Not too many years back, there were essentially two housing options for those with dementia: stay at home with family, or move into institutional care, which meant a nursing home. But families now have more choices. Assisted living facilities are increasingly open to housing adults with dementia, as we wrote about not long ago here on the Blog. Memory care units in senior living communities are proliferating.

Adult family homes, are also an increasingly popular choice. Typically licensed to care for up to six residents, these facilities provide homelike living in a far more intimate setting than a nursing home, and at less cost. Here in Washington State, home to AgingOptions and Life Point Law, adult care homes have been part of the landscape of licensed senior care since 1989.

But what are the best options for families feeling the pressure of caring for a loved one with dementia? What are some of the costs? And how do families struggling to care for a loved one at home decide when it’s time to choose another living option? We encountered some good information about this important topic when we read this recent article on the website Medical News Today. This article describes when a loved one with dementia might be better off – not to mention their family – by moving into a different type of care facility.

Adult Care Homes Make Sense When Symptoms Create Risk

Most people prefer to age at home, and most families would rather remain intact, even in the face of dementia. But there are times when circumstances make such resolve impossible.

For example, says Medical News Today, “If someone with dementia has severe symptoms that put their health and safety at risk or a caregiver is unable to cope, a care home may be necessary.” The best of intentions has to give way when health and safety are at stake.

The inability to care for oneself can be another trigger. “A person with dementia may require a care home if they are having difficulties carrying with daily living, such as bathing, eating regularly, and taking medication,” says the article. This is especially true if they’re living alone with no family nearby.

Adult Care Homes Offer an Array of Choices

When it comes to choosing housing alternatives today, families have a range of options. “There are several types of residential care with different price points and levels of assistance,” the article points out. “Some care homes will offer housing and 24/7 support with meals, medication, and daily functions.” 

The article explores the types of housing available, and provides some telltale signs that choosing one might be necessary. The authors also address the range of housing costs and provides some tips for a smooth transition as you move a loved one into unfamiliar surroundings.

Some Obvious Signs That It’s Time for an Adult Care Home

The Medical News Today analysis quotes a 2020 analysis from the National Institutes of Health that suggests that people with moderate or severe dementia “may require care within a nursing facility if their symptoms become severe or if a caregiver is facing burnout.” But how does a family determine when dementia symptoms have become a potentially hazardous problem?

Again, quoting research from the NIH, the article lists several signs that may indicate someone with dementia requires a change in their living conditions. These can include:

• A decline in grooming or personal hygiene
• A habit of leaving appliances on unattended, such as a stove
• A pattern of forgetting to take any medications
• Frequent refusal to seek medical help for significant health issues
• A tendency to forget to eat or drink
• The inability to dress properly or wear clothing appropriate for the weather
• The inability to keep up with everyday tasks, such as housekeeping
• The tendency to wander or get easily lost
• A general display of confusion.

According to the Alzheimer’s Association, if the health and safety of the person with dementia is at risk, or if the dementia sufferer is feeling isolated and alone, a care home may provide a safer and more social setting for them.

Adult Care Home Can Also Benefit the Caregiver

Besides focusing on the needs of the loved one with dementia, the needs of the primary caregiver have to be considered as well.

“It is important to consider the primary caregiver’s needs,” says Medical News Today. “It may be time to consider additional support, such as a care home, if a caregiver can no longer cope with the demands of care.”

Specifically, if a primary caregiver is starting to show signs of exhaustion, resentment, or persistent stress caused by increasing demands for care, other family members may need to step in and suggest a change.

Choosing an Adult Care Home Involves the Family

In a perfect world, the person with dementia could decide for himself or herself where they want to live – but the odds are that won’t be possible. “If a person with dementia cannot decide about their care themselves, it may fall to family members or caregivers,” says the Medical News Today article.

“The National Institute on Aging recommends people talk with the person with dementia and try to accommodate their preferences as much as possible,” the article suggests, but we would advise that families be prepared for emotional resistance, especially if the dementia is even moderately advanced. Moving a loved one who doesn’t want to be moved can be one of the most wrenching decisions a family has to make.

Ideally, however, once the move is done, people with dementia can often adjust quickly to their new surroundings and some of the resistance rapidly subsides.

Hopefully, families have done their legal homework ahead of time. “Individuals with dementia will need to name a power of attorney for healthcare and finances,” says Medical News Today. “This allows the assigned person to make decisions on their behalf around medical care and financial issues.” Absent these key documents, families may need to seek qualified legal advice to sort out potential areas of disagreement.

Adult Care Homes Offer a Range of Choices

The Medical News Today article offers a broad definition of adult care homes: they are “long-term care facilities where people with dementia can live and receive support services.” According to the Alzheimer’s Association, the main living options are:

• Assisted living facilities: These may be suitable for people with early stage dementia. They generally offer housing, meals, healthcare, and support services.
• Nursing homes: A nursing home will provide 24/7 care and long-term support, including medical care, nutrition, and recreation.
• Memory care units: These specialize in providing dementia care and may form part of residential care communities.
• Life plan communities: These facilities offer varying levels of care, ranging from assisted living to nursing home care, allowing a person to transition to different levels of care if their requirements change.
• Adult family homes: The article doesn’t list these as a separate category but they are a distinct option, licensed for up to six residents (in Washington State – other jurisdictions will have different licensing standards).

Adult Care Homes: Families Incur Hefty Costs

According to the Alzheimer’s Association once again, here are the current national averages for costs of long-term care:

• Assisted living, basic services: $57,289 per year
• Nursing home, semi-private room: $100,679 per year
• Nursing home, private room: $115,007 per year
• Adult family homes: the Adult Family Home Council of Washington State pegs the average monthly cost at $3,500 to $4,500, or up to $54,000 per year.

Who pays? “In most cases,” says Medical News Today, “families will cover the cost of long-term care themselves, although some people may be eligible for long-term care insurance, Veterans benefits, or Medicaid. Medicare covers short-term care following a stay in the hospital but does not include the costs of residential care.”

What about hiring qualified in-home care? This can be a best-of-both-worlds option with an average cost of roughly $29 per hour for a nonmedical health aide. That translates into about $1,145 per week for 40 hours of care.

However, as the Medical News Today article points out, those with more advanced dementia may need around-the-clock care to keep them safe. An institutional setting might be best.

How Can a Family Create a Smooth Transition for a Loved One?

There are several suggestions included in the article to help make the transition into a care home smoother.  Based on data from the Alzheimer’s Association, these include:

• telling the person about the move close to or on the day of the move to reduce anxiety
• telling the individual this is a short-term move until they become more familiar with their new home
• coordinating with care home staff to provide the same messages and reassurance
• talking with a doctor about using anxiety medication to ease the move
• decorating their new space with familiar, comforting objects, such as photos or books
• waiting a few days before visiting to allow the person to settle in

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Your retirement can be the exciting and fulfilling life you’ve always wanted it to be. Start by reading and sharing Rajiv’s important new book. And remember, Age On, everyone!

(originally reported at www.medicalnewstoday.com)