Considering Residential Placement?
For many very understandable reasons, families sometimes
wait too long to put an appropriate care plan in place
for their family member with dementia. The memory
loss, confusion and disorientation of the person with
dementia may have stabilized and it is hard to imagine
that this progressive degenerative disease will do just that,
progress and cause further degeneration. While a certain
amount of “healthy denial” and “living one day at a time”
may make things easier in the short run, it can make for
delays in planning.
In this column, I want to focus on the critical decision
making times, and to encourage family members to
delay less. In presenting some of the key issues to think
about, I hope to provide information that will get family
members to think outside the box if they are not already
doing so, and to proceed with, rather than to put off,
the next steps in an appropriate care plan for the person
with dementia.
In reflecting on the calls to the Helpline, one of the
most challenging questions for consideration is at what
point should residential care be considered for persons
with dementia. What makes this question so uniquely
challenging is that it is often confronted after many years
of caring for your family member with dementia at home.
It is after you and your family have dealt with either being
the primary caregivers and/or arranging for professional
home care, adult day care, respite care, etc. It is after you
and your family have experienced the emotional pain of
losing significant aspects of the person with dementia;
and of having had to tap into emotional, spiritual and
financial resources that are by now in shorter supply.
One way of determining whether or not it is time to
consider residential placement is to take a reading on the
effects of caring for your family member at home. Are
the day to day activities and functioning of your family
members being seriously compromised? Are you and
your family experiencing increased frustration, resentment,
and, at times, anger? Are you aware of feeling
guilty about the possibility of not honoring the person
with dementia’s desire to remain at home, even if the
promise was made at a time when this level of mental and physical deterioration could not have been imagined or
foreseen? If the answer to any or all of these questions is “yes,” then it most probably means that the accumulated
stress of caregiving is at a point where action is needed
for all concerned. While it can be extremely difficult to
give over the daily care of the person with dementia to
professionals outside the home; ignoring the crisis level
signs of caregiver stress can have serious consequences.
The intensity of the feelings of anger and guilt, combined
with the family conflict and disagreement which often
occur at this time all contribute to why this is as challenging
as it is.
Clearly families who have considered and planned for
the possibility of this option earlier on in the illness are
at an advantage. Families who have been able to communicate
more openly with each other about the care
planning for the person with dementia are in a better
position to face this emotionally laden challenge. The
value of having done the legal and financial planning
early enough cannot be overemphasized. Preserving
the financial and emotional resources of the family so
that the person with dementia can receive adequate and
humane care throughout the entire course of the illness
can best be accomplished if the temptation to avoid the
planning process can be faced.
Even though the clear message here is to not wait too
long to anticipate what you will need in order to be ready
for all care planning options for the person with dementia
in your family; know that the delays are understandable.
So, whatever stage of planning you and your family are
at; do not hesitate to contact us on the Helpline and in
Care Consultation. We welcome your calls, e-mails and
requests to come in individually or in family groups.
For information and support, please call the Helpline day or night at
800.272.3900.
— Reva Hoffman,
Director of Clinical Services
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