Geriatrics and Extended Care
Dementia Care (including Alzheimer’s Disease)
Dementia Care (including Alzheimer’s Disease)
Care for Veterans with Alzheimer’s or dementia is provided throughout the full range of VA health care services. Depending on the Veteran's needs, services may include Home Based Primary Care, Homemaker and Home Health Aide, Respite Care, Adult Day Health Care, outpatient clinic, inpatient hospital, Nursing Home, Palliative Care, or Hospice Care. Caregiver support is also an essential part of these services.
If you’ve been diagnosed with dementia or Alzheimer’s disease or are caring for someone who has, become familiar with the symptoms, types, stages, and treatments:
- Understanding Dementia - Get basic information about what dementia is, the stages, and treatments.
- Coping with Your Dementia Diagnosis - Find out how to keep healthy and active, arrange for safety at home and in the community, and plan for the future.
- Understanding Reversible Dementias - Read about factors that can cause symptoms that mimic Alzheimer’s disease.
- Caring for Dementia: What to Expect - Learn how caregivers can help with daily life, find new ways to communicate, and cope with problem behaviors.
- Caring for End-Stage Dementia - Learn how to recognize advanced or end-stage dementia and what to do to help.
Veteran and Caregiver/Family Resources
Most of the support provided to older adults and persons with disabilities is provided by unpaid family caregivers and friends. Many caregivers report their health to be worse because of caregiving strain and only half report another unpaid caregiver assists them in their tasks. Few caregivers have care managers to assist with planning and obtaining resources.
Supporting the health and vitality of the caregiver is just as important as meeting the health care needs of the affected person:
- Remind yourself that your work has value
- Find ways to communicate and share your needs with others
- Join a support group
- Be organized, use calendars, gather information on helpful resources and services
- Nurture the positive relationships in your life with family and supportive friends
- Give yourself a break to avoid burnout
- Take care of your own health
Home and Community Based Care Options
Remote Monitoring Care - Allows a Veteran’s doctor or nurse to monitor the medical condition using home monitoring equipment. Remote monitoring can connect a Veteran to a VA Hospital from the home using regular telephone lines, cellular modems, and cell phones.
Homemaker and Home Health Aide Care - Provides a trained person to come to a Veteran’s home and help with daily activities such bathing, dressing, or fixing meals.
Veteran Directed Care - Allows Veterans to receive the Home and Community Based services they need in a consumer-directed way. Veterans who need assistance with daily activities such as bathing, dressing, and grooming can have more access and more choices over their home care or long term care services.
Adult Day Health Care - Is a structured day program for older and disabled Veterans, permitting family members and caregivers time to pursue personal and employment opportunities while still helping affected individuals remain in the home setting.
Respite Care - Provides temporary in-home assistance or placement (foster home, nursing home, or hospital) of a disabled individual (often several days to weeks) to allow a rest period for family and/or caregivers.
Home Based Primary Care - Provides a VA physician-supervised home care team for primary care for Veterans who have complex health care needs for whom routine clinic-based care is not effective.
Skilled Home Health Care - Provides skilled home care services such as case management, physical therapy, occupational therapy, speech therapy, wound care, or IV antibiotics through contracted community-based agencies.
Assisted Living - Is a residential setting that provides services designed to allow older and disabled persons to remain in the community. Assistance may include: meals, administration of medication, homemaker services, transportation, health reminders and personal care.
Board and Care - Is a residence, such as a Medical Foster Home, Community Residential Care or Adult Family Home, for individuals who can walk or self-propel in a wheelchair. Meals, personal care, medicine administration, and group living environment are provided.
Nursing Home Level I (Intermediate Care) - Provides institutional care for individuals whose functional disability prevents residence at a lower level of care. Many seniors with stroke, cancer, and cardiovascular disease reside in long term care facilities, such as Community Living Centers (VA Nursing Homes), Community Nursing Homes or State Veterans Homes.
Nursing Home Level II (Skilled Care) - Provides institutional care for individuals with skilled nursing needs, in facilities such as Community Living Centers (VA Nursing Homes), Community Nursing Homes or State Veterans Homes. This includes frail elderly with feeding tubes, post-operative care, wound care, and rehabilitation.
