31: Continuum of Care: At Home Care With In-Home Assistance

This program will present:

  • Some principles and strategies for meeting the varying needs in early to middle stage care
  • Information about caregiver assistance and support options
  • There are no easy answer when its comes to the care of another
  • Our hope is to offer you useful information and guidelines for caring for someone with dementia
  • These guidelines will need to be adjusted to suit your own individual needs

Early stage (2-3 yrs)

  • Forgetful
  • Declining social skills
  • Obsessed, restless, depressed, or apathetic
  • Sleep changes may begin

Middle stage (3 to 4 yrs)

  • Difficulty functioning at home and at work
  • Personality changes and difficult behaviors
  • Sleep pattern changes more common
  • Able to manage personal care with prompting

Late stage (4 to 7 yrs)

  • Greater difficulty with activities of daily living
  • Reduced mobility
  • Communication difficulties
  • More difficult behaviors
  • Worsening of sleep pattern disturbances
  • Need 24 hour care

End-stage (less than a year)

  • Unable to walk
  • Unable to recognize people or objects
  • Weight loss
  • Incontinence
  • Need complete care
  • Planning care for individuals with a range of programs and services to meet their needs as their illness evolves
  • Planning for care should begin soon after diagnosis of the disease
  • Goal: transition from lesser to more intense levels of care over the course of the illness
  • Placement in a long-term care facility will be a much smoother transition if family members are prepared, and the person is acclimated to settings other than a familiar home

What would be the best arrangement for Robert when Mary has to go to work?

  • A. Leaving Robert alone and have someone check in on him frequently throughout the day.
  • B. Arranging for in-home assistance.
  • C. Having Robert come to work with her so that she can watch him.
  • D. Placing Robert in an Alzheimer’s care facility.

Choice A: Leaving Robert alone and have someone check in on him frequently throughout the day, is a good option.

  • The longer individuals can be cared for in their own home and by loved family members, the longer they will be able to function at an optimal level.

Choice B: Arranging for in-home assistance, is the best choice.

Choice C: Having Robert go to work with Mary so that she can watch him, is a possibility.

Choice D: Placing Robert in an Alzheimer’s care facility, is a possibility, but not a very good choice at this stage.

  • Abruptly changing the person’s environment can cause faster functional decline
  • The longer people can remain in the familiar environment of their own home, the better will be their adjustment to subsequent levels of care
  • Go through the house with an eye for safety hazards on a daily or weekly basis
  • Lock away cleaning materials and other products containing dangerous chemicals
  • Medications for the person should be arranged in a daily medicine caddy or a dispenser
  • All medications should be controlled by the caregiver
  • Provide bright, indirect lighting without glare
  • Rooms should be kept organized without clutter
  • Floors should be kept clean
  • Pathways from room to room should be kept clear and well-lit
  • Prepare meals for the person to heat up
  • Highlight or label the correct buttons to push on the microwave or stove
  • Heat water in the microwave or a kettle with an automatic shut-off
  • Get assistance from community services such as Meals on Wheels
  • Have people stop in to check on the person throughout the day
  • Make phone calls to the person throughout the day
  • Enroll in a program that helps find people if they wander away from home
  • Use a locating device to help find the person
  • Comfort can help reduce the risk of agitation and difficult behaviors
  • Clean, comfortable clothing that is easy to put on and take off
  • Comfortable temperature in the house
  • Have sweaters and blankets available to prevent chill
  • Treat any pain issues
  • Show love and support
  • Allow independence and autonomy
  • Support retained capacities as long as possible
  • Allow choices in a framework that is safe

Getting Support

  • Alzheimer’s Association

Tel: 800.272.3900 TDD: 866.403.3073 Website: www.alz.org

  • National Family Caregivers Association

Website: www.nfcacares.org Tel: 800.896.3650

  • Lotsa Helping Hands (ARCH National Respite Network)

Website: archrespite.lotsahelpinghands.com/eldercare/home/ Tel: 919.490.5577

  • Administration on Aging (AoA)

Website: www.aoa.gov Tel: 202.619.0724

  • National Council on Aging

Website: www.ncoa.org Tel: 202.479.1200

Getting Support (cont’d)

  • Senior Companions

Website: www.seniorcorps.gov Tel: 202.606.5000

  • Local volunteer services
  • Religious organization

Getting Support (continued)

  • Respite Care
  • In-home respite


  • Specialized facility
  • Sitter-companion services
  • Emergency respite
  • Adult day care
  • Caregiver checklist
  • National Council on Aging (NCOA), National Adult Day Services Association (NADSA)

Website: www.ncoa.org Tel: 202.479.1200

  • ARCH National Respite Network

Website: www.chtop.org Tel: 919.490.5577

  • Eldercare Locator

Website: www.eldercare.gov www.aoa.gov Tel: 800.677.1116

  • Alzheimer’s Association

Website: www.alz.org Tel: 800.272.3900

  • LightBridge Healthcare Research, Inc.
  • Alzheimer’s Disease Education and Referral Center (ADEAR)
  • Alzheimer’s Disease International (AI)
  • National Adult Day Services Association (NADSA)
  • Assisted Living Federation of America (ALFA)
  • The longer people can be cared for in their own home and by a loved family member, the longer they will be able to maintain their functional abilities
  • Caregivers should gradually transition individuals to more intense levels of care from visiting caregivers in the home to care outside of the home
  • Homes should be safety proofed
  • Caregiving assistance
  • Family members and friends
  • Respite services
  • In-home assistance
  • Adult day care
  • Overnight respite facilities
  • Support groups, caregiver organizations, senior organizations, and volunteer organizations are available to help caregivers

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian


30: Memory Impairment: Prevention & Improving Functioning

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion

  • Assisted Living Federation of America. (2008). Federal statutes that impact assisted living. http://www.alfa.org/i4a/pages/Index/
  • Butcher HK, Holkup PA, Maas M, (2001). Thematic analysis of the experience of making a decision o place a family member with Alzheimer’s disease. Res Nurs Health 24(6): 470-80.
  • Gaugler J, Leach C, Clay T, Newcomer R. (2004). Predictors of nursing home placement in African Americans with dementia. Journal American Geriatrics Society. 52:445-452.
  • KaganJ. Respite Care. (2006). Wikipedia. Retrieved on March 17, 2009, from http://en.wikipedia.org/wiki/Respite_careARCH National Respite Coalition.
  • McClendon MJ, Smyth KA, Neundorfer MM, (2006). Long-term-care placement and survival of persons with Alzheimer’s disease. Journals of Gerontology Series B. 61B(4) p220-7.
  • Wang S, Davies E. (2007). [Family caregivers’ adjustment to nursing home placement of older relatives].Journal of Nursing (China). Jun; 54(3): 82-86.
  • Schur D, Whitlach CJ. (2003). Circumstances leading to placement: A difficult caregiving decision. Lippencott’s Case Management 8 (5): 187-97.
  • Whirrett T. Adult Day Care: One Form of Respite for Older Adults. (2002). ARCH Factsheet Number 54. Retrieved on March 17, 2009, from http://www.archrespite.org/archfs54.pdf.