Home Care for Dementia and Alzheimer’s

Home Care for Dementia and Alzheimer’s Patients by Jennifer Adams, LMSW, CDP.

According to the dictionary, Alzheimer’s Disease is a “progressive mental deterioration that can occur in middle or old age, due to generalized degeneration of the brain.” Alzheimer’s Disease is very progressive and has been listed as the 6th leading cause of death in the United States. There are over 5.5 million people with Alzheimer’s Disease, just in the United States alone, and it is estimated that in about 30 years that number will jump to 16 million in the United States. It is also the most common cause of Dementia in patients over the age of 65. Approximately 44 million people have Dementia in various forms in the world today. Dementia describes memory loss and a declining ability to efficiently perform daily tasks.

Before deciding what type of care is needed, it is important to verify that a diagnosis of Alzheimer’s Disease or Dementia is in line with symptoms exhibited by a loved one. Dementia and Alzheimer’s have specific signs that families can use to determine whether a loved one should be evaluated for Dementia or Alzheimer’s Disease. These signs can vary, and the presence of one or two does not necessarily mean that the diagnosis is guaranteed. However, the presence of many of the signs may lead families to discuss how they can care for their loved one at home in the event of a Dementia or Alzheimer’s diagnosis. Some of these signs include a decline in problem-solving, planning, time management, and decision-making skills. Poor judgement, confusion about times, dates, and locations, and frequently losing personal items and artifacts are also prominent symptoms of Dementia and Alzheimer’s Disease. Some other signs to look out for are difficulty in having and following conversations, withdrawal from social groups and hobbies, and unexpected changes in mood and personality. It is important that patients exhibiting these symptoms speak to a doctor to determine if Alzheimer’s Disease or Dementia are present.

With so many older adults diagnosed today, and so many more to come, families must consider the best way to care for their aging family members that have been diagnosed with Alzheimer’s or Dementia. Home Care is an option for early to middle stage patients and there are varying assistance options available for those diagnosed with Dementia or Alzheimer’s. Families must consider the safety, pros, and cons of home care for dementia or Alzheimer’s, as well as the costs associated with it.

Home Care Assistance Options for Dementia

There are various types of home care assistance available for Dementia and Alzheimer’s patients. These include companion care such as supervision, recreational activities, and social activities with an allocated assistant. Another type of care is daily activities assistance. In this type of care, an assistant helps the Dementia or Alzheimer’s Disease patient with food planning and preparation, bathing, transportation services, and shopping. The care needed for patients suffering with middle or later stage Dementia or Alzheimer’s Disease may include all of the before mentioned services, as well as some health care services. Home health care services can encompass dressing wounds, giving injections and other prescription medicines, providing physical therapies, checking vitals, and other skilled care services.

Families in need of home care or home health care for their loved one with dementia can obtain information on local agencies and caregivers through a number of different mediums. The Dementia or Alzheimer’s patient’s doctor is probably the first and most accessible option for referrals and information. The doctor is also going to be able to offer suggestions based on the level of care medically necessary for the dementia patient, so this is a good place to start.  The local Alzheimer’s Association chapter is an information hub explicitly designed to provide resources to families facing a loved one’s diagnosis of Dementia or Alzheimer’s disease. In addition to using these helpful resources, Medicare and Eldercare Locator have online tools available, and there may be some accessible community resources that can assist in gathering information on local agencies and private caretakers specifically trained for memory care. Personal references can also be an invaluable resource as they can offer first-hand experience, opinions and care outcomes.

Safety Planning for Dementia In Home Care:

Dementia and Alzheimer’s Disease can affect the brain of the patient in many ways. It can alter judgement, cause memory loss, disorientation and confusion, and can even affect the Dementia or Alzheimer’s patient’s senses. The sense of smell can be affected and things that are not food, may start smelling like it is. The brain can be easily confused by what it sees and hears because of the Alzheimer’s Disease or Dementia. Even the ability to determine if water is too hot can be damaged. These diseases can change a person’s entire perspective on the physical world. The changes caused by Dementia and Alzheimer’s Disease bring safety issues to the forefront in every family. There are things that family members can do to ensure the safety of their loved one that has chosen to remain in home to receive dementia care. It is very important to secure dangerous household items. Posting emergency numbers on the fridge and by the phone is very important. Other safety precautions include locking up medicines, alcohol, household cleaning products, power tools, lawn equipment and weapons. Other items such as car keys, soaps, shampoos, lotions and laundry detergent may also need to be placed out of sight or in a locked cabinet. Stairs should be marked with bright colors or turned into ramps where possible. Hand rails can be added to stairwells that cannot be transformed into ramps. It is important to remove locks from interior doors because Alzheimer’s Disease and Dementia can cause confusion and the patient may not be able to work the locks. All electric blankets and space heaters should be removed from the home to prevent fire hazards. Loose rugs and carpet corners should be adhered to the floor to prevent fall hazards and grab bars should be added in the shower and next to the toilet for further fall prevention protection. To prevent unintentional burns, lower the water heater temperature and label the water faucets red or blue to indicate hot and cold. To prevent Dementia and Alzheimer patients from being scammed, place a no soliciting sign on the property and set up alerts on bank accounts and credit cards. Install safety shut off switches on appliances, add night lights to all rooms, and install a digital thermostat that can be controlled remotely. It is also important to check smoke and carbon monoxide detectors regularly to ensure they are functioning properly. To prevent wandering outside of the home, “stop” signs should be placed on doors that lead out of the home. Door alarms and locks placed high or low may also help prevent wandering. It is important to let friends and neighbors know about the Dementia or Alzheimer’s patient’s condition. Make sure they have emergency numbers to reach family members in case they see the patient wandering around outside. These safety steps will minimize health and safety risks for your loved one diagnosed with Dementia or Alzheimer’s Disease, and will help to care for them at your own home.

