Assisted Living / Memory Care Homes for Persons with Dementia & Alzheimer’s: How to Choose

Long-term residential care, some form of assisted living, is the answer. Of the millions of Americans over 65 in assisted living—a combination of housing, support, and healthcare—the Alzheimer’s Association says more than half have some form of dementia. The elder-care industry is brimming with specialized options, which can make the important task of choosing where to live next overwhelming.

These are anxious times, but change can be positive if you enter the process with the right information and, especially, questions.

Types of Memory Care Residences

Not all options for residential long-term care are suitable for persons with Alzheimer’s disease (AD) or another type of dementia. In the disease’s early stages, when functioning independently is still possible, retirement housing or independent living may be appropriate.

Around-the-clock supervision provided by nursing homes is best for persons with moderate to late-stage dementia, but there are also options specifically for persons afflicted with dementia. Dementia care facilities, which may be stand-alone facilities or a wing of an assisted living facility or nursing home, are sometimes called Alzheimer’s special care units or memory care units. Learn more about the differences between assisted living and memory care units here.

Another (more expensive) consideration is Continuing Care Retirement Communities (CCRCs), which offer services on a continuum from independent living to assisted living to full-time nursing home care. CCRCs let residents stay in a single location throughout the progression of their condition.

Getting Help Choosing: How Assisted Living Referral Services Work

What follows is advice for finding the best assisted-living options, and key questions to ask, but keep in mind that experts are available to help. Free assistance can be invaluable, alleviating the emotional stress that comes with taking these difficult steps toward moving into a facility that offers housing and full-time specialized care.

Assisted living referral services or placement agencies, such as A Place for Mom, Seniorly and Caring.com provide helpful services in helping families find the right home for their loved one, doing much of the legwork on the family’s behalf. These organizations work by providing free, local advisors who are familiar with the nuances of all the residences in a certain geographic area. The advisors are compensated by the assisted living residence when someone moves in. This is how these organizations are able to provide their services for free. A good advisor will carefully consider the individual’s care needs and preferences and attempt to match that individual with a home that has strengths in those areas. An advisor will narrow down options and arrange tours for the potential resident or their family members. A family has no commitment to an advisor and if the advisor is not providing value, a family should not hesitate to find a different person.

The downside of assisted living referral services is that when matching families to multiple communities, the admission offices at those communities can be aggressive in contacting the family. The phone will ring. That said, this is a small price to pay for what can be an invaluable service.

Considerations When Choosing a Dementia Care Residence

Choosing a dementia care facility for your loved one requires time and effort. Research several facilities before making a decision, and visit your top options armed with knowledge and good questions. Preparation ensures the decision ultimately benefits your loved one.

Familiarity with Alzheimer’s Disease / Dementia

Some assisted living communities may have specialized dementia care units, and entire facilities exist whose specific purpose is to care for individuals with AD/dementia. When scouting a dementia care facility, get a sense of how knowledgeable the staff is about the needs and care of persons with Alzheimer’s disease or other types of dementia, and consider if the facility is designed to handle the requisite challenges.

• Are there special measures for security or supervision to prevent wandering (or other behaviors associated with dementia)?
• Is rehabilitative or therapeutic support offered, and does the staff encourage residents to be active?
• How often does the staff update its training and education?
• Does the staff help with cleaning and dressing after instances of incontinence?
• What is the protocol for behaviors like wandering and aggressiveness?
• Can a resident be expelled for bad behavior?
• What is the staff-to-patient ratio, and does it change during nights, weekends, and holidays?

Quality of Care

Anxiety can come with wondering how high-quality the care is at the facility. When you visit, make sure to talk not only to the administration and staff, but also to some of the residents and their family members. Visit the residence multiple days, at different times each day, to get a feel for the overall experience. Eat meals there, and participate in activities with residents. Try to understand how things operate when you are not around. Check for cleanliness, especially in shared common areas. Get a feel for whether the residence is warm and tranquil. Keep notes on likes, dislikes, and features or characteristics that distinguish one residence from others.

• What kinds of staff or health professionals are available on a daily or semi-daily basis?
• Time outside has been demonstrated to alleviate symptoms of AD / dementia, so does the residence provide activities to enjoy safely outdoors?
• Because everyone with Alzheimer’s or dementia experiences it differently, are there organized activities throughout the day for those who require more structure?
• Can a resident’s loved ones hire supporting caregivers from outside the facility for supplemental help? This can be crucial for extending the stay and / or getting financial assistance from Medicaid.

Practical Matters

Remember to ask the practical questions.

• Is the facility licensed and certified?
• How many rooms and beds are there, and what is the availability of rooms within the facility?
• If a waiting list exists, how soon would your loved one gain entrance?
• Does the residence provide transportation to doctor’s appointments?
• Do residents get opportunities to shop and run errands? How are they transported?
• Are there any important policies regarding equipment like wheelchairs or oxygen tanks?
• How are medications managed? (Are residents allowed to take CBD oil, whose benefits have been demonstrated in studies against the symptoms of dementia? Learn more about CBD in assisted living.

Costs of Memory Care

Be crystal clear on exactly how much a residence will cost, including placement fees and what kinds of payment they take.

• What is the cost per month?
• What do monthly payments cover, and are there additional benefits for more money?
• Is insurance or Medicaid accepted? State-run Medicaid or long-term care insurance may be able to help finance your loved one’s stay.  And while Medicare will not pay for extended stays in nursing facilities, the definition of “supplemental benefits” under Medicare laws is expanding in 2019 and 2020, so aspects of assisted living, like health equipment and safety upgrades, may be included. More on Medicare Advantage expansion for assisted living.

Family Involvement

Finally, when talking to residents and their families, ask whether they are satisfied with the level of involvement and interaction in the facility. As a caregiver, you have a lot of knowledge and experience that is valuable to the continued care of your loved one, even in a long-term care facility.

• How open is the facility to visits from family members and friends?
• Are there certain hours when you can or can’t visit your loved one? Do appointments need to be made for visitations?
• Does the facility ask for or allow the input of family members in designing a care plan and activities for their loved ones?
• How, and how often, does the facility communicate with family? Under what conditions would staff reach out?