Say your aging mom, who’s living with dementia, has always been conscientious about opening her mail and paying her bills. You and other family members check on her regularly to see if she’s OK. Yet, over time, you notice she’s letting her mail accumulate unopened and forgetting to make her payments, or, she’s paying the same bill multiple times. Or maybe, she’s always cooked for herself, but lately, she’s been unable to prepare meals. And as time passes, she may start having trouble with other basic tasks of daily living, like dressing herself or using the bathroom.
There may come a time when a person living with Alzheimer’s disease, or another form of dementia, will need more care than can be provided at home. During the middle to late stages of Alzheimer’s, it becomes necessary to provide 24-hour supervision to keep them safe. In some cases, more specialized care is needed.
Overall, more than 6 million people in the U.S. have Alzheimer’s, the most common form of dementia, according to the Alzheimer’s Association. More than 11 million family members care for someone with dementia, and others live in assisted living communities, nursing homes or memory care units.
“When choosing a residential or long-term care setting for someone with Alzheimer’s or another dementia, it is really important to do your homework and understand the different levels of care these settings provide,” says Monica Moreno, senior director, Care and Support at the Alzheimer’s Association. “Assisted living facilities offer support for the person, but do not provide full-time medical care. Nursing homes provide medical care, but may not offer specialized dementia care. Knowing the levels of care these different facilities provide can help families make the best choice.”
People with dementia who exhibit certain behavioral changes that affect their day-to-day living are recommended to start living in memory care units, where they can receive specialized care from health care professionals trained to work with such patients, says Dr. Ardeshir Hashmi, section chief for the Center for Geriatric Medicine at Cleveland Clinic.
[SEE: Early Signs of Dementia.]
Warning Signs That Someone Needs Memory Care
Here are six behaviors or circumstances that can indicate someone needs memory care:
— Changes in behavior.
— Confusion and disorientation that imperils physical safety.
— A decline in physical health.
— A caregiver’s deterioration.
— Failed electronic and phone communications.
Changes in behavior
Some people with dementia may start acting in dramatically different ways.
“Someone very independent may suddenly be apprehensive about driving, decline social invitations and become withdrawn,” says Dr. Elaine Healy, vice president of medical affairs and medical director of United Hebrew of New Rochelle in New York. “Someone meticulous about their appearance may suddenly forget daily hygiene or how to do basic tasks like bathing and hair styling, and are too embarrassed to ask (for help).”
A person may also become more anxious or agitated. Agitation “is a behavioral syndrome characterized by increased, often undirected motor activity, restlessness, aggressiveness and emotional distress,” according to research published in 2021 in the journal Frontiers in Neurology.
According to several observations, such agitation occurs in 30% to 50% of individuals with Alzheimer’s disease, and to a lesser extent in people with other forms of dementia, researchers wrote. This type of dementia can be precipitated by the sunset, low-lighted environments, hospitalization, admission to a nursing residence or changes in pharmacological regimens, according to the study.
Confusion and disorientation that imperils physical safety
Dementia can cause confusion and disorientation, which can lead to accidents. For example, someone with dementia could forget the rules of the road and run through a traffic light when driving. It’s also common for people with dementia to become confused and wander away from their homes, which can also put their physical safety at risk.
“Someone with dementia symptoms may forget where they’ve walked, and end up somewhere they don’t recognize,” Healy says. “When your loved ones are continually putting their physical safety at risk, it’s time to consider memory care.”
A decline in physical health
“Physical changes are often the first noticeable differences when someone has dementia or Alzheimer’s,” Healy says.
If someone becomes thin or frail, it may mean he or she is forgetting to shop for groceries, or they may be forgetting to cook and forgo eating. Some people forget to take their medication, or take more than they are supposed to, which can also be detrimental to their health.
A caregiver’s deterioration or death
Some people with dementia are cared for by relatives, often a spouse or significant other. When the caregiver dies or their health falters, that often means the spouse or significant other who is being cared for needs a higher level of attention, like memory care, says Dr. Rhonna Shatz, a behavioral neurologist at the University of Cincinnati’s College of Medicine. She is the director of the college’s Cognitive Disorders Clinic.
