What are the best dementia nurses

From: Alzheimer Info 2/14

Living at home with dementia: options for outpatient care for people with dementia

"Outpatient before inpatient" - this is the motto for nursing and medical care in Germany. Outpatient care is usually cheaper than inpatient. In most cases, it also meets the needs of people in need of care. In fact, around two thirds live in Germany of all dementia sufferers in private households.They are predominantly looked after and cared for by relatives, friends and neighbors, in some cases with the support of professional or voluntary helpers.

In recent years, a number of different offers have been developed that want to enable people with dementia and their relatives to lead a better life with and in spite of dementia. However, the full range of these offers is not available everywhere, financing is sometimes difficult and there is often a lack of networking between the offers. Therefore, early and competent advice is particularly important for people with dementia and their families.

For many people, the family doctor is the first point of contact. That is why a good family doctor should be familiar with the diagnosis and treatment of dementia. He should know when it is advisable to consult a specialist, and he should have both the address and the opening times of the nearest dementia and care center to hand. In the best case scenario, if desired, he will arrange a consultation for his patient right out of the consultation hour.

In the consultation at a local Alzheimer's society, a care support center, a dementia or elderly advice center, it can be jointly considered which support offers are individually required at the current time. On the one hand, it is about relief offers for the carers, who often only find out during the consultation how important it is to relieve themselves and to have times of relaxation in order to regain strength. It is also a matter of discussing visits to a care group, sports or music offer for the sick.

There are no patent remedies for home care and care for people with dementia. It is always important to find individual solutions that depend on the wishes of the sick person, the current symptoms of the disease, the possibilities of the relatives, the available financial resources, as well as the offers on site, which are different in the city than in the country. Even if appropriate professional or voluntary services are used, it remains very important that relatives, friends and neighbors are included. It is usually a good idea to spread the load over several shoulders.

A future vision would be a society in which all citizens feel jointly responsible for those in their environment, their village or neighborhood who need support to participate in community life - be it people with dementia and their relatives, wheelchair users or single parents with small children. As Thomas Klie shows in his book “Who cares about the elderly”, there are already some congregations in Germany that have set out to become a “caring community”. They proudly emphasize: "We are neighbors!"

How care can be organized - an example

Ms. Koch takes care of her mother who has dementia and lives in the neighboring house. Ms. Koch works, so four days a week from 8:30 a.m. to 4:00 p.m. it must be ensured that someone else looks after her mother. The mother can stay alone for another hour or two, but then becomes restless, scared or begins to clear out all the cupboards. She also forgets to eat and drink if no one reminds her. Because she now also needs a lot of help with dressing and undressing, she was awarded care level 1. Ms. Koch has contacted the local Alzheimer's Society to clarify whether her mother's care can be organized in such a way that she can continue to work. From the daughter's point of view, placement in day care four days a week would be the cheapest solution. But it quickly became clear that it is not that simple:

  • The daily rate in the facility near you that specializes in dementia is € 75. With the benefits of long-term care insurance, you can only finance six days per month.
  • A cheaper day care is only available 30 km away, but there the admission of dementia patients is only possible in exceptional cases.
  • A trial visit to the day care on site showed that Ms. Koch's mother was very unsettled by the unfamiliar environment. Allow time to get used to it. And it would be good if she came regularly two days a week so that she can develop a steady rhythm.
  • In addition, the car service would pick up the mother at 7.45 a.m., so Ms. Koch would have to have her ready by then by helping with washing, getting dressed and having breakfast - a procedure that usually takes more than an hour.

Nevertheless, Ms. Koch finally decides to register her mother in day care for two days a week. The additional costs are covered from the mother's “old age” reserves. For the other two days, Ms. Koch organizes a care mix with the support of the counselor: On Tuesdays, a neighbor is ready to look after the mother from 9 a.m. to 1 p.m., have lunch with her and then accompany her to the care group of the Alzheimer's Society . The mother feels at home there very quickly because she is looked after by a volunteer helper with whom she can talk about her favorite topic, cake recipes. Then Ms. Koch can pick you up there.

Friday was the hardest to organize. Finally, the daughter hired a housekeeper to clean the mother's apartment for two hours in the mornings and also to do the laundry. This is reluctantly accepted by the mother. At lunchtime, the “mobile lunch table” brings a warm meal and the driver only leaves when the mother is sitting at the table with a fork in her hand. And in the afternoon a lady from the parish drops by again for about two hours, who sings with her mother and plays dominoes.

Ms. Koch finances the contribution for the care group from the “additional care benefits” of the long-term care insurance, the expense allowance for the neighbors and the lady from the community and the wages of the domestic help from the care allowance for care level 1. This mix currently works relatively well. However, if the need for support from Ms. Koch's mother increases and she can no longer stay alone, a new arrangement will be necessary.

Susanna Saxl
German Alzheimer's Society, Berlin