These and many other concerns, indicate the possibility of dementia. Dementia is a slow or progressing decline in mental abilities, such as concentration, staying on task, and memory. Once someone has been diagnosed with dementia, it means that other medical possibilities which may account for the declining abilities have been examined and ruled out. The task is now to figure out how to make choices in dementia care that will provide safety and basic needs in the least restrictive manner, and the least costly way.

One method of caring for a person with dementia is at home. Many American spouses currently care for their husband or wife at home, which can be physically and mentally stressful for the caregiver spouse. Sometimes the adult children help their parents cope with the extra responsibilities. Most people don't like to go out of their homes when they are experiencing some confusion or forgetfulness. They like the routine and familiarity with their home and will become angry and resistant of out-of-home care.

There are many cases in which additional help is brought in. For example, there are many home health and companion agencies which provide paid helpers to take care of the family member with dementia, and also of the spouse. Also, there are products which can be purchased to make the house a safer environment.

Other times, the aging parent or parents move in with their adult children. Relocating, however, can cause stress and irritability, and can even result in reduced mental or cognitive functioning, as the safety and familiarity of the home, and the sense of belonging and ownership is lost.

Adult day care centers are springing up around the nation as an alternative to home based care. These centers provide structured activity and supervision, along with socialization and stimulation, while the spouse and caretakers have relief or go to work. Many participants of such programs get used to the new routine and enjoy the socialization and stimulation, while at the same time continue to return home in the evening.

Assisted living facilities are also a fast growing industry, as nursing homes become cost prohibitive and focus on the most intensively medically needy members of the population. Many assisted living facilities offer quiet and modern appearances, private rooms, all or most meals, and security for dementia care.

As the residents of these facilities age, the assisted living facilities offer increased levels of care to provide an opportunity for “aging in place” and avoid the need to move to a nursing facility. Trips are often provided when a person is able to benefit from and safely attend a trip out of the facility. Group activities are often offered on site as well.

Nursing facilities, or nursing homes, are the most costly and most restrictive outside of hospitals. They provide more intensive medical care, and have historically provided choices in dementia care, including locked units and fenced in yards. Many facilities offered skilled care, and are called skilled nursing facilities or skilled nursing homes. The skilled level of care includes intensive nursing care, physical therapy and other therapies and rehabilitation. Medicare covers some of this care, which takes place after a brief hospitalization, with the hope of recovery and movement to a less restrictive environment.

Unskilled or custodial care in a nursing home is designed for those whose abilities to care for themselves or to receive care at home or in another setting is declining. Examples of these types of nursing home placements include choices in dementia care, long term care for hip fractures, heart failure and other medical conditions that have worsened over time. Medicare does not usually cover the long term placement.

The many choices in dementia care can be overwhelming. Talk to your doctor about where to start. Visit adult day care, assisted living facilities and nursing homes, and interview the social workers and admission professionals. Hospital discharge social workers are also a good source of help; their job is to find placements for hospital patients who are being discharged and they know many of the area resources.

In addition, most counties have an office dedicated to consulting for elderly issues, such as the county Area Agency for the Aging (AAA) or there are Geriatric Care Consultants, who you can find in your yellow pages, who will advise you about the choices in dementia care in your community.

Don't be afraid to ask questions about the care and how to finance it; there are many government programs that may help pay the cost.