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Residential Care, such as Assisted Living, Memory Care, & Nursing Homes for Persons with Dementia

Last Updated: September 19, 2018

Even with help from community-based services and respite services, providing care for a loved one with Alzheimer’s disease (A/D) or dementia becomes more difficult with time. In later stages of the disease, many people will require more care and assistance than their family members can provide. Even for people who don’t need intensive hands-on care, safety may be an issue and they may not be able to stay home alone. Residential care options may be able to provide best for the needs of some individuals. However, these options are often considerations that caregivers and their families find difficult to plan for, or to even discuss.

Please note, caregivers should explore short- and/or long-term care options for their loved ones before the dementia progresses to the final stages. Respite care and adult day care are good options for caregivers who want to keep their loves one at home, but who work or need a break from their caregiving duties. When elders care for elders, it is also important to consider that the abilities of the caregivers may also decrease with age.

 

Residential Care Options for Dementia

The natural progression of Alzheimer’s Disease, as well as other forms of dementia, will result in the need for care for loved ones. Depending on one’s stage of Alzheimer’s/dementia, and his/her ability to function, the level of care and supervision that is required varies. For most families, this means some form of residential care. This is where assisted living, “memory care,” also referred to as Special Care Units (SCUs) or Alzheimer’s Care Units, and nursing homes (also known as skilled nursing facilities) come into play.

 Those seeking information about paying for memory care, as well as other forms of dementia care, should begin here.  

 

Assisted Living Residences (Communities)

Assisted living facilities, such as continuing care retirement communities, are especially suited for those individuals in the earlier stages of Alzheimer’s disease and dementia who do not have many medical problems, but who do need more intensive support for Instrumental Activities of Daily Living (IADLs). Many people with dementia will need help with IADLs. These are activities that we perform from day to day that add to our quality of life, but are not as basic to self-care as Activities of Daily Living (ADLs). ADLs are the basic activities that we must perform every day in order to take care of ourselves. Individuals with dementia may also need help with these tasks.

The following tasks are considered to be IADLs:

  • Managing money (i.e., writing checks, handling cash, keeping a budget)
  • Managing medications (i.e., taking the appropriate dose of medication at the right time)
  • Cooking (i.e., preparing meals or snacks, microwave/stove usage)
  • Housekeeping (i.e., performing light and heavy chores, such as dusting or mowing the lawn)
  • Using appliances (i.e., using the telephone, television, or vacuum appropriately)
  • Shopping (i.e., purchasing, discerning between items)
  • Extracurriculars (i.e., maintaining a hobby or some sort of leisure activities)

Typically, ADLs refers to the following tasks:

  • Bathing (i.e., able to bathe without assistance in cleaning or getting into tub or shower)
  • Toilet Use (i.e., able to use the toilet and clean oneself afterwards)
  • Control or continence of urine and bowels (i.e., able to wait for the right time and the right place)
  • Dressing and grooming (i.e., able to button a shirt, choosing appropriate clothing)
  • Moving about (i.e., able to move in and out of a chair or bed, walking)
  • Eating (i.e., able to eat without having to be fed by another)

Those who are in the middle-stage of dementia require a greater amount of supervision and care than those in early-stage dementia, and for those in middle-stage dementia, assisted living is also a good option. In assisted living facilities, individuals generally live in a private studio, private apartment, or a shared apartment, and have staff available to assist them 24-hours / day. This type of living arrangement is ideal for those who are still able to live with some independence, but do require assistance with ADLs. Transportation to and from doctor’s appointments and social activities are also offered at assisted living facilities. In addition, assisted living facilities have dining halls where residents gather to eat meals.

Memory Care Units

For individuals with dementia who require a higher level of skilled care and supervision, memory care units are an ideal option. These units offer both private and shared living spaces. Sometimes they exist as a wing within an assisted living facility or nursing home or they sometimes operate as stand-alone residences. Supervised care is provided twenty-four hours / day by staff trained to care for the specific needs and demands of dementia patients. Memory care units offer the same services as assisted living facilities, in addition to activities that are intended to stimulate the memory of those with Alzheimer’s and other dementias, and possibly slow the progression of the disease. Activities may involve music, arts and crafts, games, etc.

 There are free advisors available who help families located memory care residences that match their loved ones’ care needs, preferences and budget. Get help finding care here.

 

How “Memory Care” for Dementia / Alzheimer’s Differs from Assisted Living

Many of the same services are offered at assisted living facilities as in memory care units. However, there are also several ways in which assisted living differs from memory care.

Physical Differences Between Memory Care and Assisted Living

Memory care units are typically architecturally designed to meet the specific needs of Alzheimer’s patients. Unlike some assisted living facilities, memory care units do not have individual kitchens for their residents. This is to keep the stress of those with dementia at a minimum.

While some assisted living facilities do have secure areas to accommodate those with mild dementia, memory care units put an extra emphasis on security to prevent patients from wandering, which is common in those with more advanced dementia. Many locations offer a secure outside area, so that patients can still enjoy being outdoors, while being unable to leave the property.

