“Memory care” has a gentle ring to it, a sense of precious keepsakes highly valued and lovingly tended. In the realm of long-term care, memory care refers to specialized settings offering stepped-up services for people with Alzheimer’s or other types of dementia. Demand is rising for this type of care — usually found within assisted living facilities and nursing homes — despite the premium cost. If you’re thinking about memory care for a family member, here’s what to consider.
Secured units, alarm devices and enclosed outdoor areas to keep people safe from wandering are only part of the picture. Staff members should be trained to understand the needs of people with dementia, who can lose the ability to communicate in normal ways yet still respond to verbal cues and sensory stimulation. Good memory care engages residents and gives them space to be active, promotes their physical and emotional well-being and doesn’t overly rely on medication.
The type of memory care that is best suited for someone depends on how far dementia has progressed and how symptoms manifest. In early stages, people can do well in memory care communities. But eventually, they may need services within a facility.
Nancy D’Auria, assistant director of nursing care at the Hebrew Home at Riverdale in New York City, says families usually seek memory care when they’re in a crisis situation. “For the spouse or family member who’s caring for them, it just becomes too much,” she says. “One day they’re just like, ‘I can’t do this,’ and they suddenly start looking for placement.”
Along with traditional units, Hebrew Home has a range of memory care, with early-to-moderate and moderate-to-advanced units, D’Auria says. Sometimes new residents can be placed right away, but other times no rooms are available.
Safety and Room to Move
Eloping or wandering is a risk for some people with dementia. At Hebrew Home, D’Auria says people who have “exit-seeking behaviors” wear RoamAlert bracelets, which sound an alarm if they go too near an elevator. The bracelet also allows staff to track residents if they get off the floor, she says. Elevators require staff to punch in key codes for access.
Freedom of movement is important for people with dementia, who, as younger seniors, tend to be physically active, D’Auria says. “People who are coming into early-to-moderate [memory care] are in their mid-70s,” she says. Some with early Alzheimer’s can be in their 40s or 50s.
A long , indoor pathway between units at Hebrew Home at Riverdale lets memory care residents move safely within a large area, with staff assigned to look out for them. With a Central Park theme, the pathway ceiling is painted with sky and clouds, along with murals of trees, a koi pond and tables and benches where people can sit and have lunch.
Outdoors, residents can use an enclosed space fenced by a brick wall and topped with iron railing. “They’re safe, and they can’t hurt themselves or get lost or anything else , but they can go outside,” D’Auria says. Raised flower beds mean residents can have gardens. An aide is assigned to be outside with residents.
Memory units are also classified based on whether residents exhibit certain behaviors — aggressive or destructive behaviors that sometimes appear with dementia. Banging on objects or throwing dishes are examples, D’Auria says. Medications may be needed in some cases, she says, but well-designed facilities, supportive staff members and tailored activities go a long way to easing disruptive behaviors without requiring drugs.
[See: The 10 Best Exercises You Can Do for the Rest of Your Life.]
Staff: Quantity and Quality
Adequate staffing ratios are critically important for good memory care, says Mitzi McFatrich, executive director of Kansas Advocates for Better Care, a statewide nonprofit focused on long-term care issues. An ideal ratio is about five residents to one care staff member, she says, meaning nurses and aides (not dietary or housekeeping staff) who actually provide care to residents.
“You absolutely want staff who have good , solid training to understand geriatric care, so the specific care of older adults, and training in dementia and Alzheimer’s and the differences between those illnesses,” McFatrich says. “How they manifest, how they respond to medications, the differences there are in individuals on medications, so you know what to look for.” Sometimes, medication side effects can make people act out.
It’s important to look at the reasons behind disruptive behaviors, McFatrich says. “People are losing their language skills,” she says. Staff members need to understand how to communicate with people as dementia progresses.
If you’re considering a memory care facility, McFatrich says to look for these signs of respectful care:
— Do staff members respond to individuals in a patient, positive and caring way during interactions?
