Thursday, September 17, 2015

When Is It Time To Place My Loved One With Dementia

One of the most frequent questions we get here on Mp is "How do I know when it's time to place my loved one?"
This is course is different for every patient, but it is also different for every caregiver. 
My rule of thumb is and always has been that there is no down side to placing a loved one in a facility too soon.
There are many down sides to waiting too long, and none of them are good. The number of things that can potentially go wrong in waiting to long to place a loved one are endless. 
I will go over a few. Medications. In a facility the meds are regulated and can be changed usually within the hour for whatever reason. When your loved one is at home, try getting them to the doctor to see them to evaluate them to change their meds. This in itself is a disaster and needed have to happen when you have placed them.
Mobility. Toward the end stage, there is none. Take a 70 year old spouse, weighing in at about 90lbs soaking wet, trying to get their 180b. husband to the bathroom, two, three times a night.
All this does it put both of them in danger of one falling, or both. And the end result could be a broken hip, which in some elderly people is in itself a death sentence.
Or just trying to bathe the patient. Get them moved from the bedroom to the couch, from the couch to the kitchen table, and back to the bathroom two or three times an hour.
Then there's the fear of them getting out of the house and you not knowing. Wandering. Wandering can and does happen in a facility, but the chances are a lot slimmer your loved one will wander there. And the response time when someone does wander is greatly increased because of the number of people there to look for them.
Stress. Anyone who cares for a loved one knows what I am talking about here. It doesn't matter if you are in your thirties, or in you seventies, the stress that this disease puts on a caregiver is the same.
The thing is chances are if you are in your thirties you are in reasonably good health. If you are in your seventies, you probably have several medical conditions of your own to contend with.
Long distance caregiving. This never works. How could it? There are families who have the help of others in the family there locally who cannot stay on top of what it takes to care for a dementia patient, and some try to do it from a couple of thousand miles away.
It doesn't work. It can't be done. If you are one of these who are doing this, you too know what I am talking about.
But, the most important reason to have a plan way before it comes time to even think about placement is because you said you would. What does that mean, "you said you would?"
That means that somewhere along the line you probably promised to take care of your parents, your spouse, your siblings, whoever. You may have said that you will never place them in a nursing home for any reason.
Well, never sometimes gets here before we know it. I am telling you this as a patient who knows his destiny. I know what is coming. In a year or two I may not, but right now I do and I do not want to put my wife nor our daughter through that. Period.
Then theres the fact that as a patient I deserve and demand to be taken care of to the best of ones ability. My daily care should not be substandard simply because of a promise you made some twenty or thirty years ago.
Chances are we all have made promises we haven't kept for one reason or another. This thing about "I promised my Mom I would never put her in a facility" is noble, but thats about it.
Dignity also plays a huge role in this. We all want to be cared for with dignity. Just because we may not be able to communicate or the patient has no idea what is going on around them, they deserve to have their dignity intact.
It tends to be pride thing also, believe it or not. One doesn't want their family to know they can no longer take care of their Dad, so they do the best they can, not even realizing that what care they are trying to give him is substandard at best.
Every patient deserves to be taken care of. That should never even be up for debate. But it is. Many times I read posts on here and the one thing you have to remember is that we are always just getting what information that the person giving it allows us to have.
When you couple the elderly trying to take care of their elderly spouse, or the daughter who is trying to care for her Dad and has a husband and three kids of her own an hour away, this soon becomes an ordeal that simply won't work.
In closing I want to tell you something and you need to think about this. Placing your loved one in a facility needn't be the dramatizing thing it is portrayed to be.
The nursing homes now a days are nothing like they were thirty years ago when you made that promise to never place them. Chances are the patient nor the caregiver have been in a facility that cares for dementia patients, ever.
Why is that? Because no one has a plan. Some think that one day they can decide they can no longer do this and just drive up to a facility with their loved one in the back seat and tell the nurse at the desk you have arrived and you can't do this anymore.
This only happens in row movies. The only person who can place your loved one is their doctor. You as their caregiver can and should know when it is time you can no longer do this, but it is only by doctors orders can a patient be placed in facility.
This has to do with all kinds of laws and insurance reasons, but all you need to remember is you just can't drive to a facility and announce you have arrived, get your loved one settled and that will be that.
First of all, these facilities are in business to make money. And there is only two ways they can do that. Private pay, or insurance. Now they don't care if it's either. but they do want their money and that is the bottom line.
It is imperative to have some sort of long term health insurance in place, preferably before the patient was even diagnosed way back when.
But this rarely happens. So you have to depend on what money your parents have and chances are you have no idea where or how much that is.
Try to run down insurance policies that were taken out forty years ago to see what is covered. All these things have a factor in your loved one being placed.
And, the biggest hurdle is does the facility you are looking at to place your loved one have the room? Again, you can't just drive up and think they have a room that has been waiting just for you to realize your loved one needs placed.
This post could be twice as long and I still would have just grazed the surface on why you have to have a plan when it comes to placement.
There are only two choices that every family member will face in time. You either place your loved one, or you don't.
This is what it comes down to. 90% of you will end up placing the patient, for some of the reasons I have mentioned. 10% will have the means and the money to have private care come and in and do what needs to be done.
The chances you will never place your loved one are slim. The promise that you made that you never will are just down right dumb.
This disease is bad in the beginning stages. I am not one to go by the "stages" of dementia. I feel someone sitting behind a desk somewhere came up with these stages and my guess is a patient wasn't even involved.
So the two stages I go by are the beginning stage and the end stage. We all know there is both of these. And most are not prepared for either.
Do yourself and your loved one a favor and be prepared. Placing a loved one to me is one of the most loving things you will ever do for them. You are doing something your heart tells you not to, but you are doing something that your mind knows is the right thing to do.
This is exactly what you said you would do all them years ago. Take care of them. And when you can't, yet seek out placement, you are in fact taking care of them.
We patients deserve to be taken care of. If our families would only have a plan, none of this would be an issue. But, as always, it is because of the lack of planning...