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15 March, 2010

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Dementia - choosing residential care

Making the decision to find an alternative to caring for a person at home can be one of the most difficult decisions a carer will make – particularly if the person with dementia has been a long-time companion. Being prepared can help make this decision less stressful. Knowing about the services, government policies and costs of residential care beforehand can help carers to make the best choice, even if the decision has to be made quickly.

Where to begin
Talk to:

Your doctor
Alzheimer’s Australia
Other families and carers
The local Aged Care Assessment Team (ACAT)
The Commonwealth Carer Resource Centre – they provide carers with information about their caring role and about relevant carer services and entitlements. Commonwealth Carer Resource Centres can be contacted from anywhere in Australia on 1800 242 636.

Residential facilities
Facilities that provide long-term care are usually grouped into two categories: those providing high level care and those providing low level care.

Low level care residential facilities
Low level care residential facilities are funded by the Australian Government and are suitable for people who are mobile and may require assistance with personal care, laundry, cooking, shopping or the supervision of their medication. Accommodation is usually bed-sitting rooms with private or shared bathroom facilities.

High level care residential facilities
High level care residential facilities provide 24-hour nursing care for residents and are staffed by nurses, assistants or personal care assistants. Generally, these facilities are most suitable for a person in the later stages of dementia or those with other medical conditions. The Australian Government funds all high level care residential facilities.

Specific dementia units
These are units designed specifically for people with dementia and can be classified either as high or low level care, depending on the level of care provided. Not all people with dementia require a specific dementia unit. People with special care needs, such as those who may not be safely accommodated in general residential facilities, are best suited to these units.

Assessment
The Aged Care Assessment Team (ACAT) will determine the level of care needed by the person with dementia. The team will recommend appropriate types of residential care, and provide names and addresses of suitable facilities for the carer to visit and choose from. Any concerns or issues that the family or the person with dementia may have can be discussed with the team.

As applications will usually have to be made to several facilities, it may be necessary to visit a number of places. Try to work through the list of facilities in an organised way, taking notes as you go. If possible, take a friend or family member on the visits. Trust your intuition and common sense when assessing accommodation for a person with dementia.

Residential care decision-making checklist
When looking at a residential facility, here are some things to consider:

Does it feel like a friendly, welcoming place?
Are surroundings – such as buildings, grounds and individual rooms – suitable?
Is there somewhere to sit privately?
Is the security satisfactory? Is there freedom to move around?
Can the family come and help the person eat and shower?
Are day-to-day care issues – such as food, access to the bathroom and temperature control – satisfactory?
Are there procedures in place in case of a fire?
Is there at least one person on duty at all times?
Has the fee structure been fully explained? Are there extra costs?
What are the individual resident’s rights regarding such issues as their own belongings, pets, mail and religious beliefs?
What is the attitude of managers and workers – do they listen to carers and ask for information?
What training have the staff had? Do staff have dementia-specific training?
What is the staff to resident ratio?
Is the range of activities and choices for recreation satisfactory?
Are visiting times and access for family members satisfactory?
Can outings, overnight stays and holidays with family members be easily arranged?
Do other residents appear well cared for?
Can residents have their own doctor?
What is the medication policy?
What are the arrangements for giving medication?
Are the medical services and specialist services satisfactory?
Does anyone speak the language of the person with dementia?
Are other services, such as hairdressing and massage, provided?
Is there any assistance in making the move from home to the facility?
Can increased needs be catered for?
Are carers asked for suggestions and comments?
Is there a complaints policy?
Can carers join a residents and relatives committee?

Standards are monitored by the government
All residents should have access to the quality of care and the services that they need. The Commonwealth Government monitors care and accommodation standards in residential aged care services.

Planning for the move
Once a place becomes available in a residential facility, a decision may need to be made very quickly, so it is helpful for the carer to plan the move in advance.
People with dementia can be disturbed by change. If at all possible, introduce the person with dementia to the new facility gradually, so that the place becomes a little more familiar and a little less confusing and frightening. Sometimes, of course, this is just not possible, especially if the move has to be made quickly.

Some tips that may help with the change include:

Ensure that the person’s room has as many familiar items as possible. Family photos, familiar prints or paintings on the wall, and familiar bed coverings can make the new room look a little more like their own bedroom at home.
Label all personal items with large and easy-to-read identification.
Make each visit as rewarding as possible. There is no correct number of times that the carer should visit or amount of time they should stay. Many carers will wish to visit frequently during this time. Others will want to rest and recover from the strain of caregiving.
Be aware that, during this initial moving stage, it will take time for both the person with dementia and the carer to adjust to the new situation. Expect a period of adjustment. People do settle.

Many people with dementia actually do better in a structured environment – they may feel more secure and get more stimulation.

Care of the carer
It is important to take care of yourself when the move takes place. Use friends and family for support during and immediately after the move, and counselling services if needed.

Where to get help

Alzheimer’s Australia, National Dementia Helpline Tel. 1800 100 500
Aged Care Assessment Services – contact your regional Department of Human Services office
The Aged Care Information Line Tel. 1800 500 853

Things to remember

Making the decision to find alternative care for a person with dementia can be one of the most difficult decisions a carer will make.
There are different types of residential care available and it may help to have some practical advice before making the move.
Careful planning and support from family, friends or carer support services can help make the move less stressful.

You might also be interested in:
Dementia - communication issues.
Dementia - coping with placement.
Dementia - different types.
Dementia - early planning will help.
Dementia - safety issues.
Dementia - support services are available.
Dementia - through all its stages.
Dementia and memory loss.
Dementia explained.

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