Finding residential long-term care is relatively straightforward for most seniors. Are Mom and Dad still safe living on their own but craving a little more stimulation in their daily lives? Independent living is the perfect fit. Is Grandma largely independent except for the help she needs with bathing, dressing, and transportation to errands and appointments? She’d likely thrive in assisted living. Does your husband require around-the-clock supervision and skilled nursing care? Then a nursing home is the correct level of care for him.
The different types of senior living seem easy enough to understand at first glance, but deciding where and when to place an aging loved one is far more complicated when they have some form of dementia. One would think that the spectrum of long-term care would match up well with the progressive nature of Alzheimer’s disease and other types of dementia, but that is not always the case. Several factors go into choosing a long-term care facility for a dementia patient. Even if you get it right, there’s no telling how long the perfect fit will last.
Assessing Needs is Complicated by Dementia
Unlike other chronic conditions, such as heart failure or chronic obstructive pulmonary disease (COPD), which progress in a predictable, linear manner, dementia advances uniquely in each person. In addition to impaired cognitive function, there are certain hallmark changes in abilities and behavior that occur with different types of dementia, like wandering, hallucinations and dysphagia (trouble swallowing). However, the order in which these changes occur and their severity (if they ever happen at all) is highly individual.
To make matters more complex, such changes are not always permanent. Many dementia patients go through stages of decline, but they can also have hours or days when they “improve” and seem more like their old selves. Many seniors also tend to “showtime” or have unusually lucid moments during important events like doctor’s appointments and cognitive assessments. All these factors combined can make it extraordinarily difficult for doctors, family caregivers and senior living personnel to accurately assess the current needs of dementia patients and anticipate how and when these needs may evolve.
Nonetheless, a needs assessment conducted by a knowledgeable professional is usually the first step in moving a loved one to senior living. These assessments typically focus on a senior’s ability to complete activities of daily living (ADLs) with or without prompting, partial assistance or total assistance. In some cases, more than one assessment may be needed to establish a realistic level of abilities and needs. At the very least, this evaluation will help narrow down a senior’s options for care and housing.
Senior Housing Options for Dementia Patients
Each type of residential long-term care community has its own rules strictly dictating the extent of care it can provide. While these regulations can vary by state and facility, understanding the general care levels for senior living options will help you match your loved one’s needs with the right level of care.
Independent Living Communities
This most basic level of senior living is only intended for residents who are still capable of what the name implies: living independently. No assistance with ADLs is provided, but meals, social and recreational opportunities, and private, no-fuss living arrangements are included. Only self-sufficient seniors in the earliest stages of dementia can reside in independent living (IL), and, because of this, a dementia patient’s stay in this setting is not likely to last.
This arrangement usually lasts longer when a couple moves into IL together and the healthy spouse is present to help support and supervise their partner. Caregiving can take a toll on one’s health, though, so there is no telling which spouse’s needs will increase first. When either (or both) does require a higher level of care, the next step is usually a move to an assisted living facility (ALF).
Assisted Living
ALFs offer an intermediate level of care that provides residents with hands-on assistance with activities of daily living, and many offer a wide array of add-on care services at additional cost. Skilled nursing care, however, is NOT provided. Dementia patients in the mild to moderate stages often spend quite a bit of time in this setting. The daily personal care allows them to maintain their health and safety and retain some of their independence, but there is a limit to what assisted living can provide.
Rooms in ALFs are still private and the care the staff provides is not intended to be one on one or available 24/7. Yes, if a resident has an emergency, staff members are available to help around the clock. But if one resident constantly requires assistance, it detracts from the care others receive and usually indicates that it’s time to move to the next level of senior living. Persistent falls and troublesome dementia behaviors like wandering and outbursts are the most common instigating factors for the move to a higher level of care.
Specialized Memory Care
Depending on what resources are available in the community, a dementia patient’s next move may be to a memory care unit (also known as a special care unit). Memory care can be provided in a dedicated facility, in a secure wing of an assisted living facility or at a continuing care campus that offers multiple levels of care in one location.
While the physical setting may vary, the goal of all memory care facilities is to provide long-term residential care tailored to individuals with moderate- to late-stage dementia. The professionals who work in this level of senior living are well-versed in dementia care. Staff members understand the difficult behaviors that may arise and how to diffuse them, they know how to communicate with their residents, and they are trained to recognize the subtle signs that can indicate changes in a resident’s mental and/or physical health.
Aside from this specialized care, one of the largest benefits that memory care units offer is increased supervision and a secure property to prevent seniors from wandering. The activities and social programs are also adapted to meet dementia patients’ unique needs and abilities.
Nursing Homes
At some point, many seniors must move to a nursing home (also known as a skilled nursing facility), which offers the highest level of long-term care. This setting provides around-the-clock skilled nursing care as well as assistance with ADLs. Staff members have varying levels of medical training and can assist with administering medications, IVs, injections, wound care and other complex medical tasks that are typically unavailable in the other settings mentioned above.
