Skip to main content

Nursing Home Decision: General Considerations and My Story

VirginiaLynne was a caregiver for in-laws with Alzheimer's, and she shares her extensive research in dementia and elder care to help others.

My in-laws with my daughter. Both my mother-in-law, Nicole, and my father-in-law, Michael, were in the middle stages of the disease in this photo.

My in-laws with my daughter. Both my mother-in-law, Nicole, and my father-in-law, Michael, were in the middle stages of the disease in this photo.

Why Consider Professional Help?

If you are worn-out with caring for your loved one, you are not alone. Some caregivers end up having worse health issues than the ones they are caring for. When I was caring for both of my in-laws, my cousin, who had been a geriatric nurse for many years advised me to get professional help so that I could be sure to do a good job loving them as only a family can.

Let the professionals do what they can, so you can do what only you can.

— Renee, experienced hospice nurse

Professional service can help you be a better caregiver. There are many types of services available, including:

  • Respite care in your home.
  • Daycare outside your home.
  • Independent living with some daily needs support.
  • Assisted living care.
  • Combination care facilities which have graduated care from independent living to assisted living to nursing care.
  • Long-term care nursing homes.
  • Specialized Alzheimer's Units in Long Term Care Facilities.
  • Memory Care homes.

The type of facility and care you choose will depend on your loved one's needs. However, it is important to consider not only the immediate care the person needs, but also to plan for the future. When a person with memory issues moves, they tend to lose their orientation and often decline more rapidly. Therefore, it is helpful to choose a place where the person can be cared for even as they move towards an advanced stage.

Long Term Care Poll

When my mother-in-law moved into a nursing home, we could focus more on creating special memories with her and enjoying our time together.

When my mother-in-law moved into a nursing home, we could focus more on creating special memories with her and enjoying our time together.

Many times, families feel guilty about not being able to care for their loved one with dementia. Often, when a person is in the early stages, changing schedules and reducing work can allow families to provide the assistance their relative needs to continue to stay in their home. However, as a person enters middle and late stages, caring for a person can be overwhelming. Long-term care should be considered when:

  1. The elderly loved one needs 24-hour supervision.
  2. The individual needs more medical monitoring and nursing care than can be provided in a home setting.
  3. The main caregiver is facing health problems, feels overwhelmed, doesn't get enough sleep, feels isolated or becomes depressed. If the main care provider is a spouse, other relatives need to watch for these signs. The caregiver may feel guilty and reluctant to admit they can't cope.
  4. Caregiver and patient are having difficulty in their relationship.
  5. Safety of the loved one with Alzheimer's is a concern because of falling, wandering or other behaviors.
  6. If the person lives alone, are they becoming unable to continue daily living tasks, feed themselves, and take medicines appropriately?
  7. Doctors and other professionals recommend considering it.

You may wonder if a person with memory loss needs to be in a facility which specializes in Alzheimer's patients. Here are some things to consider:

  • Special Memory Care May Cost Much More: While many of these facilities might have resources which could help your loved one, the added cost of many of these types of long-term care homes may not be necessary. In our town, memory care homes cost 30% more.
  • Most Long Term Care Facilities Have Patients with Dementia: A large majority of people in most nursing home facilities have some form of dementia, so staff is familiar with handling the different needs of memory challenged individuals. So even if the nursing home does not state a specialty in memory care, they may very well be quite competent to take care of your relative.
  • Alzheimer's Patients are Difficult. No matter where your loved one stays, whether at home or in a care facility, they will probably encounter many difficult days as they struggle with continued declining abilities. Delusions, hallucinations, anger, sundowning (mixing up days and nights) and other behaviors make caring for a person very difficult. Even the best caregivers will sometimes be stumped at how to handle a behavior. No matter what facility you choose, you may be called upon (as we were) to be involved in helping devise strategies to handle different problems that arise.
Often a crisis leads to choosing care outside the home. My mother-in-law had a series of accidents which caused her to require 24-hour nursing care.

Often a crisis leads to choosing care outside the home. My mother-in-law had a series of accidents which caused her to require 24-hour nursing care.

