____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
ACCOMMODATIONS FOR SAFE DISEASE PROGRESSION
• The provider can discern if the hallucinations are physiological or environmental. ‒ Address lighting in personal space. ‒ Minimize noise. ‒ Maintain comfortable temperature. ‒ Clear room of dangerous items. • Avoid stress and increased anxiety. • Address the person in a calm, soothing, reassuring voice. Redirect, distract, and provide a change of scenery. • Track hallucinations and assess potential correlated trends to relieve the situation.
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 determine a plan of care in the early stages of AD, but this does not typically happen. Limitations of caregiving combined with an increased need for care prompt loved ones to explore day care options and/or residential options with 24-hour care. 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 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 sometimes transportation. Assisted Living Facilities (ALF) ALF may be appropriate for earlier stages of dementia, as they adjust the level of care to accommodate the disease. And they often have separate memory units to provide higher levels of care. These facilities can be paid for by long-term care insur- ance, private pay, or Medicaid. Memory Units These units are designed specifically for the patient with dementia. Buildings are often structured to safely accom- modate wandering and mobility, and they provide structured activities 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. Skilled Nursing Facilities (SNF) Skilled nursing facilities (SNF) are long-term living facilities for people who require extensive 24-hour care. Patients experienc- ing end-stage AD may move to a SNF for care. These facilities are the most expensive of the residential options and 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. 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. Addi- tionally, hospice provides respite care for the caregivers for a set amount 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 it is needed.
ENVIRONMENT
PHYSICAL SPACE Doorframes can be painted different colors to differentiate and delineate the space. This can occur in the community and at home. Walkways should be cleared, and nightlines situated along baseboards can provide dim lighting that can guide the person through the hallways. Use basic furniture arranged for easy access—don’t overwhelm spaces. If possible, include outdoor green space. People with AD who are exposed to green spaces experience improved mood and focus (Sturge et al., 2021). Other interventions for safe and inviting space for the person with AD include the following. • Remove area rugs for fall prevention. • Hang meaningful photos on the walls for reminiscence.
• Limit wall mirrors to avoid confusion. • Provide storage space, such as baskets, for
placement of preferred blankets, pillows, and other comforting items that the patient will use on a regular basis.
Self-Assessment Quiz Question
15. What are some things to remember about the physical space for a patient with AD? A) Doorframes can be painted a separate color.
B) Area rugs should be removed. C) Wall mirrors should be limited. D) All of the above.
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