Yesterday, for a modest fee, I was able to get copies of the doctor's notes regarding my DH's ALZ meetings with him...as an aside, I sent an email to each of the kids with just hte salient points, not the BP etc just the observations.... Anyway, in one of his remarks, he stated the necessity of nursing care should be considered sooner rather than later. He went on to add that patients " who are transferred to a nursing home facility after they are no longer able to comprehend that they have been moved, tend never to adapt to the new surroundings and do rather poorly."
When the subject of nursing home care came up in 2010 I told the doctor that as long as my DH knew his home, his surroundings here etc I was not about to move him from the place and things he recognizes and gives him pleasure. So what is the doc saying, that when moved at the point they no longer recognize their surroundings and are moved they do poorly and would they be doing less poorly if moved even when they do recognize home and things they like?
I worked with a GP, a geriatric specialist, the director of a nursing home which also had a respite center, and a case manager who had arranged the placement of hundreds of patients AD or not and they all agreed because I asked a lot of questions that it was so much better for my DW that she did not have the comprehension that she was moved - PRECISELY BECAUSE SHE HAD NO COMPREHENSION OF BEING MOVED!
Sorry. I know it's difficult to think about these things. How is it that a person without comprehension of where they are does not adapt to where they are? At any rate I asked this question directly and got a very clear answer.
My DH was placed for medical reasons beyond but in addition to his Dementia. He knew where he was and had at least some idea why, but it was weeks and finally having the Dr. say he had to stay because of all the care he needed, before he finally settled in. In his case his VaD made it harder for him to comprehend what was happening to him and why, but until the end he knew where he was, accepted it, but wasn't happy about it. Ironically, the Dementia became the secondary condition, not the one that took him.
Sorry, but that makes no sense to me, but I'm not a doctor. I agree with what Wolf said. Sid keeps telling me that he can't be separated from me. He can't sleep without me next to him. But if he didn't know the difference, I would think he would adjust to it.
I feel that as long as my DH knows where he is, is not lost in the house, enjoys looking at his airplanes etc etc..he is staying home..It seems to me that when they DON'T know where they are, nursing home vs home that it is not really so much an issue..I don't think a NH is needed yet unless he needs more nursing skills than I can provide here at home as regards his other health conditions.
I don't know what the doctor meant since not having talked to him. But, I have been told by the visiting nurses and the hospice nurses that have been here to see my dh. That most people when placed in a nursing home don't live as long as they probably would if they were kept at home. When I asked why does this happen...their reply was because they do not get the same care they get at home.
Some might think that is the reason not to place their spouse and others think it might be a blessing for them not to last very long. And, of course placement also can be because the caregiver can no longer lift the person out of bed or move them in their bed, etc. and there is no other choice but to have the placed.
So...I am not saying anything new. Each case is different and also some of the spouses have numerous conditions to consider.
Mimi--I felt like you do, wanted to keep Steve at home until he reached the point he didn't recognize it. It seemed a more humane approach to me that way--so I hung on with dear life until he reached the stage where it was apparent, he didn't realize where he was. I took him directly from the hospital geripsych ward to a dementia ALF. He never made one comment re going home/where are we/what is this place, etc. This was a year ago and he made a beautiful adjustment and is not functioning any lower than when he entered last August. I visit him every day and he has not made one statement that indicates he realizes anything is amiss--he recognizes me, is affectionate, but is strictly living in the moment. He is in late Stage 6, but is completely ambulatory and the AD has not affected him at all physically (yet), beyond his brain function. This would appear to be in direct conflict with what the doctor told you.
marilynmd that is so great to hear of your experience. How blessed you both are for this mostly smooth transition. I was almost ready to start placement for Dado after this nightmare of a July, and now., am going to hold off a bit . However I am going to view some places.
I agree with the others, that the views of that doctor seem a little unfounded.
That sounds silly to me. How can they not adapt to the "new surroundings" when they can not comprehend that they are IN new surroundings? People, including doctors, sometimes offer opinions based on what they would justify as the right thing to do if they were in that situation. Mimi, if keeping your DH home as long as possible is the right thing for you, than it is the right thing.
I have a feeling it's one of those things that has been passed to your doctor as "common AD wisdom," which is based on nothing more than one anecdotal experience, if that.
I'm with everyone else, and you, on this. I didn't want to move Jeff as long as he appreciated and recognized his home. Later, maladjustment problems probably have more to do with disruptive processes going on in their own heads (for which medication may be indicated) rather than being unable to adapt to the surroundings.