decline progresses there is a transition from self-care to needing various types of external support. Using outside resources such as companions and aids is a natural component of any good plan and helps both the person with the decline as well as the caregiver function better and allows adaptation to external supports for care.
When external care and companions are an integral component of caregiving all along, placement is often less traumatic as there is no single caregiver or place of care. When placement is desired, it may help to place in steps rather than all at once. For example, getting involved in lunch and activities at the facility while still at home softens the change for all involved. Because proactive transitions are slower, familiarity can be established with the new environment and staff before moving in. The major factor to consider in choosing a facility is personalized programming that keeps resident engaged rather than passive. Even persons with middle stage dementia need stimulation; so care needs to be active. Care needs to emphasize productivity rather than competence.
Finally, these decisions are best made with the help of a knowledgeable and skilled professional who can compassionately guide all through this difficult process. There are many excellent ways to monitor the changes in cognitive decline with the intention of helping all involved be more proactively rather than reactively responding to decline. It is critical to have placement done with support for both the person who has declined and those who are intimately involved in their care.