Institutional placement for patients with Alzheimer's disease. How to help families with a difficult decision.

Family members confronting the difficult decision of whether to place a patient with Alzheimer's disease in an institution find it helpful to have explicit criteria on which to base their decision. Regular incontinence of bladder and bowel, inability of the patient to cooperate in his or her care, inability of the patient to realize that he or she is at home with familiar caregivers, the withdrawal of a paid caregiver, risk to the health of the primary caregiver, and primary caregiver burnout are all grounds for considering institutional placement. Options include assisted living facilities, dementia-specific assisted living facilities, general nursing homes, and nursing homes with dementia-specific care units. Institution-like care can be provided at home, but this is expensive and may be inconvenient and stressful for family members. Hospice care is appropriate at the end of the patients's life.