Shatz says she had a patient with Alzheimer’s whose health seemed to be faltering rapidly. He’d lost weight and was increasingly confused. Shatz investigated and learned that this man’s wife had also developed dementia, and was unable to shop and cook for him, or make sure her husband took his medications. A daughter then arranged for the couple to move from their home into memory care.
Caregivers can handle a lot, but if incontinence gets to the point that adult undergarments are ineffective, it may be time to look for memory care, says Dr. Clifford Segil, a neurologist at Providence Saint John’s Health Center in Santa Monica, California.
This is because bladder or bowel incontinence can lead to potentially serious and even fatal infections. For example, a urinary tract infection can ascend and become a kidney infection and can also cause blood infections, he says. Such infections can also cause bacteremia or septicemia, which often causes septic shock. Bacteremia is the presence of bacteria in the bloodstream, and septicemia is also a bloodstream infection.
Bacterial infections that ascend into the blood and kidneys are often the product of neglect and poor care, Segil says. Patients in memory care units receive a level of care to avoid allow incidental, small and easily-treated infections from progressing into life-threatening sicknesses. The higher level of attention provided in memory care could help prevent such infections.
Failed electronic communications
If your loved one starts sending texts, emails or leaving voice messages that don’t make any sense, that may be a sign that it’s time for memory care, Segil says. This may look like reading the texts multiple times and listening to the voicemail more than once, and still not figuring out what they’re trying to communicate.
“When you contact them to ask them what they were trying to say, they’re unable to because they’ve forgotten,” adds Segil.
Should My Loved One Be in Memory Care?
When considering whether it’s time for a loved one to go into memory care, here are some questions to consider:
— Is it safe for the person to continue living in his or her current environment?
— Is the person’s behavior likely to cause harm to others?
— What does this person want, need and say about their situation?
— What do medical professionals and other family members suggest?
— Are there resources and support systems which can help the person to continue to “age in place,” or is a move necessary to provide care and protection?
[See: Best Foods for Brain Health.]
Different Memory Care Options
If a medical professional recommends memory care, here are some options:
Some people who may need memory care are already living in a nursing home or assisted living facility. Such facilities sometimes have memory care units, which are run by staff members trained in working with people who need additional care with day-to-day living.
Many individuals diagnosed with mild or moderate stages of Alzheimer’s disease or dementia can live to the fullest with some help, such as the kind provided in an assisted living environment. “Assisted living will help patients who are having trouble with grooming, feeding and compliance with medications,” Segil says.
For those concerned with having adequate care onsite, a continuing care retirement community will typically have assisted living where people can live relatively independently in the early stages of dementia, and a memory care unit on campus that individuals can transition into as the disease progresses.
Dedicated memory care community
A dedicated memory care community could be another option, Sigel says. This is a specialized type of assisted living that provides comprehensive care in a secure environment. Typically, these are units in which patients are locked in, so there’s no risk of them wandering and getting lost.
In addition, physical spaces within the unit are often designed with visual cues and artwork to help with navigation and ease anxiety. Meal preparation, medication management, assistance with daily life and personal care and enriching activities — like outdoor walks, arts and crafts and gardening — are all part of a memory care community that’s designed to meet the healthcare needs of residents and keep them engaged in the world around them.
Skilled nursing homes
A secure memory care unit in a skilled nursing facility is a good option for people who need more care than they’d likely receive while living at home. Sigel says he tells patients that this setting is comparable to a college dorm where everything is provided, including meals and help with medication administration.
“There will be other people your same age to talk with and hang out with,” says Sigel. The same assistance with daily activities and personal care that is provided in assisted living communities and dedicated memory care facilities is applied, with a greater emphasis on meeting the medical needs of those with chronic or complex illnesses.
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Update 11/02/22: This story was previously published at an earlier date and has been updated with new information.