Alzheimer’s disease, which is a form of dementia, and other types of dementia are becoming an increasingly large part of the health care conversation in America, with our aging population rising and more people developing these cognitive ailments.
The Centers for Disease Control and Prevention reports that in 2020, about 5.8 million people were living with Alzheimer’s disease. That figure is anticipated to nearly triple to 14 million by 2060.
For many people, once dementia has progressed in severity, they may need more care than family members can provide and require placement in a long-term care facility — either an assisted living community or a nursing home.
Some of these facilities provide amazing care and support for older adults dealing with cognitive decline or dementia. Others may not. And if you’re considering placing a loved one in an assisted living facility that offers dementia care, there are a few factors you should consider when evaluating whether a specific community is the right one for you.
Memory Care vs. Assisted Living
Within assisted living facilities, there’s an enormous variety in types of programs and their quality. Of the 30,000 or so assisted living facilities currently operating in the United States, some cater specifically to adults with cognitive deficits, and they may be labeled as memory care centers.
These facilities may offer better care for seniors with Alzheimer’s or dementia than a traditional assisted living community. These memory care facilities typically provide 24-hour supervised care in a separate wing or floor of a residential facility; this keeps residents safer and prevents them from wandering out of the building and potentially into danger.
Jackie Barbarito, the administrator of assisted living and memory support at Goodwin House Alexandria in Alexandria, Virginia, says that “assisted living care for those living with dementia can involve a more focused assistance with memory, judgment, process and communication. It may be managing an individual’s medication, reminding them of mealtimes or going to the bathroom.”
People with dementia need this assistance because “dementia affects not only memory, but cognition and physical abilities,” too, Barbarito adds.
Because many people with Alzheimer’s and dementia essentially revert back to an earlier time in their life, these centers often try to provide outlets for people to express their needs in a healthy way.
For example, people with dementia who raised children when they were younger may feel the need to engage in a mothering role, so some facilities set up a room with a crib and a doll, which residents can tend to when they feel agitated about missing a child.
For others, going to work every day was their primary driver in life, so some facilities set up a desk and a phone that’s not plugged in so they can go through the motions of going to work when they feel the urge to engage with that previous self.
In some facilities, the hallways are painted like a roadway or park so that residents feel like they’re outside when they’re actually safely indoors. Other assisted living facilities go to great lengths to recreate the appearance of the resident’s former home to increase their sense of safety and familiarity.
In short, there are many ways for different memory care facilities to cater to the needs of residents well — the key is finding a facility that offers three important components:
— Extensive staff training.
— A structured, patient-centered program that offered appropriate activities.
— Affordability.
[READ: 5 Signs It’s Time for Memory Care.]
Staff Training
“Quality dementia care starts with understanding the principles and practices that are rooted in person-centered care,” says Taneisha Hampton, a gerontologist and administrator of assisted living and memory support at Goodwin House Bailey’s Crossroads in Falls Church, Virginia.
“While dementia training standards vary, each state does have mandated hours of required dementia training,” Hampton says. Check with your state’s agency overseeing assisted living facilities for more info about requirements, and whether specific facilities are actually meeting them.
The Alzheimer’s Association’s Dementia Care Practice Recommendations document outlines best practices for providing care for people living with dementia. These guidelines help put the patient at the center of the conversation with all things regarding long-term care with dementia and define what’s considered high-quality care for individuals with dementia.
“Staff who work in assisted living communities are required by states to attend continuing education classes specifically on dementia,” Barbarito says. “These courses are mainly focused on understanding the brain of those living with dementia, tactics for redirecting those with dementia and strategies to reduce agitation.”
She adds that “many communities do significantly more than what is required.”
The best dementia care programs train everyone who works at the facility, not just the clinicians or caregivers who are directly responsible for delivering dementia care. That means staff working in the dining room, housekeeping and maintenance personnel, in addition to nursing staff, need to be trained on how to assist a person with dementia.
“Many staff are eager to learn new techniques when working with individuals with dementia, since it helps them significantly in their careers,” Barbarito says.
These individuals, while not directly involved perhaps with resident care, are likely to come into contact with dementia patients from time to time, and they need to know how to respond if a resident is confused or combative and needs assistance.
Each facility solves the riddle of training in its own way, but it’s important to ask whether and how staff are specifically trained to care for people with dementia.
Structured Programming and Specialized Activities
What makes one assisted living facility better for a person with dementia than another facility often comes back to how the care for these individuals is structured, and what services and activities are offered.
