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Easing the transition of loved ones with dementia into an aged care home.

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The decision to place a loved one with dementia into an aged care home is one of the most difficult decisions you can make and is a life event of enormous significance. Following this decision, there are numerous practicalities to attend to including organising assessment through an Aged Care Assessment Team (ACAT), choosing a facility, the actual move and planning care within the home.Anne Deck, Manager of Alzheimer’s Australia Support centre said “Placing a loved one into aged care is going to be a very emotional time for the carers and the person with dementia so it is best to have all the practical things in place before that time comes. This will help support the emotional response as well as taking away some of the stress of the situation.” Professor of Alzheimer’s Disease and Neurodegeneration, Colin Masters from the University of Melbourne’s Pathology department said “In terms of easing patients into aged care, forward planning is critical.”

Alzheimer’s disease is characterised by the progressive decline of cognitive function including language, behaviour, emotions, judgement and the ability to do complex tasks. As the disease progresses, so does the level of assistance your loved one requires and placement into an aged care home is often necessary. You may be able to ease the transition into an aged care home by talking about it with your doctor early. By discussing your needs early, you may get access to some additional home services which may delay the move or at the very least, allow a timely smoother transition prior to reaching breaking point. The more in control you feel, the more able you are to make well-thought out decisions and find help.

Professor Masters said “The doctor undertaking the medical management needs to determine an appropriate time for these issues to be discussed with the carer and patient”

Moving a loved one into an aged care home is a process. First of all, an Aged Care Assessment Team (ACAT or ACAS in Victoria) will assess whether your loved one is eligible for Australian Government subsidised care in an aged care home (low-level or high level care). The ACAT can provide you with information about finding a home, how to apply, accepting a place in a home and practicalities regarding moving in. Some aged care homes have additional facilities for residents with dementia including specially trained staff, clear signage and safe wandering areas. The ACAT will provide names and addresses of homes with these additional facilities.

Ms Deck said “ One of the issues we often come across from the family carers who are having to put someone into nursing home is there is a lot of anxiety about how to make the move most comfortable for the person with dementia. What we suggest is that the family and carers come and talk to the facility. This will help the carers and the nurses identify things that may potentially be very upsetting for the person with dementia and therefore they can avoid them.”

Once a place has been accepted, the move may be within days. It is advised to make a list of care needs prior to entering a facility including:

  • Physical needs: diet, what daily activities (such as toileting, showering, dressing) does your loved one need assistance with, do they require nursing care (medications, catheters, wounds) and do they have other health care needs (physiotherapy, occupational therapy, podiatry etc.).
  • Emotional, social and spiritual needs such as hobbies, community participation, religious provisions and requirements for you, their family and friends to visit.

Ms Deck said “When preparing to place a person with dementia into aged care it is helpful if the family puts together a life story of the patient to pass on to the facility so they can know a bit about the person before they go in. The nurses can then use this to make conversation with the patient in order to develop a connection and make the patient feel more comfortable. Also in the process leading up to putting a person into care we suggest that the carers make a list of special things to that person. This could be ornaments, photographs, paintings or anything significant to the person with dementia. These things will help ease the transition and make the patient feel more comfortable in their new home. This should be done before reaching the point of relocation, so the carers feel prepared.”

Included in the care plan should be the use of dementia medications in the nursing home. Cholinesterase inhibitors (anticholiesterses) are the first line treatment for Alzhemier’s Disease. Anticholinesterases are a class of drugs that decrease breakdown of acetylcholine (a chemical messenger in the brain); it is thought that there is a lack of this messenger transmission in the brains of dementia patients. 

Professor Masters said “Cholinesterase inhibitors are an important part of medical management for people with dementia, it doesn’t matter if it is in a nursing home or not.”

