In memory care, safety is the bottom line. Residents live in secured memory-care facilities because dementia or cognitive impairment makes it difficult for them to look out for themselves and it is risky for them to live alone.
For many of these older adults, issues with wandering mean they need more protection than regular assisted living or a nursing home can offer. A memory care unit, with staff that’s received extra dementia training and lower resident-to-staff ratios, might be the best option.
[See: 7 Red Flags to Watch for When Choosing a Nursing Home.]
About 10 percent of assisted-living facilities serve only people with dementia, says Lindsay Schwartz, senior director of workforce and quality improvement for the National Center for Assisted Living, part of the American Health Care Association. Another 12 percent have some kind of dementia care unit, wing or designated floor. The need is there: Some 40 percent of residents in assisted living have dementia.
Once a parent settles into his or her new home in a well-run memory-care unit, daughters and sons can breathe a sigh of relief — their loved one is safe. However, quality of life and staying active and engaged are still important. With ongoing communication and awareness, family members help parents have the best possible experience.
Maintaining an open dialogue between family members and memory-care providers is essential, Schwartz says. It starts with your sharing background knowledge, including your parent’s likes and dislikes and possible triggers he or she reacts to. For instance, facilities may offer pet therapy but your parent might be afraid of dogs. That’s information to share in advance.
Subtle Differences
When you visit someone in memory care, you shouldn’t necessarily notice: “Oh, this is a dementia unit,” Schwartz says. Just like the regular assisted-living unit on the first floor, she says, enrichment and engagement activities should be going on, although they might be modified. “A lot of times you can’t tell the difference — that’s kind of the whole point,” she says.
[See: Beyond Bingo: Innovative Activities at Today’s Nursing Homes.]
However, you will see some differences. Getting on and off the elevator, you might have to punch in a numerical code to gain access to and leave the restricted unit. Your parent’s kitchenette may have a sink and refrigerator but there’s no stove or microwave. In the bathroom, where the light is always on, you won’t find an electric razor, curling iron or blow-dryer.
Objects taken for granted at home may be forbidden — such as small nail scissors or a collection of sewing needles. Restrictions exist for good reason: to prevent accidents or injuries to individual residents and their neighbors in the unit. Still, your parent may resent these restrictions and not understand why they’re needed.
As their disease progresses, people with dementia have less awareness of safety, Schwartz says. In memory care, she says, it’s not about eliminating an enjoyed activity; rather, it’s adapting it to make it safer. For instance, a parent who’s always enjoyed doing crafts such as needlepoint or woodworking could do so with supervision, perhaps as part of a group activity.
Mobile as Possible
Wandering is a major reason people seek memory care for loved ones. However, a parent who always enjoyed brisk outdoor walks can become unhappy and restless when pacing down the long unit hallways fails to replace the feeling of freedom.
When adult children start the discussion about placing a family member in memory care, it’s important to clarify their goals and expectations and write them down, says Dr. Saket Saxena, a geriatric medicine physician at Cleveland Clinic. In the following weeks and months, it helps to revisit those goals periodically.
Residents should stay active to the best of their abilities. “The goal was not to restrict mobility,” Saxena says. “The goal was to provide more supervision.” Cognitive or physical decline is not identical for any two people, he says: “We have to account for that. That’s why it’s important to be an advocate for your loved ones.”
Let staff know about your parent’s activity habits as well as limitations in memory and thought processes, hearing, eyesight, mobility or balance, Saxena says. Also, ask if there’s a walking program available, as well as other activities to maintain strength and muscle tone, appropriate to your parent’s level.
Some memory care facilities offer enclosed walking areas, indoors or outdoors, which give residents a safe place to enjoy exercise (and possibly fresh air) while still under supervision.
Another health issue to watch is how well your parent is eating. Nutrition can be compromised with dementia, Schwartz points out. Share your parent’s food preferences with staff but also understand that eating habits change as the brain changes, she says. Visit during a meal if you can.
Make sure pain is being addressed, Schwartz advises. Often, she says, people with dementia may not be able to tell someone they’re having pain or where it’s located.
It’s worth finding out how much time your parent spends in his or her own room during the day, versus being out in common areas with other residents. Quiet time and privacy are important, Schwartz says, but with dementia, engagement is important, too. Residents with dementia are at risk for depression, she says, especially in the earlier stages of memory loss, and self-isolation doesn’t help.
Consistent staff assignment is also really important, Schwartz says. As staff members get to know a resident, they can pick up on changes early, know what behaviors to expect and what might upset the resident. As a family member, continue to engage with staff, whether you can visit in person or live in a distant state. Have a scheduled time to call to see how things are going, she suggests.
[See: The Best Ways for Nursing Home Residents to Stay Active.]
Family Due Diligence
“Trust but verify,” advises Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care. “You need to do due diligence. Don’t assume that just because they say they’re memory care that they have the necessary expertise, structure or activities.”
Staffing ratios can vary widely among centers, and coverage may differ on day versus night shift, or on weekends. You really have to ask about staff ratios and dementia training when considering any memory care facility.
There are no national guidelines for staff-to-patient ratios specific to memory care. Staff ratios for assisted living, in general, vary by state. For memory care, an ideal ratio is one staff member to five residents, according to dementiacarecentral.com, a website managed by the American Elder Care Research Organization. However, a six-to-one ratio is more common, the site notes.
If you have any questions about your parent’s ongoing care, it’s absolutely your place to bring them up, Grant says. “I would ask from the beginning: How do you involve family?” she says.
It’s helpful to ask about your parent’s care plan or service plan, Grant says. Ask to sit down with the director of nursing, administrator or whomever is appropriate, depending on the facility. Address any concerns you have, from your parent’s daily routine to emergency plans, such as evacuations in the event of a fire or severe storm.
Hiring a local geriatric care manager is an option. “They can monitor things and if they’re not going well, they can report that to you,” Grant says. “They can go to the staff there and talk about what they observed, what the concern is and how it could be addressed.”
Staying Engaged
Even with the best of care, parents may still not be happy or satisfied as their family had hoped, Saxena says — and that’s understandable. “You are taking the individual out of the community and putting them in a place where they don’t have friends,” he says. “They’ve probably lived in their house [for decades]. That’s a very traumatic experience. It’s not easy for them to have that transition.”
The simple truth, Saxena says, is that residents miss their loved ones. Show your parents you’re still available, he encourages, whether it’s by visiting, calling or through FaceTime or Skype. “It goes beyond knowing they’re safe; that they’re all right and they’ll be taken care of,” he says. “Keep on engaging them as best as you can.”
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Why Ongoing Vigilance Is a Must When a Parent Lives in Memory Care originally appeared on usnews.com
