May Caregiver Connection: How to Know When It’s Time for Long Term Care

The decision to place a loved one with dementia in a long term care facility isn’t easy for most families.  Many seniors prefer to remain in their homes, and because changes in functioning due to dementia can be gradual, it is easy to put off making this difficult decision.  However, as with all things related to Alzheimer’s, it’s much better to anticipate a need than to have to respond to one in a crisis.  Below are examples of signs that your loved one may be better cared for in a long term care facility to help inform your family’s decision.


Whether your loved one lives alone or in your home, as their dementia progresses they will need increasing levels of supervision in order to ensure their safety.  If the person with dementia is prone to restlessness, pacing, or is easily disoriented in the home, they may be one of the 60% of people with Alzheimer’s disease who will wander.  Keeping the person engaged in activities, making sure that they get some level of physical activity, and securing their living space to prevent exit-seeking are some ways to prevent this behavior, but these methods require a large investment of time and attention from the caregiver.  In a long-term care facility that is designed and staffed to meet these needs, wandering is not as great a concern.  Another potential danger is falling.  If your loved one shows signs of poor balance, if their gait becomes more shuffling, or if you are noticing changes in their vision or depth perception, they may be at risk of falling.  In the home environment where the person may have to accommodate stairs, throw rugs, cluttered or poorly lit walkways, or may have small animals or children underfoot, this risk increases. It can be very difficult for a person with dementia to recover from a fall, and they are best avoided.  A long term care facility is not only designed to minimize these hazards, but also is staffed to respond to a fall more expediently.  Medications are another concern.  If your loved one is mis-administering their own medications, or is unable to correctly manage a chronic health condition like diabetes, and the caregiver is unable to provide the level of medical support necessary, this might be a factor that contributes to the decision to place the person in long term care.  Also consider that as the person loses their ability to communicate their symptoms using language, it is helpful to have a trained professional with the training to detect infection, illness, or injury.

Personal Care

Another indication that it might be time for your loved one to make the transition to a long term care facility is a change in their ability to manage personal care tasks.  It is common for a person with dementia living alone to neglect bathing, changing and washing clothes, and other personal grooming needs.  The person will eventually need help toileting and managing their incontinence.  They may also have difficulty maintaining healthy eating habits due to memory loss or changes in appetite.  If you notice your loved one rapidly losing or gaining weight, or if you notice stale, spoiled, or expired food stored in their home, this may be a warning that living independently is no longer a healthy choice for them.

Problems Managing Household

Keeping a home in working order takes a lot of work and organization.  Household management tasks may outstrip the abilities of a person with dementia living alone.  You may notice unanswered mail piling up, and may find that your loved one is no longer capable of managing their checkbook or remembering to pay monthly bills.  You may notice a general decline in the cleanliness of their home, and excessive clutter may begin to accumulate.  Another canary in the mineshaft is the status of your loved one’s pets – they may be over or underfed, may be soiling the home, or may be otherwise neglected.


Alzheimer’s disease impairs a person’s ability to communicate, regulate emotions, remain focused on a task, and cope with unpredictable situations.  Because of these changes, it is difficult for a person with Alzheimer’s to remain engaged in formerly meaningful hobbies or to maintain their relationships.  Social and intellectual stimulation is not only important for a person’s quality of life, but it has important cognitive benefits as well.  People with dementia need a lot of support in social situations, and need activities to be appropriately tailored to their ability level.  Those who don’t receive this type of support may become isolated and disengaged.  If your loved one spends most of their time sleeping or watching television or otherwise unoccupied, they may benefit from the structure and community of a long term care setting.

Caregiver Burnout

Reading this article, you may have thought that a better solution might be for you to assume responsibility for these aspects of your loved one’s care.  It is common for caregivers to gradually take on more and more of their loved one’s care needs, often moving the person with dementia into their home and assuming full-time responsibility for their care.  While this is a very loving act, it isn’t always the best way to ensure that the person with dementia is well cared for.  Over time, the stress of managing their life in addition to your own may become overwhelming, and it is very common for family caregivers to suffer emotional and physical consequences from spreading themselves too thin.  Meanwhile, the person with dementia’s needs will only increase with time.  In the later stages of Alzheimer’s disease, the person will be completely reliant on their caregiver for all of their personal care needs, including bathing, feeding, dressing, and toileting.  Their care will require physical strength as well as consistent patience and positivity.  A caregiver who is depressed, irritable, poorly rested, and overwhelmed is not as capable of providing high quality care as a staff of trained professionals in a setting more suited to caring for an elderly person with a disability.  Consider how your own well-being affects your loved one’s care, and don’t discount this factor in making the decision about a transition to long term care.

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