Millions of people who have just finished raising their children find themselves faced with choices about taking care of their aging parents. Many loving children choose to place their parents in nursing homes, but some intrepid caretakers attempt to accommodate parents who have Alzheimer’s or other forms of dementia in their own homes.
The answers to the questions of Alzheimer’s care are intensely personal, but there are concerns that affect nearly every family who has an elder with this devastating disease. Here are ten of the most important and most common considerations in choosing between a nursing home and live-in care, read more from here.
Ten Important Questions
- Does your parent want to live at home?
The answer to this question is not necessarily “yes.” In the early stages of Alzheimer’s, many older people still prefer regular social contact. Keeping your parent used to activities with other people through day care and respite care gives you free time, and makes it easier for your parent to adjust to a nursing home if that placement is inevitable.
- Would taking care of your parent create embarrassing personal situations?
People who get Alzheimer’s often need help with dressing, personal hygiene, and going to the bathroom. These activities are impossible for certain parent-child relationships.
- Can you provide a safe physical environment for your parent?
The most dangerous situation in taking care of someone who has Alzheimer’s is sudden improvement in symptoms, especially after legitimate physical therapy. A parent who has been bedridden for a long time who regains the ability to walk, for example, may try to resume pre-Alzheimer’s activities and take a fall down stairs, or on a rug, or walking across waxed floors. The solution is not keep your parent in bed, but to make sure that general health improvements do not result in tragic at-home accidents.
- Is the presence of your parent safe for other members of your family?
In my own family, long-term decisions about elder care were changed when my father (who had Lewy body dementia) drove five miles down the wrong side of a highway. An observant neighbor raced ahead of his car and blocked on-coming traffic, probably saving his and other lives. By the time Alzheimer’s is obvious, it may be necessary to separate your parent from the ability to cause traffic accidents, household fires, and similar household disasters. The safety of the youngest members of your family has to take precedence over the comfort of the oldest members of your family.
- Are you certain of your parent’s medical diagnosis?
Alzheimer’s disease is not the only cause of dementia. Different disabilities require different treatments, and misdiagnosis can result in choices that backfire. Both Parkinson’s disease and Lewy body disease, for example, cause tremors and often cause loss of the decision-making ability psychiatrists call executive function. Giving someone with Parkinson’s disease L-dopa may help symptoms, but giving someone with Lewy body disease L-dopa may make symptoms much, much worse. Don’t accept a cursory or rushed examination as the basis of a medical diagnosis that will follow your parent for the rest of his or her life.
- How will the setting you and your parents choose for their care affect their family legacy?
Some loving children keep their parents at home to create a legacy of loving care. Some loving children place their parents in nursing homes so that grandchildren, friends, and neighbors can have memories of dignified interactions.
- Will you parent have access to emergency medical care?
At least during the early stages of Alzheimer’s disease and other forms of dementia, most patients and most families want their parent to stay around a little longer. It is especially important not to place yourself in a position where you would feel guilty for not “being there” in a life-threatening emergency.
- Does your parent have a living will and an end-of-life directive?
Nothing is more divisive to families than one child fighting to keep a parent alive and another child fighting to end medical care to allow death. Ideally, parents and children should talk about and understand the parent’s choices before a living will is needed. The location of the documents, and updates to the documents, must be known to doctors and powers of attorney.
- Do your siblings understand your choices in elder care?
Except in very rare circumstances, only one child will have primary medical power of attorney to make end of life choices for the parent. It is important for all children of the parent to know which child that is. It is better for decisions about end of life care to be made together, although in real life, they often are not.
- Do you have the personal and financial resources to support your choice?
Time and time again, children who take care of their parents succumb to illness and even die almost as soon as their parents do. It’s important to know exactly what you will have to spend, whether you will be able to inherit, and how you will keep your own job and financial resources while you take care of your parent. And if you make a hard choice that is also a loving choice, don’t let anyone discourage you from doing what is best.