What happens as Alzheimer's disease or other dementia progresses?
The level of care and assistance a person requires
increases as the disease progresses. Basic activities such as eating, dressing,
bathing, using the bathroom, and simply moving around become more difficult or
impossible for the person to do alone. Disruptive, frustrating, and sometimes
dangerous behavior problems may develop. These behaviors often pose the biggest
challenge for caregivers. Taking care of the person at home often becomes more
difficult or even impossible, both physically and emotionally.
the same time, your relative may become less aware of who you are and where he
or she is. Some people feel that caring for their spouse or parent at home is
important only so long as the person knows them and knows that he or she is at
What kinds of long-term care facilities are available?
"Nursing home" is commonly used when referring to any long-term care
facility, but there are several kinds of long-term care facilities. Each
provides different levels of medical care, personal assistance, and programs
and support services. The quality and costs of care and services at long-term
care facilities vary widely, and options vary from community to
- Assisted-living facilities usually provide private, apartment-style housing and offer a
range of services. These services may include meals, cleaning and laundry
services, and help with personal needs, such as bathing, grooming, and
dressing. Assisted-living facilities do not provide medical care. An
assisted-living facility may be appropriate for people with early mild
Alzheimer's disease or another dementia who cannot live alone but who can still
function fairly well on their own.
- Residential care facilities, which include board-and-care homes, retirement homes, and
foster care homes, typically provide a greater level of supervision than
assisted-living facilities. They offer community-style housing, meals, laundry
and cleaning services, and help with other personal needs. They do not provide
daily medical care. A residential care facility may be appropriate for a person
with mild to moderate Alzheimer's disease or other dementia who needs daily
assistance and supervision but does not require daily nursing care. Residential
care facilities are less expensive than nursing homes.
- Nursing homes provide skilled nursing care up to 24 hours a
day. All aspects of care are provided, including medical attention, medication,
housing, meals, laundry, help with personal needs (such as dressing, bathing,
and using the toilet), and other support services. A nursing home is the most
expensive type of long-term care facility, but it also may be the most
appropriate choice for many people with advanced dementia.
- Special care units (SCUs) for people with dementia are a
feature of some residential care facilities and nursing homes. These units are
designed to meet the needs of people with this disease, and they include staffs
experienced in dealing with people suffering from dementia. Studies of these
special care units, however, have been unable to confirm that they offer any
clear benefits over regular care facilities. Also, they often are more
expensive than regular long-term care facilities.
- Continuing-care communities offer different levels of care,
from assisted living to full nursing care, within the same facility. These
facilities are an expensive but appealing option for caregivers looking at
long-term care because they are well equipped to meet the person's changing
needs as the disease progresses.
What are the options for part-time care?
people find that part-time help allows them to keep their relative at home for
a longer time. Part-time care may take place either at home or in an adult day
care facility. As in long-term care facilities, home care can provide different
levels of assistance. A home health aide, for instance, can help with tasks
such as bathing, cleaning, and washing clothes and linens, and a nurse may
provide medical care and help with behavior issues. Adult day care and respite
services have temporary responsibility for the person and allow the regular
caregiver to take a break. This may relieve some of the stress of caregiving
and allow time for other responsibilities and activities.
health professionals or other caregivers to provide around-the-clock care in
the home is another option. This option is more expensive than a nursing home
and also requires time to hire, supervise, and coordinate the team of