When is it time for a nursing home dementia
When Is It Time for a Nursing Home? Alzheimer's Dementia Care
[Music]
hello Matthew Bell with Alzheimer's
proof calm and today I want to talk to a
little bit about that point in time
where it becomes necessary to make the
decision to put your loved one into a
nursing home
specifically I want to think about the
question of when is it time to put your
loved one into a nursing now this is a
huge and traumatic issue I can tell you
this is gonna be heavy going I'm gonna
go through a lot of stuff I was
surprised in preparing for this video
the number of times I actually teared up
reminiscing about my dad and so it's
it's tough this is difficult material
it's also complicated material it really
is complicated and the answer is gonna
be different for everybody and you
should understand this right from the
beginning first of all we know
Alzheimer's has multiple stages many
times its enumerated as 3 there's also I
have a video up with the link in the
description put a screen shot up maybe
where I talk about the seven stages view
versus the three stages view but we
don't have to deal with any of those
niceties here we can simply say
intuitively Alzheimer's is early middle
and late stage so everybody's experience
is going to be a little bit different
everybody's actual symptoms of
Alzheimer's are gonna be a little bit
different their care environment
everything is going to be unique to
their circumstance and so there's no
one-size-fits-all answer that's for sure
somebody could theoretically progress
through the entirety of Alzheimer's in
other words do a full progression from
early middle to late stage and die as my
dad did from the Alzheimer's directly
and they could be in their home the
entire time that is possible on the
other hand a person could perhaps have
to enter into a care environment very
early maybe even with mild cognitive
impairment or in an early stage of
Alzheimer's disease they may require
nursing home care and one reason for
that might be that they have some other
condition or conditions that reduces
their ability to care for themselves
apart from the Alzheimer's so every
family every person their experience
here is going to be entirely different
the most that I can hope to do is kind
of run through a series of
considerations that I hope might assist
you in trying to work through these
issues for yourself and for your family
but because of the complexity and
because of time limitations in other
words I don't want this to be this could
be a seminar this could be an entire
class probably which I'm not saying I'm
competent to teach but my
you hear is gonna be just that it's
gonna be somewhat superficial I'm gonna
kind of look at in survey issues but
it's going to be necessary certainly to
dive more deeply into these things I
might do that in future videos
but certainly you yourself are gonna
want to talk to advisors like doctors
possibly lawyers other people who might
be able to help you trusted friends and
family members who are going to help you
to think through and make decisions in
these very vital areas let me start with
this when is it time for a loved one to
go into a nursing home I'm gonna say
that I think actually this question
should really be understood to be two
distinct questions so the first question
I think that's really embedded in here
is the question of when does it become
necessary to give your loved one
intensive daily assistance care
supervision that's question number one
and question number two is going to be
when is it the case that that type that
level of assistance is no longer
possible to give them in their home or
in your own in other words when does it
become necessary to say the nursing home
is the only place that can effectively
deliver care to my love life those are
two distinct questions but to complicate
things further I think you can only
really begin to adequately answer those
questions if you take certain factors
into consideration it's probably any
number of factors that could be
mentioned here but I'm gonna mention for
medical logistical financial and
relational and I will explain what I
mean by those and hopefully it'll become
clearer as we move along but I need to
make the usual disclaimer I am NOT a
medical practitioner I am NOT a
financial adviser I am NOT a lawyer I
cannot give you specific advice on any
of the things that we're about to
discuss what I am talking about is an
overflow number one of my own
experiences that I had with my dad to a
lesser much lesser extent my grandma but
also research that I have done some of
it for the website but meant much of it
going back to the time period where I
was the primary caretaker for my dad and
had to make I had to make the decision
basically to put him into a nursing home
but let's take that first question when
does your loved one start to require
intensive daily care so notice that this
question concerns care level it's a care
level question so one obvious factor
that's relevant here is going to be
Medical Factor ideally we would like
then a way of gauging what the person's
medical need is now the long-term care
industry has certain terms and certain
metrics or at least they're working
