More than six million Americans are living with dementia, and by 2025, that number is projected to rise to nearly 13 million, according to the Alzheimer’s Association. The statistic is alarming and even more so if memory loss affects you, a loved one, a neighbor, or a friend. As awareness of the prevalence of dementia grows, evaluating memory care facilities is a task families increasingly face. The difference between the many types of memory care options can be confusing, so we’ll explore and explain the options from which families can choose.
Memory loss may start to be noticeable when someone you know begins to act a little differently than they have in the past. Sometimes it sneaks up on us … little signs here and there, small enough to make note of but not necessarily to act upon. We don’t want to jump to conclusions and certainly don’t want to offend this individual. But then something else out of character happens, and at some point, you know – you just know – that the person needs help. What’s your next step?
As a neighbor or a friend, you may want to gently bring the concerning changes in behavior to the attention of that person’s family or trusted advisor. If, however, you have responsibility for a loved one who is exhibiting signs of memory loss – confusion, forgetfulness, getting lost while walking or driving to a familiar place – it’s a good idea to schedule an appointment with his or her primary care physician (PCP) as soon as possible.
Who Might Need a Memory Care Facility?
Think of “dementia” as an umbrella term. Several types of dementia exist; Alzheimer’s disease is just one. Other conditions include vascular dementia, Parkinson’s-related dementia, frontal lobe dementia, Lewy Body Disease, and more. Someone who has abused alcohol may experience dementia. Someone who has sustained severe or repeated head injuries also may be at higher risk for developing dementia later in life, according to the Alzheimer’s Association.
A primary care physician can identify which type of dementia may be affecting your loved one and whether a referral to a neurologist may be necessary. Neurologists, who specialize in disorders of the brain and nervous system, are often the doctors with the background and expertise to diagnose dementia, though geriatricians, geriatric psychiatrists, and neuropsychologists also may be involved in determining a diagnosis.
Once the diagnosis and stage or severity of dementia are determined, you may experience a wide range of emotions. While you give yourself time to process those emotions, you’ll still want to get started planning for the future and evaluating memory care facilities.
What Kinds of Memory Care Facilities Should You Consider?
Families evaluating memory care facilities for a loved one have several options from which to choose, including:
- Respite care at adult day centers
- Memory care units within a personal care or assisted living community
- Dedicated memory care facilities
Adult day centers are one option for families who still are able to care for their loved one at home. These centers enable your loved one to spend mornings and/or afternoons in a setting with trained staff members offering activities and meals or snacks. Bathing may be offered as a service for an additional charge.The adult day center is similar to the more familiar child’s daycare center in that the caregiver transports the adult with memory impairment to the center and picks them up several hours later. Services of an adult day center are helpful for primary caregivers (often a spouse or adult child) who need to run errands, clean the house, or take a few hours of much-deserved rest.
Caring for a loved one with Alzheimer’s disease or other forms of dementia can be exhausting. You are on call 24 hours a day, seven days a week. As your loved one requires more and more care, it may be time to evaluate memory care facilities, such as personal care or assisted living settings that offer specialized, 24-hour supervision for people with memory impairment. Trained staff members provide assistance with Activities of Daily Living (ADLs) including bathroom needs, medication management, dressing and grooming. Social activities vary by level of resident ability and engage different residents in different ways. For example, some residents flourish during guided art classes, while others are partial to their individualized music playlist, while still others enjoy engaging in physical exercise.
Secure memory care units provide a safe setting for those with dementia who tend to be physically active. A secure facility uses electronic locking devices to ensure the safety of those with memory impairment who tend to wander. Before you become concerned that your loved one will feel locked in, please know that the memory care industry’s preferred approach is to redirect the resident away from “going home” to a friendly conversation or craft or other activity/distraction. This is a very effective method and is much preferred by all involved, rather than a debate or argument that can cause feelings of confusion, fear, and anger on the part of the person with memory impairment.
