It’s time. The difficult decision to begin the search for assisted living has been made and now you are faced with the task of finding the right place for your loved one. What can you expect to find in your search? What are the needs of your loved one and your family, and can these needs be met? Is it possible for your loved one to be safe, happy, and cared for the way they are at home?
First: Know What You Need and Want
The first thing to do is to determine the requirements and most important aspects of a community you are seeking. This may seem obvious, however, consciously considering what you want and expect will give you conclusive information about what compromises you are not willing to make. Do you want your loved one to shower daily? Is a healthy diet at the top of the list? Are you looking for opportunities for your loved one to engage in stimulating activities? Is it important that caregivers are kind and respect your loved one’s dignity? Are trips out into the community important? How about the opportunity to continue their religious traditions? Is safety at the top of the list? How important is it that the staff are well-trained in dementia care and understand the behaviors that may arise? Are you looking for a place that welcomes family-member involvement? Is it important that end-of-life care is provided?
Now that you know what is most important to your loved one and your family, can an assisted living community meet your needs? Let’s look at what you can expect.
History of Assisted Living
An article on the website www.assistedlivingfacilities.org, explains that assisted living came to be out of a distaste for nursing home care back in the late 1970s and early ‘80s. By the late 1980s “providers, consumers, and the government became interested and created four distinguishable kinds of assisted living communities.” As assisted living became more popular, the Assisted Living Workgroup was formed in 2003, as an initiative of nearly 50 national organizations “representing providers, consumers, long-term care, health care professionals, and regulators formed at the request of the U.S. Senate Special Committee on Aging to develop consensus recommendations to assure quality in assisted living.”
As a result, assisted living communities to provide individualized scheduled services based on residents’ assessments and unscheduled needs as they arise. These services are overseen by state law and may vary from state to state. In general, most state regulations include:
- Twenty-four-hour “alert” staff to provide oversight and meet scheduled and unscheduled needs
- Provision and oversight of personal and supportive services (assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs))
- Health-related services (e.g. medication management services)
- Recreational activities
- Housekeeping and laundry
- Residents have the right to make choices and receive services in a way that will promote the resident’s dignity, autonomy, independence, and quality of life
- Assisted living is not required to provide ongoing 24-hour skilled nursing
Memory Care units or communities, as described by the Alzheimer’s Association, “are designed to meet the specific needs of individuals with Alzheimer’s and other dementias.” They may be stand-alone communities or exist within various types of residential care, including assisted living. According to www.alzheimersreadingroom.com, they may be called “communities,” “neighborhoods,” “units,” “wings,” or “hallways.” Regardless of what they are called or where they are located, they are residences devoted to serving people with dementia.
Memory Care units or communities may be either “locked” or “secured.” Locked units have doors that residents cannot go in and out of without help from staff. Secured on the other hand means the doors are alarmed, but not locked. Locked units are under greater regulation and often require that certain personal care items, such as poisonous shampoos or alcoholic mouthwash, be locked up and away from residents.
You can expect Memory Care to be more expensive than standard assisted living because residents require more care. These communities offer specialized care and activities that meet the needs of residents with dementia. Also, keep in mind that not everyone who lives in “Memory Care” has memory impairment. A resident with fronto-temporal dementia does not have a poor memory in the beginning stages of dementia. For this reason, some facilities use the term Dementia Care. Whether it is called Memory or Dementia Care, or if it is a unit in a larger assisted living facility or a stand-alone community, Certified Geriatric Care Manager Carole Larkin, an expert in Alzheimer’s and related dementias, suggests you consider the following when visiting locations:
The Philosophy and Goals of Care
- The facility encourages resident independence and functioning.
- Ensures dignity and individual expression.
- Ensures resident safety.
- Provides peace of mind.
- Reduces confusion and agitation.
- Minimizes the use of chemical restraints (medications to control behavior).
- Promotes family involvement
Individualized Care Plan
- Uses a comprehensive assessment questionnaire to address the resident’s current and changing needs.
- Creates a personalized plan of care for each resident.
- The planning process involves the resident, family, and physician.
- Regularly reassesses the needs of the resident.
- Has a full-time program director for memory care.
- Staff is well-educated in Alzheimer’s disease and other types of dementia.
- Requires ongoing specialized staff training and education.
- Has high staff-to-resident ratios on all three shifts (preferred: under 8:1 on day shift).
- Seems attentive to the residents while you are visiting (not ignoring them).
- Has a consulting medical director, and other specialties as needed for the residents.
- Uses an interdisciplinary team approach.
- Has a licensed nurse on the premises a minimum of 8 hours per day.
- Has individually tailored activities scheduled seven days a week (minimum 6 per day except for Sunday).
- Activities are focused on the resident’s strengths and preferences (the thing they can and like to do).
- Active and passive programs from life skills to exercise, music, art, current events, and social activities.
- Offers short, flexible and success-oriented activities.
Offers large group, small group, and one-on-one activities.
- The Care Facility Environment
- Self-contained, secure, cheerful yet calm atmosphere.
- Enclosed courtyard/backyard.
- Dedicated dining, activity, and private areas.
- Uncomplicated floor plan and visual cues to help residents stay oriented.
- Easily accessible bathrooms in common activity area.
- Simplified, soothing and home-like atmosphere.
- Meets all city, state, and county health codes, and has current certificate posted.
- Is clean and smells good (does not smell of urine anywhere in the building).
- Is licensed by the state as an assisted living, and the license is current.
Do the Current Residents Seem
- Engaged in activities?
- Appear to be comfortable?
- Settled and well adjusted?
- Generally accepting of the staff?
Family Services are Available
- Offers family support group meetings.
- Offers ongoing education, support, and counseling.
- Offers family conferences and involvement in care planning.
- Offers and encourages opportunities for families to socialize.
Dining and Nutrition
- Individually tailored food and nutrition plans created to individual’s needs and capabilities.
- Modified menus (diabetic, low salt, etc.).
- Between-meal snacks and drinks.
- Innovative food presentation techniques that ease and encourage eating.
- Special adaptive utensils available if needed.
- Family is welcome to eat with the resident (maybe an extra charge for a family member).
Additionally, look for answers to the following questions:
- Are there levels of care the community provides?
- What is the monthly rate for housing and care? What services does that rate include?
- Are rooms private or semi-private? How do prices vary for each?
- What level of personal assistance can residents expect?
- What is the policy for handling medical emergencies?
- How is the community secured?
- How often are housekeeping and laundry service provided?
- What outside providers (i.e., physical therapy, occupational therapy, speech therapy, hospice services, etc.) does the community offer?
- Does the community accommodate special care needs, such as diabetic care, mobility issues, physical aggressiveness or wandering?
- Are residents grouped by cognitive level?
- How does the community communicate with families about a resident’s well-being?
- What is the discharge policy?
Putting it All Together
With all of this to consider, it is recommended that planning begin early. The search for the most comfortable fit for your loved one is already difficult and time-consuming; add the additional stress of being in crisis-mode and it may feel unbearable. The Alzheimer’s Association promotes early diagnosis. This allows the person with the dementia diagnosis to be involved in the decision-making process. If you know what your loved one’s preferences are, what is most important to your family, and have your list of questions ready when touring communities, you can meld all of this information together and find a home away from home for your loved one that meets everyone’s expectations.