Since individuals with dementia may easily become stressed and confused, a special emphasis on creating a relaxing environment is common in memory care units. This may be done by creating a place where residents can gather, such as a television room, painting the halls with bright, colorful paint, and featuring a lot of natural light.

Another common manifestation of Alzheimer’s disease is a lack of appetite, so some facilities may have a fish tank displayed in the dining room. This is because studies have found that something as simple as watching fish swim can stimulate one’s appetite.

Other Differences

Generally, safety checks are done more frequently in memory care units, and some residences even utilize tracking bracelets that will sound an alarm if a resident goes too near an exit. Memory care units also tend to follow a more rigid scheduling structure, since those with dementia can easily become stressed in unfamiliar environments and generally do better with routine.

It’s common for those with Alzheimer’s to have a lack of appetite, so memory care units put forth considerable effort to design meals to address this issue. This may be done by creating a contrast between the color of the food and the plate on which it is served so that residents can easily see their food or by offering flexibility with dishes.

Extra safety measures are also taken on memory care units to ensure the safety of their residents. Examples include locking up items that are poisonous, such as shampoo, laundry detergent, and mouthwash containing alcohol.

Skills / Training of Staff

In assisted living, staff is trained to assist patients with their activities of daily living, such as helping an individual to bathe and offering help with changing clothes. In memory care units, staff is also trained to assist with activities of daily living, as well as trained to handle the specific needs of those with Alzheimer’s and other dementias. This training includes understanding how the disease manifests, knowing why dementia patients may exhibit disruptive behavior, how to respond to it, and how to communicate with individuals with dementia.

Staff to Patient Ratio

For assisted living facilities, there currently is no nationally set guideline as far as what is an appropriate staff to patient ratio. This is left up to individual communities to determine the “sufficient” ratio to best meet the needs of their program and residents. (This may be governed by the state in which one resides). That being said, memory care units do require a higher staff to patient ratio in order to adequately provide the care needed for persons with dementia. An ideal staff to resident ratio is 1 staff member to 5 residents, but again, the staff to patient ratio is not nationally governed, and 1 staff member to 6 residents is commonly seen. It is worth noting that even in well-run, properly staffed memory care units, the needs of an individual resident may exceed what the staff can offer. In these situations, the family may be asked to pay for several hours of outside care assistance each day.

Total Number of Residents

Assisted living communities offer a number of options as far as size. There are small communities that house four to six people, medium communities that house 11 to 25 people, large communities that house 26 to 100 people, and even communities that house over 100 people. As with the size of assisted living communities, memory care units also range in size from small to large. However, memory care with 100 residents is rather rare. The number of residents has little impact on cost. Some persons with dementia will feel more comfortable with a greater number of fellow residents and others with fewer. Families should choose accordingly.

Stand-Alone Memory Care versus Memory Care Wings

Stand-along memory care units are generally better designed to specifically meet the needs of individuals with Alzheimer’s or related dementias. Often these types of residences are designed architecturally to make occupants feel as comfortable as possible. An example is designing the facility in a circular layout. This is done because those with advanced dementia often feel an increased level of stress when approaching a barrier in their environment, such as a hallway that comes to an end. This also allows residents to safely wander.

Costs

For both assisted living and memory care, several variables come into play when it comes to cost. These include the geographic area in which one lives, whether one has a private room or a shared living space, and the amount of care service one requires. However, due to the specialized dementia care that is offered at memory care units, this type of care is overall more costly than assisted living. On average, one can expect to pay approximately $3,700 / month for assisted living and $5,400 / month to reside in a memory care unit. More specific regional cost information for dementia care is available using this regional Cost of Care Calculator.

 

Researching Assisted Living and Memory Care

When searching for an assisted living facility or a memory care unit, it’s important that one thoroughly do their research. Since residences vary on services and care provided, number of occupants and staff, layout of the community, cost, and so forth, it’s vital to find a home that best meets your loved one’s needs. This process can be overwhelming. Fortunately, free assistance is available to help families locate and evaluate assisted living and memory care residences. Get free help here.

 

Skilled Nursing Facilities as Option

Another option in addition to assisted living facilities and memory care units is skilled nursing facilities, which provide more extensive medical care than the other two options. Nursing homes are best suited for individuals with AD/dementia who are in the later stages of the disease and who have more serious problems with their health or with daily living. In spite of your best efforts to support and to care for your loved one, you should consider long-term care for him/her in a skilled nursing facility in the following circumstances:

  • Your loved one needs more constant supervision than you are able to provide, whether for wandering or for other behaviors.
  • Your loved one is posing a danger to himself/herself or to others because of their behavior and actions.
  • Your loved one is becoming more difficult to keep adequately nourished, hydrated, and/or healthy.
  • Your loved one is no longer able carry out their activities of daily living, such as bathing, dressing, personal hygiene, and mobility.

 

Skilled Nursing and Medicaid

Some families end up having their loved one move into a nursing home because Medicaid is more likely to pay for nursing home care than for assisted living or memory care. While this is an unfortunate reality, many states have recognized that persons with Alzheimer’s or dementia may not require full-time nursing home care and state laws are slowly changing to accommodate these individuals in less restrictive living environments. More on Medicaid and Alzheimer’s care.