Perhaps your loved one has been diagnosed with memory loss or dementia and has been told by a doctor or health care provider that a memory care community might be the best option for them at this stage, especially if they are currently unsafe at home.
Just for the record, we in eldercare don't refer to them as "dementia facilities" or "dementia units" anymore. This terminology is cold and sterile and it paints a picture of an institutional environment. Memory care isn't as institutionalized as it was in the early days of nursing homes, but there are some things to be aware of when you decide to shop around for a loved one.
Memory Support in Assisted Living or Personal Care:
Just because your loved one has memory loss, it doesn't mean that they absolutely need to be in a skilled nursing facility. Most assisted living or personal care homes with memory support are much more home-like and inviting and can absolutely take good care of your loved one. You may opt for a skilled nursing facility if your loved one is a two-person assist to transfer or they have skilled need such as an inter-venous medication, tracheotomy, or a feeding tube.
Narrow down the search:
I think it's best for families or advisors to vet the desired locations before bringing the potential resident to see. Once you narrow it down to one or two, invite your loved one to take a look. While this seems like you're not giving them as many options and choices, and you want to show them everything, it's really not the best idea to do so, and can cause a lot of stress, energy, and second guessing. The inability to make a decision can be one of the first signs of a memory problem, and putting a major decision on someone who doesn't have the brain function to make one can be stressful for all parties.
It's really up to you and your family to decide what's most important for your loved one. Keep in mind that what used to be most important to them, might not be at this stage and safety is one of the more important functions of this move. You will want a place where they can progress in their disease and age in place without having to move again.
Care is not one-on-one:
If you are worried about your loved one falling and think that they need one-on-one supervision, a memory care neighborhood might not provide the undivided supervision that you are thinking it will. Communities aren't staffed to that level and though they will have closer supervision and safety than a non-memory support assisted living or personal care, just know that falls can still happen and you as an advocate want to understand the staffing situation before you assume that your loved one will be watched 24-7. Most places will also allow you to hire additional help if you feel that it would be beneficial. Home care companies will often help people who need additional support in a memory care neighborhood.
Secured for safety:
Senior living communities that have memory care specific neighborhoods, or even stand-alone memory care communities are usually secured. This means that they will have a code or fob to get in and out and will often have alarmed doors which can be off-putting if you're not prepared for it. Even with the higher level of supervision, the ratio of care to resident is not 1:1 as mentioned above. This means that if your loved one is quick or savvy, they might try to leave. The coded and alarmed doors gives the staff a heads up if someone attempts an elopement.
Small Apartment Size:
When someone moves from a five bedroom home to a studio apartment it can be upsetting for the family. Keep in mind that as a person struggles with memory loss, their world gets smaller. They need less space, less belongings to keep track of, and less stimulation in general. Most memory care communities only offer smaller apartments for this reason. While the family may feel that their loved one is being closed in, there are ways to make it functional. You can bring some of their more treasured furniture or items to decorate and make it feel more like home.
Shadow boxes on the doors :
Don't be surprised if you see display boxes on the doors or the walls next to the apartments for families to place pictures and personal items. This helps to remind the resident which apartment is theirs. It also offers the caregivers a glimpse into the previous lives of their residents.
Activity Stations:
Most progressive memory care programs have activity stations for residents to utilize in the common areas. This may include a work station with a typewriter or unplugged computer; a fashion station with jewelry and other items to dress up with; a laundry station with a washer, dryer and folding table; a work bench with tools and fidget items; and a baby station with changing table and realistic looking baby dolls.
The baby station can hit a little different because it doesn't really make sense for an adult to want to play with dolls and I have had adult children get upset when they see that. I always like to warn new-comers about the stations because they can seem childish or upsetting to someone who doesn't fully understand the progression of the disease their loved one is suffering with. As people experience brain loss, they may regress to a period in their lives when they were younger and had a job, kept a house, or had small children. The babies are utilized and can offer a great deal of comfort. There might also be realistic looking stuffed animal cats that purr and are weighted. These can often bring comfort to someone who is an animal lover without having to worry about actually taking care of a pet.
If you see these items on your tour, just understand that they do serve a purpose.
