How do you know when it is time to seek help?

A conversation with Megan Carnarius, executive director of Balfour Cherrywood Village, a Memory Care Residence. If you're caring for a family member with Alzheimer's, one of the most difficult decisions can be the question of when is it time to seek professional help. We present this discussion with Megan Carnarius in hopes that it will address some of the issues and concerns you may be facing.

Megan Carnarius is the executive director of Balfour at Cherrywood Village. She is a registered nurse (RN), licensed nursing home administrator, and much sought after speaker on the topic of Alzheimer's care. She blends both medical and holistic patient care experience in leading a program at Balfour to help Alzheimer's patients and their families. Megan is an adjunct faculty member for Naropa University, gerontology program, Masters in Health Care Administration.

Megan, you speak with families who are caring for someone with Alzheimer's all the time. What are some of the issues that come up?

There are a number of questions that arise. The first is — "Has a diagnosis been made?" Alzheimer's is difficult to confirm, but doctors these days have better diagnostic tools and a better understanding of the disease. While no one can predict the pace of the disease, the course it will take is highly predictable, and certain plans can be made to anticipate and manage changes effectively.

A critical question in early-stage Alzheimer's is the resources or networks you have to help you begin this arduous and profound journey. In initial consultations with families, we analyze these resources, because an accurate assessment is important. If there is only one primary care giver, that is different from a family that has a network of people who can share the responsibilities.

It's important to explore what systems can be put in place that support the increasing needs of the person with Alzheimer's. How do these systems work? How do you take care of meals or general day-to-day activities? How much independent time can the person safely manage?

How do you know when it's time to consider professional help?

This is always a very personal decision. I usually inquire how closely the person is supervised. Are they eating well? Can they take their own meds? Can they go for walks in the neighborhood? Are there habits or patterns of behavior that are changing? Sometimes relationships with neighbors begin to deteriorate. Sometimes fears or isolation or depression sets in. The key is close monitoring so you know what is going on.

The next level — and this may be the most critical one — regards safety concerns. Are there periods of confusion? Can the person drive safely? How do they handle appliances in the house, particularly the stove? Can they manage their money or everyday events? Are they vulnerable to persons selling things, or intruding or taking advantage of them? There is seldom one defining moment, but concerns about safety usually mean it's time to explore possibilities beyond the home.

What other factors are important in this decision process?

Probably the most important is the caregiver's stress level. If you're the primary caregiver, and your role is exhausting the loving connection you have to your family member, it's important to consider what that means. I often find a spouse can no longer provide the essential emotional support because they are so overwhelmed by the constant tasks and responsibilities inherent in the situation. If some of those tasks can be transferred to others, then often you can shift your energies to being in the relationship. You can then take on an advocate role, and enjoy more fully the remaining time you have with your loved one.

It isn't always a complete "this or that" answer. There are many transitional possibilities, including in-house care, or respite stays at adult day care, especially where there is staff and facilities appropriate to those with memory impairment. Sometimes these alternatives can help for a while. But there usually comes a time when it makes sense to turn to a full-time residence.

How can a professional Alzheimer's residence make a difference?

Each person is unique. No one story is alike. But in general, the biggest benefit is that the isolation is often cut through when one moves to a residence specifically designed for the care of people with memory impairment. At home, a person typically sees just the few people tending to their care. For a period of time this may be adequate, but over time we see depression, excessive sleeping, and resistance-to-care behaviors creep in. Often these are signs that increased structure may be necessary. In a community, the resident can make friends, begin new networks, share meals, and feel less isolated. In a professional setting, often the person begins to perk up. Simple routines designed to occupy and stimulate the person reduces anxiety and helps them relax. In a structured setting, a person can revisit the stages of their life in a non-threatening way. The properly designed building actually works to deal with memory loss. As inhibitions drop away and the person accesses their childhood and earlier adult memories, a well-trained staff can help make them feel comfortable and more at home. This steady "de-aging" requires different skills at different stages, and again this is how an experienced and caring staff can better respond to challenges as they come up.

Any other advice you wish to offer?

I encourage everyone to get as much education as they possibly can on what's required for the road ahead. Whether you keep a loved one at home, or seek a professional residence, your role is central in the journey to come. Find a community that knows and understands the path. Open your heart to a new way of relating. And most of all, take care to nourish yourself so you can be there for the long haul.