May 4, 2009 -- Question: At what point should I move a loved one from a facility for Alzheimer's to a nursing home with palliative care?
What I suggest to everyone is the decision to move into the facility balances the resources of the caregiver at home with the needs of the patient. It has to take into account the health and other obligations of the caregiver as well as the time and time of day that the person with Alzheimer's disease needs personal care.
Some families make the decision for such a transition when the patient needs supervision 24 hours of the day. Other families make the decision when there's trouble with continence, namely incontinence, or the person has trouble walking around -- in other words, trouble with mobility. Others make the decision when the person's cognitive impairment is so severe that they no longer recognize people around them or the environment.
For me, those are all good reasons to make a transition depending on the resources and context of the given patients or given family.
Another reason that's commonly used is that the patient is having behavior problems--they're getting in the way. It's important to remember that behavior problems can usually be improved upon.
And so with good attention from a specialist who has expertise with managed behavior, it might be possible to delay the transition into a facility related to behavior.