Evaluating memory care facilities involves understanding the differences between types of facilities and what each has to offer. Some are dedicated memory care communities, meaning that the facility provides only memory care. Others may have a dementia wing tucked inside a larger personal care or assisted living neighborhood. This type of arrangement is helpful for those with early dementia who need minimal assistance but require oversight to ensure they are safe; later, as dementia worsens, residents can then transition to the memory care unit within the same familiar facility. Still other memory care facilities may be a component of a Continuing Care Retirement Community (CCRC) where all levels of care, including skilled nursing, are provided within the same senior living community.
When it comes to each memory care facility’s capabilities, the level of care varies between a social model and a medical model. A social model is a setting for those in early stages of dementia where they can benefit from socialization while participating in arts and crafts, movies, and other activities to create a fulfilling day. A medical model may offer all of the former and also be positioned to care for your loved one as he or she begins to need more intensive medical attention.
Some medical models provide dietetic services to those with late-stage dementia who have swallowing difficulties. If your loved one is at a facility that chooses not to provide that level of care, your loved one would need to be moved to another setting, perhaps a skilled nursing facility, if they develop difficulties swallowing. Unfortunately, moving a person in later-stage dementia can present adverse issues, as the person then is forced to acclimate to a completely different facility and staff, a transition that is significantly more difficult later in the dementia experience.Evaluating Memory Care Facilities’ Costs
Some memory care facilities are for-profit, meaning they are owned or operated by corporations and/or investors whose financial goals need to be met. Others are not-for-profit or nonprofit, in which case, while they do need to make a profit, that profit generally is reinvested back into the community, as opposed to paying returns on investment.
Pricing structures tend to differ from facility to facility, making it difficult to compare one to another. The comparison can be done, however; a spreadsheet is an excellent tool for doing so. Ask questions when you seek clarity on any topic. Some facilities offer all-inclusive pricing while others list a lower daily or monthly rate but add services on an a-la-carte basis. Still others may have a basic fee that is mostly inclusive but then add fees based on level of care, increasing the cost occasionally – at pre-determined levels – when a person’s care markedly exceeds the baseline at which they first started. None of these pricing structures is necessarily wrong: each has its own benefits and drawbacks. For instance, the all-inclusive fee may at first seem costly, but it’s easier to forecast your loved one’s expenses over the length of his or her stay. The a-la-carte approach means that you’ll be billed with individual line items for the specific services your loved one receives; you’ll need to examine your statement to be sure you understand and agree with the amounts charged each month.
It is important to know that, in the Commonwealth of Pennsylvania, no Medicare or Medicaid funds are available to offset your loved one’s expenses. Personal care and assisted living are considered “private pay,” meaning that your loved one must use his or her own private funds. An exception to this would be if the person had purchased long-term care (LTC) insurance, and even then, not all LTC insurance policies are the same.
See: Does My Long-Term Care Plan Cover Memory Care Facilities?
How to Start Searching for a Memory Care Facility
As you begin to evaluate memory care facilities, conduct an online search within a certain radius of the primary caregiver’s home address or request a listing from your local government’s Area Agency on Aging or similar agency. It is a good idea to select a facility geographically closer to your home, so you have easy access in the event of an emergency or simply for ongoing visits. Everyone’s distance tolerance is different; if your daily travels keep you within a 10-mile radius, you may prefer something closer to home. But if you learn of an excellent memory care setting that is 15 to 20 miles away and you don’t mind the distance, you may find that it is worth it to go farther to receive the better care.
As you read through each memory care facility’s website, you can select your top three candidates based on location, online reviews and ratings, and, when possible, personal testimonials from others. Once you narrow down to your top few facilities, call to request an appointment to tour. It is recommended that you make the preliminary visits without your loved one. You’ll be receiving a lot of information, and you’re likely to have many questions along the way. It is better for your loved one to remain comfortable at home, with supervision, instead of being exposed to multiple, unfamiliar environments, which is likely to cause distress.