towards a certain way of measuring this
and I'm gonna mention it here so in the
long term care lingo essentially your
loved one would require care intensive
long term care if he or she meets one of
two separate triggers the first trigger
is going to be physical so a physical
trigger in this one and I've mentioned
this in numerous other places but this
trigger essentially means that a person
would lack two out of six what are
called activities of daily living okay
they have to lack two out of six the
activities of daily living are things
like bathing yourself dressing yourself
feeding yourself being able to transfer
in and out of bed by yourself being able
to toilet by yourself and being able to
maintain bodily functions or be
Continent essentially is what it is that
is to say you have control over your
bladder over your bowels and so on now
once again these are physical triggers
they can be prompted by other conditions
other than Alzheimer's disease and as
good as these definitions are for the
long-term care industry they do depend
on doctor evaluations in ways that can
mean that whether a person lacks one or
other of these is going to be open to a
doctor's interpretation possibly several
doctors interpretations so once again
this underscores the need for you to
maintain a good level of dialogue with a
trusted circle of advisers including
those people who have a finger on this
kind of information presumably medical
practitioners and professionals of one
sort or other now the second trigger the
first Herger was physical the second
trigger is mental that is to say
cognitive impairment so in other words
you could lack two out of six activities
of daily living and be long-term care
certified or you could have a severe
cognitive impairment and likewise be
certified even if you contain yourself
feed yourself dress yourself and so on
cognitive impairment in this respect is
going essentially to be some kind of
severe deficit of cognition that is
going to affect a person's ability to
err for him or herself or that would
make them potentially a danger to
themselves or to other people if they
didn't have constant supervision
constant assistance so once again when
you lack the activities of daily living
you're gonna need daily assistance and a
person who is cognitively impaired to
such an extent that they essentially are
gonna need round-the-clock supervision
or whatever
also is going to be a trigger for
long-term care cognitive impairments in
view once again dementia or a deficiency
of memory which is obviously a symptom
of Alzheimer's disease not just that
there are other kinds of cognitive
impairment there are neurological
dysfunctions there could be traumatic
brain injuries there is other kinds of
dementia so for example there's
something called Lewy body dementia
there are any number of different
possible deficits and conditions that
might prompt the need for care and in
fact from the physical standpoint I mean
a person could lose continence in virtue
of some kind of a severe cognitive
impairment and that often happens
however a person could also lose
countenance for any number of other
reasons and I won't enumerate them but
there can be additional reasons for that
and similarly a person might lose the
ability to transfer in and out of bed
for any number of reasons they might
lose the ability to eat because they are
paralyzed for instance so there are any
number of different conditions that
might bear here but from a strictly
cognitive standpoint we're talking about
things like negatively effected
awareness decision-making judgment
memory perception reasoning almost all
aspects of what we call thinking
behavior emotional response all of these
can be negatively impacted now the
implications for such a cognitive
impairment are probably fairly obvious
to people who are watching the video
because they're they're dealing with
some of these right you're talking about
behaviors that are disruptive to the
household behaviors that are potentially
dangerous wandering sundowning certain
activities that might compromise
personal safety ideal in other places
with driving so a person who has such a
severe cognitive impairment that they
can no longer be trusted to even remain
in a safe place or they can't be trusted
to be able to care for themselves to not
electrocute themselves
not eat spoiled food to not turn the gas
on and forget that it's on to not wander
from the house and not remember how to
get back home these are the kinds of
things that people were living with
somebody with dementia face on a daily
basis and once they reach that critical
mass once that person's deficits start
to manifest in behavior that is
consistently pathological then it is
potentially time to start to weigh your
options obviously these considerations
bear on the safety of the person and
also frankly the safety of the other
people in the house I mean if my dad for
example had accidentally turned on the
gas or turned off the pilot light or put
dish detergent in the Sugar Bowl there
could be any other person in the
household who could be negatively
impacted because of those those things
and so this brings us to the second
consideration that I said the second
factor first was medical the second is
