How to Select a Senior Living Community for a Loved One With Dementia

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Finding residential long-term care is relatively straightforward for most seniors. Are Mom and Dad still safe living on their own but craving a little more stimulation in their daily lives? Independent living is the perfect fit. Is Grandma largely independent except for the help she needs with bathing, dressing, and transportation to errands and appointments? She’d likely thrive in assisted living. Does your husband require around-the-clock supervision and skilled nursing care? Then a nursing home is the correct level of care for him.

The different types of senior living seem easy enough to understand at first glance, but deciding where and when to place an aging loved one is far more complicated when they have some form of dementia. One would think that the spectrum of long-term care would match up well with the progressive nature of Alzheimer’s disease and other types of dementia, but that is not always the case. Several factors go into choosing a long-term care facility for a dementia patient. Even if you get it right, there’s no telling how long the perfect fit will last.

“Staging” Dementia Can Be Tricky

Unlike other chronic conditions, such as heart failure or chronic obstructive pulmonary disease (COPD), which progress in a predictable, linear manner, dementia advances uniquely in each person. In addition to impaired cognitive function, there are certain hallmark changes in abilities and behavior that occur with different types of dementia, like wandering, hallucinations and dysphagia (trouble swallowing). However, the order in which these changes occur and their severity (if they ever happen at all) is highly individual.

To make matters worse, such changes are not always permanent. Many dementia patients go through stages of decline, but they can also have hours or days when they “improve” and seem more like their old selves. Many seniors also tend to “showtime” or have unusually lucid moments during important events like doctor’s appointments and cognitive assessments. All these factors combined can make it extraordinarily difficult for doctors, family caregivers and senior living personnel to accurately assess the current needs of dementia patients and anticipate how and when these needs may evolve.

Nonetheless, a needs assessment conducted by a knowledgeable professional is usually the first step in moving a loved one to senior living. These assessments typically focus on a senior’s ability to complete activities of daily living (ADLs) with or without prompting, partial assistance or total assistance. In some cases, more than one assessment may be needed to establish a realistic level of abilities and needs. At the very least, this evaluation will help narrow down a senior’s options for care and housing.

Senior Housing Options for Dementia Patients

Each type of residential long-term care community has its own rules strictly dictating the extent of care it can provide. While these regulations can vary by state and facility, understanding the general care levels for senior living options will help you match your loved one’s needs with the right new care home.

Independent Living

This most basic level of senior living is only intended for residents who are still capable of what the name implies: living independently. No assistance with ADLs is provided, but meals, social and recreational opportunities, and private, no-fuss living arrangements are included. Only self-sufficient seniors in the earliest stages of dementia can reside in independent living (IL), and, because of this, a dementia patient’s stay in this setting is not likely to last.

This arrangement usually lasts longer when a couple moves into IL together and the healthy spouse is present to help support and supervise their partner. Caregiving can take a toll on one’s health, though, so there is no telling which spouse’s needs will increase first. When either (or both) does require a higher level of care, the next step is usually a move to an assisted living facility (ALF).

Assisted Living

ALFs offer an intermediate level of care that provides residents with hands-on assistance with activities of daily living, and many offer a wide array of add-on care services at additional cost. Skilled nursing care, however, is NOT provided. Dementia patients in the mild to moderate stages often spend quite a bit of time in this setting. The daily personal care allows them to maintain their health and safety and retain some of their independence, but there is a limit to what assisted living can provide.

Rooms in ALFs are still private and the care the staff provides is not intended to be one on one or available 24/7. Yes, if a resident has an emergency, staff members are available to help around the clock. But if one resident constantly requires assistance, it detracts from the care others receive and usually indicates that it’s time to move to the next level of senior living. Persistent falls and troublesome dementia behaviors like wandering and outbursts are the most common instigating factors for this move.

Specialized Memory Care

Depending on what resources are available in the community, a dementia patient’s next move may be to a memory care unit (also known as a special care unit). Memory care can be provided in a dedicated facility, in a separate wing of an ALF or at a continuing care campus that offers multiple levels of care in one location.

While the physical setting may vary, the goal of all memory care facilities is to provide long-term residential care tailored to individuals with moderate- to late-stage dementia. The professionals who work in this level of senior living are well-versed in dementia care. Staff members understand the difficult behaviors that may arise and how to diffuse them, they know how to communicate with their residents, and they are trained to recognize the subtle signs that can indicate changes in a resident’s mental and/or physical health.

Aside from this specialized care, one of the largest benefits that memory care units offer is increased supervision and a secure property to prevent seniors from wandering. The activities and social programs are also adapted to meet dementia patients’ unique needs and abilities.

Nursing Homes

At some point, many seniors must move to a nursing home (also known as a skilled nursing facility), which offers the highest level of long-term care. This setting provides around-the-clock skilled nursing care as well as assistance with ADLs. Staff members have varying levels of medical training and can assist with administering medications, IVs, injections, wound care and other complex medical tasks that are typically unavailable in the other settings mentioned above.

Unless there are other serious medical issues present, patients with dementia have usually progressed to the later stages when they transition to a nursing home. At this point in the disease, many are incontinent and may be unable to walk safely, communicate or feed themselves. These high-level needs require intensive care and supervision that only a nursing home can provide.

Supplementing Senior Living with In-Home Care

Of course, family and friends can provide loved ones with assistance regardless of where they live, but the reality is that they cannot be there all the time. There is a limit to what one person can provide, whether it is at home as a sole caregiver or as a visitor supplementing the care provided in a senior living facility. The good news is that hiring in-home care can help a dementia patient remain in a certain level of care for a longer period.