During the initial conversation with representatives from the facility, you likely will be asked about your loved one’s financial situation. It may feel uncomfortable divulging finances this early in the process, but the sooner it can be established that your loved one can afford a given community, the more efficient the search process will be for all involved. There’s no sense getting your heart set on a place that you later learn your loved one can’t afford.
The search for this level of care, as you already know, can be daunting. Once you’ve done your homework and made your appointments to tour, it is time to visit the communities you’ve identified as potential residences for your loved one.
As you tour through each community, the surroundings and furnishings may catch your eye. Some neighborhoods may be large and brand new; others may be on the smaller side and look outdated. Cleanliness is important, of course, but be mindful not to rule out a facility just because it doesn’t have high-end décor. You are seeking good quality care; remember to keep that at the forefront of your discerning eye.
When evaluating memory care facilities, take note of the residents themselves. Do they appear to be clean, well cared for? Are they engaged in an activity? Don’t be put off by some residents who may be napping; if some or most are involved in an activity, that’s what you want to focus on. Or perhaps you want to ask questions of the dining or housekeeping personnel; feel free to do so but know that they have a lot to accomplish in a day’s time. Your marketing or admissions person can answer most, if not all, of your questions.
The inquiries that you’ll have for each facility will depend on what is important to you. For example, how many beds does each facility have? Is it non-smoking? What are the visiting hours? Make your list of questions ahead of time and be sure to ask them at each facility, so when you return home to make your comparison, you’ll have all the information you need.
Other Questions Should Always Be Asked, Including:
- Is there a nurse on duty, on-site (versus on call) 24 hours a day?
- Does a nurse or a medication technician (“med tech”) dispense medications? A nurse has much more credentialing than a med tech, but good med techs free up the nurses’ time to provide higher level care.
- How long has the facility been providing memory care?
- What are the administrator’s credentials, and how long has he or she been in this role?
- Is there a dedicated person in charge of activities/life enrichment?
- Are the rooms private or shared?
- How are meals served? In each room? In a dining room?
- How are medical emergencies handled?
- How often can I visit my loved one and how does the facility keep in touch with me?
As you ask your questions, each facility’s representative will be asking you questions as well, primarily about the type of care your loved one needs. It isn’t expected that you would know the answer as to which level of care is appropriate. Rather, they are asking so that they can make that determination based on their own facility’s capabilities.
Once you have selected your preferred facility, you will be asked to bring your loved one in for an assessment; this allows the facility’s management to determine whether they can provide the proper level of care that your loved one requires. The assessment visit focuses solely on your loved one and will be as brief as possible.
Making the Decision to Place Your Loved One in Memory Care Facility
Even after carefully evaluating memory care facilities in your area, it may feel overwhelming to make a decision about memory care for your loved one. Sometimes families want their loved one in need of memory care to weigh in on this decision. They are likely to say that they just want to go or stay home. Adult children, especially, struggle with the decision; they have lived their entire lives knowing that their parent has been in charge, and it may feel disrespectful to take this decision from them. But when looked at from a different perspective, the adult child is respecting the parent by getting them the care they need.
Caregiver Support
One way for caregivers to adjust to the idea of placing a loved one in a memory care facility is to attend monthly support groups for caregivers coping with loved ones with dementia. There’s nothing like hearing another person express frustration with the same challenges you’ve experienced, and then to learn of workable solutions. Often conducted right within a memory care facility, Alzheimer’s or dementia support groups provide information on what to expect as the future unfolds, as well as help caregivers realize that resources are available to help them overcome certain hurdles, like managing your emotions, dealing with sleep deprivation, etc. Another reputable resource is, of course, the Alzheimer’s Association (www.alz.org).
While families sometimes experience guilt in placing their loved one in a memory care facility, they soon find peace of mind knowing that their loved one is well cared for and the caregiver can return to a more manageable pace at home. The move almost always works out to be a positive one. Not knowing what the future holds, it can be difficult to gauge which setting is absolutely the right fit for your loved one; when it comes down to the final decision, if you find yourself wavering between two good choices, go with the one that feels right.