logistical so now remember the second
question I said when you're thinking
about the question when is a time for
your loved one to be in a nursing home
the first question is when does your
loved one require intensive daily care
that's the first question but the second
question was when can that care no
longer be reliably consistently safely
delivered in the home so in other words
when can your loved one no longer
receive their necessary care in the home
environment pertains in the first place
to the care environment now you have to
understand the Alzheimer's proof project
so my site my website Alzheimer's
groov.com this channel in the first
place the concept that I had was twofold
the first was how to make changes in the
home environment in order to try to make
that environment safer a more effective
care environment for people who are
living with somebody who has dementia or
Alzheimer's disease so that was the
first meaning of Alzheimer's proof I
think of it as something like baby
proofing or child proofing a house when
expectant families bring a child into
the house they have to baby-proof it
well if you're caring for someone with
Alzheimer's you have to Alzheimer's
proof your house now the second meaning
is simply change us to your own personal
diet lifestyle to try and minimize your
risk but for the present purpose when
you think about those changes you might
need
make in your home environment which are
faced within is the prospect of making
your home environment more like a care
facility more like a nursing home
possibly like a hospital in various
respects and obviously you can't
completely convert the house into a
nursing home or into a hospital but
you're talking about adding additional
locks to doors maybe safety latches to
prevent your loved one from accessing
certain rooms from eloping I have videos
where I deal with adding certain devices
on to a door or on to an oven or on to a
microwave or on to a refrigerator to try
and prevent your loved one from
accessing things that he or she
shouldn't or can't safely this might
include things like adding closed
circuit TV cameras or other kinds of
cameras that you can access through your
smartphone might include monitors and
sensors or GPS trackers that you fit on
to your loved one to try to recover them
really in case they elope or wander away
from the house and those are all assists
to safety those are almost always going
to pertain to some cognitive deficit
there going to be an assist to the
caretaker to care for someone who cannot
be policed without them the second set
of logistical considerations has to do
with physical assists so these are
things like adding handrails grab bars
lighting possibly adding wheelchair
accessibility ramps widening the doorway
to accommodate a wheelchair or walkers
converting a bathtub to a walk-in in
other kinds of interventions that are
designed to give a person help from the
physical standpoint but to bring in now
my third consideration medical
logistical the third one was financial
first of all all of these contemplated
interventions cost money there are any
number of videos that I have on this
channel where I deal with paying for
long-term care how to get long-term care
insurance policies involved how to think
about paying for long-term care I've got
a lot of different content just on this
question so I don't want to make this
video overly long which it's already
running long in virtue of getting into
topics that I explore in more detail
elsewhere suffice it to say that from a
financial point of view you really only
have three ways to pay for long-term
care you pay out of your own income and
assets you pay until your income and
assets are spent down and you have to
and you're able to qualify for
government assistance or Medicaid or
you've never had any assets to begin
with and Medicaid is the only game in
town
and the third way so will private pay
Medicaid or number three proceeds from a
long-term care insurance policy those
are really the only ways to pay now
there are really two reasons why person
might want a long-term care insurance
policy the first of those is to protect
their assets so that they can be used
for legacy so they could be used for
survivor so if you have a spouse that
you want to be able to use your
retirement money you don't have to spend
it on one person's care you're gonna
need some way of protecting that asset
from having to be depleted in virtue of
paying for your for your nursing home or
for your homecare but the second reason
a person might want a long-term care
insurance policies to be able to
exercise greater control over where they
receive their care so for instance if
you have a long-term care insurance
policy and it provides for home care
then you take some of the burden off of
the care taker and we'll talk about that
in just a moment but you may be able to
stay in your home for longer than you
would have otherwise if your only care
taker let's say was your spouse your
spouse could be aging your spouse could
have cancer your spouse could be unable
to lift you or unable to cope with the
stress don't get me wrong there are
other strategies there are Medicaid
trusts for example but really that's not
a separate way to pay all the Medicaid
