This article is part of a series on elderly care. The series provides important information about caregiving practices.
A dementia diagnosis comes with a complex, overwhelming assortment of emotions for patients, caregivers, and family members alike. Adjusting to the diagnosis is incredibly difficult, and it’s important to understand that coming to terms with it isn’t going to happen overnight.
Instinctually, family members may snap into caregiving mode, but it’s important to take time to learn about the condition and consider what the options for dementia care are going forward, including in home care and nursing homes.
Caregivers must be patient and kind to themselves first and foremost in order to provide the best care possible.
How do you treat an elderly person with dementia? Below, find out more about dementia and gain insight into the various stages of the disorder and the relevant options for elderly care for dementia.
Table of Contents
What are the 7 Stages of Dementia?
‘Dementia’ is a disorder that can be caused by numerous diseases or traumatic brain injuries. The term is most commonly associated with Alzheimer’s disease because it is the most common cause of it.
All types of dementia are associated with similar symptoms, which become progressively worse as time goes by. These include memory loss and confusion, which manifests as behavioral problems, disorientation, and language problems.
Most sources suggest seven discernible stages to dementia, based on the ‘Global Deterioration Scale’ developed by Dr. Barry Resiberg, a leading expert on Alzheimer’s. Learn what they are below.
Stage 1. No observable impairment
Dementia is rarely diagnosed at the earliest stages, because it progresses very slowly. It’s impossible to notice it initially.
Stage 2. Early stage dementia (very mild cognitive decline)
Forgetting names and misplacing everyday items are occasionally symptomatic of very mild cognitive decline.
Again, this is unnoticeable, and is also indicative of plenty of other mild health problems, including general age-related mental decline.
Stage 3. Mild cognitive decline
- Memory loss
- Repetition
- Inability to navigate
At the third stage, dementia begins to make itself noticeable to other people, although it may not be apparent to the person suffering from it.
Increasing memory loss, inability to concentrate, and general disorganization are typical of this stage. Getting lost when navigating on foot or in a car may also be observed.
Stage 4. Mid stage dementia (moderate cognitive decline)
- Nonsocial, unresponsive
- Moody
- Denial
By the fourth stage, dementia is easier to diagnose, and is around the time when alarm bells start to be rung among family and friends.
It’s typified by a noticeable withdrawal from socializing, including periods of not responding or zoning out.
Mood swings may also occur, particularly as a result of the difficulty in sticking to routines. When questioned, the person may respond with denial.
Stage 5. Moderately severe cognitive decline
- Frequent bouts of intense confusion and delusion
- Memory loss, particularly regarding recent events, names, etc.
- Difficulty in problem-solving
Stage 5 dementia is when caregiving will need to be arranged to help loved ones with hygiene, dressing, eating. They might not need to be moved to a community immediately, but they will certainly need a carer in the home.
Stage 6. Late stage dementia (severe cognitive decline)
- Insomnia
- Paranoia, anxiety
- Inability to recognize loved ones
Though in reality this is a late stage form of dementia that will require full time care, this stage is sometimes referred to as ‘middle dementia’.
Basic activities will be mostly impossible to carry out without assistance. Sleeping issues will be observed, as well as a marked increase in paranoia and anxiety.
If money isn’t an issue, family members may want to consider moving patients to a community or care home, but be aware that this can cause severe distress. Full-time at home care may be a less distressing solution.
Stage 7. End stage dementia (very severe cognitive decline)
- Inability to speak
- Inability to walk
- Catatonia
Catatonia is common but under-diagnosed in dementia patients, according to research. End stage dementia is characterized by catatonic or near-catatonic symptoms: the person may be unable to walk, talk, or carry out any basic tasks.
They may be able to communicate with noises, but these will be illogical. They may refuse to eat, thereby becoming malnourished.
This stage is extremely taxing on informal caregivers, so professional care should be considered seriously. Doctors will need to come to assess the patient where they are, and they may recommend hospice care.
When Should a Dementia Patient Go Into Care?
As awkward, painful, and emotional as these conversations can be, family members will have to make big decisions alongside their loved ones—alongside, because it is important to respect the dignity and integrity of the individual diagnosed with dementia.
There is no clear answer as to when a dementia patient should go into or receive care, but it can make the decision easier to navigate when recognizing what types of care are necessary at what stages.
