Thursday 22 February 2018

'My husband has Alzheimer’s - is it time to consider a nursing home?'

Making a decision to place a loved one in a nursing home can be difficult
Making a decision to place a loved one in a nursing home can be difficult

Dr Jennifer Grant answers your health queries.

Dear Dr Grant, 

I’m in my late 70s and I care full-time for my husband who has Alzheimer’s. His reason and focus, ability to pay attention, understanding, memory etc are severely impaired and his mood can be unpredictable, but thankfully, he has never become physical and I have a lot of help from our children — plus the little bit of home help we can get. We’ve been married for over 40 years and I love him deeply, but at some stage, I know that this arrangement will no longer be sustainable, regardless of our love. Already the kids have been asking me to look at homes but I’m not sure how you know that it’s time for that...

 

Dr Grant answers: You are clearly the main care-giver for your dear husband and although you are in your late 70s, you must be in good shape to be able to do this. The weight of this decision should not land on your shoulders alone. You need to discuss your husband’s rate of deterioration and your ability to sustain the live-at-home situation with your family doctor, the consultant he is under at your local hospital and the whole family.

There are assessment tools that the occupational health, physiotherapy and social work departments can perform on your husband to aid the whole team come to a decision about the need for long-term care. In general, if your husband’s daily needs are beyond that which can be met by the home help and the support from family members, then the time has come to think about finding the right long-term care facility.

You should try not to feel any guilt about this because, as much as you love your husband, he loves you, and the last thing he would want is to be a burden on you. This situation often comes to a head when the main care-giver becomes unwell due to stress and this is a situation that everyone wants to avoid. 

Late-stage Alzheimer’s patients tend to have difficulty eating and swallowing, are more prone to infection, need full-time help with personal care and need assistance walking. Weight loss becomes a problem as Alzheimer’s patients lose their appetite and forget to eat and may need assistance with feeding or prompting to drink fluid in order to prevent dehydration. 

To ensure a regular bladder and bowel habit, it is recommended to keep a toileting schedule. Communicating pain or illness is often difficult for the patient at this stage of the disease and, therefore, an episode of anxiety, agitation, shouting or disturbed sleep may be a sign that something medical is wrong.

Watching out for physical signs such as swelling or redness on the skin or a joint, fevers, dental pain or tummy upset may alert you to get your doctor to examine your husband and treat appropriately. This is one of the most difficult decisions that a family has to make so getting advice and assessments and moving forward is the way to go.

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