Nursing Home

As dementia progresses, most patients develop severe functional deficits or behavior problems that make living at home impossible, even with the most dedicated family caregivers supported by home health care workers. Nursing home admission is a traumatic experience for the patient and family even in the best of circumstances. The trauma is reduced if the admission can be anticipated and the patient and family have meaningful involvement in the decision-making process.

The physician's role in caring for the dementia patient in the nursing home includes direct patient care and IDT communication. The physician and family can help the nursing home staff learn the patient's premorbid status and personality to identify any idiosyncrasies that could be helpful when providing care (e.g., "She always calms down if she has chocolate milk"). Open and efficient communication with nursing home staff enhances patient care and promotes creative problem solving.

It is necessary to see the dementia patient in the facility for most visits because transporting the patient to the office is often burdensome for the patient and can precipitate a florid delirium. On-site visits can also facilitate communication with the nursing home staff. Professional groups have provided formal guidance for nursing home attending physicians (Besdine et al., 1996). Physician and family confidence in the care provided in the nursing home allows for quality end-of-life care without the need for hospital transfer when signs of imminent demise are evident.

Advocacy organization for patients and families dealing with Alzheimer's disease and other dementias; useful patient and care-giver education materials; also offers information for physicians and other professionals. www.lbda.org

Advocacy organization for patients and families dealing with Lewy body dementia; useful patient and caregiver education materials; also offers information for physicians and other professionals.

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