In my last article, I discussed the role of using a geriatric care manager, especially when dealing with a family member with dementia. In the earlier stages of most forms of dementia, we usually don’t think in terms of discussing facility-based care. But over time, the question of patient safety and increased care demands often become more critical, particularly if the care provider happens to be an aging spouse.

Two issues that come quickly to mind are availability and/or limitations of choices of facilities that specialize in memory care and the cost involved. Please remember, Medicare will not pay for long-term nursing home or custodial care, and sometimes the availability of a placement for memory-specific care is an issue as not all nursing homes have dementia-specific sections at their facility.

The situations for patients vary, but facing a decision about placing a loved one is often based on, and driven by, several factors:

1. Is the patient a wander risk, particularly at night? If so, this may prevent the caregiving spouse from being able to sleep, or even with an alert system, having to be awakened throughout the night if the patient gets out of bed for any reason.
2. Does the patient require assistance with ADLs? Do those requirements exceed the spouse’s ability to provide the help necessary in areas like transferring from bed to chair or toileting? This is of particular concern if walking or balance issues make the patient a likely fall risk.
3. Does the patient become physically abusive to the care provider, even if it’s a spouse? With advanced memory loss the patient may no longer recognize his/her spouse, and may become anxious or angry seeing the spouse as a stranger and an authority telling them what to do all the time.
4. Does being a 24/7 caregiver leave any personal time for the care provider? If not, statistics show that the caregiver may predecease the patient.

These are just a few reasons to think in terms of a facility placement. There are certainly other reasons to consider for looking at placement in a facility, but the emotional cost for some spouses and families are as high as are the financial costs. Promises made years ago to never place one or the other in a nursing home doesn’t match the reality of any seriously disabling disease later in life, and tough decisions may have to be faced and made.

The best way to avoid some of the emotional pain involved in the future is to have a realistic discussion with your spouse and your adult children long before the need or the issue ever comes up. If finances allow, invest in long term care insurance, because you never know if you’re going to need it. Think of LTC like home fire insurance, it’s best to have it, and if bought early enough in your life, premium costs tend to remain affordable, when compared to $5,000 to $9,000 monthly rent for residence in a skilled facility.

For families where affordability of LTC is out of the question, planning still must take place, and doing it early is far less stressful than waiting until the disaster is on your doorstep and begins to limit your options.

Ron Kauffman is a consultant and expert speaker on issues of aging, Medicare and Obamacare. He may be contacted at 828-696-9799 or by email at drron561@gmail.com.