trust is is a way of handling your
personal assets to try to prevent them
from being used to pay for your
long-term care
you could also implicate a life
insurance policy here there's a couple
of ways to do that one is with writers
there are chronic illness writers there
are long-term care writers or say my dad
who was in a nursing home it was about
$300,000 for the four years he was in
the nursing home if my dad had privately
paid he didn't but if he had and if the
family had had a $300,000 policy
life-insurance on him we didn't but if
we had then that life insurance policy
would have in principle restored those
funds that we pay it on his care to the
family after he died now these are
complicated issues I cannot get into
them here there are many questions many
problems many difficulties here but for
further information I invite you to see
my other videos where I deal more in
detail with those questions but the
final point that I want to make the
final of
the four factors that I mentioned so
medical logistical financial and the
fourth one is relational I can't think
of a better way of putting this except
to just say this is the point where
you're dealing with other people other
people in your life your spouse your
family your children your friends
perhaps and there are some tips that I
have to at least suggest you one is plan
early now for many people watching this
video it might be too late because
you're coming to this video because
there's somebody right now who has these
problems you can't you can't go back in
time and plan early but you can take the
lessons for example the lessons I
learned from my experience with my dad
the lessons that I learned I'm trying to
apply to my life in hopes that I can
help my children avoid having to go
through the same thing with me that I
went through with my dad the second part
of this is in order to plan early you're
gonna have to have frank discussions you
cannot Oscar it you can't put your head
in the sand and refuse to talk about
issues with respect to end-of-life care
or the possibility of long term care
because if you do that you're not doing
a service to any of your loved ones or
to yourself another thing that I would
say is only make promises that you can
keep if you're gonna promise your loved
one that they will never have to go into
a nursing home only make promises that
you are prepared to keep and from the
flipside of that only ask for promises
that you are prepared to lay on the
person that you're asking it from
another make no mistake about it asking
a person to commit possibly a decade of
their life five years ten years whatever
it might be to care for you in a home
environment an order that you don't have
to go into a nursing home it's it's
Noble and I can't tell you not to do it
I can't tell you to do it I'm not
telling you what promises to make or not
make I'm only saying you have to realize
it's a gravity of what you are asking
caretaking duties take a tremendous toll
on the caregiver they can negatively
impact almost every aspect of a person's
life they can negatively impact a job
some people might be in a position of
almost losing their job because they
have had to devote time to caretaking
they might be in a precarious situation
financially it's possible that children
spouses grandchildren are kicking money
in to try to pay for certain aspects of
a loved one's care that maybe they can't
otherwise afford it can negatively
impact
the health of the caretaker can
negatively impact their life expectancy
it can cause them physical injury
lifting a person from the a bed to take
them into the bathroom or to try and get
them in and out of a bathtub or to try
and wipe their butt when they make a
mess or to try to bathe them when like
my dad was he was irritable agitated
much of the time he was belligerent
none of these are easy tasks this can
cause enormous stress enormous anxiety
frankly and here's a bit of a personal
thing I was physically sick many days
worrying about what my dad might do that
day what I might have to do I was
advised and I won't say by who but by a
trusted organization to contact the
police department when my dad got out of
hand and I remember the first time I
actually had to do that or I felt like I
had to do it and the police showed up
and they essentially looked at me
dumbfounded like what did you call us
for what do you want us to do my dad was
simply out of control in the house and
the police wanted to know what do you
want us to do I mean you want us to
arrest your dad you want us to taser him
I mean they they it was obviously a very
awkward situation simply the police
presence in the house call my dad down
because as far gone as he was in terms
of his impairment he still had an innate
respect for authority I suppose but at
the same time I realized in virtue of
that that I couldn't just call the
police
every time I dad got agitated like that
and so it really caused me to become
sick because I didn't know what was I
supposed to do you know handcuff my dad
to the bed and then there can be
enormous and guilt one of the most
haunting images that I have frankly is
the image of my dad being driven away
from the house me knowing that he was on
his way to a nursing home to be put into