Dementia Home Care Benefits:

Being able to stay at home and have caregivers come to the Dementia or Alzheimer’s patient allows them to remain calm, comfortable, and safe. In home care requires much less adjustment than moving to a memory care facility for care and treatment. In home staff can keep the patient engaged and make them feel heard and respected, adding to their quality of life. This can also boost a Dementia or Alzheimer’s patient’s self-confidence and outlook. Companion home services can provide personalized social and mental interaction that may not be provided as thoroughly in a memory care facility. The Dementia or Alzheimer’s patient can have improved health both mentally and emotionally because of companion services in the home. Prescription and pain management can be provided on a one on one basis, making mistakes less likely to occur in medical treatment. Also, in home care for a Dementia or Alzheimer’s patient can provide peace of mind and support for the family members.

Alzheimer’s & Dementia Home Care Negatives:

We would be remiss not to consider the negative effects of in-home care for those diagnosed with Dementia or Alzheimer’s Disease. Some of the cons to in home care can include the expense. The cost of changes to the home to accommodate safety and disability needs can be very high as the diseases progress and more changes are needed. There is also the price of materials, prescriptions, and caretaker costs to consider. In addition to this, your loved one with Dementia or Alzheimer’s Disease may exhibit some emotional and mental distrust of the strangers coming in to their home. These feelings can be exasperated by the loss of independence that comes with these diseases. Home health care is also a very unregulated industry and is frequently fraught with high turnover rates, and occasionally with caregiver deficiencies depending on the level of demand and availability of training. Since the Dementia or Alzheimer’s patient is staying at home and not in a memory care facility, response to emergencies may be delayed. This is particularly true of Dementia and Alzheimer patients that still live alone and do not receive 24-hour care from in home employees. Another con to in home care is the possible lack of social variety that your loved one would otherwise get in a memory care home.

Cost of In-Home Dementia Care and How to Pay:

As mentioned before, the costs for in-home care and related expenses play a major role in decision making when it comes to care for your loved one with Dementia or Alzheimer’s Disease. The expense for in-home care can average around $10,000 annually not including the cost for in home assistance. The annual costs include prescription medications, personal supplies, safety expenses, and other costs. The average cost for in home care assistance averages between $20.00 and $24.00 per hour. There are several factors that affect the cost per hour. These variables include state of residency, level of care needed, whether in a rural or urban area, local regulations, and industry demand. Another factor in pricing is whether the assistance is being provided by a home health agency or an individual care taker.

Now that pricing has been broken down, how can it be paid for? The only choice that is available to every Dementia or Alzheimer’s patient is out of pocket pay. This could come from retirement funds, asset liquidation, financial assistance from friends and family, or savings plans. Most other options have regulations and qualifications. Medicare, for instance, will provide very limited care specifically relating to medical needs. It will only cover these specific medically related needs for a short period of time as well. Medicaid offers more in-depth assistance and will typically cover expenses for both medically necessary care and other in-home health services for those diagnosed with Dementia or Alzheimer’s Disease. There are also various state programs available, depending on your state, that can assist with paying for care. Veterans have the benefit of specific veteran programs available to pay for care related to Dementia and Alzheimer’s Disease. Non-profit organizations and foundations can also provide some financial advice and aid in care.

Caring for a loved one that has been diagnosed with Dementia or Alzheimer’s Disease can lead to some difficult decisions regarding care options. Not every care option is right for every person, and the needs of each Dementia and Alzheimer’s patient will change over time as the disease progresses. Home health care is a viable option, and frequently the least expensive option for those diagnosed with Dementia or Alzheimer’s, particularly for those in early to mid-stages of the diseases. There are still things to consider when making a decision, though.  Family members and patients need to ask if at-home dementia care is the right fit. Are the costs within budget, or can additional financial aid be found? Can the home in which the Dementia or Alzheimer’s patient resides be made safe and secure for the changing needs of the diagnosed individual? Do the pros outweigh the cons for the family and patient? Do the home health options available locally provide the necessary levels of care needed for the Dementia or Alzheimer patient? Are other alternative care options available? What does the patient’s doctor recommend? These are the questions that will help determine if home health care options are right for your loved one with Alzheimer’s disease or dementia.

About the author:

Jennifer Adams received a Master’s Degree in Social Work from the University of Denver and currently lives in Boulder, Colorado. Jennifer frequently contributes to online blogs and publications on topics that relate to dementia, Alzheimer’s disease and caregiving. As part of her on-going quest for learning, Jennifer also received a Certified Dementia Practitioner certification by NCCDP as well as EssentiALZ certification by the Alzheimer’s Association.