How to Choose Care For a Loved One With Alzheimer’s

Like Alzheimer’s disease, the caregiving needs of someone with Alzheimer’s or another dementia will progress over time. The more caregivers anticipate disease-related changes and educate themselves about caregiving options and resources in their local communities, the better prepared they will be to ensure their loved one or family member remains safe while getting the care they need.

“In the wake of an Alzheimer’s or dementia diagnosis, it is important for caregivers to think about care as a continuum,” said Monica Moreno, senior director, care and support for the Alzheimer’s Association. “The average life expectancy following an Alzheimer’s diagnosis is four-eight years, but some individuals can live with the disease longer, up to 20 years. So it’s important for caregivers to reassess care decisions and options regularly.”

Anticipating Care Needs 

Alzheimer's disease typically progresses slowly in three general stages — mild (early stage), moderate (middle stage), and severe (late stage). Since Alzheimer's affects people differently, each person will experience symptoms - or progress through Alzheimer's stages - differently.

In the early stage of Alzheimer’s disease, most people can function independently and may continue to live independently. The person may still be able to drive and can participate in favorite activities. However, they may need medication reminders or help with remembering appointments. 

Middle-stage Alzheimer’s is usually the longest and can last many years. Individuals in the middle stage can often still participate in conversations, activities, and their daily care, like dressing, bathing, and using the toilet. However, they will need additional support for these activities over time. 

Late-stage Alzheimer’s disease is when people will experience major declines in their ability to respond to their environment or carry on a conversation and will eventually be dependent upon others for all of their care.

Assessing Care Needs 

“The first step in choosing the right care provider is determining the current care needs of the person living with dementia,” Moreno said. “Whenever possible, especially during the early stage of the disease, involve the person living with dementia in both current and future care decisions. Knowing their care wishes can be helpful in guiding these decisions.” 

Some important questions to ask yourself as you evaluate care needs: 

• Safety: Is the person living with dementia safe? What type of supervision is necessary? Does the person require supervision for some activities, such as cooking or using certain appliances? Does the person need 24-hour supervision or care?

• Health: Does the health of the person with dementia require specialized care? Does he or she require help with medications?

• Care: Does the person with dementia need more care than they are receiving right now? Does the person need help toileting, bathing, dressing, or grooming? Is caring for the person becoming difficult for you? Can you physically manage to provide the care needed?

• Social engagement: Is the person with dementia engaged in meaningful activities during the day? Would spending time with other people living with dementia be beneficial?

Care Options

There is no one-size-fits-all formula when it comes to Alzheimer's care. Needs change at different stages of the disease, and each family's situation is unique. However, here are some common care options you can consider depending on the disease stage.

In-Home Care

In-home care includes a wide range of services provided in the home rather than in a hospital or care community. It can allow a person with Alzheimer's or other dementia to stay in his or her own home. It also can be of great assistance to caregivers. 

In-home care services can range from simple companion care to help with bathing, dressing, or meal preparation. Home health care can include skilled care typically delivered by a licensed health professional or therapist after being ordered by a physician. 

Adult Day Centers

Adult day centers offer people with Alzheimer's and other dementias the opportunity to be social and to participate in activities in a safe environment. In addition, an adult day center can be very helpful as you try to balance a job with caregiving duties. Hours of service vary at each center, but some are open from seven to 10 hours per day. Some also may offer weekend and evening hours, and transportation and meals are often provided.

Respite Care

Respite care can be provided at home — by a friend, other family member, volunteer, or paid service — or in a care setting, such as adult day care or long-term care community. Respite care provides caregivers a temporary rest from caregiving while the person living with Alzheimer's continues to receive care in a safe environment. Using respite services can support and strengthen your ability to be a caregiver.

Long-term Residential Care

If the person with Alzheimer's or other dementia prefers a communal living environment or needs more care than can be provided at home, a long-term care setting may be the best option. Different types of communities provide different levels of care, depending on the person's needs. These include:

• Independent Living/Retirement Housing: This may be appropriate for individuals living with early-stage Alzheimer’s who can care for themselves but are challenged managing a household.

• Assisted Living: Offers greater supervision of residents but not round-the-clock medical care.

• Skilled Nursing (Nursing home or long-term care): Provides round-the-clock supervision and medical care.

• Memory Care Units: A specialized care unit, either independent or within nursing homes, designed to meet the specific needs of people living with Alzheimer’s and other dementias.

• Life Plan Communities (also known as continuing care retirement communities): Provides different levels of care (independent, assisted living, and nursing home) based on individual needs. A resident can move through the different levels of care within the community as their needs change.

Tips for Choosing a Care Provider

“Choosing a care provider, regardless of care setting, requires homework,” Moreno said. “Location, cost, and care services are always factors in making a decision, but we encourage people to dig deeper and ask others for referrals and then screen any provider you are considering. You want to find a care provider whom you trust and who interacts well with your loved one.”

Making a Decision Can Be Stressful 

“Making decisions about a loved one’s care can be extremely stressful,” Moreno said. “Family members often feel guilty and wonder if they are doing the right thing. It’s important, however, to remember these decisions are about making sure a loved one is getting the care they need. Making difficult decisions to ensure that is the best thing you can do as a caregiver.” 

Help is Available

Caregiving for someone living with Alzheimer’s or another dementia can be stressful, but the Alzheimer’s Association is here to help. Our caregiving web pages have robust information about caregiving throughout the disease continuum, various care options, and resources to help with financial and legal planning.  

The Alzheimer’s Association Community Resource Finder can help families find local residential care options by simply entering their zip code.

In addition, the Alzheimer’s Association 24-7 Helpline (800-272-3900) is staffed by master’s level clinicians and specialists who are available 365 days a year and can help families navigate a variety of disease-related issues. For more information: go to ALZ.org.