In regards to Memory Care facilities, what are the pros and cons of multiple small buildings vs. one, large, continuous big building?

My experience from looking around is that the facilities vary a lot. First, I only toured licensed facilities. There are many smaller facilities which are extensions of private homes, which are or employ unlicensed individuals.

I toured one facility where there were 8 residents per building and a total of 4 buildings with another building as a communal area (no residents, however also doubled as the administrative area and where food was prepared). Each of the residents had their own bedroom and bathroom. The building had a common area for meals, medication, laundry, etc. There were minimum of 4 caregivers per building during the day and minimum of 2 caregivers per building at night with 2 nurses for all buildings 24 x 7. There were lots of walking/picnic areas (useful for visitation), all openings in the building were alarmed, the entire facility had decently high concrete walls or gates. Residents were not allowed out of the building without a caregiver. They went to the communal building for activities as not all residents participated in the activities. We ultimately chose not to utilize these smaller facilities because of potential medical needs. If she fell and needed an xray, she would have to go to the ER at a hospital to get this done, they could not take her to Urgent Care Facility under the terms of their license. In addition, my mother used to inspect these facilities over 60 years ago and she had it in her head that these places could not be trusted. From my point of view, they provided the most personalized service and even catered to an individual's taste in food. I later found out that many of these facilities were not licensed all the way to end-of-life and that she might have to move to another place if her needs got really worse (which in memory care, that is a real possibility).

I also toured and my mother did a respite stay at a larger AL & MC facility (approx 80 people per floor). She would enter in at AL and as her needs changed, she could move to MC. The main difference was in cost. After you reached a certain number of services (e.g. medication management, laundry, etc), it became more cost effective to move her to MC. MC had activities that were targeted towards memory, whereas AL had classes in cooking, art, etc. We ultimately chose not to go with this facility as they wanted all their residents in memory care to stay in their room after 7 and as a result, my mother's arthritis got worse due to lack of exercise. They also ordered medication without my knowledge and then charged me $35 to have the medication brought to the facility (total out-of-pocket to me after insurance was $37.) My mother does not watch television, however we found out they turned off the cable between 7 pm and 6 am. For at least the last 20 years, my mother has never slept 8 continuous hours so asking her to stay in her room for 11 hours during the night was a definite red flag to me. We only found this out when she did the respite stay.

I ended up putting my Mom into a facility that has approximately 60 residents per floor. The facility happens to be separate, yet location wise, part of a larger campus that includes a Skilled Nursing Facility and Rehab Center. I stayed away from any facility that was totally locked down during COVID as I heard that the forced isolation took more lives than COVID did in our state. If I have to take her to the hospital, it is less than 10 minutes from where she is. My Mom's care in a facility will never be as personalized as the care I was giving her. However, I could no longer deal with the caregivers that did not show up, the complaints and accusations that my Mom made about the caregivers, the denial of memory loss and her insistence that she remembered everything correctly. By telling my Mom that I could not longer take care of her, she was more willing to accept that she had to move our of her home and into a facility.

My dad's memory care was one rectangular building with rooms down the long walls and the entrance with conference rooms on one end and a porch and enclosed garden on the other. The center contained the nursing station, kitchen, dining room, and a area with couches and rocking chairs. This layout seemed to work well. Residents could stay in their rooms but the common area was always close at hand and the staff was able to keep an eye on people in the resident rooms and in the common area or out on the porch.

As memory declines I think the multiple buildings would be very confusing.

My mom is in a small ( 13 resident ) locked down MC, with a cafe area and a couple of activity rooms in the middle with the rooms spit on either side. Cafe and activity areas are open and there’s a lot of large windows so it’s bright and cheery. There’s also a closed-in patio garden residents can go to but not be able to wander out of.