Studies have shown that up to 47% of patients living in aged care homes had their cholinesterase inhibitors discontinued over a period of 1 year.  A resident with dementia will require a considerable amount of staff assistance in the aged care home (one estimate is an extra 229 hours per year spent per dementia patient compared to residents without dementia). Commencing or continuing medical treatment with cholinesterase inhibitors (including donepezil (Aricept), rivastigmine (exelon), galantamine (reminyl) and tacrine(Cognex)) to reduce difficult behaviours can reduce health care costs while improving your loved one’s outcomes.

Ms Deck said “There is no ideal time to discuss moving into a nursing home with the person with dementia. It depends on each situation and each circumstance and predominantly the person and how receptive they are to the concept.”

“Usually about a week before the patient is moved into the nursing home the carers will start talking about the change. However talking specifically about moving into aged care will cause a great deal of anxiety in some patients. Sometimes it will have been discussed previously with the patient but they may not remember. Therefore in some cases if you have somebody who is very resistant about going into a nursing home it is better to not mention it at all. This often will bring about guilty feelings for the family carers as they feel they are betraying the person however any change will cause anxiety for the patient so the carers will need to decide whether discussing the move with the patient is in their best interests” said Ms Deck.

Alzheimer’s Australia provides a number of suggestions for coping with the transition emotionally for both you and your loved one including how to prepare the room, an option of staying with your loved one while they settle in, how to part with your loved one, activities to try when visiting and practical ways to continue their caregiving such as helping out at mealtimes, participating in activities and joining a support group.

References

  1. Therapeutic Guidelines of Australia. Therapeutic Guidelines: Psychotropic. Melbourne: Therapeutic Guidelines Limited; 2003.
  2. Wilson R, McCann J, Li Y, Aggarwal N, Gilley D, Evans D. Nursing Home Placement, Day Care Use, and Cognitive Decline in Alzheimer’s Disease. The American Journal of Psychiatry. 2007;164(6):910-5.
  3. Australian Government Department of Health and Ageing. Aged Care Australia [online]. 2007 [cited 2008 Dec 7]. Available from: URL: http://www.agedcareaustralia.gov.au/
  4. Rang HP, Dale MM, Ritter JM, Moore PK. Pharmacology. 5th Ed. London, Churchill Livingstone; 2003 
  5. Buhr G, Kuchibhatla M, Clipp E. Caregivers’ Reasons for Nursing Home Placement: Clues for Improving Discussions with Families Prior to the Transition The Gerontologist. 2006;46(1):52-61.
  6. Grossberg G. Impact of Rivastigmine on Caregiver Burden Associated with Alzheimer’s Disease in Both Informal Care and Nursing Home Settings. Drugs and Ageing. 2008;25(7):573-84.
  7. Dybicz S, Keohane D, Erwin G, McRae T, Shah S. Patterns of Cholinesterase-inhibitor Use in the Nursing Home Setting: A Retrospective Analysis. The American Journal of Geriatric Pharmacotherapy. 2006;4:154-60.
  8. Tariot P, Cummings J, Katz I, Mintzer J, Perdomo C, Schwam E, et al. A Randomized, Double-Blind, Placebo-Controlled Study of the Efficacy and Safety of Donepezil in Patients with Alzheimer’s Disease in the Nursing Home Setting. Journal of the American Geriatrics Society. 2001;49:1590-2599.
  9. Winblad B, Kilander L, Minthon L, Båtsman S, Wetterholm AL, Jansson-Blixt C, et al. Donepezil in patients with severe Alzheimer’s disease: double-blind, parallel-group, placebo-controlled study. Lancet. 2006;367:1057-65.
  10. Wallin Å, Andreasen N, Eriksson S, Båtsman S, Näsmann B, Ekdahl A, et al. Donepezil in Alzheimer’s Disease: What to Expect after 3 Years of Treatment in a Routine Clinical Setting. Dementia and Geriatric Cognitive Disorders. 2007;23:150-60.
  11. Alzheimer’s Australia. Residential Care [online]. 2005 [cited 2008 Dec 7]. Available from: URL: http://www.alzheimers.org.au/content.cfm?topicid=60
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Dates

Posted On: 22 December, 2008
Modified On: 15 April, 2014

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