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Residential Care for Dementia: Assisted Living, Memory Care, Nursing Homes & Other Options

Last Updated: April 24, 2023

 

Alzheimer’s and dementia affect the quality of life of your loved one and as the disease progresses living at home becomes nearly impossible. This could be because caregiving can be overwhelming, hiring care becomes expensive, and it becomes an unsafe environment. Residential care may be best because it combines housing, support, and health care. Understanding residential care options for patients with dementia, such as assisted living and memory care, is crucial for your loved one to find the best housing option that fits their needs.

 Did You Know? There are free resources that match care needs, preferences, and budget for families and their loved ones with dementia who are searching for an assisted living or memory care residence. Get Help Here.

 

Residential Care Options for Alzheimer’s and Dementia

 Residential Alzheimer’s Care During COVID-19
The Coronavirus has changed much about assisted living and memory care for residents and their families. These changes vary by state, residence, and with the outbreak’s severity at any given time.
Admissions – Residence tours have become mainly virtual. In many cases, families are unable to assist with the move-in process. Instead, they must rely on staff to move their loved ones in and to make them comfortable during the first few weeks following admission.
Staffing – Training on using personal protective equipment (PPE), infection prevention and control (sanitizing, etc.). Staff is subject to frequent testing especially when an outbreak has occurred within the residence.
Residence – Changes to group dining and activities to allow distancing. Mask-wearing, while encouraged, is difficult to enforce. Some residences have created COVID-wings, separating healthy residents from those testing positive. This means residents may be required to make room changes. Other residences attempt to isolate infected persons to their rooms with meal delivery.
Visiting – Many residences have temporarily halted visits or require a mask and allow outdoor visits only. This may change with the approach of winter. Exceptions to these rules may exist if someone is near the end of life. 

 

Assisted Living Residences (Communities)

Assisted living facilities provide basic care that is generally sufficient for individuals in the earlier stages of Alzheimer’s and dementia. People with dementia may not have many medical problems at this stage, but they do need more support for Instrumental Activities of Daily Living (IADLs). This includes activities performed every day that add to one’s quality of life like managing money, meal prep, light housework, medication management, or transportation. Additionally, there is extra care and support for the basics of independent living which are called the Activities of Daily Living (ADLs). ADLs are normal daily activities. This includes bathing, going to the bathroom, eating, mobility, and getting dressed. Individuals with dementia need extra help with these tasks.

In assisted living, individuals generally live in a private studio, private apartment, or shared apartment. All have staff available to assist them 24 hours per day. This type of living arrangement is ideal for someone who can be mostly independent but needs assistance with ADLs. Transportation to and from doctor’s appointments and social activities are also offered in assisted living facilities. There are other social aspects like dining halls where residents gather to eat meals.

Some assisted living residences also offer “special care units” or wings of the residences to which the individual can move when their needs become too severe for general assisted living.

 

What are the Activities and Instrumental Activities of Daily Living?
Instrumental Activities of Daily Living (IADLs)  Activities of Daily Living (ADLs)

Take an Online ADL Assessment

-Managing money (like being able to write checks, handle cash or keep a budget)
-Managing medications (like being able to take the appropriate dose of medication at the right time)
-Cooking (like being able to prepare meals or snacks and use the microwave or stove)
-Housekeeping (like being able to perform light and heavy chores, such as dusting or mowing the lawn)
-Using appliances (like being able to use the telephone, television, or vacuum)
-Shopping (like being able to purchase and discern between items)
-Extracurriculars (like being able to maintain a hobby or some sort of leisure activities)
-Bathing (like being able to bathe without assistance cleaning or getting into tub or shower)
-Toilet Use (like being able to use the toilet and clean oneself afterward)
-Control or continence of urine and bowels (like being able to wait for the right time and the right place)
-Dressing and grooming (like being able to button a shirt and choose appropriate clothing)
-Moving about (like being able to move in and out of a chair, bed or walking independently)
-Eating (like being able to eat without having to be fed by another person)

 

Memory Care Units

For individuals with dementia who require a higher level of skilled care and supervision than is provided in assisted living, memory care units are an ideal option. Also referred to as Special Care Units [SCUs] or Alzheimer’s Care Units, these units offer both private and shared living spaces. Sometimes they exist as a wing within an assisted living facility or nursing home or as stand-alone residences. Supervision is provided 24 hours per 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 but with a couple of key differences. There is increased supervision, and activities intended to stimulate memory and slow the disease’s progression. Activities may involve music, arts and crafts, and games.

