In the earlier stages of most forms of dementia we usually don’t think in terms of 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. Just as a reminder, Medicare will not pay for long-term nursing home or custodial care, and sometimes the room availability for memory specific care is an issue.

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

The patient is a wander risk, particularly at night. 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;

The patient’s requirements for assistance with ADLs exceed the spouses ability to provide the help necessary in areas like transferring from bed to chair or toileting, particularly if walking or balance issues make the patient a likely fall risk;

The patient may be physically abusive to the care provider, even if it’s a spouse. With advanced memory loss that caregiver may no longer be recognized as being a spouse, and becomes a person who makes the patient anxious, angry or represents authority telling them what to do all the time;

The time demands for advanced care can be 24/7 leaving no free personal time for the care provider.

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 $7,000 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 & Expert on Issues of Aging, Medicare & Obamacare. His consulting practice serves clients in Henderson, Polk & Brevard Counties.  He is the author of Caring for a Loved One with Alzheimer’s Disease, available as a Kindle book on Amazon.com. His podcasts can be heard weekly at www.seniorlifestyles.net. Contact him at (828) 696-9799 or by email at:  drron561@gmail.com.