How to get home care for a dementia patient?

According to the Alzheimer's Association, over 7 million Americans are living with Alzheimer's, a number that is expected to rise. For family caregivers of those with dementia, providing constant supervision and care can be overwhelming. Understanding how to get home care for a dementia patient is a crucial step in managing this journey, ensuring your loved one receives professional support in a familiar environment while providing much-needed respite for the family.

Quick Summary

This article outlines the steps for securing in-home care for a dementia patient. It explains how to assess needs, find and screen providers, understand different service types, navigate costs and payment options, and prepare the home environment for safety and comfort.

Key Points

• Assess Needs and Plan: Before searching for care, identify your loved one's specific needs, such as assistance with daily activities, supervision, or medical care.

• Choose the Right Type of Care: Understand the difference between companion care, personal care services, and skilled nursing to match the care to the patient's stage of dementia.

• Screen Providers Thoroughly: Research and interview potential home care agencies or independent caregivers, checking for licenses, training in dementia care, and references.

• Prepare the Home for Safety: Implement safety modifications, such as removing tripping hazards and installing locks, to create a secure and familiar environment.

• Explore Funding Options: Investigate potential financial aid from sources like Medicare, Medicaid, Veterans benefits, or long-term care insurance to manage costs.

• Handle Legal and Financial Planning Early: Address legal documents like durable power of attorney while the patient can still make decisions.

• Utilize Respite Care to Prevent Burnout: Incorporate respite care services to give family caregivers a temporary, but essential, break.

Understanding the Types of Home Care for Dementia

Before you begin your search, it is essential to understand the different levels of in-home care available. The type of care required will depend on the stage of dementia and your loved one's specific needs.

Companion Care

This is the most basic level of home care and focuses primarily on social interaction and supervision. A companion caregiver can provide conversation, engage in stimulating activities, and offer light assistance with daily tasks.

• Services include: Social interaction, recreational activities, supervision, and light housekeeping.
• Best for: Early-stage dementia patients who need companionship and supervision to prevent isolation and wandering.

Personal Care Services

As dementia progresses, patients often need more hands-on assistance with personal tasks. Personal care services include help with activities of daily living (ADLs).

• Services include: Bathing, dressing, grooming, toileting, and eating assistance.
• Best for: Mid-stage dementia patients who need regular, hands-on support to maintain hygiene and safety.

Skilled Nursing Care

For advanced-stage dementia or complex medical needs, skilled nursing care is required. These services are provided by licensed health professionals and are often coordinated through a Medicare-certified home health agency.

• Services include: Medication administration, injections, wound care, and physical or occupational therapy.
• Best for: Advanced-stage dementia patients with specific medical needs that require the expertise of a licensed medical professional.

Respite Care

Respite care is a temporary service that provides a well-deserved break for family caregivers. It can be provided in-home by a professional caregiver or through an adult day center or short-term facility stay.

• Services include: Supervision, companionship, and activities for the patient while the family caregiver is away.
• Best for: Allowing family caregivers to rest, run errands, or take a vacation to prevent burnout.

A Step-by-Step Guide to Getting Home Care

Step 1: Assess Your Needs and Create a Plan

Before hiring, sit down with family members to create a list of your loved one’s specific needs and your expectations for care. Consider the following:

• Safety: Does the patient need 24-hour supervision or just a few hours of help?
• Health: What medical conditions exist beyond dementia? Is medication management or other skilled care required?
• Daily Activities: What level of help is needed with ADLs like bathing, dressing, and meal prep?
• Social Engagement: What activities are stimulating and enjoyable for your loved one?

Step 2: Research and Screen Providers

Once you have a clear plan, start researching agencies and individual caregivers. Use resources like the Alzheimer's Association Community Resource Finder or Eldercare Locator.

• Ask for Recommendations: Consult with doctors, social workers, and other caregivers for personal recommendations.
• Call and Screen Agencies: Inquire about licensing, accreditation, employee training (especially in dementia care), bonding, and insurance. Ask what their protocol is if an aide doesn't show up.
• Interview Candidates: Meet potential caregivers in your home and observe their interaction with your loved one. Prepare a list of questions about their experience, approach to dementia care, and availability.
• Check References: Always ask for and follow up with references from other families who have used their services.

Step 3: Prepare the Home Environment

Modifying the home can significantly improve a dementia patient's safety and well-being. Simple changes can reduce confusion, prevent falls, and make daily routines easier.

