[The end of home care or the end at home?]

The decision to refer a demented patient to a nursing home is not always an easy one. The family physician has an active role to play: asking timely questions, helping families to prevent what can be prevented; giving proper advice on how and when to make arrangements for private or public accommodation; giving adequate support to the patient and his/her family before and after entering a nursing home. Some difficult situations can occur: family members may disagree on the necessity for the patient to be sent to a nursing home, or the patient may refuse to leave home. Here as well, the physician can play an essential role: his knowledge of the patient's family and personal history, his communication skills and his capacity to assess the patient's ability to consent are key factors in making a smooth transition. Occasionally, the patient's family decides to keep the patient at home until the end. The success of such a venture is highly dependent on the following elements: thorough understanding of the patient's condition and of its possible complications, a readily available and reliable support network, good teamwork, medical follow-up and full-time on-call system.