Dementia is a progressive disease that begins with virtually unnoticeable memory blips and develops into a situation where adults cannot remain independently safe, secure, and well.
Because there’s no “one point” or a prescribed date when an adult with dementia moves from independent to care-dependent, it’s up to loved ones and caregivers to recognize the signs indicating that more support and care are needed.
Scaled Support for a Loved One With Dementia
A dementia diagnosis deserves the immediate creation of a long-term dementia care plan, including in-home care and support as the disease progresses. At first, this plan accommodates ways to support daily needs such as transportation, meal planning and preparation, errand running, and medication reminders. However, by mid-to-late-stage dementia, families need to think about 24-hour care.
There are many misconceptions about home care, including that it’s only a short-term option, which isn’t the case. In-home care is an ideal option for adults with dementia who want to age in place independently because it allows for the ability to scale up appropriately as dementia-related progressions continue.
Understanding that support needs increase proportionally with disease progression helps families make proactive care decisions.
Stage One: The Beginning
Home care services in the beginning stages of dementia have two main purposes.
- The first is establishing part-time shifts that ease the way to establish a comfortable relationship with the client, their spouse, and family. This is especially important if clients are initially resistant to in-home care services.
- The second is to support daily tasks and activities that become harder or more dangerous with memory loss.
At this stage, home care support includes things like:
- Companionship for clients that live alone since social engagement and mental stimulation improve quality of life and slow down dementia progression
- Respite care for spouse and family caregivers who need regular breaks to prevent caregiver fatigue or burnout
- Transportation when it’s no longer safe for clients to drive, including transportation for social engagements, club meetings, or other outings aligned with the client’s interests
- Errand running
- Meal planning and preparation
- Medication reminders
Stage Two: Mid-Stage Dementia
By the middle stages of dementia, clients are no longer safe to be in their homes without some level of supervision. Loved ones who seem clear-headed and “just like themselves” one minute can rapidly shift into confusion, agitation, and significant forgetfulness, compromising their safety—or the safety and wellbeing of others.
This is the stage clients are more likely to:
- Get lost on familiar routes, unable to find their way back home
- Wander out of the house late at night or in the wee hours
- Have trouble recognizing formerly dear friends, neighbors, or family members
- Begin showing signs of sundowning, irritation, or unusual angry/violent outbursts
- Forget to turn off the stove or oven, or forget to blow out candles
- Lose track of days and times, skip meals, or forget to perform daily hygiene tasks
- Shuffle more and have trouble with balance and gait
At this point, caregiving is a full-time job because there’s no way to predict or determine lucid from non-lucid moments. Consistent supervision is essential to ensure the client’s dignity and overall independence.
If a loved one who lives alone progresses to this point, full-time (live-in) care is essential. This doesn’t mean hiring one person to move in. Instead, professional home care agencies implement a team of regular caregivers who work shifts around the clock.
Mid-Stage Dementia Support
At this point, it’s not healthy for a single individual to provide full-time care. The tasks are overwhelming, and caregivers develop deep fatigue and burnout.
If you’re wondering at what point dementia patients need 24-hour care, the slide into mid-stage dementia behaviors is a strong red flag.
In addition to the services listed for early dementia (companion services, transportation, support with daily tasks, making meals/snacks, etc.), clients with mid-stage dementia need:
- 24-hour supervision by caregivers who are fully awake and alert, minimizing trip/fall accidents and preventing wandering at any time
- Respite care to relieve primary spouse/family caregivers
- Personal care to provide a safe and consistent hygiene routine
- Meal provision, reminders, and encouragement to eat and hydrate
- Toileting/incontinence care
- Knowledgeable, compassionate support for increasingly agitated or angry episodes
- Help with using phones or technology to connect with family members and friends
- Weekly light housekeeping, organization, laundry, and bed/towel linen changes
We want to emphasize the first bullet point. When a loved one moves into the mid-stage dementia phase, they need caregivers who are awake and alert around the clock. If family members can rotate caregiving shifts, you might look into professional overnight in-home care services to keep you covered until 24-hour care is required.
Stage Three: Late-Stage Dementia Care
By the time aging loved ones head into late-stage dementia, they are mostly chair- or bed-bound. For those still mobile, assistance while moving and transitioning/transferring from place to place is critical because clients are weak and struggle with balance.
Your loved one may only recognize a few people (or nobody at all), and it may feel as if they’re living in a different reality. Clients sleep a lot at this stage and may need to be fed. Toileting and incontinence care are a must.
This is often the time when hospice care is brought in, and our 24-hour in-home caregivers partner seamlessly with hospice to provide high-quality care and support for clients and their families.
In-Home Care: Scheduling an Assessment Is the First Step
Scheduling an assessment by an experienced, licensed Inland Empire home care agency is a helpful and objective way to determine whether or not it’s time to implement 24-hour dementia care.
Families Choice Home Care is a family-owned home care agency that specializes in memory care. Our assessments are always free and carry no obligation. What’s most important to us is that you have the information necessary to make the best long-term care plans for your loved one.
