Placement in a memory care or skilled nursing unit is a very difficult 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 family members. However, there may come a time when a caregiver can no longer manage alone at home. The most typical causes for placement are behavioral problems (e.g., wandering, aggression, delusions, hallucinations), incontinence, refusal of personal care, or caregiver illness or stress. All of these reasons involve a crisis and are often made when emotional resources are drained.

I have worked with many who see me early in the disease process and we develop a plan that we follow by monitoring and decision making over the course of several years. Care evolves as decline progresses from being able to manage on one’s own to needing various levels and types of external support. This support can be provided by a family member (e.g., spouse or child) or by professional caregivers.  Using outside resources such as companions (CompanionPlus at 370-7130) and aids (there are many good home care agencies) helps both the person with the decline and the caregiver function better for longer at home and allows adaptation to external supports for care.

If use of external care and companions has been part of the process of caregiving all along, placement may be less traumatic. It is also helpful to have the person placed in stages rather than all at once.  For example, getting involved in lunch and activities while still at home softens the change for all involved. This way the changes can be slower and familiarity can be established with the new environment and staff before moving in. This is true for assisted living as well as for placement in more secured care settings such as dementia assisted living or skilled nursing facilities. The major factor to consider in a facility is programming (getting the person out of their room and to activities). Even persons with middle stage dementia need stimulation; so care should be active rather than custodial and emphasize productivity rather than competence.

Finally, these decisions are best made with the help of a knowledgeable and skilled professional. There are many excellent ways to monitor the changes in cognitive decline and help all involved be more proactive. It is also very helpful to have placement made in a supportive context for both the person who has declined and those who are intimately involved in their care.