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Ask the Caregiving Expert

More on Care Transitions and Social Services

What caregiving resources exist for a loved one with a prosthetic leg? Robyn Golden shares her advice on this and more

Q: My husband is in a nursing home because he can't walk on his own. He also has dementia. I don't think he's getting the best care, so I want to bring him home. He'll need 24-hour care. How can we do this?

A: It's important to think about how you came to the decision to put your husband in a nursing home in the first place. Are things that different now? You may want to consider ways to improve the care where he is or look for another facility, before bringing him home for 24-hour care. Consider, too, that people with dementia get more stimulation in an environment with other people around than at home in a one-on-one situation. If you do bring him home, realize that 24-hour care can be expensive and tricky to manage. Also, you will need to be comfortable with a third person in the house all the time. It's possible to find good care.

I prefer to go through an agency. That way you have someone supervising the situation, managing employees and making sure there is backup care. Or you can go on the private market and use someone who is recommended. That works well, too. There is a whole realm of private care managers who can help coordinate and provide oversight. Once your husband is home, you become not only a hands-on caregiver again but also a business employer, and that's not a good fit for everybody.

Portrait of a senior couple. Ask the Caregiving Expert

Stimulation in an environment with other people is important for those with dementia. — Maskot/Corbis

Q: How do I find resources to care for my father-in-law, who recently had a leg amputated? He is 72 years old and also has several medical conditions such as diabetes and high blood pressure. We plan to care for him at home after he's released from the facility. I'll need to find a hospital bed and learn how to care for his prosthetic leg.

A: Ask your physician, who should be connected with social workers to help you navigate these resources. Home health care agencies also are helpful at finding medical equipment, such as a medical bed, and helping people learn how to take care of a prosthesis. To find home health agencies, go to your area council on aging, or consult with your discharge planning professional at the hospital or rehab agency. Check out the quality of home health care agencies on the Center for Medicare and Medicaid Services website.

Q: How do I determine if my 92-year-old mother, who has dementia, should be moved from her assisted-living facility to skilled nursing care?

A: When you hear from staff that there is a problem, things are being missed or her needs aren't being met. It could be behavioral — your mom is not getting along at the dinner table or others are having a hard time understanding her when she speaks. Or she may look thinner or not be taking her medicine. If she begins to wander in the neighborhood, it could be an issue of safety. Request a meeting with those in the assisted-living facility. Talk to the aides, nurses, a social worker or director on her floor. Some assisted-living facilities are better at dealing with dementia than others. Also, whoever is treating her dementia — a geriatrician or a memory center treating her cognitive issues — should weigh in on your mother's condition to see if her health status has changed before making the move.

Robyn Golden, LCSW, is director of health and aging for Rush University Medical Center in Chicago; she is also a member of the AARP Caregiving Advisory Panel.

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