- The Washington Times - Sunday, May 12, 2002

It becomes necessary at some point for many Alzheimer's disease patients and their caregivers to look for care in a nursing home or assisted-living facility.

That brings up another set of emotions for the caregiver, says Dr. Dolores Gallagher-Thompson, a professor of psychiatry at Stanford University and co-author of "There's Still a Person in There: The Complete Guide to Treating and Coping With Alzheimer's."

"Some people may feel that placing a loved one in residential care signifies failure," she says. "But on the contrary, residential care is often necessary for the person's safety."

Dr. Peter V. Rabins, a psychiatry professor at Johns Hopkins University Medical Center who specializes in Alzheimer's, says making that decision is an individual one for each family. However, there are some basic guidelines that signal it may be time to think about nursing care:

• Is the person in danger or causing harm?

"If they are living alone or wandering out of the house or leaving the stove on, that is when I make the strongest recommendation for long-term care," Dr. Rabins says.

• Are there significant behavior problems?

"Sometimes [the] patient gets aggressive or so apathetic that one person cannot manage them," he says.

• Are the day-to-day care demands so much that the family members feel overwhelmed?

As the disease progresses, so does the list of situations, such as incontinence or inability to communicate, to which the caregiver must adapt. When the physical and behavioral needs and the caregiver's needs become overwhelming, it is time to think about nursing care, Dr. Rabins says.

"When it takes two or three people to manage the patient in the bathroom, it becomes very difficult," he says. "There comes a point when it is in the patient's best interest" to be in residential care.

Sarah Harris of Fairfax cared for her husband, Ernie, for three years. A year and a half ago, she made the agonizing decision to place him in residential care.

"It got to the point where he became very unpredictable," Mrs. Harris says. "Not necessarily violent, but he didn't understand much and had very little communications skills left. I never knew how long it was going to take to get him up in the morning. I would brush his teeth for him, and he wouldn't know how to spit. I just couldn't do it anymore and take care of my family."

The key to having a good nursing home experience is to do your research, Dr. Gallagher-Thompson says. Some points to consider:

• Is it conveniently located? Your loved one might be there for several years, so if it is far away, visiting might be difficult. After two stays at homes farther away, Mr. Harris resides at Sunrise of Fair Oaks, an assisted-living facility about a half-mile from his wife. Mrs. Harris visits twice a day.

• Is it licensed and accredited? Check with the state regulatory agency.

• Look past the lobby decor. An entry with flowers and artwork is nice, but residents don't live in the lobby. Focus your attention on the rooms, bathrooms and kitchen.

• Follow your nose. In a facility where residents are likely to be incontinent, bathroom odors are inevitable. However, they should not be overpowering.

• Check the menu. You know what your loved one will eat. Will he or she be happy with the food selection? Are there snacks in addition to meals?

• Check the bathrooms. Are they clean and equipped with grab bars and other aids the patient needs?

• What proportion of the residents have Alzheimer's? You don't need to have the patient in a place exclusively devoted to Alzheimer's, but you want a staff who knows how to deal with the disease.

• How does the staff deal with Alzheimer's patients? Alzheimer's causes a lot of behavioral problems. Talk with some nurses and aides and find out how they deal with such problems. Also, check the resident-to-staff ratio. Some facilities are notoriously understaffed, meaning it could be your loved one who gets neglected.

• Check how the staff interacts with one another and with the residents. Does the staff seem to enjoy working there? Do staff members work closely with the residents?

• Observe the activities. Do the residents watch TV all day, or are there organized activities? People with Alzheimer's disease tend to be less agitated and require less medication and restraint in facilities with rich programs that include music, exercise, games, etc., Dr. Gallagher-Thompson says.

Dr. Rabins says there tends to be a myth that families are dumping loved ones into long-term care. He finds the opposite to be true in many cases. Many family members continue caring for loved ones longer than they are physically and emotionally able to do so, he says.

Bill Kays of Vienna says sending his wife, Pearl, to residential care was "undoubtedly the most difficult thing I had ever done in my life." He didn't take that step until his adult children intervened and told him the situation was more than he could handle.

"I cried all the way home," he says of the day he took his wife to Royal Haven, an assisted-living facility in Front Royal. Mrs. Kays lived there for four years before dying in February. "But it was a great place, and they were wonderful to her there," Mr. Kays says.

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