Expert: Paula Damgaard - 8/18/2008

Question
My father is in the endstage of Alzheimer's and my mom has been caring for him at home now for 8-9-years. He can seldom form sentences any more, sleeps most of the time, even while eating (although per doctor, we are decreasing certain medications to see if this will help), and needs a walker for balance but can barely walk due to a recent onset of a turned in ankle. It's hard to get him to eat, and drink enough.  My mom was concerned about labored breathing, fearing pneumonia though a recent CT scan did not show anything.  A visit to the doctor this morning revealed that the bottom of his lungs were collapsing, apparently another sign of Alzheimer's.  The doctor indicated mom may want to make sure he has a living will, but made no mention of the possibility of Hospice care. My mom has recently indicated that she doesn't think she can safely care for him like he needs any longer. My question is, will this lung collapsing worsen significantly? And at this point, what factors need to be considered before we determine whether we should look into Nursing Home care, or Hospice instead?  (We know the typical fate of Hospice, but we don't know what stage dad is really at at this point).  Thank you!

Answer
Dear Susan, I have never heard of "collapsed lung" as part of the disease.  Doesn't mean it can't happen,just never heard of it.  I think that most probably what is happening is that his body is shutting down.  It is kind of too late for your doctor to be worried about a living will, does he really think your dad could voice an opinion and then sign it?  

The way Hospice works (at least in this area) is that they can be called in for AD patients even if they are not within 6 months of dying.  They know that this illness is terminal and they can start to offer support.  If I were you I would call them.  Let them evaluate your dad and offer suggestions of care that they can provide.  You mom most certainly needs help.  If not a nursing home, then help in the house.  Has anyone checked their insurance to see if they have any form of inhome paid care benefits?  

A call to the department of Social Services would be beneficial for you as well.  Or the Department of Aging in your area.  If you can't find anything like this call the Alzhiemer's Association in your area and they can help direct you.  

I hope that you can find some help with this. Let me know how it goes.  Paula