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When home care no longer works (Part 2/3 on Alzheimer's care)

05 December 2007
Bonnie Sandler, S.W., The Senior Times - December 2007

This article is the second of three discussing care for a loved one diagnosed with Alzheimer ’s Disease/Related Disorders, from home care to choosing a care facility

Families dealing with Alzheimer’s will often try out different types of resources to keep their loved one at home as long as possible. Because the illness progressively manifests challenging behaviours and physical issues, many families will find that home care no longer works.

This article will look at some reasons why families, committed to keeping their loved one at home might consider a move to a residential facility. Alzheimer’s affects each person in a unique way, so it is impossible to determine how long a person will be able to remain at home. Of consideration is the family’s coping mechanisms and the resources available to them.

Here are indicators that home care is no longer working:

Caregiver burnout. The family’s primary caregiver’s health is compromised. An overstressed caregiver, even with hired help, cannot provide the best care.
Inability to manage difficult behaviours, such as wandering, incontinence, agitation, repetition, combativeness or inappropriate social behaviour like refusal to keep clothes on, refusal to bathe or allow for hygienic activities, yelling and outbursts.
Paid caregivers’ inability to manage the individual because they must work one-on-one in an isolated environment, without support or backup.
Little relief from difficult behaviours, such as the patient’s nighttime agitation. In this case, daytime naps offer relief to the patient but not the caregiver.
Home help is required 24/7 and this is costly or the spouse is uncomfortable with this living arrangement.
The caregiver does not live with the patient so overseeing their full time care proves too difficult.
The patient is no longer able to leave their home and therefore lacks stimulation.
It is difficult to administer medications.
Complications from the illness require constant medical attention, unavailable in the home.
The person needs assistance in all activities of daily living.
The patient is no longer ambulatory and requires specialized equipment.
The patient has lost mobility and requires specialized equipment.
The person is in the last stages of the illness and palliative care in a nursing care facility is the best way to meet these needs.

Sometimes the decision is taken out of the family’s hands. Homecare may work until a crisis, like a fall, occurs and the person requires hospitalization.

My friend Alice in B.C. was the primary caregiver of her two parents with dementia. After a long heart-wrenching conversation, I asked her how she did it. She said: “When I think back to the years when I cared for both my mother and father at exactly the same time and try to remember what enabled me to manage and cope, I always remember the phrase my social worker gave me: ‘The goal posts keep changing.’ It is extremely difficult to keep up with your loved one and their changes, and not get stuck in your own ideas of what should happen. That phrase was a gift.”

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Bonnie Sandler

Residential Real Estate Broker, Housing Consultant for Seniors

514 497-3775