the nursing home essentially for the
rest of his life I mean you don't
necessarily think about it like that
because it's too painful to think of it
like that but you realize he's got
Alzheimer's disease it's a progressive
disease
he's already unable to be cared for in
the home you realize this is a one-way
ticket and I had nightmares about him
coming back to
house because it was so riddled with
difficulty and and stress and I had two
children small children in the house at
the same exact time and so I felt
horrible that I couldn't do more for my
dad but at the same time I was petrified
that I would be in the position again
even when my dad was in the nursing home
so it just is a psychological mess it's
a mess it is hard enough to make an
objective good decision based on facts
about the care environment and facts
about the home environment it's hard
enough to do that from an objective
standpoint without factoring in all of
these psychological aspects which they
can't be eradicated essentially let me
just say a few words in summation the
issue is not easy it's difficult to get
a handle on you're gonna have to do
essentially just think about some of the
pros and some of the cons it's going to
matter the answers to those questions
when do they start needing daily care
when is it not possible any longer to
provide that care in the home is it even
possible at all to provide care given
their home environment or your home and
right if it isn't then you have at least
the makings of an answer you're either
gonna have to make changes to your home
environment or you're going to have to
look for an alternative environment now
of course in principle some of the pros
that go along with a nursing home are in
principle that the home is going to be
safe it's going to be secure it's going
to provide them with skilled care that
they desperately need in theory in
practice many nursing homes are
substandard in a variety of ways they
are understaffed many of the people are
overworked they tend to over medicate
they're underpaid this can lead to a
lack or a deficit of attention on your
loved one it can even make it the case
and some people's judgment that your
loved one might decline faster in a
nursing home than they would decline in
another environment because no one loves
your loved one like you do that doesn't
mean you can't be involved so you want
to keep that in mind as well but the
other major factor here is going to be
cost what is going to be the impact in
terms of finances do you have resources
is Medicaid the only game in town for
you and if it is then you have to
realize Medicaid is going to limit the
location where you're going to be able
to find a nursing home that takes
Medicaid has an open Medicaid bed
and possibly you're gonna be faced with
waiting lists for certain nursing homes
and you may end up having to put your
loved one in a location that's not ideal
that's not located close to you there
are so many different factors here again
I told you this was going to be a
whirlwind I'm sorry that I got as long
as it has obviously the very final thing
that I'll say is clearly we want to try
and make a decision that is in the best
interest of our loved ones we want to
think about it in terms of objective
interest in terms of where are they
going to receive the best care available
but at the same time I recognize that
not everybody there's gonna be different
ways of weighting factors here if you
have made a promise to your loved one if
you know that he or she would be
uncomfortable outside the home
environment and you want to make every
effort to try and accommodate their
wishes I respect that totally but you
have to realize the difficulty involved
and I'm sure you many people do but at
the same time recognize that there are
other people in the same position that
you are and part of the entire thrust of
the Alzheimer's proof project is trying
to assist you it's trying to assist you
in order to keep that promise in order
to make your home environment as safe as
possible now is it gonna cost money yeah
unless it's good unless you have some
handyman or carpenter and your family or
unless you yourself were able to perform
some of these interventions it's going
to cost money no matter where they
receive their care you may have to at
some point reach out to other people you
may even have to bite the bullet and
actually put them into a nursing home if
you can no longer reasonably meet your
obligation because you have to remember
too that it not only doesn't impact your
health but obviously if they are
receiving substandard care it's not
doing anybody any good this is obviously
a very very tough issue so I hope that's
something that I said was of help to you
I hope maybe it got your thinking going
I hope it provided an answer possibly
that you were looking for I am going to
try and make videos possibly touching
and going more deeply into some of the
other things that I've discussed but
this video I need to wrap it up I thank
you for watching I invite you to check
out some of the other content that I've
done and all I can really say is I wish
you the very best in making this
decision the
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you