Staff, in most states, are required to undergo special dementia training and staff-to-patient ratios are typically lower in memory care.

 Wondering how to pay for memory care, assisted living or other forms of dementia care? Learn about your options here.

 

Nursing Homes

Another option is skilled nursing facilities, which provide the highest level of residential medical care. Nursing homes are better for individuals with Alzheimer’s or dementia who are in the disease’s end stages and have serious health or daily living problems. Despite your best efforts to support and care for a loved one, consider long-term care in a skilled nursing facility when:

Your loved one needs more constant supervision than you can provide, whether for wandering or other behaviors.

Your loved one poses a danger to themselves or others.

Your loved one is becoming more difficult to keep adequately nourished, hydrated, or healthy.

Your loved one can no longer carry out activities of daily living, such as bathing, dressing, personal hygiene, and mobility.

 

  Nursing Homes and Medicaid

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

 

Adult Foster Care Homes

Adult foster homes are typically family homes in which up to four residents are cared for by one or two caregivers. While they can be less expensive than memory care or assisted living, they are less popular for people with Alzheimer’s or dementia because of logistical challenges. With fewer caregivers on staff, it is more difficult to offer 24-hour supervision. Having said that, some people with dementia excel in the home-like environment offered by adult foster homes. In rural areas, it may be difficult to find an adult foster care residence that has the training and security Alzheimer’s patients need.

 

Board and Care Homes

Generally, between 6 and 12 people live in these homelike environments, which can be a good option for people with dementia. Individuals who require a lot of attention but not necessarily a lot of activity may prefer the individualized attention of a board and care home to a larger memory care residence which can have more than 40 residents. Another difference between board and care homes and larger homes can be seen in their secure outdoor space, which can be limited. Assistance finding board and care homes is available here.

 

Continuing Care Retirement Communities

Dementia is a progressive disease meaning it worsens over time. This results in your loved ones ever-increasing need for care. Increasing care needs often force a change in living environments. In a fairly short period, a person with Alzheimer’s may move from their home to assisted living to memory care, and finally to a nursing home. These moves are often marked by difficult transitions as the resident and their family adapt to a new environment. This is where Continuing Care Retirement Communities (CCRC) can be beneficial. Housed in a single location, residents can receive whatever level of care they require. As the disease progresses, individuals are not required to move. For almost anyone with Alzheimer’s, this is preferred but the drawback is the expense of CCRCs. CCRCs often require a large upfront “move-in” fee and for many middle-class Americans, this is out of reach unless they sell their homes to offset the move-in cost.

 

How Memory Care Differs from Assisted Living

Cost of Memory Care vs. Assisted Living

For both assisted living and memory care, several variables affect cost. These include the geographic area where one lives, whether one has a private room or a shared living space, and the amount of care service required. However, due to the specialized dementia care that is offered at memory care units, costs are higher than in assisted living. On average, one can expect to pay approximately $4,500 per month for assisted living and $5,500 per month to reside in a memory care unit.

Another crucial new consideration in paying for assisted living and memory care is the updates in 2019 and 2020 to Medicare laws. Medicare Advantage, a Medicare option that partners with private insurers to provide customized care, is expanding its definition of “supplemental benefits,” and will allow assisted living and memory care communities to be officially designated as a beneficiary’s “home.” While the program won’t cover the entire cost of living in these residences, it can potentially save a good deal of money by paying for various aspects of care and support services in assisted living or memory care. About one-third of Medicare recipients are enrolled in Advantage, and that number is likely to rise. More on the new Medicare Advantage.   More about paying for memory care.