Like many people caring for loved ones with Alzheimer's, it took a crisis for us to consider long-term care. In our case, the problem was compounded by the fact that we were caring for two loved ones at once, Michael and Nicole, my husband's parents.

For two years, we managed to help them stay in their own home. I stopped working so I could be available for their emergency needs and medical care. We assisted in caring for them and changing their routines so that they could cope with their changing abilities. However, eventually, there came a medical crisis which put Nicole into the hospital. Within six months, both Michael and Nicole needed 24-hour care. Many of the items on the list above were true for us. We considered the special Alzheimer's facility in town, but they did not have beds at the time; moreover, as we investigated our choices in long-term care facilities, we realized that we needed to consider the different needs of each of them:

Scroll to Continue
  • Nicole needed 24-hour nursing and medical supervision of her condition. She needed people who were very compassionate but able to deal with her explosive anger.
  • Michael needed to be assisted living services to help with daily living and activities to keep him busy. He also needed a locked facility that he could not leave. Furthermore, he also needed people who could re-direct his paranoia.
Assisted living facilities often promote relationships through a common dining hall.

Assisted living facilities often promote relationships through a common dining hall.

The most important factor in choosing an Alzheimer's facility is determining what your loved one must have to be safe, emotionally stable and taken care of physically. What is important to you and your loved one may be different from what another family would need. However, here are some typical questions you might want to consider:

  1. Do they have locked doors and alarms?
  2. Are there cameras for monitoring patients?
  3. Are there lots of activities to keep them busy?
  4. How does the community encourage socialization?
  5. How are meals provided and are their choices about what to eat and where the individual can eat?
  6. Do they provide help with eating if necessary?
  7. What is the noise level?
  8. Is there a place where your loved one can have privacy?
  9. How do they handle incontinent care?
  10. What sort of personal care services do they provide and how often are showers, hair washing, and shaving done?
  11. What is the daily schedule and how can you find out about activities?
  12. What kind of therapy is available?
  13. Is there a doctor or nurse practitioner who visits? What is the schedule?
  14. Is the facility close enough for the family to easily visit?
  15. Do the staff seem to be compassionate and patient caregivers?
  16. Would your loved one have a consistent caregiver or a variety of different faces?
  17. Is there a 24-hour nurse on site?
  18. What provisions are made for moving from assisted living to nursing home care?
  19. Is there a place where your loved one can go outside, or at least look at the outdoors?
  20. Is this a physically attractive facility?
  21. Is this a place where family involvement is encouraged? Do they have activities to involve family members in special events?
  22. Are they adept at handling psychotic medications for individuals with difficult behaviors?

Red Flags to Watch For

Just as no one solution fits all needs, you may also find that one care solution may not be enough. In the end, we used three different long-term care facilities. Our problems came because:

  • One facility was not able to handle the two of them together.
  • Another facility had staff changes which made them unable to keep Michael safe.
  • Michael initially needed the stimulation of assisted living, but as he declined he needed to have the medical services of a nursing home facility.

In the end, we found that caring staff made the biggest impact on how well Michael and Nicole adjusted to the facility and felt about their time living there. Caring and gracious staff would be the first thing I would look for while touring any facility in the future. In fact, our doctor told us that several of the homes that he felt provided the best care in our town were not particularly attractive in appearance, but had very experienced and caring staff.

Have you chosen a long-term care facility for your relative with Alzheimer's or dementia? Please share your stories and ideas for making the choice in the comments below.

Alzheimer's Caregiving Changes Family

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


Mona Sabalones Gonzalez from Philippines on July 19, 2014:

My mother had Alzheimers' when she died. She lived with my brother, who never complained and would not have it any other way. However, it's nice to know that there are options where the elderly can find good and loving care in a nursing home. This is a lovely and helpful hub.

andredavidson on August 22, 2012:

Seems that while an Alzheimers facility sounds like the best choice, nursing homes have similar support without being as expensive.

Virginia Kearney (author) from United States on August 22, 2012:

Jordan--I very much sympathize with you about your grandfather. I am so glad that you were able to have him in a caregiving place where they really helped him. That was our experience too.

