When is 24-hour Care Necessary for a Person with Dementia?

Dementia is often a progressive condition, meaning that it can get worse over time. As the condition progresses, the person with dementia may require more support and assistance with daily activities. This support and assistance may eventually transform into needing 24-hour care. This type of care involves having a caregiver present at all times to provide support, supervision, and assistance with activities of daily living. At this point, the person is no longer able to be home alone.

24-hour care can be provided by family members, professional caregivers, home care agencies, or care facilities. However, whichever the case, the idea is that there will need to be someone available at all times to keep a watchful eye on the person with dementia and assist as necessary.

Here are 7 signs that a person with dementia may require 24-hour care:

1. Unsafe within the home: If your partner demonstrates unsafe behaviors in the home such as repeated falls, consuming inedible liquids or objects, turning and leaving on ovens and stove burners, putting inappropriate items and materials in the microwave or oven, sticking inappropriate items into electric outlets, overestimating their strength or balance and attempting to move unsafe objects or climb on top of things, mishandling sharp or dangerous objects, or improperly taking medications even when additional support is provided — 24-hour care may be necessary.
2. Wandering and getting lost: Due to confusion or a desire for something, people with dementia may wander off and become disoriented, putting themselves at risk of getting lost or injured. If your partner says thing like "I want to go home" or "I need to go..." or asks "Where is....?" this is a sign that your partner may be at risk for wandering. If your partner is often confused about where they are or pace around the home, they could also be at risk for wandering off.
3. Difficulty with toileting: As the condition progresses, a person with dementia may have difficulty with tasks such as bathing, dressing, and toileting. However, it is difficulty with toileting specifically, that indicates that a person with dementia is in need of 24-hour care, especially if they are incontinent. You want to make sure they get the proper assistance when they need to go to the bathroom and/or are changed in a timely manner when they have an incontinent episode.
4. Increased agitation, aggression, or delusions: Dementia can cause changes in behavior, such as agitation, aggression, or delusions. These behaviors can put the person with dementia at risk for harming both themselves and others and may require constant supervision to ensure safety. This can especially be the case if your partner experiences sundowning, which is increased agitation, irritability, or confusion as the day wears on. Sundowning is most common in people with dementia after about 2pm, but can vary for everyone.  
5. Increased vulnerability to scams: People with dementia can be particularly vulnerable to scams and financial exploitation. It may be challenging for them to recognize fraudulent schemes or understand the consequences of their actions. Scammers often target older adults with dementia, taking advantage of their confusion and trusting nature. If you notice an increase in your partner answering the door for strangers or in your partner's phone calls, emails, or mail related to suspicious offers or requests for personal information, it may be a sign of their vulnerability to scams. In such cases, 24-hour care can provide the necessary supervision to prevent your partner from falling victim to scams.
6. Lack of mobility: As dementia progresses, individuals may experience a decline in their mobility and ability to perform daily activities independently. This means that they will eventually need some level of supervision or assist anytime they need or want to move. Once a person becomes chair or bed bound, it will be up to the caregiver to provide the person with the necessary movement in order to reduce the risk of developing pressure sores, contractures, and further complications from immobility.

Please keep in mind that this is not an all-inclusive list. There could be other signs your partner living with dementia may require 24/7 supervision. But, ultimately, if your partner demonstrates any concern involving safety, that is a tale-tale sale that 24-hour care may be necessary.

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If you are wondering if it's still safe for your partner with dementia to live alone or if it's time to place them in a care facility, consider downloading our 'Living Alone with Dementia Checklist' and 'Is It Time for a Care Facility? Checklist' by grabbing a Paw Pass for the Treehouse!