What is the best care for dementia patients
At stage 4 (moderate cognitive decline) or below, moving a dementia patient out of their own home isn’t necessary. A part-time carer or family member will be able to care for them adequately.
In the earlier stages of dementia, a combination of part-time or informal care and surveillance can help keep carers stay on top of things without always having to be present in person. Find out more about how indoor cameras like AlfredCamera can help provide adequate care.
However, if the patient has already received a diagnosis, having these conversations earlier is better than having them later. At later stages, which are typified by anxiety, paranoia, and mood swings, moving the patient from their home can cause serious emotional distress.
That’s why it’s also important to discuss power of attorney, guardianships, and other legal roles that the caregiver can take on during the early stages. As painful as it is to discuss these matters early into the diagnosis, it’s a necessary evil.
Bombarding someone that’s just received a diagnosis with talk of money is insensitive, but do recognize that a loss of the capacity to discuss property is an eventuality, not a possibility. Gently ease them into discussions in which they are able to clearly state their wants and needs.
Ask them if they wish to make or update their last will and testament, and arrange legal counsel if they do.
After stage 5, moving the patient out of the home may be considered, particularly if the caregiver is a family member with a full-time job. Have the doctor recommend communities and nursing homes.
At stage 7, hospice care will likely be necessary, particularly if the caregiver up until that point is unable to commit to 24/7 care. Ultimately, caregivers must try to respect the wishes of the patient, which is again why it’s important to have difficult discussions while they still retain capacity. If they had previously expressed a desire to home, for example, try to hire a live-in carer.
Don’t be afraid to ask the doctor for their opinion, even if it means being persistent. Invariably, caregivers will have to make difficult decisions on behalf of the person they are caring for. Consult with medical professionals, family members, and friends so that the input of others is respected.
What are signs that dementia is getting worse?
Early signs of severe cognitive decline are insomnia, paranoia, and anxiety. Anxiety and other mood problems are fuelled by difficulty sleeping, so it’ll be obvious that both get progressively worse at the same time.
The most painful sign of worsening dementia is the inability to recognize loved ones. Very severe dementia is characterized by catatonic or near-catatonic symptoms, like losing the ability to walk and talk, at which point full-time care is a necessity and will more than likely need to be carried out by professionals in a hospice.
In Home Care vs Dementia Care Facilities
Can a dementia patient be cared for at home? Yes, and many dementia patients will request being cared for at home for the remainder of their lives. It’s not an impossibility, but it will require full-time care during the later stages.
Hiring live-in carers may be necessary if informal caregivers are unable to dedicate themselves to 24/7 care, which is always a requirement of late stage dementia care.
In-home dementia care costs are more affordable than facilities, which include memory care facilities, dementia care facilities, and generalized nursing homes and hospices (which cater to elderly people with a range of health issues).
The national average cost for memory care in the US is $6,935 a month.
Difference Between Memory Care and Dementia Care
Services for dementia patients can be defined loosely as either ‘memory care’ or ‘dementia care’, though there’s significant overlap between the two.
A ‘memory care’ facility is a care facility that has a specific focus on memory-related conditions. Staff there will be capable of caring appropriately for those with dementia round-the-clock. It can be thought of as more appropriate for earlier stages of the disorder, because it isn’t as medically intensive as a specialized nursing home.
‘Dementia care’ facilities—i.e. nursing homes with dementia programs—are more relevant for later stages of the disorder. Patients will be able to access much more involved medical care to help them carry out basic daily tasks, like eating, washing, and so forth.
Does Medicaid Cover Dementia Care?
Memory care and dementia-based services are covered under the remit of Medicaid’s nursing facility services. Whether or not Medicaid provides home-based nursing care or nursing care in senior living facilities, however, is not the same across all states. Some may provide both, others may not.
Caregivers or family members will need to check with the State Medicaid Agency where they live to find out what benefits are available.
Medicaid covers:
- Nursing facility services (including memory care)
- Inpatient hospital services
- Outpatient hospital services
- Early and periodic screening, diagnostic, and treatment services
- Home health services
- Physician services
- Prescription drugs
- Federally qualified health center services
- Laboratory and X-ray services
- Transportation to medical care
Via https://www.seniorliving.org/memory-care/medicare-medicaid/
Will medicare pay for home health care for dementia? In a word, no. While a select few memory care and dementia-based services are covered under Medicare, long-term care (custodial care) is not covered by Medicare. There’s also plenty of additional costs it won’t cover, like prescriptions.
