Let's face it, no one wants to place their loved one with Alzheimer's in a nursing facility. But sometimes that's the best (or only) alternative, especially for those in the late-stages of the disease.
It takes a large team to care for people in these stages. They need a doctor on call 24 hours a day. They need a nurse available at all times. They need aides, a social worker, activity professionals, cooks and laundresses. And they need to be around other people for social stimulation. They need 24/7 supervision and they need to be in a safe, secure environment. Providing for all these needs can be done but it's a full-time job.
In many cases the primary caregiver has to work full-time and thus can't provide adequate care. People with Alzheimer's (as well as most people without it) who have a clear and compelling need to be in a long-term care facility typically want to remain in their own homes. Often they are unaware that their condition is such that nursing home placement would be best for them.
Family members are sometimes adamantly opposed to the idea as well. Some view putting their loved one in a facility as a criminal act. In many cases it's even more difficult because the patient's staunch objections usually make the family member(s) feel incredibly guilty.
The decision to place a loved one in a care facility can be agonizing, but caregivers need to consider the following: 1) Long-term care placement can be the most loving choice for their loved one and 2) Caring for the loved one at home is probably seriously affecting their own physical and mental health and well-being. People can't be good caregivers if they are exhausted and burned out all the time.
"I often work to convince reluctant spouses to change from being a 'caregiver' to being a 'care advocate,'" William G. Hammond, founder of the Elder and Disability law firm in Overland Park, Kansas, told me. "They can then be vigilant to ensure their loved one is receiving appropriate treatment in the facility while preserving their own health."
Many people with Alzheimer's, however, flat out refuse to go. In such cases you can try to convince them that it's best for their own health and well-being. If that doesn't work you may enlist the help of another family member or even the person's physician or attorney to talk with them. People with Alzheimer's will sometimes pay more attention to the advice of a person other than their primary caregiver. You may also obtain the services of a geriatric care manager, who can guide you through the process.
Another approach is to use what is referred to as "compassionate deception." You can convince the person to go for a limited period of time, such as a week. Then you stretch it out to two weeks, then three, and eventually they will probably adjust to being there full time. Loved ones who are significantly impaired may even forget they were supposed to go back home. Or they may not be aware they aren't at home.
You may also take the person to a facility, saying you're going to visit someone there or you have dinner reservations there (or some other reason for visiting). Then when you leave don't take them with you. You will probably feel terribly guilty, but the person will almost certainly adjust.
If none of these suggestions work and you have power of attorney, you may have to enlist the help of law enforcement. According to Hammond, "You should do this only as a last resort. It's only for the most severely impaired people and the most dire circumstances - such as if the person becomes a danger to him or herself or others." Law enforcement typically takes the person to a hospital geriatric psychiatry unit for evaluation and treatment, from where they may be released to a nursing home.
"If all else fails and you don't have power of attorney," says Hammond, "you may face costly court action in order to be appointed the person's guardian or conservator. You can then make all decisions for them about where they will live."
When you must take a person with dementia to a nursing home against their will and/or go to court to get guardianship, be sure to consult a local elder law attorney for advice because laws vary from state to state. You can call your local bar association to get a referral.
Marie Marley is the author of the award-winning, uplifting 'Come Back Early Today: A Memoir of Love, Alzheimer's and Joy,' and co-author (with Daniel C. Potts, MD, FAAN) of 'Finding Joy in Alzheimer's: New Hope for Caregivers.' Her website (ComeBackEarlyToday.com) contains a wealth of information for Alzheimer's caregivers.