— Do they communicate with residents as adults who can make choices, affording them dignity rather than treating them as infants?
— Is the staff good at redirecting individuals in ways that don’t escalate anxiety or anger? For instance, they might take the time to walk on the grounds with a resident who seems eager to leave the building whenever he sees visitors do so.
— Are basics of communication the norm? Looking into people’s eyes when speaking and using an appropriate volume and tone of voice are as important as ever in memory care.
— Are staff members gentle in assisting a person to move, rather than pushing him or her in a direction?
— Is the staff open to nonverbal communication methods? For instance, using pictures and symbols, such as pictures of food for eating, or of baths and showers, or indoor and outdoor activities, allows people to make day-to-day choices.
[See: 7 Red Flags to Watch for When Choosing a Nursing Home.]
Premium Care/Premium Costs
Memory care costs more than standard nursing home care. For those who qualify, Medicaid may cover dementia care costs. Medicare typically does not cover long-term nursing home care because it’s considered custodial care. However, Medicare special needs plans may offer some benefits for people with dementia.
In her Kansas area, McFatrich says, it costs about $2,000 more a month to purchase memory care than it does to pay for regular assisted living or nursing facility care, or an extra $24,000 a year. That’s on top of regular nursing facility costs ranging between $60,000 and $150,000 yearly in the state.
For those interested in community-based memory care, SeniorHomes.com has compiled a state-by-state list of costs. Monthly averages range from a low of $3,165 in Idaho to a high of $5,800 in Maine.
Memory Care at Night
Sleep patterns may change with dementia, and that can be difficult for family caregivers of loved ones in the home. “With Alzheimer’s and dementia , there’s a lot of sleep dysrhythmia,” D’Auria says. “It interferes with people’s circadian sleep and wake cycles. The caregiver may be up and down all night long trying to prevent them from leaving the house.”
Hebrew Home at Riverdale runs an overnight program. Instead of coming in the morning, participants arrive at 7 p.m. and stay all night.
“We have evening activities , and we try to do patterning behavior as much as possible to see if we can get them into a better sleep pattern,” D’Auria says. “And it not, we run activities all night long. We have barbecues at 2 a.m. in the morning. Why not? They’re up.”
McFatrich says memory care units should take varying sleep patterns into account. “I would expect to see staff that are as comfortable during the night as they are during the day,” she says. “And I would expect to see a unit that has as many staff on during the night as they do during the day, which is very different from the way most residential facilities are staffed.”
Sensory Stimulation
In memory care, activities to engage residents often reach them through their senses. “Music is huge,” D’Auria says. “We do a lot with show tunes , and we try and go with big band. We’re trying to gear it toward the population to bring something back to them, to their memories.”
[See: How Music Helps People With Alzheimer’s Disease.]
D’Auria describes an innovative program at her facility. “One of the things with Alzheimer’s is they’re very fearful of people they don’t know — and we’re people they don’t know,” she says. “We’ll have their children videotape, ‘Good morning, Mom — this is Mary , and it’s time to get up now. You’re going to have some breakfast.’ Or a spouse might say, ‘Hi, how are you? I’m going to be there on Saturday.'”
A team approach to memory care is needed, D’Auria says, whether it’s the physical therapy/rehab department suggesting a walker to help someone get up and do more, or the therapeutic activities department bringing in arts and crafts, like beading, or even the dietary program, whose pancake and waffle days are big hits. The smell evokes memories of childhood, she says, and people are encouraged to eat more and eat better.
Individual Needs
If you’re evaluating memory care facilities, McFatrich says, look for those that offer cutting-edge ways to help people enjoy life and communicate with others. “Always, always talk to residents that are there,” she says. “Talk to their families. Find out what people think about what works there and doesn’t.” She cautions people to be wary of cookie-cutter approaches, like having a stuffed animal in every room. “Because something works for me,” she says, “that doesn’t mean your needs are going to be the same.”
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What Nursing Home ‘Memory Care’ Means originally appeared on usnews.com