In-home care can be provided in whatever setting a senior considers home. For example, assisted living only offers intermittent care and supervision, but hiring a professional caregiver to spend one-on-one time with your loved one could improve their safety and postpone a move to the next level of care. As long as this supplemental supervision keeps the senior safe and falls within the current facility’s qualification guidelines, a transition to a nursing home could be delayed or even avoided entirely. The only catch is that the facility must have a policy allowing such an arrangement with an outside provider.

Tips for Choosing A Senior Living Facility for a Loved One with Dementia

After your loved one has undergone a care assessment, you’ll need to begin researching facilities in your area that provide the level of care he or she needs. Narrow down your list of choices and then decide to visit a handful of prospective communities. Seeing each one in person will help you to compare the environment, staff, costs and care services each offers.

If you tour one you like, make a few more visits at different times of day to ensure you like what you see. Enjoy a meal or two at the facility and ask to observe or participate in a couple of activities you think your loved one would enjoy. Be sure to take notes on the basic information like services and costs, but also keep records of pros, cons and your reactions to certain features. This will help you determine the best fit for your loved one.

During a visit, here are some things to look for:

  • Safety devices and precautions, such as door and window locks, monitoring systems, grab bars, adequate lighting, and non-slip flooring
  • Compassionate, friendly and attentive staff
  • A structured routine for residents
  • Activities that are designed for people with varying ability levels
  • Outdoor activities and safe outdoor recreation areas for walking, gardening, etc.
  • Residents who appear clean, healthy and content
  • Clean, tidy and fresh-smelling common areas
  • A calm, pleasant and home-like atmosphere

General Questions to Ask About the Facility

There are some things you simply cannot observe while on a tour. Instead, address the following questions with your tour guide, an administrator or another staff member:

  • How many rooms/residents are there?
  • How many Alzheimer’s and dementia patients live there?
  • Is the facility licensed and certified?
  • Is the staff specially trained in dementia care?
  • What are the staff’s ongoing training and continuing education requirements?
  • How are aggression, wandering, hallucinations and other difficult dementia symptoms and behaviors handled?
  • Can a patient be asked to leave due to aggression, anger and other bad behavior?
  • What is the ratio of staff to residents on a normal day? What about evenings, weekends and holidays?
  • What levels and types of care does the facility provide for all residents?
  • What levels and types of care does the facility provide specifically for Alzheimer’s and dementia patients?
  • Is transportation provided for doctor’s appointments, errands or shopping?
  • What is the facility’s policy on wheelchairs, oxygen tanks and other medical equipment?
  • Does the facility accept seniors who need assistance with incontinence care?
  • Does the facility allow a resident to hire supplemental outside help through a home care company?
  • Are residents allowed to bring furniture and/or personal items from home?
  • Does the facility host support groups, meetings or events for family members to attend?
  • How are changes in a resident’s care communicated to family members?
  • How often are care plan meetings held?
  • What safety measures are in place for Alzheimer’s and dementia patients?
  • Will your loved one have to move to a different area or facility when their condition progresses?
  • What is the policy for prescribing new or “as needed” medications for residents?
  • What is the process for ensuring patients get their prescribed medications on time and in the correct dosages?
  • What happens if there is a medical emergency?
  • What are the facility’s hospitalization and bed-hold policies?

Important Questions to Ask About Costs

Long-term care of any kind is expensive, but there are additional costs associated with dementia care. Because this condition usually progresses so slowly and unpredictably, making a financial plan for current and future needs to the best of your ability is crucial. Most senior living communities are “private pay,” which means the resident (or their family) is responsible for all costs unless coverage through Medicaid or the Department of Veterans Affairs (VA) is a possibility. Remember not to lose sight of what your loved one can and cannot afford when dealing with this emotionally charged issue.

Some financial questions to ask while touring facilities include:

  • What is the baseline monthly fee?
  • What services and amenities does this monthly payment include? (e.g. how many meals/snacks per day, transportation services, special Alzheimer’s/dementia services, etc.)
  • What additional services and amenities are offered and what are the additional costs? (If possible, request an itemized list.)
  • Does the facility accept long-term care insurance or Medicaid?
  • What happens if your loved one runs out of money and can no longer pay privately?

For more information on senior living options and to find long-term care facilities in your area, visit AgingCare’s Senior Living Directory.

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12 Comments

I am owner/provider of Residential Care in Wa state and I take care of late/end stage of dementia. So, not just nursing homes and/or skilled nursing facilities are qualified for taking care of these cases. We are trained, certified to take care of any elderly with Dementia and Mental health condition. The only difference is we charge way less than NH's and/or SNF's and the ratoi is 1 caregiver per 3 Residents. We do not accept people who are having behaviors who puts in danger other Residents or themselves. We have geriatric doctor visits monthly or as needed as well as visiting nurse. So, we are prepared and qualified to take care of all these challenging people, we loving and devoted. Most of us have 2 caregivers a day to handle 6 Residents. That's the maximum of Residents we are allowed to offer caregiving services in home like environment by the Wa state law. We are inspected by the state unannounced visit at least once a year.
I feel for you. My Mom wants to stay in her home and not go to a "home". I found a wonderful in home service in NW Connecticut called Amy's Angels. The aid are kind, respectful, caring and knowledgeable. You may be able to find such a service through your local VNA Hospice service.
My mom lived in an assisted living 6-bed home in an upscale neighborhood in Indialantic FL. It has end of life care at the same rate ($3600 mo.) until they pass. She received excellent loving care until she died (Sept 29, 2015) of Alzheimer's related issues. Her pension and Social Security paid 95 percent of the cost alone. She had a room mate, which she objected to at first, but who quickly became a comfort. I found this unadvertised home through "A Grand Daughter's Promise" started by a woman whose own grand mother had died due to neglect in a large nursing home. She is dedicated to finding the just right place for our elders. I will be forever in her debt.