“Has Anybody Seen Mom Lately?”
According to a recent AARP survey, nearly 90% of senior Americans over age 65 want to live at home as long as possible, and 12 million seniors are currently doing just that. Half of women over age 75 live alone and even a third of seniors who reach the age of 100 are living alone. Clearly, as a culture and as individuals we place a high value on the independence and freedom of staying home in our senior years.
Ironic then, that the older we get the more prone we are to what is termed “critical wandering,” the drive to get out and about associated with various forms dementia, especially Alzheimer´s. It´s termed “critical” because wandering away, with little sense of where we´re headed or what we´re doing, usually places the senior at risk. Ironic too, that another term for a senior wandering away from a controlled environment is “elopement,” as if the senior had finally found and were running away with their long-lost partner.
Maybe dementia patients are trying to tell us something. Many studies show that social isolation and loneliness are detrimental to the long-term health of any age group. But within the group of 60% of seniors with some level of dementia, the subgroup of 25% living alone has far greater safety concerns. The risk of falling and remaining unattended, of critical health conditions remaining undiagnosed and untreated, of poor nutrition, of being unable to keep up with daily chores, of not paying bills or keeping appointments, and of taking the right number of proper medications regularly, are just a few of the issues and risks that arise from staying at home too long. Not coincidentally, researchers report that people with the “mildest dementia and least difficulty functioning” are those with the most unmet basic needs. Over 90% of this group lives alone.
Levels of Functioning vs. Level of Care
If the health of a loved one deteriorates to the point where they can no longer function effectively and have become a danger to themselves and others, they must find long-term housing that meets their individual needs. How to match a proposed patient with the right level of care depends on their present level of functioning, their long-term prognosis, and adjusting their individualized care accordingly. Here are some of the options available:
- Post-hospitalization: With a prognosis of eventual recovery, post-hospitalization care is At-Home Care, with professional nurses and therapists visiting less and less over time as the patient improves and returns to former health.
- Early Stage Care: Keeping a loved one, a senior with advancing “mild cognitive impairment” (MCI), at home can be sustainable either within a larger family home or at their own home. Someone should always be around and paying attention. Expect the level of care and assistance needed to increase over time.
- Home Care: Seniors can remain living at home, despite increasing the increasing impairments associated with dementia, with the support of neighbors, friends, and family. In addition, professional health aides and nurses should check in regularly to help with bathing, cleaning and laundry.
- Home Health Services, Home Health Care, Formal Care, Domiciliary Care, Social Care, or In-Home Care: This broad category refers to all in-home care by licensed medical professional care-givers only. Care that is given in the home by non-licensed medical personnel, not doctors, and not nurses is generally called custodial, or private care. Home health services are provided by registered nurses (RNs), licensed practical nurses (LPNs), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), home health aides (HHAs) and medical social workers (MSWs). Medicare Home Health Benefits cover a limited number of in-home visits of up to one hour for specific items of care from specifically trained professionals.
- Respite Care: When a patient requires continual care and lives at home, a family member is often acting as primary caregiver. The primary care-giver should have regular relief from the physical and emotional strains of providing round-the-clock care. Adult day care allows the patient to get out and interact with others, and also gives the primary caregiver a break.
- Assisted-Living, Adult-Living, and Supported Care Housing: A wide assortment of facilities provide assistance with the basic functions of everyday living. Aides can help with getting dressed, bathing, grooming, preparing meals, and cleaning in an apartment-style atmosphere of about 50 to 100 units. However, residents must function fairly independently to live in “assisted-living” facilities. Medical care is not provided, nor transportation to medical facilities. The average length of stay is about in an ALF is about 28 months.
- Memory Care Wards, Special Care Units (SCUs): These units, within assisted-living facilities or nursing homes, are physically separated wings or floors of buildings designed for the specialized care needed by dementia and Alzheimer´s patients. “Memory Care” units are more highly staffed, more activity-oriented, have secured exits, and well-marked exits and signage. Cost of care is priced accordingly.
- Nursing Homes: Like assisted-living facilities, nursing homes provide long-term care in facilities that house large numbers of patients. In addition, nursing homes provide ongoing nursing care and supervision, for patients with minimal capabilities and/or advanced dementia. A nursing home is almost always the last move for the chronically or terminally ill patient, and can work in conjunction with Hospice.
- Hospice Care: A steadily growing field in health care, Hospice focuses on the process of a peaceful, dignified and spiritual transition for all the chronically and terminally ill. Hospice workers, often volunteers, provide relief of pain and mental stress as well as treating the patient’s spiritual needs – no matter what the disease. Costly emergency room visits and often-traumatizing inpatient hospitalization can be avoided through Hospice philosophy and transitional care. The pharmaceuticals, medical equipment, and twenty-four-hour/seven-day-a-week at-home access of Hospice care can be covered by Medicare, Medicaid, and most private insurance plans. Hospice also provides Medicare-covered care and support to family members after a death. Most Hospice care takes place in family homes, with more than one-third of dying Americans using Hospice services.