Dementia makes picking a nursing home harder

It took three tries before Leslie Reid-Green found a suitable nursing home for her 88-year-old mother, Bella Solomon, who has advanced dementia.

The first home her mother moved into “was dreary and gray, in an old hospital,” Reid-Green said. “The staff wasn’t very nice, my mother hated it, and it was far from where I live.” Frequent visits were an exhausting challenge.

The second home was “a newer and much nicer facility, though still more like a hospital than a home.” But the staff was unable to deal with her mother’s aggressive behavior.

Within weeks, the home sent her to a hospital, where she was given antipsychotic medication. She was returned to the nursing home, but that stay lasted just a week or so, followed by three months in a psychiatric hospital. Solomon’s behavior issues were finally stabilized, and she returned again to the nursing home.

After another hospitalization for an infection, she was placed on hospice care. The staff started ignoring her and failed to treat her conjunctivitis, Reid-Green said. Finally in January, after Solomon had been on a waiting list for a year and a half, a bed became available at a facility in Piscataway, N.J., closer to Reid-Green’s home.

Despite costing significantly less, it offered “a homier atmosphere, an attentive and pleasant staff, and a more serene environment,” Reid-Green said. “They take her outside, the other residents seem content, there’s no smell of urine in the hallways, the residents are treated with respect, and even aides from other wings say hello to her by name.”

Dogs are brought in for pet therapy, and children visit the residents. Solomon no longer needs antipsychotics, which are poorly metabolized by older adults and often overused.

“The take-home message: More expensive is not necessarily better,” Reid-Green said.

Making the decision

Nearly half of the residents in nursing homes are there because their dementia, primarily Alzheimer’s disease, has reached a point where caring for them at home has become unsustainable. They may wander from home, not knowing how to return or even who they are, or awaken many times a night, causing mayhem and exhausting their caregivers. Falls, fires and physical aggression often are ever-present dangers.

It’s not a sign of weakness – more likely a sign of strength – to move a loved one with advancing dementia to a nursing home. But it isn’t easy to find a place that offers the services and environment the patient needs.

Simply having a specialized dementia unit is not enough: The quality and extent of services may vary widely.

“There are different levels of dementia, and people with it have different needs,” said Joanna Leefer, author of “Almost Like Home,” a guide to choosing a nursing home.

“Although most nursing homes now have a dementia wing, they’re not all good,” she said. “I had to move my mother three times before I found the right place for her where my father, who didn’t have dementia, could live, too.”

Leefer recommends looking for a place with different levels of care. As dementia progresses, a resident’s needs will change. The nursing home must be able to adapt to those changes.

Some people with dementia benefit from stimulation, but overstimulation, like a noisy environment, can make others agitated and aggressive. Some homes rely too much on sedatives or antipsychotic drugs to calm aggressive behavior, experts say.

“Agitation can be triggered by factors like pain, anxiety, hunger or the need to toilet,” Leefer wrote. “Before assuming that sedatives are the only solution, a doctor should assess any possible underlying factors that might be triggering or aggravating a patient’s symptoms.”

Questions to ask

Leefer lists six crucial questions to ask when assessing a nursing home for someone with dementia.

One of the biggest challenges involves patients who wander. While some facilities lock the doors to residents’ rooms (or even tie them to their beds), others use a more humane approach: “Wander guards” worn by patients set off an alarm when they stray too far. Of course, all doors to the outside must be locked at all times.

But no matter how good a home might be, experts say that continued family support and involvement are critical to assuring good patient care. Plan to spend several hours with the patient on the day of admission, when anger, hurt and acting out are likely. Visit often on different days and times, and get to know the staff.

Finally, if the facility you choose does not offer personalized music therapy, which can reawaken “lost” memories and emotions in dementia patients, encourage the staff to watch “Alive Inside,” a documentary available on iTunes for $14.99.

This story was originally published September 8, 2014 at 8:37 AM.