- Don't base your decision solely on what you see and hear on tours. While many dementia facilities are brand new and pleasing to the eye, remember that you must see past the external environment to truly evaluate the care! Try to spend at least two hours on the floor on which the person will live. Visit more than once if you think that you need more time to make a decision. Drop by unannounced at different times of the day to observe the behavior and attitude of the staff toward the residents and the flow of activities. Visit in the evening and on the weekend to speak to the families of the residents and to observe the staffing patterns of the facility. Does the staffing appear to be adequate to meet the needs of the residents regardless of the time and day of your visit? You should make the following kinds of observations during your visits to help you determine if the facility is right for your family and your loved one. Are the residents active and engaged in activities? Are they neatly dressed and groomed? Are the residents wearing appropriate clothing for the time of the day? For example, you should not see people dressed in pajamas at 3 o'clock in the afternoon. Are residents who need help with eating adequately tended to? Try to observe the interaction of the staff with the residents during mealtimes. Are residents treated with respect? Do residents look well cared for?
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View the facility from the perspective of the residents and the staff. Would you want to live there? Would you want to work there? If your answers are negative, there is likely to be high staff turnover and as a result, greater resident disorientation.
- Pay attention to the physical layout of the facility and the health status of residents. Is the entire facility devoted to those with dementia or is there a separate wing dedicated to dementia care? Ask what types of dementia patients (for example, early stage or middle stage) are best suited for the facility. Also, ask how the facility deals with the progression of the disease. This is a particularly important question for assisted living facilities because residents who develop late stage dementia may require transfer to a skilled nursing facility (nursing home). Some facilities allow the families of the residents to employ outside help, such as round-the-clock companions or private duty nurses, in order to avoid transfer to a nursing home. Again, the state regulations that define the kinds of care that can take place in an assisted living facility also define when a person with dementia has to be transferred to a nursing home.
- Most assisted living facilities evaluate the need for transfer on an individual basis. Ask who makes the decision about transfer and how the facility decides when skilled nursing home care is necessary. Ask how and when families are involved in this decision. Become familiar with the facility's policies regarding transfers to nursing homes as well as transfers to and from hospitals. If the resident requires hospitalization, how long will the facility save his/her place in the residence and is there an additional cost for this service?
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