“Individuals with dementia can present themselves differently — it’s not all about memory,” Barbarito says. “It can be about processing, word-finding, communication, depth perception, etc. We train our staff and cater activities to best suit the needs of every individual.”
While care needs to be tailored to each individual, a common theme for all patients is that structure and a predictable routine are critical. This structure can offer residents an important sense of autonomy and self-control that may have been missing before.
“From a resident, or a family, point of view — what you want to look for in assisted living is do they have activities for cognitively impaired adults? A lot of assisted living is widely different — some are just pure memory care and pure dementia care. Those are fabulous facilities. But some are a mixture of elderly, from those who don’t want to cook to people with dementia,” says Dr. Douglas Scharre, a neurologist and director of the division of cognitive neurology at the Ohio State University Wexner Medical Center. It’s important to carefully investigate how a particular facility treats and supports residents with dementia, he adds.
That’s a wide spectrum of needs and preferences. And it can be challenging to cater to all of those different needs and demands well.
Tiers of Dementia Care
Often, as dementia progresses, a resident will need additional care. This is why some communities are structured with tiers of care that a resident can progress through as needed. “These different levels of care ensure that residents can have a great experience and remain as independent as possible throughout their dementia journey,” Hampton says. “As residents transition throughout the levels of care, we continue to celebrate them where they are and promote a holistic approach to their care.”
Some facilities will “close off a doorway and lock a door on some little hallway and say, ‘This is our memory unit,’ but they have no training,” Scharre says. “If you’re a consumer, what I would suggest is to look carefully at their activity program for the cognitively impaired. Brain stimulation increases quality of life.”
And by and large, if people with dementia are active and engaged during the day, “they’re not up at night,” which is a time when some people with dementia have a tendency to wander or get hurt.
Activities for Dementia Care
Activities specifically geared for people with dementia might include:
— Socializing one-on-one through conversations or reading a book together.
— Enjoying simple arts and crafts.
— Listening to and talking about music, or singing and playing music together.
— Working on puzzles.
— Looking through photo books together and recalling fond memories.
— Exercising — like taking a walk in nature or simply get outside for some fresh air.
— Visiting with animals, such as therapy dogs brought in specifically to stimulate the sense of touch and a feeling of unconditional love.
Engaging in more than one activity at a time can also lead to good outcomes. For example, combining cognitively stimulating activities, like putting together a puzzle or folding napkins while listening to music, can help some people with dementia feel more grounded and focused.
No matter which specific activities are on offer, the Alzheimer’s Association reports that it’s important that interaction be done “with— not to or for — the resident,” so look for facilities that emphasize one-on-one caregiver to resident interaction and resident-to-resident social activities.
Scharre says that when it comes to cognition, there’s a very real “use it or lose it proposition,” so look for facilities that work hard to keep seniors with dementia actively engaged and challenged throughout the day, with an emphasis on socialization at a range of different levels in a structured environment.
Financing Dementia Care
As with all discussions of senior care options, cost becomes a factor when determining the best approach or placement for someone with dementia. Selecting a community your family can afford is a key consideration when looking for the right place.
Gregg Ratkovic, senior vice president and president of Medicare with eHealth, a health insurance broker and online resource provider headquartered in Santa Clara, California, says that “unfortunately, Medicare will not typically cover assisted living or memory care facilities.”
However, “Medicare will typically pay for things like cognitive assessments, home safety evaluations and hospital stays. Prescription drugs can be covered under Medicare Part D plans or Medicare Advantage plans with drug coverage.”
Similarly, there are limitations on what Medicare will pay for when a senior is living in a nursing home. “In some circumstances, Medicare can pay for the first 100 days in a nursing home. But after 100 days, nursing home costs would need to be paid for with personal resources or Medicaid, or a combination of both,” Ratkovic says.
When a senior has spent down their reserves and can no longer cover the cost of living in a long-term care facility out of pocket or via private or long-term care insurance options, another federal health insurance program called Medicaid may kick in. That program provides coverage for long-term or in-home care in some cases.
Start Your Search Early
“Memory support in assisted living will continue to evolve as medicine advances and as we continue to create and explore non-pharmacological interventions, programming and technology,” Hampton says. Lots of research is underway into how best to treat and manage dementia. There’s much reason to be hopeful for the future of dementia care.
But Hampton notes that the best time to look for such care is before you even need it. “I would highly suggest beginning your research early, exploring options for the future, engaging in brain health programming and taking the initiative in self-care.”
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Everything You Need to Know About Dementia Care in Assisted Living Communities originally appeared on usnews.com
Update 11/14/22: This story was previously published at an earlier date and has been updated with new information.
