Meeting the Home Care Needs of Patients with Dementia & Alzheimer's Disease

For patients who want to be home but need ongoing care that can't be managed by friends or family, home health care services can be invaluable. Patients with dementia, including Alzheimer's disease, particularly benefit from receiving care in a familiar environment.

Flexibility, creativity, and consistency all come into play when providing home care services to this population: It's about promoting maximum independence while maintaining safety.

Generally, Medicare and managed care insurance will cover home care if there is a skilled need for services and the patient is homebound. Services typically include:

• Nursing for disease and symptom management, and medication teaching and management.  Many patients with dementia also have chronic medical issues that require the skilled intervention of home nursing. The home care nurse provides support and education for the patient and his or her family.
• Physical therapy can help patients maintain their flexibility and increase their strength and balance. The physical therapist assesses a patient's mobility and recommends equipment to help him or her maneuver safely at home; the therapist also evaluates the home and advises on how to prevent falls and promote maximum independence. We are fortunate that Hebrew SeniorLife's home care team includes a physical therapist who is a geriatric-certified specialist.  She is a wonderful resource for all of the clinicians at HSL Home Care.
• Occupational therapy helps with personal care skills like dressing and personal hygiene. The goal is to help maintain the patient's dignity while working within the constraints of the disease. For example, it's not uncommon for patients with Alzheimer's to avoid showering, because they fear the water spraying down on them. Modifying the environment (for example, making sure the bathroom is warm or using music to create a soothing ambience) may help the patient relax. In the early stages of dementia, the occupational therapist can focus on simple kitchen tasks, like making a sandwich or getting a drink from the refrigerator. 
• Speech therapy can help the patient preserve communication skills and cognitive functioning and address any swallowing problems. Routines and schedules are very important, especially in the early stages of dementia; speech therapists can create charts and calendars to help the patient stay focused and organized.
• Home health aides help patients with personal care, like sponge bathing and dressing.
• Social work services can assist families with accessing community resources and planning for the patient's immediate and long-term needs.

Patients who receive dementia home care benefit from receiving skilled care in their home because they're in a familiar, reassuring environment. Patients can also retain some sense of independence by having choices, from what time they have meals to choosing what to wear. 

Consistency is also critical to help minimize any confusion. Our patients with dementia are seen by the same team members who communicate with each other to ensure smooth coordination of services. This consistency helps to build trust between the patient and the home care team, which is imperative for a positive home care experience.

A home health care provider plays a key role in a patient's quality of life, so choosing the right one is an important decision. You'll want to consider the quality of care, availability of services, and personnel training and expertise.