It’s a lovely space but I was worried that I’d have to move mom out because she’d be like a bull in a china shop plus the different levels of cognizance being mixed seemed awkward at first. Fast forward and over time I realized the staff is SO KIND and they’ve created such a lovely mellow vibe there, it supercedes everything else. There is almost no staff turnover and the kindness of the staff begets more kindness…residents from the independent living area volunteer in the MC garden and visit residents, somebody from IL recently donated money to get virtual reality goggles in the MC ( true! ) The staff decorate for every holiday like gangbusters, etc..

Mom had a seizure and is not a bull in the china shop any more so the mixing is a better fit. That said, IMO kindness of the staff is EVERYTHING. Mom’s MC is small but mighty and all due to the people there. My recommendation would be to scope out how the staff is treated and how they act to residents and each other, then go from there.

Good luck!

Our locked MC was the top (3rd) floor of a new modern building.

It turned out to be just about perfect for our LO. There was a nice sized dining room/day room with a TV/hobby area, accommodating about 30 people before COVID.

Since then, the 3rd floor has become the site of a COVID wing, and my LO has entered the SNF in the same small complex.

Are you describing the only 2 options that you’ve seen in your area, or are you still looking?

One friend investigated them for her father. He tended to wander; she thought the best place had long halls in one locked building. He would not be confined to his room but had a place to stretch his legs and work off his anxiety safely. I know they can be safe because as a visitor once I misapplied the code posted and was rescued by several staff members who thought I was wandering out when an alarm went off.

I’ve been touring local memory care options for my husband (Alzheimer’s). All are on one level & single building designs. Private pay gets you a private suite, private room or semi-private room. State pay gets you a semi-private room. Costs are fairly similar. It might be different if he were placed for any other reason, but to me I found that homes that were X shaped, with one end (wing) for memory care locked down, very confining. (I peeked out through blinds at one & they just looked out to a drab parking area. My guide actually said it was “to keep them from getting ideas”. My original choice, where one of his daughters works, is rectangular in shape, built around a central courtyard. All exit doors are locked down, although families have an access code to enter & leave. There is a hall that goes all the way around through the building which is nice for strolling. The dining area & rehab suites are at one (short) end, the TV & Activities rooms are at the opposite end, nurses’ stations are along both long sides. Unfortunately, it is now under new ownership & no longer provides memory care. My current top choice, although X shaped and secure over all, does not confine dementia patients to just one wing at this time (being remodeled), but eventually will. (Many families pulled loved ones out when Covid hit, so with census numbers down, the home chose to take advantage the time & remodel. Once it is finished I will need to check it out, before assuming it is the best place for him.) It is unionized, so well staffed. There is a large central dining hall, a number of smaller common areas and quiet seating areas, and several staffed nurses’ stations throughout. What I liked most about it, is that it was originally a county home built as an old folks home for county farmers. It is on the edge of town in a rural community with lots of open green space on the property. (If someone did get out, they could be seen for quite a ways.) It is home to more than just memory care, so has been designed with visiting families in mind - with a playground, screened in pavilion and a small barnyard with animals (seasonally) spread around different sides of the building. Short walking paths (wheelchair accessible) wind thru the property with several outdoor seating areas. It’s old, but maintained. I know none of this really relates directly to how my husband will fair there, and the aides could rarely, if ever, take him outside, but family can.

My husband & I both grew up on farms. I think on his good days he will enjoy it there. On his bad days, it will be a good place for me to step outside & pull myself together. At some point, none of it will make any difference to him. But when discussing pros & cons with a friend, she simply asked which one I would most want to go visit him at.

[An attorney recently mentioned I should consider personal injury cases when looking at facilities. He said locally, two had a very high number of pending lawsuits. He couldn’t remember the last time the county home had one. Who knew?]

The purpose of Memory Care is to have a shrunken down world for a resident to live in. Not to get lost wandering around different buildings, which makes no sense at all. My mother's Memory Care AL was a small building, only housing 23 residents in all. It was shaped in a square; the rooms were dotted around the perimeter of the square, with the activity room in the center. Nobody could get lost b/c the hallways all led to the activity room.

