Alzheimer’s: When Living Alone Is No Longer An Option

The Royal Health Group has opened a memory care program at our Harwich assisted living facility. The following is the latest in a series of articles by Maureen Bradley, Director of the Royal Innovation: Alzheimer’s Care program for Royal.

When Your Loved One Can No Longer Live Alone

By Maureen Bradley LPN, CDP

Director, “Royal Innovation: Alzheimer’s Care” Program for the Royal Health Group

It is the sad truth about Alzheimer’s: there comes a time when your loved one is no longer able to live alone. The telltale signs are everywhere: Their living space is not as clean as it used to be; they forget appointments; they may even call you multiple times a day with the same request. They are forgetting to pay their bills, and are not as in tune with their personal hygiene as they should be. You worry about them constantly and know in your heart they should not be on their own, but perhaps you have a full time job, or are just no longer able to be the caregiver twenty four hours a day, seven days a week.

So what are the options?

Some families will assign different family members to stay in the home with the loved one. This may be manageable if you do not work, or don’t have a family of your own. But few are able to put their lives on hold for an extended period of time. And things happen: people get sick, for example, or unexpected responsibilities at work may keep you away. Being a family caregiver can work for a short period, but with a lengthy commitment it can cause friction even in the closest of families.

Hiring live-in help is an expensive option and not always reliable. If you hire someone and they get sick, what do you do? How quickly can you find a replacement? How do you know what goes on when you are not there? Is your loved one sitting in a chair watching TV all day? Are they being taken outside, out to lunch, out for a walk? Is their customary routine being followed or is it all about the caregiver’s routine?

One solution is to supplement live-in help with a supportive day program. This is a great option if you can afford it, because your loved one will be engaging with others who have the same memory issues, enabling them to build relationships.  And more activity means more energy burned and less boredom, which in turn will help them sleep more soundly at night. 

Things you should look for in a program

Are the participants engaged? Does the staff interact well with the clients? Do they go on outings?  What does a typical day look like? Is there a place for them to sit alone when they need to be by themselves? What is the staff-to-participant ratio? Does the environment look clean with no odors? Ask to look at a daily activity schedule – is there variety in the day? This also allows them to live in their own environment. Remember that even if you secure a day program, you will still need to find help for nights and weekends.

A nice option: assisted living

An assisted living facility may be the best choice for a memory-impaired loved one, but only if the home has a dedicated memory-impaired unit. Many assisted living centers will admit people with cognitive issues, but not have specialized programs in place. This is a recipe for failure, as the staff is not trained in dealing with memory-impaired people, and residents who are do not have cognitive issues will generally not like being with those who do. The memory-impaired person will likely have trouble fitting in during activities. Since the unit is likely not secure in this setting, your loved one may decide to go for a walk and not be able to find their way back.

You need a memory-impaired unit

But not just any memory-impaired unit. When you walk in, take in the environment. Is it calm and comfortable or does it look like a hotel? “Home” is not a hotel; it’s a comfortable place with things people can touch and rearrange. Most homes do not have beautiful chandeliers and silk furniture. Who could be comfortable in an environment that makes a person feel as though she must be on her best behavior? I want to be able to walk barefoot or grab an afghan and curl up in a chair. And is there a kitchen – supervised, of course – where the residents can cook?

Other signs of quality

Look at the residents – are they smiling? Are they engaged, or are all the people in the common areas sleeping? Is there an activity going on? If so, take note of the number of residents taking part; if there are only a few involved in an activity, it may mean there are many others left alone in their rooms. What you want to see are actively engaged, happy residents enjoying a failure-free, calm environment.

Does the staff look happy? Do the residents eat together or in their rooms? You want them to eat together because meal times are social events. Does the dining area have a homey look, or does it present more like a restaurant? Where would you be more comfortable? Well, the same is true for your loved one.

Is the staff trained?  Do they have monthly in-services? Are the apartments safe? For example, microwave ovens pose a danger for a memory-impaired person. Is there an outside area where they can sit and enjoy the fresh air or plant a garden? Do they go on outings? If so, how often, and where to?

Moving out of the home is a difficult decision, just one of many difficult choices you will have to make in the wake of an Alzheimer’s or dementia diagnoses. You’ve been doing a great job as a caregiver, but the time may come when another address is a better option for both you and your loved one. The answers to these questions should help you make the best decision for your family.

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The Royal Health Group offers the Royal Innovation: Alzheimer’s Care program at its nursing centers in Braintree, Bourne, Fairhaven and Falmouth. Royal’s latest initiative in this area is the Transitions Memory Care program at the Royal at Harwich Village,  an assisted living community on the lower Cape, now with a dedicated floor for Alzheimer’s/dementia residents. Learn more at