Many families consider living at home as a “safe” choice. The family home remains the family home. Mom is comfortable there. Nothing much changes, except that the family now understands that Mom needs care, and a lot of it. Is it time for in-home care or do you want to provide that care yourself? Are you prepared for what is to come?

Understanding the situation

In-home care options provide safety and security to those who live alone.

The most common advice I offer families is to first consider the nature of dementia. Whatever symptoms or behaviors your loved one is showing, each will become more severe as the disease progresses. She may forget that she ate dinner, eat excessively, or skip meals completely. Her wandering will become more severe as long as she remains ambulatory. Her gait will become (more) impaired with age, and she becomes more of a fall risk. She is even more at risk for a fall or other accident if she forgets important items like eyeglasses or medications. If she seems anxious now, will that turn to agitation or even combativeness in the future?

Living at home with dementia is fraught with peril. This is even more true if she lives alone.

If you don’t live with your loved one, you may have difficulty observing signs of her worsening memory impairment. Habitual behaviors in the home can help her through routine days. She wakes, showers, and eats breakfast. Her daily routine has served her well for years, allowing her to manage her memory loss until it’s time for bed. She may even pay all her bills as soon as they arrive in the mail, so nothing seems to be a great concern.

When things go wrong

Bad things can and will happen when routines are disrupted, however. The knock at the door by an unscrupulous pest control company stating that a termite infestation needs to be addressed (even without an inspection). The so-called handyman insists that work needs to be done or she could lose her home, leading her into a financially irresponsible decision to authorize—and pay for—unnecessary repairs that may not even get done. You cannot ignore this potential for elder abuse by unscrupulous people.

If a spouse is providing care, this will add tremendous strain on his health and well-being. Whatever stress is on the spouse now will become more stressful as time passes and affect his quality of life and, arguably, shorten his lifespan.

Ensuring good in-home care

To help your loved one remain in her home (or if you transition her to your home), you need to honestly assess her situation and understand your options.

Physical and mental activity are important for people as they age, especially with dementia.

Your aging loved one will likely need physical accommodations to her residence to make it age-in-place friendly. This may include adding grab bars for showering and toileting, and possibly installing ramps or lifts to overcome steps. You’ll generally need to address bathrooms, baths and showers, sinks, non-slip flooring, cabinets, steps, and entry threshold trip hazards. Stairs are particularly dangerous, as a fall could lead to life-threatening injury, or even death. There are numerous resources on the Internet offering suggestions for making homes age-in-place friendly. I suggest starting there before turning to contractors, who can then provide the services you need.

In-home care options

In addition to physical accommodations needed by anyone aging in her own home, your loved one with a memory impairment needs special assistance and care. She will need help with medication management, for one. Ensuring medications are properly administered is not as easy as it seems. Pill organizers can help, but someone needs to properly fill the organizers and then ensure the medications are being taken at the proper time. You can’t rely on your loved one to do it for themselves, even if they seem able today.

If you or someone else is unable to provide the level of care needed, which will increase with time, consider professional caregiving options. Generally, I find care options are most easily considered in general terms for planning purposes, understanding that all can be tailored to meet your needs.

A few options to consider:

  • Periodic caregiving visits, possibly by a nurse
  • Adult day care program in your area
  • Daily in-home care
  • 24-hour in-home care

After considering current and future care needs, families sometimes (or later) decide that a transition (move) to a dedicated care facility is in the best interest of all concerned. The cost is typically much lower than 24-hour care and avoids retrofitting homes to become age-in-place friendly. If this becomes the case, I do recommend professional advice and care management.

Medical alert system

If your loved one is ever on her own at home, even if you or another caregiver runs to the store for an hour, you should consider some type of medical alert system. These systems typically use a device worn at all times, such as a necklace, with a button that your loved one can press in an emergency. That sends a distress signal to a base unit that connects to a telephone line or its own cellular service. The base unit in turn contacts you, a call response center, or emergency personnel, depending on the unit and your preferences. Such a system can be a great peace of mind for you if your loved one is living at home.

Additional resources may be found in a variety of places. Check the Alzheimer’s Association or the Aging Life Care Association for more information.

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