The residents were all gotten out of their rooms by 9:30ish in the morning and taken into the activity room where there were tables set up for meals; the residents did everything there; they ate meals, they socialized, they did arts & crafts, activities, watched movies, etc. On the far side of that room was a set of French doors leading out to the garden; there was no exit from the garden so it was a safe space for the residents to sit and relax.

There were a few restrooms off of the activity room; the caregivers would toilet the residents on a strict 2 hours schedule; not in their rooms, but in those restrooms, so they were sure to have their briefs changed if necessary, and/or were able to use the toilet if they needed to. That prevented accidents and diaper rash, etc.

Residents were not allowed to eat in their rooms, nor were they allowed to stay holed up in their rooms all day long unless they were sick or on hospice. I as POA signed mom up for this knowing in advance what would happen; I was totally on board NOT allowing her to stay in her room all day and allowing her to eat in there. I wanted socialization for her, I wanted communal dining, I wanted her brought out of her room every morning and her to be fully dressed and coiffed, etc.

You don't want your mother brought from bldg to bldg which makes NO sense, esp in AZ heat. That scenario makes no sense to me, so make sure you're understanding how the place works before you sign on the dotted line. Having demented elders go outside in sweltering heat when they don't HAVE TO is absurd. You want an air conditioned one building set up where mom can stay indoors during the summer months, where she will be TAKEN to the restroom on a schedule, and where you will be given a detailed care plan for her care. The care plan should be gone over every 3 months with you as her POA, and updated as you and the nurse in charge see fit. That's how Memory Care SHOULD work.

I've also worked in a national Memory Care franchise which worked in basically the same manner as the privately owned facility I had mom in. It was larger, housing approximately 75 residents, but set up the same way, in a square, with the rooms dotted around the square, and the activity room in the center. That set up works best. Both MCs, by the way, were locked facilities meaning the residents were unable to walk out the doors and off the premises.

Wishing you the best of luck.

The facility that my pop has spent time in for respite care had a few small buildings (none being particularly that small, he had plenty of room to be active, different activity rooms, etc), but the concept was to house people together who were at similar levels of progression. I thought this was a pretty smart idea as to not “scare” people who are earlier into their dementia. He had a good experience being with people at the same stage as him.

My brother's assisted living was made up of cottages that had about 14 residents in either one or two room studios. These rooms were arranged around the main dining on one end, snack room and extra bathroom in middle, and communal room on other end. Each cottage seemed to have a different "personality" if you will. The grounds were spacious and beautifully kept and residents could visit other cottages. Then TWO of these cottages were memory care. Sligihtly longer in length but otherwise much the same with usually two residents to room. Much better staffing of course for the MC. The setup was beautiful and worked so very well. Each cottage had weekly or bi-weekly resident meetings to chat (as my bro said, always complaints, just like a commune in the 60s).
The other place my brother looked into was more like an apartment building. Fewer meeting rooms. Better food, almost fine dining, but that was the only upside along with a pool usually locked down. Residents seemed more isolated, less well watched, less safe, more confined to room.
It is a matter of checking out what assets available and what places are like before going in. I think the residents in the "hotel" like one liked it. Said like being permanently on vacation at a lovely hotel, but I would have chosen the cottage atmosphere, myself.

I think most of the ones with smaller individual "houses" are self contained. They would remain in and around their house.
Someone in Memory Care is not going to be allowed to wander from building to building. Most if not all Memory Care is or are locked units.
The smaller "houses" are then set up just like a home would be with a kitchen, bedrooms, bathrooms. the resident then becomes comfortable within the home they are "assigned" to.

I think to ease your mind a tour is in order and you can ask all the questions that you have that are concerning to you.

One large building. I toured some of the other types and going outside was not an option for one in memory care unless there was a courtyard that they could go through and that still was not good idea here in Florida, too hot and too wet during rainy season.

If she would be in memory care the staff encourages residents to join in and not sit in their room.