Many of the physical and behavioural problems that occur during a dementing illness make it impossible for a member of the family to carry on caring right up until the end. Under these circumstances, some sufferers will be admitted to a long-term-care ward in one of their local hospitals. Others may instead move to a private nursing home. There are advantages and disadvantages to both options. A hospital has doctors and nurses on site to deal with any complicated medical problems, but they often have to look after too many patients at one time and are really very stretched. In addition, few people in the terminal stages of dementia have medical problems that require a doctor on site.
Nursing homes on the other hand tend to have a more relaxed atmosphere and better staffing ratios. ‘Quality control’ of the care that your relative receives will have to be mainly your responsibility. In a hospital, although it is important that you keep an eye on what is happening, there are many in-built quality control procedures that may not operate in a private nursing home or similar institution.
Many nursing homes won’t wish to take on people with dementia, for various reasons, and the fees for those that will may seem very high. The same is often true for private residential homes. Nevertheless there are a number of statutory grants available, some of which are means-tested, to help families meet the costs of such care. The social worker attached to your local general practice or to the hospital – if the sufferer is attending as an in-patient or day-patient — will be able to give advice on sources of funding and provide you with a list of nursing homes. It is unlikely that social workers will be prepared to recommend one against another and this is only fair as different aspects of different homes will appeal to different people.
Before making the decision that you can no longer cope, do make sure that all possible community resources have been made available to you. Many carers are unaware of the support that they can call upon locally. Many of these services have been described elsewhere, but it is important to realize that even if available in theory, some of them may be very thin on the ground, especially as the number of older people with dementia is rapidly increasing.
Making a decision like this is very much a matter for the family and it is important to discuss it with the other relatives who are involved. You can also take professional advice from the general practitioner, or a member of his or her team, or from an appropriate member of the hospital staff if your relative is a hospital patient.
The difference between nursing homes and residential home needs to be stressed. In the latter, whether provided by the social services, a voluntary body, or privately run, nursing care is not usually available. Each resident has to be fairly independent and more than a minor degree of confusion is unacceptable unless it is a home specifically for the elderly, mentally infirm.
Some homes are dual registered which means that they can take reasonably independent people in the early stages of an illness and continue to care for them when they need the sort of help that is usually only available in a nursing home.
All homes are overseen by either the local authority or the health service, at least in principle. The degree of supervision, however, varies significantly from region to region.
It is very difficult to know which home is most appropriate for a particular individual. What seems best for one person may not suit another at all. Close relatives and carers are often best placed to make this decision, as they will often get a ‘feel’ for the home and for how their relative will fit in there. Don’t accept a place simply because it is the first empty bed that you come across. Visit a number of homes, ask to see around, and inquire about the points listed at the end of this section, as well as any other matters that you think are particularly important.
As you go round the home, try to establish whether it feels homely, whether the residents are sitting around doing nothing; if you see a member of staff talking to or helping a resident, try to assess their attitude. It is also important to look carefully in the bathroom areas for adequate safety features such as rails and non-slip surfaces. Also make sure that it is clean. Above all, try to imagine how happy your relative would be there.
Ask whether it is possible for your relative to be admitted for a fortnight or so in the first instance to see how he or she gets on. This will give everyone an opportunity to assess at first hand how things will go. If a sudden transition is likely to cause a major degree of upset, some homes will allow potential residents to attend on a daily basis several times a week, rather like going to a day centre or a day hospital. This manoeuvre can sometimes be used to ease a person with dementia gently from one environment to another.
Finally, beware of brochures. These can be very helpful, but they can also be extremely misleading. It is better to use your own eyes, to listen carefully, and to try to pick up the general atmosphere. No matter how splendid the surroundings and the fitments may appear to be, don’t forget that the most important aspect of a nursing home is probably the attitude of the staff, both to those that they are looking after and also to their relatives.
Points to Consider When Choosing a Nursing Home
Are rooms shared or single?
Are personal possessions and furniture allowed?
What are the visiting arrangements?
What activities are encouraged, other than watching the television?
What is the menu for a typical week?
Can residents keep their existing general practitioner?
How many trained nursing staff are available during the day and at night?
Have they ever had to ask residents to leave – if so why?
Do residents have their own washing and toilet facilities?
How large are the bedrooms and sitting rooms?
Is there a smell of urine?
How flexible is the daily routine, e.g. mealtimes?
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