Prevalence and duration of nursing home stays for Alzheimer's patients
Studies indicate that a high percentage of individuals with advanced dementia spend their final months or years in a nursing home. According to the Alzheimer's Association, 48% of nursing home residents lived with Alzheimer's or other dementias as of 2020. More specifically, a 2018 study from Harvard's Department of Health Care Policy estimated that 70% of Americans with dementia will die in a nursing home. A 2025 study in The BMJ found that around one-third of the remaining life expectancy for people with dementia was spent in a nursing home.
The length of stay for these residents can vary, but national data shows that for many, the time is relatively brief. A 2010 study published on GeriPal analyzed data from older adults who died between 1992 and 2006. It found that the median length of stay in a nursing home before death was just five months, though the average (mean) was longer at 14 months due to some very long-term residents. This means that over half (53%) of those studied died within six months of being admitted, while 65% died within one year.
Why the move to a nursing home becomes necessary
Moving a loved one with Alzheimer's to a nursing home is a difficult decision, often driven by the increasing intensity of care required. Several factors can precipitate this transition, moving care from home-based to a facility setting.
- Increased care needs: The disease's progression inevitably leads to a decline in the ability to perform activities of daily living (ADLs) such as eating, bathing, and walking. By the late stage of Alzheimer's, intensive, round-the-clock assistance is often required, which becomes unmanageable for family caregivers.
- Safety concerns: As dementia progresses, individuals may wander, get lost, or use appliances unsafely. When a person's behavior creates an unsafe home environment, a nursing home with secure facilities and 24/7 supervision offers a safer alternative.
- Caregiver burnout: The intense physical and emotional demands of caring for an individual with advanced dementia can overwhelm even the most dedicated family caregivers. Caregiver illness, exhaustion, or competing life demands frequently contribute to the decision to seek institutional care.
- Medical complexity: Late-stage Alzheimer's often involves medical complications such as difficulty swallowing, infections, and other health issues that require skilled medical attention. A nursing home can provide the continuous, specialized care that a home setting cannot.
Trends in end-of-life care location
While a significant number of individuals with advanced dementia spend their last days in nursing homes, recent trends indicate a shift in end-of-life care locations.
- Between 2018 and 2022, the percentage of dementia deaths occurring in nursing homes or other long-term care facilities declined from 53.6% to 44.6%.
- During the same period, deaths at home from dementia increased from 23.7% to 30.4%.
- The use of hospice care, which can be provided at home or in a facility, is also a growing factor in end-of-life care planning for dementia patients.
Comparison of end-of-life care settings for Alzheimer's
Deciding on the best place for end-of-life care for an Alzheimer's patient involves weighing several factors, including medical needs, costs, and desired environment. The following table provides a comparison of common settings.
| Feature | Nursing Home | In-Home Care with Hospice | Assisted Living/Memory Care |
|---|---|---|---|
| Level of Medical Care | Offers 24/7 skilled nursing care, ideal for complex medical needs. | Hospice team provides comfort care and symptom management; family handles daily tasks. | Provides personal care assistance and supervision; more limited medical care. |
| Environment | Structured, institutional setting with 24/7 staffing and medical equipment. | Familiar home environment, which can be less confusing and comforting. | Secure environment with specialized layouts and social activities for residents. |
| Cost | Typically more expensive than in-home care, with costs covering accommodation, meals, and medical services. | Can be less expensive than facility care, especially with hospice services covering medical equipment and visits. | Costs vary but are generally higher than standard assisted living due to specialized services. |
| Staffing and Expertise | Staff includes registered nurses, licensed practical nurses, and certified nurse aides with varying dementia training. | Hospice team (nurses, social workers, aides) coordinates care and supports family caregivers. | Trained caregivers specializing in dementia techniques and common behaviors. |
| Family Involvement | Can reduce caregiver burden but may feel less personal; family visits are crucial. | High degree of family involvement in daily care, with extensive support from the hospice team. | Encourages continued family involvement while providing a secure and supportive environment. |
What to expect in the final months and years
As Alzheimer's progresses into its final stages, the focus of care shifts from cognitive management to comfort and dignity. Families should prepare for changes in a loved one's condition, including:
- Physical decline: Swallowing and eating difficulties become common, and individuals may become bed-bound or chair-bound. Mobility issues increase the risk of falls and pressure sores.
- Communication loss: The ability to communicate verbally is often lost. Individuals may use nonverbal cues, but it can be challenging to determine their needs or manage discomfort.
- Increased vulnerability: Susceptibility to infections, especially pneumonia, increases. A good end-of-life care plan focuses on managing symptoms and providing comfort.
- End-of-life planning: Decisions around life-sustaining treatments, like feeding tubes or respirators, should be addressed in advance directives. This ensures a person's wishes are honored as they approach the end of life.
The growing need for compassionate care
With the number of people living with dementia projected to increase, the need for high-quality, compassionate end-of-life care will become even more critical. Whether a person with Alzheimer's spends their last years or months at home, in assisted living, or a nursing home, the goal remains the same: ensuring dignity, comfort, and peace. Many resources, including hospice services and specialized memory care units, exist to help families navigate these final stages.
It is vital to prioritize early and open communication with healthcare providers and family members to ensure that care aligns with the individual's wishes. Organizations like the Alzheimer's Association offer extensive resources and support to help families make these complex decisions and find the best possible care for their loved ones.
Conclusion
The question of how many Alzheimer's patients spend their final period in a nursing home does not have a single answer, as statistics show a notable variation. However, a significant percentage of those with advanced dementia do transition to institutional care, often due to increasing care needs, safety concerns, and caregiver burnout. The median length of stay in a nursing home at the end of life can be relatively short, signaling that many admissions occur in the advanced stages of the disease. Families must consider all options, including at-home hospice and specialized memory care, to ensure their loved one receives compassionate and appropriate end-of-life care tailored to their needs and preferences. Planning ahead and leveraging available resources can help ease this challenging transition.