Jordan Campbell on August 22, 2012:

This is a very touchy topic for me, in my Grandpas last days, he suffered from cardio vascular dementia. I was heartbroken to see a man that was once brilliant fight to remember some of the most simple things. Luckily, he was in place where the faculty really cared about the patients and went out of their way to keep them happy and satisfied .This was a wonderful and reassuring article that showed me there are other loving caretakers that really aren't there for only a paycheck.

Virginia Kearney (author) from United States on August 21, 2012:

arkirchner--thank you so much for the thoughtful reply and examples from your own life. It is so very hard to know how to handle this very difficult situation. In my own family, I've had three relatives who were kept at home with family until there was a crisis. In all three situations, the person was put into full-time care when they were actually very near death. The move in that case was very traumatic for everyone and probably not as helpful to anyone as care help could have been if it had been considered earlier. You are so right that it is just by God's grace!

Audrey Kirchner from Washington on August 20, 2012:

Saddest thing, Alzheimer's or any form of dementia. I was raised by my grandmother pretty much and she suffered from schizophrenia and dementia--it was so hard for her to chase the demons away.

Over the years, I've known a few friends too who ended up with dementia and it's just the most devastating thing. I have a really good friend who kept her mom at home with Alzheimer's as long as she could and it certainly was a challenge--but I remember growing up with my grandmother. You just did what you needed to do--that was life then. Today it seems it's much easier to forget about our family and friends and just put them somewhere so they can be someone else's problem.

Working in medicine, I do see both sides of it--my friend's mom actually eloped one night and was hit by a car, rolled into a ditch and had no ID on her...all the day of her daughter's graduation--my daughter's too. The whole town was out looking for her. That finally led my friend to have to institutionalize her for her own safety even though they were using every precaution under the sun at home. But I always give her the greatest kudos because she tried so hard. Just like we all did in our family to just keep my grandmother from being put somewhere--she eventually too had to go somewhere.

I always say though--there but for the grace of God go I--your info and insights are spectacular~ Great photos and what a great family!!

Virginia Kearney (author) from United States on August 19, 2012:

Thanks picadilly. I know I often talk with people who say they'd "never put their parents in a home" but I know that usually means they haven't really been close to taking care of Alzheimer's loved ones who show some of the most difficult characteristics of the disease--or ones who have serious medical needs.

Priscill Anne Alvik from Schaumburg, IL on August 18, 2012:

You have written a dynamic hub on a subject that needs to be discussed more in today's world. I could hear your heart from the personal experience with the disease within your family unit. Bravo to you for tackling a difficult subject.

Virginia Kearney (author) from United States on August 13, 2012:

Seeker7--What a blessing you have been to many people! No one can pay someone enough to care for Alzheimer's patients in a loving way. It has to be a decision that comes from a person's heart. We were incredibly blessed by several people who chose to love my in-laws and care for them as if they were family. Thanks for sharing!

Helen Murphy Howell from Fife, Scotland on August 13, 2012:

Another excellent hub on this important topic. I agree with you 100% about the attitude of care givers. Even if you have a facility that doesn't look quite as nice as another, but the carers are relaxed, friendly and caring, then choose this facility every time. No matter what form of dementia a person has, they will always respond so much better - like any of us would - to compassion, patience and kindness.

I was very lucky to work in an establishment and finally became manager of a facility that won a few awards for best carers etc. Time and time again the families would say after visiting, that they didn't worry about going back to their own homes, since they knew their loved one was happy, loved and cared for. That's when we knew, we were doing our jobs as carers properly and it made us even more determined to ensure that all our elderly residents and their families felt the same way.

An excellent hub with great information that will help any family to choose what care is likely to be best for their loved one. Voted up!

Virginia Kearney (author) from United States on August 11, 2012:

Thanks kissayer--I noticed that many of the websites which deal with this issue are very impersonal, but this is perhaps the most emotional decision many people ever make and I think you have to deal with those feelings.

Kristy Sayer from Sydney, Australia on August 10, 2012:

A very personal topic that you did a great job of covering, well done. I like that you highlighted that the facility that is best now, might not be later and it's important that all of their needs are catered to.

Related Articles