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Institutionalization

Decisions about placing a family member in a nursing home or long term care institution are extremely difficult and stressful. The decision is usually made as a last resort when family capabilities and resources are exhausted or when caregivers have experienced caregiver burnout and exhaustion. Unfortunately, there is no way to determine the "right" time to consider institutionalization. There are, however, some indicators that may be helpful. An important factor to consider is that waiting lists for nursing homes can be very long (potentially several years) so one should consider making arrangements for nursing home placements long before such placement is needed. Click the icon below to view a video from Dr. Guy Proulx concerning the move to long term care.

Institutionalization Indicators
The following are potential indicators of the need to consider institutionalization:

  • Deterioration
  • Caregiver stress
  • Financial hardship
  • Family conflict

Indicator
Points
Deterioration
  • Dementia is a progressive neurological disease.
  • As the severity of impairment increases, the incidence of challenging behaviours often increases (e.g. aggression, hallucinations, incontinence, confusion, wandering).
  • As individuals continue to deteriorate it becomes increasingly difficult to provide the level of physical and emotional care required.


Indicator
Points
Caregiver
Stress
  • Caregiver stress and burden is a significant issue for those who provide care for individuals with dementia (this is true for both family caregivers and for nurses and professional caregivers). Extended periods of stress can result in "caregiver burnout".
  • Burnout is associated with increased physical health problems (e.g., decreased immune system functioning) as well as mental health problems (e.g., depression).
  • If you are feeling increasingly stressed and burdened by the care you provide and your health is suffering you should consider institutionalization.


Indicator
Points
Financial
Hardship
  • Balancing work and caregiving demands may result in financial hardship, either through loss of work or the financial burden of paying additional caregivers.
  • There may also be costs involved in adapting the environment to make it safe and comfortable for individuals with dementia.


Indicator
Points
Family
Conflict
  • Family conflicts can occur from perceived inequities between the needs of family members and the sharing of responsibility for care for the individual with dementia.
  • Communication may break down and decision-making regarding care may become fragmented and ineffective.
  • Ideally, decisions about institutionalization should take place within families as early as possible in the disease process.



 
 
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