Sometimes you can no longer care for the person with AD at home. The person may need around-the-clock care. Or, he or she may be incontinent, aggressive, or wander a lot. It may not be possible for you to meet all of his or her needs at home anymore. When that happens, you may want to look for another place for the person with AD to live. You may feel guilty or upset about this decision, but remember that many caregivers reach this point as the disease worsens. Moving the person to a care facility may give you greater peace of mind. You will know that the person with AD is safe and getting good care.
"We knew it was time to find another home for dad. But where? We had so many questions. And, more than anything, we wanted him to be safe and well cared for."
Choosing the right place is a big decision. It's hard to know where to start.
Below we list steps you can take to find the right place:
1. Gather information
- Talk with your support group members, social worker, doctor, family members, and friends about facilities in your area.
- Make a list of questions to ask about the facility.
- Call to set up a time to visit.
Check these resources:
Centers for Medicare and Medicaid Services (CMS)
7500 Security Boulevard
Baltimore, MD 21244-1850
CMS has a guide to help older people and their caregivers choose a good nursing home. It describes types of long-term care, questions to ask the nursing home staff, and ways to pay for nursing home care. CMS also offers a service called Nursing Home Compare on its website. This service has information on nursing homes that are Medicare or Medicaid certified. These nursing homes provide skilled nursing care. Please note that there are many other places that provide different levels of health care and help with daily living. Many of these facilities are licensed only at the State level. CMS also has information about the rights of nursing home residents and their caregivers.
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
The Joint Commission evaluates nursing homes, home health care providers, hospitals, and assisted living facilities to determine whether or not they meet professional standards of care. Consumers can learn more about the quality of health care facilities through their online service at www.qualitycheck.org. 
Other resources include:
601 E Street, NW
Washington, DC 20049
Assisted Living Federation of America
1650 King Street, Suite 602
Alexandria, VA 22314
National Center for Assisted Living
1201 L Street, NW
Washington, DC 20005
National Clearinghouse for Long Term Care Information
Administration for Community Living
Washington, DC 20201
2. Visit assisted living facilities and nursing homes.
Make several visits at different times of the day and evening.
- How does the staff care for the residents?
- Is the staff friendly?
- Does the place feel comfortable?
- How do the people who live there look?
- Do they look clean and well cared for?
- Are mealtimes comfortable?
- Is the facility clean and well maintained?
- Does it smell bad?
Ask the staff:
- What activities are planned for residents?
- How many staff members are at the facility? How many of them are trained to provide medical care if needed?
- How many people in the facility have AD?
- Does the facility have a special unit for people with AD? If so, what kinds of services does it provide?
- Is there a doctor who checks on residents on a regular basis? How often?
You also may want to ask staff:
- What is a typical day like for the person with AD?
- Is there a safe place for the person to go outside?
- How do staff members speak to residents—with respect?
- What is included in the fee?
- How does my loved one get to medical appointments?
Talk with other caregivers who have a loved one at the facility. Find out what they think about the place.
Find out about total costs of care. Each facility is different. You want to find out if long-term care insurance, Medicaid, or Medicare will pay for any of the costs. Remember that Medicare only covers nursing home costs for a short time after the person with AD has been in the hospital for a certain amount of time.
If you're asked to sign a contract, make sure you understand what you are agreeing to.
Assisted living facilities
Assisted living facilities have rooms or apartments. They're for people who can mostly take care of themselves, but may need some help. Some assisted living facilities have special AD units. These units have staff who check on and care for people with AD. You will need to pay for the cost of the room or apartment, and you may need to pay extra for any special care. Some assisted living facilities are part of a larger organization that also offers other levels of care. For example, continuing care retirement communities also offer independent living and skilled nursing care.
A group home is a home for people who can no longer take care of themselves. Four to 10 people who can't care for themselves and two or more staff members live in the home. The staff takes care of the people living there: making meals, helping with grooming and medication, and providing other care. You will need to pay the costs of the person with AD living in this kind of home. Remember that these homes may not be inspected or regulated, but may still provide good care.
Check out the home and the staff. Visit at different times of the day and evening to see how the staff takes care of the residents. Also check to see how clean and comfortable the home is. You'll want to look at how the residents get along with one another and with the staff.
Nursing homes are for people who can't care for themselves anymore. Some nursing homes have special AD care units. These units are often in separate sections of the building where staff members have special training to care for people with AD. Some units try to make the person feel more like he or she is at home. They provide special activities, meals, and medical care. In most cases, you will have to pay for nursing home care. Some nursing homes accept Medicaid as payment. Also, long-term care insurance may cover some of the nursing home costs. Nursing homes are inspected and regulated by State governments.
How to make moving day easier
Moving is very stressful. Moving the person with AD to an assisted living facility, group home, or nursing home is a big change for both the person and the caregiver. You may feel many emotions, from a sense of loss to guilt and sadness. You also may feel relieved. It is okay to have all these feelings. A social worker may be able to help you plan for and adjust to moving day. It's important to have support during this difficult step.
Here are some things that may help:
- Know that the day can be very stressful.
- Talk to a social worker about your feelings about moving the person into a new place. Find out how to help the person with AD adjust.
- Get to know the staff before the person moves into a facility
- Talk with the staff about ways to make the change to the assisted living facility or nursing home go better.
- Don't argue with the person with AD about why he or she needs to be there
Be an advocate
Once the person has moved to his or her new home, check and see how the person is doing. As the caregiver, you probably know the person best. Look for signs that the person may need more attention, is taking too much medication, or may not be getting the care they need. Build a relationship with staff so that you work together as partners.