Relying on Medicare for dementia treatment is impossible because of how limited its coverage is for long-term healthcare.
Medicaid, other private insurance policies, personal assets, disability benefits, and veterans benefits are more useful ways to fund long-term dementia care, whether that winds up being in-home or in a facility.
Medicare covers:
- Cognitive impairment assessment, diagnosis, and person-centered care planning services
- Annual wellness visits (12 months after your enrollment in Medicare Part B)
- Inpatient hospitalization to treat an injury or illness
- Up to 100 days of skilled nursing care (must meet Medicare requirements)
- Durable medical equipment (DMEs)
- Home health care
- Hospice care costs for pain relief and management in end-stage dementia
- Inpatient care for clinical research studies
Via https://www.seniorliving.org/memory-care/medicare-medicaid/
Free care for dementia patients in the US is, frankly, impossible to come by. Strong private insurance policies are the most reliable way to fund care.
Financial help for dementia patients doesn’t exist on a universal level. However, veterans are able to access numerous benefits, which can help mitigate costs and provide health care services outright.
Similarly, if the person diagnosed believes they may be entitled to some form of benefits they have yet to claim, the benefit finder questionnaire can help point them in the right direction.
If money is an issue, caregivers should gently suggest to patients to consider applying for certain benefits if they believe they might be entitled to them.
For more information on how to go about funding dementia care, contact the Alzheimer’s Association.
FAQ
What is the best care for a dementia patient?
In the early stages of dementia, part-time or informal care will be more than sufficient. Upwards of stage 5, when the patient’s condition starts to exhibit signs of moderately severe cognitive decline, full-time care either in the home or in a facility that provides memory care or dedicated dementia care will be necessary. Caregivers must try to be as cognisant of the patient’s wishes as possible.
Can a dementia patient be cared for at home?
Yes, dementia patients can be cared for at home, and many choose to remain at home even in the later stages of the disorder. However, round-the-clock care will be necessary regardless of whether they are cared for at home or in a facility. Caregivers must navigate the wishes of the patient and the advice of the doctor. In the final stages, it may be deemed necessary to move to a hospice.
Can you die from dementia?
You can’t die from dementia, but the causes of dementia invariably lead to death. Dementia is an umbrella term referring to different diagnoses that cause cognitive decline. Most cases of dementia are caused by Alzheimer’s disease. Alzheimer’s disease isn’t ‘terminal’ in a conventional way, but it is progressive and incurable, meaning cognitive decline only worsens. The leading cause of death among Alzheimer’s patients is pneumonia, while fatalities caused by falls, malnutrition and infections are also common.
Conclusion & Resources
In 2005, a report stated that there is a dementia diagnosis once every 7 seconds. This was when 24 million people in the world had dementia. The report predicted that by 2020, 42 million people would have some form of dementia.
In reality, there’s now more than 55 million people living with dementia.
These are morbid facts, but they should serve as powerful reminders to patients, caregivers, family members, and friends of those diagnosed with dementia that they are far from alone in what they’re going through. It’s a tough fight, but it’s never one that is fought alone.
Dementia Resources for Family Members
The Alzheimer’s Association has a large array of support resources available for everyone to access, including information, virtual events, and a helpline. Check it out here to find out more.
Elderly Care Series:
Choosing The Best Indoor Camera For Elderly Care
20 Essential Elderly Care Supplies for New Caregivers
The True Cost of Elderly Care at Home
Getting to Grips with Levels of Elderly Care
What Are the Types of Elderly Care? The 6 Care Services You Need to Know
9 Effective Elderly Care Tips to Help Your Parents in their Golden Years
Sources
https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2019/november/stages-of-alzheimers
https://www.aegisliving.com/resource-center/the-stages-of-caregiving-the-changes-you-will-face-with-dementia/
https://rockymountainassistedliving.com/memory-care-and-dementia-care/#:~:text=Memory%20care%20generally%20offers%20superior,substantial%20difficulty%20performing%20everyday%20tasks.
https://www.seniorliving.org/memory-care/costs/