Unless there are other serious medical issues present, patients with dementia have usually progressed to the later stages when they transition to a nursing home. At this point in the disease, many are incontinent and may be unable to walk safely, communicate or feed themselves. These high-level needs require intensive care and supervision that only a nursing home can provide.
Supplementing Senior Living with In-Home Care
Of course, family and friends can provide loved ones with assistance regardless of where they live, but the reality is that they cannot be there all the time. There is a limit to what one person can provide, whether it is at home as a sole caregiver or as a visitor supplementing the care provided in a senior living facility. The good news is that hiring in-home care can help a dementia patient remain in a certain level of care for a longer period.
In-home care can be provided in whatever setting a senior considers home. For example, assisted living only offers intermittent care and supervision, but hiring a professional caregiver to spend one-on-one time with your loved one could improve their safety and postpone a move to the next level of care. As long as this supplemental supervision keeps the senior safe and falls within the current facility’s qualification guidelines, a transition to a nursing home could be delayed or even avoided entirely. The only catch is that the facility must have a policy allowing such an arrangement with an outside provider.
Tips for Choosing A Senior Living Facility for a Loved One with Dementia
After your loved one has undergone a care assessment, you’ll need to begin researching facilities in your area that provide the level of care he or she needs. Narrow down your list of choices and then decide to visit a handful of prospective communities. Seeing each one in person will help you to compare the environment, staff, costs and care services each offers.
If you tour one you like, make a few more visits at different times of day to ensure you like what you see. Enjoy a meal or two at the facility and ask to observe or participate in a couple of activities you think your loved one would enjoy. Be sure to take notes on the basic information like services and costs, but also keep records of pros, cons and your reactions to certain features. This will help you determine the best fit for your loved one.
During a visit, here are some things to look for:
- Safety devices and precautions, such as door and window locks, monitoring systems, grab bars, adequate lighting, and non-slip flooring
- Compassionate, friendly and attentive staff
- A structured routine for residents
- Activities that are designed for people with varying ability levels
- Outdoor activities and safe outdoor recreation areas for walking, gardening, etc.
- Residents who appear clean, healthy and content
- Clean, tidy and fresh-smelling common areas
- A calm, pleasant and home-like atmosphere
General Questions to Ask the Senior Living Facility
There are some things you simply cannot observe while on a tour. Instead, address the following questions with your tour guide, an administrator or another staff member:
- How many rooms/residents are there?
- How many Alzheimer’s and dementia patients live there?
- Is the facility licensed and certified?
- Is the staff specially trained in dementia care?
- What are the staff’s ongoing training and continuing education requirements?
- How are aggression, wandering, hallucinations and other difficult dementia symptoms and behaviors handled?
- Can a patient be asked to leave due to aggression, anger and other bad behavior?
- What is the ratio of staff to residents on a normal day? What about evenings, weekends and holidays?
- What levels and types of care does the facility provide for all residents?
- What levels and types of care does the facility provide specifically for Alzheimer’s and dementia patients?
- Is transportation provided for doctor’s appointments, errands or shopping?
- What is the facility’s policy on wheelchairs, oxygen tanks and other medical equipment?
- Does the facility accept seniors who need assistance with incontinence care?
- Does the facility allow a resident to hire supplemental outside help through a home care company?
- Are residents allowed to bring furniture and/or personal items from home?
- Does the facility host support groups, meetings or events for family members to attend?
- How are changes in a resident’s care communicated to family members?
- How often are care plan meetings held?
- What safety measures are in place for Alzheimer’s and dementia patients?
- Will your loved one have to move to a different area or facility when their condition progresses?
- What is the policy for prescribing new or “as needed” medications for residents?
- What is the process for ensuring patients get their prescribed medications on time and in the correct dosages?
- What happens if there is a medical emergency?
- What are the facility’s hospitalization and bed-hold policies?
Questions to Ask About Senior Living Costs
Long-term care of any kind is expensive, but there are additional costs associated with dementia care. Because this condition usually progresses so slowly and unpredictably, making a financial plan for current and future needs to the best of your ability is crucial. Most senior living communities are “private pay,” which means the resident (or their family) is responsible for all costs unless coverage through Medicaid or the Department of Veterans Affairs (VA) is a possibility. Remember not to lose sight of what your loved one can and cannot afford when dealing with this emotionally charged issue.
Some financial questions to ask while touring facilities include:
- What is the baseline monthly fee?
- What services and amenities does this monthly payment include? (e.g. how many meals/snacks per day, transportation services, special Alzheimer’s/dementia services, etc.)
- What additional services and amenities are offered and what are the additional costs? (If possible, request an itemized list.)
- Does the facility accept long-term care insurance or Medicaid?
- What happens if your loved one runs out of money and can no longer pay privately?
For more information on senior living options and to find long-term care facilities in your area, visit AgingCare’s Senior Living Directory.