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

When safety becomes a concern because your loved one who has dementia advances past being able to independently live at home, long-term residential care or a form of assisted living becomes the next best option. Dementia is a progressive disease that after advancing past its early stages, makes regular daily activities like cooking, getting dressed, and bathing impossible to do independently. In addition, as other symptoms like wandering and confusion increase, your loved one needs a professional combination of housing, support, and healthcare. According to the Alzheimer’s Association, more than half of the millions of Americans in assisted living have some form of dementia. The elder-care industry has specialized options, making it potentially overwhelming to choose where your loved one should live. Change can be hard for someone with Alzheimer’s or dementia, but if you enter the process with the right information and questions, you can help improve your loved one’s quality of life.

Types of Memory Care Residences

Not all residential long-term care options are suitable for people with Alzheimer’s disease or another type of dementia. In its early stages, when someone can still function independently, retirement housing or independent living may still be appropriate.

Around-the-clock supervision provided by nursing homes can be an option for people with middle to late-stage dementia, but there are also specialized housing and care options that are specifically tailored for people with dementia. Dementia care communities can be stand-alone facilities or a wing of an assisted living facility or nursing home. These facilities are called Alzheimer’s special care units, dementia care units, or memory care units. Learn more about the differences between assisted living and memory care units here.

Another, and more expensive, option for your loved one is Continuing Care Retirement Communities (CCRCs). These communities offer services that range from independent living to assisted living to full-time nursing home care. CCRCs let residents stay in the same residence throughout the progression and decline 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. Keep in mind that experts are available. Free assistance can be invaluable and help alleviate the emotional stress that comes with the difficulties of moving into a community offering housing and full-time specialized care.

Assisted living 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 ones. They additionally help by doing a lot of the legwork on the family’s behalf. These organizations provide free, local advisors familiar with the nuances of the residences in their geographic area. The advisors are compensated by the assisted living residence when someone moves in. This is how these organizations can 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 with strengths in those areas. They will narrow down options and arrange tours for the potential residents and their family members. Remember, there is no commitment to an advisor and if they are not providing the help and resources you want do 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. That said, that can be a small price for a life-changing service.

Considerations When Choosing a Dementia Care Residence

Choosing a dementia care facility for your loved one requires time and effort. Start by researching several facilities before making a decision. Then, visit your top options and ask lots of questions.

Familiarity with Alzheimer’s Disease / Dementia

When it comes to Alzheimer’s and dementia, there are residential care communities called dementia or memory care units that offer specialized support for your loved one. These communities can range in size from wings at an assisted living residence to entire facilities. When researching a dementia care facility, get a sense of how knowledgeable the staff is about the needs and care of people with Alzheimer’s disease or other types of dementia, and consider if the facility is designed to handle the challenges. Ask the following questions about a residences familiarity with dementia:

– 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

It is normal to feel feelings of doubt about your loved one’s potential quality of care. 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 friendly and tranquil. Keep notes on likes, dislikes, and features that distinguish one residence from others. Ask the following questions about a residence’s quality of care:

– 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 Alzheimer’s and dementia. Does the residence provide activities to enjoy safely outdoors?

– 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 vital for extending the stay or getting financial assistance from Medicaid.

Practical Matters

Remember to ask the following basic and 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? Studies have proven positive health benefits that aid with symptoms of dementia. Learn more about CBD in assisted living.

Costs of Memory Care

It is important to have a clear understanding of how much a residence will cost and what forms of payment they will accept. That includes any additional fees like a community or move-in fee. Ask the residence the following questions about the cost and payment of care for your loved one:

– 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 expanded 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

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 when transitioning into a long-term care facility. Ask the following questions about the residences family’s participation and involvement:

– 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?

How to Find a Memory Care Facility that Accepts Medicaid

Finding a memory care residence that accepts Medicaid can be stressful. What can be even more challenging is that approximately half of the dementia care communities are certified to receive Medicaid benefits but that does not mean that they will accept patients wanting to use its coverage. No state or federal database lets you search easily for options in your area. Additionally, Medicaid pays facilities less than a patient who pays privately out of pocket, so residences do not advertise that they accept Medicaid.

The best way to search for a residence that accepts Medicaid is to call each one in your desired area. Before doing that, knowing some important information about Medicaid is important. Medicaid does not pay for room and board in an assisted living or memory care community. Medicaid only pays for supportive care services. Additionally, different programs can help pay for part of the care and support services of memory care.

Some facilities will allow programs with a consumer-directed option enabling patients to hire and pay for long-term care services through a Medicaid program. Other facilities work directly with Medicaid and bill them for their services. Lastly, some will not accept Medicaid at all.

The easiest and fastest way to find a memory care residence that accepts Medicaid is to do a Google search. Searching for facilities in your area using the search terms “memory care + your location” will give you a list of residences. Call each one and ask:

– Does the facility have Medicaid beds and if so how many are available and is there a waitlist?

– Do they permit outside caregivers to help patients with activities of daily living?

From there, you can schedule visits to check out each residence. Remember, finding a memory care home is not a fast process. Starting early will give your loved one the most amount of input for their care and where they want to live. More information can be found here about Medicaid paying for memory care.

Why is Finding a Residence that Accepts Medicaid Beneficial?

If your loved one qualifies for Medicaid, its benefits can help lessen the financial strain Alzheimer’s and dementia cause. It can be hard to generalize how much Medicaid pays because every state and program differs. There are 3 federal programs that each state manages for Medicaid: HCBS Waiver, ADB, and traditional Nursing Home. The HCBS waiver and ABD Medicaid never pay for your loved one’s room and board. That can amount to about half of the monthly cost of memory care. This means that depending upon how much care someone needs after being assessed for an HCBS waiver, or ABD Medicaid, there can be financial help for care and support services. Keep in mind, it is commonly said that the number of hours needed by your loved one will exceed Medicaid’s benefits and it is very common to have waitlists for entry into a program. Traditional Nursing Home Medicaid benefits are an entitlement, meaning anyone financially and functionally eligible must receive coverage. In comparison to assisted living and memory care communities, Medicaid does pay the entire cost of room and board in a nursing home. That means that an individual who surrenders the majority of their income (in the financial qualification process) can have their rent, meals, and personal care services paid for. More information is available here about Medicaids benefits for people with dementia.