Walking and Wandering:
Some places are specifically designed for those who enjoy walking and moving around, and gives them space to wander but not get lost. Wandering and constant movement in someone with memory loss can be a sign of agitation or anxiety, and if they have places to walk, they can usually express that in a healthier way. Most places will also have an enclosed outside space for their residents to wander. If you are looking at a place and know that your loved one will want to be able to walk around, this is something you may want to notice and ask about.
Programming:
There has been a lot of research done about memory care programming and every building has their own name for it. My suggestion is to look for a program that will stimulate your loved one and offers many options. Those of us who have delt with individuals with dementia understand that programming isn't a one size fits all, and most programs need to be flexible.
Musical programming is often the most universal for those with memory loss and I always suggest that families bring a radio, cd player or other musical device that can offer the resident's favorite tunes. Most memory care programs will offer spiritual services, creative crafts, gardening, cooking and baking, as well as some form of movement like chair fitness or yoga. Be mindful that your loved one will not be doing activities every second of every day and there is a lot of needed down time in a memory care neighborhood. If you go to visit a place and they aren't doing an activity, it's a good time to ask questions, but don't just assume that they always allow their residents to sit idle.
Keep in mind that your loved one might not be capable of doing all the things they used to be able to do. Reading, card games and trivia can be frustrating for someone who is struggling with memory issues. Even BINGO can be challenging. Just because they used to like these things, they might not be able to enjoy them anymore.
Think Twice About the TV:
Most people feel that their loved one absolutely needs a television in their apartment. Just because they watched television all day, every day at home, you may want to skip bringing it and allow your loved one to be immersed in the programming instead. You can always bring one later if they ask for it. The reason I bring it up is because local and cable news programs can be upsetting and negative and though your loved one used to follow politics or current events, it's a distinct possibility that they can no longer do so. It can be very confusing to have a cable news program on all day long and depending on how progressed, the individual might be better suited with a musical program or something light hearted or funny.
Price:
The price might be a shock to the system, but you are paying for peace of mind. If you keep your loved one home with 24-7 care you will be paying much more than the cost of a memory care community. Most memory care communities run from $5000-$12,000 a month, with the lower priced options being shared rooms with a roommate. Some do have one bedroom and two bedroom options, but keep in mind that the resident will be spending most of their time in the common areas anyway, not in their apartment. The larger apartments will cost more.
Some memory care communities have additional costs for level of care, so be sure you're clear about any and all potential increases in cost with regard to the level of care that can and most likely will increase as the disease progresses.
The Other Residents:
Most memory care neighborhoods, especially ones that have been around for a long time, have established residents that may be further along on their journey. This can be upsetting for a family to see people at end stages. I have heard more than a few times, "these people are so much further along than my mom!" This might be true, but keep an open mind that if there are people in varying stages of their disease, it means that the memory care community is able to offer a continuum of care. If everyone is only at the beginning stages, the community might be newer, but you have to ask yourself about their ability for the residents to age in place.
Most memory care communities will need to have a nurse assess the potential resident before move-in day. If your loved one is truly unsuited for the desired memory care, the nurse may offer other options, with safety being the biggest concern. Many communities offer a level of memory support in personal care or assisted living, with the idea that the resident live their best life, and if they are too independent for memory care but not independent enough to live alone, there are often bridge programs available at the communities.
Hospice in-home:
Memory care communities will often allow outpatient hospice for the residents who qualify. This shouldn't be a surprise if you see a representative caregiver or nurse from a hospice company. It's always consumer choice, but buildings often will have their preferred providers.
Know that this decision isn't easy:
In conclusion, I offer you some advice to give yourself a break. No place is going to be absolutely perfect because it's not "home", but communities work hard to keep their residents happy and healthy, so get rid of the version of the story where you're dumping your loved one into a "home".
People often liken it to dropping your child off at daycare for the first time. It can be heartbreaking, but trust the process, and trust the community once you've made your choice. They are staffed with professionals who know how to help someone adjust to a new environment.
The first couple weeks can be tough and you might want to consider not going to visit right away to allow your loved one to adjust to the move. Also consider seeking a dementia caregiver support group. Many communities offer this and they are very under utilized by the people who truly need the support.
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