Dec 22

Aging with Dementia: Housing Considerations

By: JENNIFER CROWLEY, RN CLCP MSCC

Long-term care planning can be challenging but is one of the most important tasks to be completed for anyone living with Dementia.  One step required when planning for long-term care includes a review of housing options. Statistically, most Americans have a strong desire to remain in their own home as they age.  When considering housing for someone with Dementia, one must review the current situation and options for when care needs will predictably increase. 

If there is no longer another spouse or capable adult to provide supervision and assist with care, hired help will be necessary. Can the home support an environment suitable to multiple caregivers coming and going while maintaining the highest level of security? If there is a spare bedroom, consider it for use by a caregiver to provide  overnight or carefully arranged live-in help. Use caution as laws apply to protect the caregiver, such as having their own bathroom and space for required downtime.

One of the most overlooked items is accessibility. Traditional houses are often less than ideal for aging in place due to the lack of accessibility. Modifications may be necessary, such as installing grab bars or railings, widening doorways or installing bathroom equipment. An allowance should be set-aside for purchases related to safety and security. Persons afflicted with Dementia may tamper with controls or devices, disabling them altogether or causing major problems. Homes can be outfitted with locking devices and control switch covers to prevent tampering.  Items such as stovetops and grills need to have locking devices or be disabled altogether.  Door knob covers and gates can prevent access to certain areas of the home. Security devices can be utilized to help monitor the situation and prevent a breach of security. These might include a video surveillance system or locking key holder to avoid distribution of numerous household keys. Fall risk also increases as we age and poses even greater challenges for those with cognitive impairment due to difficulties with balance and depth perception. Measures to reduce falls in the home are necessary, such as keeping halls and pathways clear and well-lit, removing throw rugs, and use of safety equipment.

Sometimes remaining in the home is not an option due to the multitude of challenges which pose a threat to the overall safety and well-being of the person. There are many potential reasons for someone living with Dementia not being able to remain in the home. There may be no capable adult or professional monitoring & managing the home health plan which creates a very high level of dependence on others, typically strangers. Situations can quickly unravel if there is not vested interest by a capable adult in overseeing the care being delivered and constantly re-evaluating the long-term care plan. Lack of funding to support care needs occurs frequently due to the rising cost of care and poor financial status. Other reasons making the home environment not suitable for aging in place may include: Inaccessibility with no ability to modify, extremely remote setting or home in disrepair or which poses a health risk. Alternative options for housing should be considered. Memory Care, specialty foster care homes, or Dementia Care Facilities can provide a safe environment with daily activities and care routines delivered by specially-trained caregivers 24 hours per day. Keep in mind the extra costs associated with the specialty care required for someone with Dementia.

Facility care may be a less expensive option than paying for 24 hour care in the home. The cost of home health care averages $23.00 per hour. For someone living with Dementia, care needs eventually rise to a level of constant, or 24 hours per day. Just 10 hours a day of care thru a home health agency can exceed $200/day or $6,000/month. Eventually, care needs rise and in-home 24 hour care can exceed $100,000.00 annually. Assisted Living & Memory Care costs with associated levels of care often fall below this amount on an annual basis.

Dementia requires a comprehensive team approach to maintain optimal wellness and prevent negative outcomes. If no team approach exists, the person often suffers from poor nutrition, rising costs, increased stress, and diminished health resulting in potentially unnecessary ER visits or hospital admissions.  Specialty memory care can bring peace of mind to loved ones by improving medication compliance, optimizing nutrition, communicating with physicians & other providers, providing social engagement & exercise opportunities regularly, and ensuring safety and security. A reasonable long-term care plan may include remaining in the home until no longer feasible with a future plan to transition to memory care. Take the time to review your community’s options for housing and start discussions as early as possible.

Jennifer Crowley is a Registered Nurse Certified Life Care Planner serving all of Northwest Montana and surrounding areas. She is the owner of Eagleview West, a care management and consulting company specializing in long-term care planning and elder care management.   She can be reached by calling 406-752-LTC1 (5821) or visiting www.EagleviewWest.com.

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