When is it time to put dad in a Nursing Home? We are faced with this Q.

Your father is in a difficult stage of the disease. Right now he is managing at home, but barely. Alzheimer's disease doesn't just affect memory, it also affects insight, judgment, decision-making, and visual perception. Unfortunately it often only after a crisis that changes can be made.

You are right to be worried about the wandering; eventually your father will not be able to find his way home. The Alzheimer's Association has a program called 'Safe Return' that partners with MedicAlert, and I encourage you to look at their website for more information (www.alz.org).

Altered visual perception coupled with poor judgment are a recipe for falls and fractures, and a hospital stay. Your mother has health issues and being the full-time caregive for your father may cause her physical decline or a crisis. Regardless of which parent has the crisis, this will be a time when you need to be ready to place your father in a facility. If it is his health, that may be a skilled nursing facility (SNF). If it is your mother's, then he may need to be in an assisted living facility (ALF), possibly with a memory care community.

It is difficult to make the choice of a facility when under pressure. The best time to shop for a facility - both SNF & ALF - is before the crisis. Set up appointments for tours. Talk to other people who have family in a prospective facility, if possible. Often the facility will invite you to lunch with the residents; take them up on it. Many buildings offer respite stays of 3 - 30 days, which provide a 'trial stay;' this might be a good answer for a stay if your mother is the one who is ill. Take the time to pick the facility that will best meet your father's social and emotional needs, as well as his physical needs. What kind of activity program do they have? How accessible is the outdoors? What about spiritual needs? Are there people that have common interests? How attentive are the caregivers to the residents, both physically and socially.

The move will not be easy - don't expect it to be. There is often a lot of anger, blame, and guilt-tripping in the beginning. However, I can't tell you the number of times I have been through this with residents and families, and, if the family remains loving, but firm (and has picked the right facility), by the end of a few months, the resident has adapted and considers the facility their home!

I have been the child who had to make the decisions about a parent, as well as being a professional in the field of eldercare for the last 23 years. You have my heartfelt wishes for a positive outcome for your parents.

Thank you so much for your reply. Your experience is so very much appreciated. You've given me a great starting point. I honestly had no idea where to begin. You've given me so much to think about and I thank you.