A Stay-at-Home Option for Alzheimer's Care.

This facility is assisting family caregivers at home

He taught you the box step and grilled the boy who took you to your first dance. He gave up his golf game to instruct you on the fine art of parallel parking. He walked you down the aisle. The years have rolled by, and now it's your turn to protect, encourage, nurture and care for your first love--your dad.

When the heartbreaking diagnosis of Alzheimer's disease is pronounced, many people vow that they can and will manage to keep their loved one close at home. But then reality sets in and symptoms begin to manifest themselves in ways that no one could have predicted. It becomes harder and harder for a caregiver to balance family life with the increasing demands of the illness. If only there was help....

Bethany Terrace Nursing Centre (Morton Grove, Illinois) was one of the first facilities in Illinois with a formal Alzheimer's program, established in 1984. Recognizing in the years since then the dedication and desire necessary to care for a person with Alzheimer's disease or other types of dementia in a warm, loving household, Bethany Terrace introduced the Alzheimer and Dementia Assistance Program of the Terrace (A.D.A.P.T.) this past January 16. Through home visits, assessments, an Alzheimer's/dementia-dedicated library and a comprehensive resource guide, A.D.A.P.T. is designed, in the words of its literature, "to assist families in exploring available homecare options for aging relatives at no cost or obligation."

A member of the United Methodist Association, Bethany Terrace Nursing Centre is a 273-bed long-term care facility with 126 beds in the Alzheimer's program. It is a facility with a difference, though--it extends its services directly into caregivers' homes. Acknowledging that a family might not be ready to place its loved one in a nursing home, Bethany Terrace conducts tours to acquaint them with life in long-term care. Anne Schnur, the facility's Alzheimer's and dementia director, moderates a monthly support group for caregivers of loved ones with Alzheimer's or dementia. Those who tour the facility are invited to join the support group to meet people who are or have been going through the same experience. Participation in the group gives the family a comfort level with the facility and helps them shape positive attitudes that are important when it is time to transition to long-term care.

Because many people resist the idea of placing their loved one in a long-term care setting, believing that they can give the same care, if not better, at home, Bethany's support group also helps a caregiver understand the special adaptations that home care requires. Bethany Terrace Administrator Ken Kolich says, "We are now offering our expertise and assistance to members of the community exploring at-home care options. We designed this program as part of our mission to be at the forefront of Alzheimer's/dementia care. By creating an at-home caregivers network with providers along this continuum, we can alert, educate and prepare the at-home caregiver for the progression of the disease."

Bethany Terrace's A.D.A.P.T. resource guide identifies and recommends metropolitan and suburban Alzheimer's disease specialists and related professional and support services. These listings are a compilation of providers that Bethany Terrace has dealt with through the years and who were recommended by its department heads and social workers. Besides specialists and service listings, the resource guide includes information on adult day care centers, counselors, senior transportation services, seniors' issues attorneys and home delivered meals.

To address caregivers' respite needs, Bethany Terrace provides short-term stays for loved ones, enabling the caregiver to go on vacation, do some household repairs or just mentally regroup. Although there is a charge for this respite service, it offers some reassurance to caregivers that they are not alone.

Anyone is welcome to access A.D.A.P.T. services. When a phone inquiry is received, a knowledgeable staff member is available to answer questions, supply information, assist in environmental assessments, help with activities planning or provide resource material to the caller. To answer questions, address problems and educate the caregiver, Bethany Terrace has compiled a complete Alzheimer's/dementia book and video reference library. Located in the social services department, the library has pamphlets, books and videos available that cover the spectrum of Alzheimer's and dementia information-from historical background to current treatments. Materials are also geared to address specific problems. For example, if a caregiver has trouble getting a family member with Alzheimer's to bathe, a video is available that shows effective ways to handle the situation. Similarly, if wandering is a problem, a video is available to help with that.

To further supplement the services and information provided by A.D.A.P.T., members of Bethany Terrace staff make house calls to perform environmental assessments addressing safety issues that might be of concern in caring for a person with Alzheimer's. The A.D.A.P.T. staff member will check for such possible safety problems as a bed that might be too high or oven knobs that might be too easily accessed.

The staffer also assists with planning in-home activities. For example, by gauging reactions to various stimuli or determining the person's past interests, the staffer might suggest activities promoting mental stimulation. Although Bethany Terrace staffers do not implement the program themselves, they might suggest appropriate equipment.

Finally, a care plan is designed to guide the caregiver. Kolich notes that "After the home visit, an A staff member will follow up on the family member's progress and see if any further advice, information or a even a pep talk is needed."

To finance this, Kolich explains, "Our budget absorbed start-up costs for the program. As this initiative expands in scope and participation, we can request assistance with funding from Bethany Terrace's Development Office."

Bethany Terrace has a dedicated staff available to assist in this outreach program. Phone inquiries are handledby Schnur, Mary Anne O'Brien, a social worker in Alzheimer's, and Lori Lentz, director of activities. If, after the phone interview, the caregiver feels that a home visit is necessary, an available staff member is scheduled to perform the assessment. Because A.D.A.P.T. uses frill-time salaried employees, this service is part of their job responsibilities. Expenses, such as mileage, are reimbursed. Use of existing staff, of course, makes the program more cost-effective.

To get word. of the program to the community, Bethany Terrace networked with churches, senior centers and discharge planners. This networking was reinforced with advertisements and press releases.

When it's time for someone to transition to a nursing home environment, the family might remember the assistance they received by participating in A.D.A.P.T. Says Kolich: "If we gain new admissions, that's great-but that's not why we put this program together. Our mission is to give back to the community, and we find that this is a sorely needed service. Our goal is to help people with Alzheimer's stay at home as long as possible."