NURSING IN THE CASE OF ALZHEIMER’S DISEASE: CARE IN A RESIDENTIAL HOME
Much of what has been said about nursing homes is relevant also to residential home care. Many people with dementia who live on their own may well need to go into residential care when they can no longer be maintained in their own home, despite the fullest use of community services. This will often happen well before the stage at which they need nursing care, and the choice will usually be between the social services welfare home, or ‘Part III accommodation’, and a private residential home. The local authority will levy a charge on the demented person’s estate, after applying a means-test, if he or she has any financial resources. Private residential home charges are often higher than those in local authority homes, but there are many statutory grants that will help cover the cost. These arrangements may change after the new regulations, based on the Griffiths Report, come into effect, but a local social worker will be able to advise.
Most residential homes cannot cope with a heavy, physical nursing load nor with markedly impaired behaviour unless the home is specifically designed for this type of resident. It is very likely therefore that the time will come when a demented person in a residential home will have to move to alternative accommodation, most usually a nursing home or a hospital continuing-care bed. This of course is where the benefits of dual registered homes come in. The criteria for choosing an appropriate residential home are very similar to those for choosing a nursing home. Private residential homes are often smaller and more homely than local authority homes, but this is by no means always the case. Staffing levels may vary considerably between homes and although it is not so important to have trained nursing staff to hand, it is essential to inquire about the staffing ratios and the qualifications of those employed.
Arranging for a confused relative to be admitted to a home can seem a major problem. The person to help you most is the social worker. He or she should get to know your relative, provide you with a list of homes, point out the sorts of things you ought to be taking into consideration, beyond those mentioned in this book, and help you with the financial arrangements. The social worker should also be able to assist you with any worries and reservations you may have about placing your relative in a home, and may be prepared to keep in touch with you for a while afterwards, as the guilt and other emotions that are sometimes aroused by such a move can be very distressing for the carers who have arranged it.
It may be more difficult to persuade a person early on in the course of his or her illness to enter a residential home, than to persuade a more demented elderly person to accept a move to a nursing home. It is important that you, and if necessary also the social worker concerned, try to involve your relative in making this decision. Again, gradual habituation to the new environment by occasional day attendance may make it easier. Because many residential homes are unhappy about taking on very confused people, occasional attendance of this sort will give them the opportunity of assessing whether or not they can cope. It will also give you the opportunity to assess how they react to your relative and to assist in making the decision as to whether or not placement in a nursing home may be more appropriate.
*97\138\2*