• Remove tripping hazards: Secure loose rugs, clear clutter from walkways, and use brightly colored tape to mark the edges of steps.
• Increase visibility: Add extra lighting to hallways, stairwells, and bathrooms, and keep lights on at night.
• Add safety devices: Install grab bars in bathrooms, extra locks on doors to prevent wandering, and alarms on doors and windows.
• Secure dangerous items: Lock up medications, cleaning supplies, and sharp objects.

Step 4: Address Legal and Financial Planning

Early legal and financial planning is critical before the patient loses the capacity to make decisions.

• Durable Power of Attorney: Appoint a trusted agent to manage financial and health care decisions.
• Legal Documents: Prepare or update wills and trusts.
• Guardianship: In cases where planning was not done early, a court-appointed guardianship may be necessary.

Step 5: Explore Funding Options

Paying for home care can be expensive, but several programs can help with the costs. Funding options vary by state and eligibility criteria.

• Medicare: Covers limited, medically necessary home health services but does not cover long-term, non-medical home care.
• Medicaid: A state-run program that may cover home care costs for eligible individuals. Medicaid waiver programs specifically target home- and community-based services.
• Veterans Benefits: Veterans and their spouses may be eligible for financial assistance, such as the Aid and Attendance benefit.
• Long-Term Care Insurance: Review existing policies to see what coverage is provided for in-home care.
• Personal Funds and Assets: Consider using savings, investments, or home equity.

Home Care vs. Residential Care Comparison

Feature	In-Home Care	Memory Care Facility
Environment	Stays in a familiar home setting, which can reduce anxiety and confusion.	Moves to a specialized, purpose-built facility designed for safety and routine.
Personalization	Highly personalized care plan tailored to the individual's routine and preferences.	More structured environment with activities designed for a group of residents.
Supervision	Can range from part-time assistance to 24/7 care, which can become expensive.	24/7 supervision and monitoring by a team of trained staff.
Safety Features	Requires home modifications by the family to prevent wandering and accidents.	Security features like alarmed doors and fenced-in yards are built-in.
Cost	National median is around $33/hour, varying significantly by location and care level.	Can be comparable to full-time home care but often includes meals, activities, and 24/7 staffing.

Conclusion: Making the Right Decision for Home Care

Choosing home care for a dementia patient is a significant decision that requires careful planning and research. By assessing your loved one's specific needs, understanding the different types of care available, and thoroughly vetting potential providers, you can ensure a safe and supportive environment. Addressing the financial and legal aspects early on is also crucial. The familiarity of home can offer immense comfort and stability to someone with dementia, and with the right support system in place, you can confidently navigate this journey while also protecting your own well-being. Ultimately, your goal is to find the best possible balance of professional support, comfort, and safety for your loved one. The Alzheimer's Association and local Area Agencies on Aging are excellent resources for assistance throughout this process.

Frequently Asked Questions

What is the difference between home health care and home care for dementia?

Home health care provides skilled medical services, such as injections or wound care, performed by licensed health professionals and is often covered by Medicare for medically necessary services. Home care, or personal care, involves non-medical assistance with daily activities like bathing, dressing, and meal preparation, and is typically paid for out-of-pocket or through long-term care insurance.

How do I find a reputable home care agency?

You can find reputable agencies by asking for recommendations from doctors and social workers, using online resources like the Eldercare Locator or the Alzheimer's Association Community Resource Finder, and checking for licensing, accreditation, and employee background checks.

Does Medicare cover home care for dementia patients?

Medicare covers limited, medically necessary home health care services, but does not cover long-term, non-medical home care, such as help with bathing or dressing. Medicaid and certain veterans' benefits, however, may offer coverage for long-term home care.

When should we start looking for home care for a dementia patient?

It is best to start planning and researching as soon as possible after a dementia diagnosis. This allows for a smoother transition to care and ensures legal and financial documents can be prepared while the patient still has decision-making capacity.

What are some signs that a dementia patient needs more help at home?

Signs that more help is needed include an increase in safety risks (like wandering), difficulty with daily tasks (bathing, dressing), noticeable decline in hygiene or nutrition, and significant behavioral changes or aggression. Caregiver burnout is also a sign that additional support is required.

What legal documents should be in place for a dementia patient receiving home care?

Crucial legal documents include a durable power of attorney for finances and a durable power of attorney for health care (advance directive). These documents allow a designated agent to make decisions on the patient's behalf once they are no longer able.

How can I make my home safer for a person with dementia?

To make a home safer, remove tripping hazards, add extra lighting, install grab bars and non-slip mats in bathrooms, secure medications and cleaning products, and install alarms on doors to prevent wandering.