ACCOMMODATIONS FOR SAFE DISEASE PROGRESSION
As AD progresses people may require oversight provided by a residential community. Most people intend to age in place at their homes, but disease progression may present limitations for safety, mobility, and socialization. Ideally a person would Adult daycare Adult daycare programs are located throughout the U.S. They allow the person to remain in the home with supervision but have a full structured day in a safe environment. These programs Assisted living facilities (ALF) ALF may be appropriate for the earlier stages of dementia, as they adjust levels of care to accommodate the disease. And they often have separate memory units to provide higher levels of Memory units These units are designed specifically for the patient with dementia. Buildings are often structured to safely accommodate wandering and mobility, and they provide structured activities Skilled nursing facilities (SNF) Skilled nursing facilities (SNF) are long-term living facilities for people who require extensive 24-hour care. Patients experiencing end-stage AD may move to a SNF for care. These facilities are the most expensive of the residential options and Hospice Hospice services can be appropriate for end-stage AD. Hospice treatment can be brought to the home, the community, or a unit that provides accommodations for overnight care. Additionally, hospice provides respite care to the caregivers for a set amount
determine a plan of care for themselves in the early stages, but this does not typically happen. Limitations of caregiving combined with an increased need for care prompt loved ones to explore daycare options or residential options with 24-hour care.
may be run by nonprofits with a sliding fee scale, or the cost can be covered in part by Medicaid. These programs include meals, activities, toileting support, rest, and potentially transportation.
care. These facilities can be paid for by long-term care insurance, private pay, or Medicaid.
for stimulation and engagement. There is a higher ratio of professional caregivers to patients. These facilities can be paid for with long-term care insurance, private pay, or Medicaid.
while a short period of time is covered by Medicare (up to 100 days), there can still be a copayment, followed by the full rate once the Medicare benefit has expired. This can also be private pay or covered by Medicaid.
of time during the service. The hospice benefit is typically fully covered, and offers many value-added services; however, the person may have to pay for caregiving assistance if needed.
CARING FOR THE CAREGIVER
Caregivers can suffer from sadness, depression, stress, feeling trapped, overwhelmed, and distressed (Shin & Habermann 2022). Stressed caregivers may find their health compromised. It is important that family caregivers build a supportive network that will help them share the responsibility. Professional caregivers may also find the role stressful. As suggested as a part of best practices, they should ensure that they are getting exercise, eating a healthy diet, having quiet moments, and reaching out for help as needed. Caregiver resources There are support resources for caregivers. The stress that a caregiver may experience is correlated to the amount of time they spend caregiving. Identifying ways to have meaningful support for the patient and the caregiver throughout each stage of AD can greatly improve the overall well-being of
New technology may be helpful for families and professional caregivers (Palmdorf, 2021). Devices include televisions, computers, smartphones, monitoring devices, fall prevention sensory devices, and robots. The goal is to provide supportive patient monitoring and engagement, caregiver connection, and telehealth. Health plans may offer these devices as a part of their coverage, and all are designed to improve outcomes and well- being.
everyone involved. For information about local caregiver support resources, ● Veteran’s Administration National Caregiver Support Line 1-855-260-3274 ● Alzheimer’s Association https://www.alz.org/about
Case study Sandy, age 78, has been living with her daughter Michelle for two years. Until recently, she could stay home by herself but lately she has been trying to leave the house and wandering is becoming a safety concern. Michelle has decided to enroll her mother in the adult daycare program near her house, but she is worried that her mother will act out and be unruly. At the daycare, she lets the administrator know that her mother has behavioral problems and is often unwilling to stick to a schedule. She also shares that her mother wanders and is unable to sit still. The administrator reassures Michelle that the daycare has the capacity to accommodate
Sandy and her disease in an appropriate, comfortable manner. When Michelle picked up her mother after the first day of day care, she noticed that Sandy was tired and sleepy. The administrator shared that Sandy had experienced an amazing day at the center. She participated in the activities, rested, and when she got restless, she was escorted by a certified nurse assistant (can) for a walk around the hallways of the building. Additionally, Sandy had eaten the food, was able to introduce herself, and appeared to be comfortable in the new environment. Michelle was amazed and when they got home, Sandy wanted to rest on the couch and Michelle was able to prepare dinner in a calm environment. Michelle decided that her mother would
go to the daycare five days a week. Michelle was also going to benefit from her mother’s new schedule. She no longer had a sense of dread that something would happen to her mother during the day, or that her mother would not have food, or would slip and fall. Michelle became a huge advocate for adult daycare and greatly appreciated the benefits for both the person with AD and the caregiver. Many caregivers are not aware of the benefits of support services such as adult daycare, respite, and other programs. Additionally, there are challenges that can be presented based on preconceived notions and perceptions of services. When addressing concerns of family caregivers, consider the following.
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Book Code: PYIL1824
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