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On The Fence: When Is It Time For Placement?


I run into this scenario on a weekly basis.

A parent with dementia lives with an adult child.  The adult child works, has kids, or has other responsibilities that take them out of the home for several hours every day.

There have been a few minor incidents when the cognitively impaired adult was left alone for a few hours… he got the lawn mower out, she moved the car, he left the refrigerator door open, she took a double dose of medicine.  In each case, the caregiver made an environmental adjustment to solve each particular issue.    Part-time paid help has been implemented, but there are still gaps in supervision.

Most of the time the parent with dementia is safe and reasonable.  The paid caregivers sit on the couch checking Instagram and Twitter.  Their presence usually feels invasive and unnecessary.

The potential for new problems exists daily.  Some days are smooth sailing.  Others are more challenging. This causes the caregiver great stress, and many battles are born from the conflict between both parties.  The caregiver is stressed, torn, tired, and broke.  The person with dementia is defensive, scared, and feels entitled to exercise his or her right to self-determination.

The adult child wants to place the parent in a care facility.  At the same time, the adult child does not want to ever place the parent in a care facility.  The parent with dementia does not want to be a burden, nor does he or she want to move into a facility and have major life decisions decided for them.

Cognitive testing has been completed.  General recommendations have been made.  But this parent is still quite functional and only makes occasional errors in judgment.  Leaving him or her alone is like leaving a nine year old home alone.  There may be a risk of injury, but it’s not against the law.

This is where the flames of the caregiver’s double-ended candle start to burn with exhausting intensity.  The weight of the placement decision is crushing and difficult.  A semi-catastrophic incident would be a welcome tie-breaker, but avoiding these events is what good caregiving is all about.  The caregiver is not free to come and go, and healthy choices to exercise or socialize feel selfish with limited time and resources.  Limbo can be a miserable place to live.

So I put this to you readers.  What advice do you have for these caregivers?  Which side of fence do you stand on? The age-in-place-and-let-nature-take-its-course philosophy?  Or the I-need-to-keep-you-safe-at-all-costs camp?

This conversation could be quite helpful.  I know dozens of people right now weighing the options.  Please comment below.

When is it time for placement?

(And for the sake of having a simple discussion, let’s assume that the financial resources of the family are very middle of the road… some savings, a few assets, not looking for the Ritz but maybe a reasonable Holiday Inn.)

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