 

Physical Differences Between Memory Care and Assisted Living

Memory care units are architecturally designed for the specific needs of people with dementia. This makes these types of residences dementia friendly. An example is designing the residence in a circular layout so those with moderate dementia do not feel stress and anxiety if they approach a barrier like a hallway that comes to a dead end. This also allows residents to wander safely. Unlike some assisted living communities, memory care units do not have individual kitchens. This additionally helps keep the stress of those with dementia at a minimum.

While some assisted living residences do have secure areas to accommodate those with mild dementia, memory care units put extra emphasis on security to prevent patients from wandering, a common habit for patients with advanced dementia. Many locations offer a secure outside area where patients can enjoy the outdoors but cannot leave the property.

Since individuals with dementia may easily become stressed and confused, memory care units emphasize relaxation. They do this by creating an area where residents can gather, such as a television room, by painting the halls with bright, colorful paint, and by featuring a lot of natural light.

A common symptom of Alzheimer’s disease is lack of appetite, some facilities may have a fish tank displayed in the dining room. Studies have found that something as simple as watching fish swim can stimulate one’s appetite.

 

Medication Management in Memory Care and Assisted Living

How medications are managed within assisted living and memory care facilities varies from state to state. For example, state regulations in California and Illinois will allow assisted living residents to keep and self-administer their medications, while other states like Wisconsin and Arizona require trained staff to administer all medications. This may be something to consider while researching assisted living options.

In memory care, residents of course require assistance with their medications. That assistance should be part of the services at any memory care community, but specifics will vary by state.

Increasingly popular for some forms of dementia, in particular dementia from Parkinson’s, is CBD (Cannabidiol). CBD is managed differently in assisted living, where some residents can control their medications, and in memory care, where residents do not. Due to the mixed legal status of CBD in different states, some memory care residents will be able to use CBD oil and others will not. See a chart of which states allow CBD in assisted living and memory care facilities.

 

Staffing Differences in Memory Care and Assisted Living

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

For assisted living facilities, there currently is no nationally set guideline for an appropriate staff-to-patient ratio. Individual communities determine the “sufficient” ratio to best meet the needs of their program and residents. This may be governed by state regulations. However, memory care units do require a higher staff-to-patient ratio to adequately care for persons with dementia. An ideal is one staff member to five residents, but again, the staff-to-patient ratio is not a national standard, and one staff member to six residents is common. It is worth noting that even in well-run, properly staffed memory care units, the needs of an individual resident may exceed what staff can offer. In these situations, the family may be asked to pay for several hours of outside care assistance each day.

Assisted living communities vary in size. Small communities house four to six people, medium communities house 11 to 25 people, and large communities house 26 to 100 people. Some communities even house over 100 people. As with the size of assisted living communities, memory care units range from small to large. However, memory care with 100 residents is rare.

The number of residents has little impact on cost. Some persons with dementia are more comfortable with a greater number of fellow residents; others with fewer. Families should choose according to what will benefit their loved one’s quality of life the most.

 

Other Differences Between Memory Care and Assisted Living

Generally, another difference between the two care residences is that safety checks are more frequent in memory care units. Some residences utilize tracking bracelets that sound an alarm if a resident nears an exit. Memory care units also tend to follow a more rigid schedule, since those with dementia generally do better with routine.

It is common for those with Alzheimer’s to lack appetite, so memory care units design meals to address this issue. They will create a contrast between the color of the food and the plate so residents easily see their food, or other facilities offer flexibility with dishes.

Extra safety measures are also taken in memory care units. Examples include locking up poisonous items, such as shampoo, laundry detergent, and mouthwash containing alcohol.

 

Help Finding & Choosing Residential Care

 Free assistance is available to help families identify care homes that are appropriate for their loved ones and within their financial means. Start here

When searching for an assisted living facility or a memory care unit, it’s important that one thoroughly researches options. Since residences vary in services and care provided, the 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 especially when already spending so much time and effort caring for your loved one. Fortunately, free assistance is available to help families locate and evaluate assisted living, memory care residences, and adult foster care homes. Get free assistance here.