Palliative Care - Uses comfort care with a focus on relieving suffering and controlling symptoms so that Veterans can carry out day-to-day activities. Palliative care aims to improve the quality of life in one’s mind, body, and spirit.
Hospice - Provides comfort care when a Veteran has a terminal condition, with less than six months to live, and is no longer seeking treatment other than palliative care.
Safety and Other Concerns
Safety in our homes is critical for those with Alzheimer’s disease or other dementia. While you may not be able to make your home completely safe, there are some easy and low-cost suggestions to solve the most common safety problems.
Driving ability is a complex task that may be impaired by health conditions common in older adults. In some cases, rehabilitation or vehicle adaptation may be possible to permit continued ability to drive. There may be many reasons to consider a formal driving assessment:
- To obtain a professional opinion to verify your confidence
- To learn new strategies to keep your driving skills sharp in the face of reduced flexibility or reaction time
- To consider rehabilitation for physical limitations
- For advice about how to meet transportation needs if driving is found to be unsafe
Certain illnesses may cause you to stop driving temporarily. If this is the case, a therapeutic program designed by an occupational therapist who is a trained driver rehabilitation specialist may help. The Driver Rehabilitation Specialist will conduct an evaluation and if appropriate may be able to provide assistive equipment such as pedal extenders, seat lifts, panoramic mirrors, and hand controls.
Those with early stages of Alzheimer’s disease or other dementia may benefit from a driving evaluation to determine whether they can continue to drive safely for the time being. People with more advanced stages of dementia should no longer be driving. It is helpful to plan ahead and find alternative modes of transportation such as public transportation or ask friends and family to assist. If you are having difficulty finding transportation resources, talk with your VA Social Worker.
Find the nearest VA Driver Rehabilitation Clinic
Find Driving Evaluations in the Community
Firearms and other weapons can be found in households across the country. Most service members and Veterans are well-versed in the handling and secure storage of firearms, and in most situations, their presence creates no problems for responsible firearm owners and others in the household.
However, if someone in the home has Alzheimer’s or another dementia, firearms can pose a significant risk for everyone. For example, as the disease progresses, the person may not recognize someone he or she has known for years and view him or her as a threat. An accessible firearm could lead to a tragic outcome. Firearm safety is not only about the handling of a firearm, but also about secure storage.
The following may help to ensure the home is a safe environment:
- Begin with a family discussion with the firearms owner and a trusted loved one about the importance of safely storing firearms while not in use. Consider inviting trusted relatives who have experience safely handling firearms, hunting buddies, etc., to take part in the conversation with the family. Also, be sure that all household members understand the safety guidelines about firearms.
- If possible and in accordance with state law, remove the firearms from the home by selling them or storing them with a responsible individual. If you are unsure of the state laws about firearm ownership or transferring firearms to another person, contact your local law enforcement office for more information.
- If during the discussion you decide that the firearms are going to remain in the home, safe storage means ensuring that firearms are locked and unloaded, and firearms and ammunition are separated when not in use. Ways to safely secure firearms include cable locks, gun cases, and lock boxes. If storing firearms in the home, it’s recommended that you provide keys to a responsible family member who can ensure safe storage.
In periods of crisis or heightened emotions, unsafe firearm storage can increase risk. By learning and practicing safe storage practices before challenging times arise, you can reduce the risk for suicide or injury for everyone in your home.
Find more information on firearms safety, details about firearms safety for people with Alzheimer’s or other forms of dementia and tips for talking with a loved one about giving up their firearms.
Frequently Asked Questions
Where can I find basic information about dementia for Veterans and Families?
- Go to the Veterans Health Library (VHL) and search for “Dementia”
What are some resources for Dementia Caregiver Support?
- VA Caregiver Support website
- VA Caregiver Support Line: 1-855-260-3274
- VHA GEC Shared Decision Making Guide
- VHA Office of Rural Health Dementia Caregiver Video Series
- U.S. Department of Health and Human Services Alzheimer’s website
- National Institute on Aging (NIA) Alzheimer’s Disease Education and Referral Center (ADEAR)
- U.S. Administration on Aging Eldercare Locator: 1-800-677-1116