When a loved one with dementia can no longer live at home, you may want to seek out a residential facility that specializes in memory care. But how do you know if a facility offers more than just a fancy label and a premium price tag?
Memory care units, sometimes called special care units, are often housed within an assisted-living or skilled-nursing facility. At their best, they can offer staff extensively trained in caring for people with dementia, individualized care that minimizes the use of dangerous psychotropic drugs, a home-like environment and activities that improve residents’ quality of life. But at their worst, they may offer little more than a locked door. There are no consistent standards for memory care.
If you’re considering memory care for a loved one, you need to go beyond the label to find out exactly what services are being offered at the facility. That means making multiple visits to each facility on your short list, studying staff interactions with residents, talking to residents’ families, and asking a host of questions about staff training, daily routines, methods of dealing with challenging behavior and other issues.
To start your search for a facility, first focus on the one factor that patient advocates say can all but guarantee better outcomes: proximity to family and friends. The task is not just to choose a good facility, “but also being there on a regular basis and being very involved,” says Ruth Drew, director of family and information services at the Alzheimer’s Association.
Do In-Person Research
When you have narrowed down your choices, make multiple visits to each facility—including unscheduled visits at night or on weekends, when the staff is more likely to be stretched thin. Is the facility clean? Does the food look appetizing and taste good? Is there adequate staff to assist those who need help eating? Are there residents calling out who are being ignored?
Ask about the staff-to-resident ratio and the level of staff turnover. Memory care facilities should have at least one staff member for every five residents. If you don’t have that, you end up with people placed in front of the television. If there’s a high level of staff turnover, that’s a very bad sign, because people with dementia tend to respond better to familiar routines and consistent caregivers. Ask about the type and amount of training the staff receives, both initially and on an annual basis.
Look for signs that the facility is responding to individual residents’ needs—not forcing them into a fixed routine.
Make sure the facility offers activities that can keep your loved one engaged—even at night, when many dementia sufferers are awake.
Ask how the facility responds to residents who may wander or become aggressive. If the answer is locked doors and antipsychotic drugs, that’s a red flag. Facilities should have a circular corridor, an enclosed outdoor area or other spaces that let residents roam freely. And they should provide enough individual attention to detect hunger, pain and other common triggers for aggression, rather than resorting to drugs.
Because transitions can be unsettling for dementia sufferers, make sure that your loved one will be able to remain at the facility for the foreseeable future. In some states, assisted-living facilities can’t provide complex medical care, so residents who need skilled nursing may have to leave—or the facility may contract with a home health nurse to provide care, at additional cost. Ask what health conditions might require your loved one to leave the facility or move to a higher—and more expensive—level of care within the facility. And find out if the facility accepts Medicaid. If not, a resident who runs out of money may be forced to move.
To be sure a facility has been treating residents well, talk with family members of residents at different stages of dementia about their experience with the facility. For memory care units housed within skilled-nursing facilities, go to Medicare.gov and click “find nursing homes” to see star ratings for a nursing home’s health inspections, staffing and other measures. If the unit is within an assisted-living facility, contact the state licensing agency (which is often the state health department) for information on inspection reports and any sanctions against the facility.
For more information, contact Spring Arbor.