Tracking Alzheimer's or Dementia in Senior Living Communities


The staff at assisted living and skilled nursing facilities is prepared to watch out for your parents' well-being, especially as Alzheimer's or dementia progresses.

You should expect them to track your parent's condition in a variety of ways, from conducting major assessments annually or semi-annually to being on alert daily for signs of a decline in your parent's behavior.

But what you are seeing and hearing in visits and phone conversations with your parents also can be signs of their condition worsening. Don't hesitate to ask questions about your parent or to discuss any changes you see or hear in their behavior, small or large, senior living facility administrators say. Staff at senior living communities should be willing to discuss any questions or concerns you have.

"I always think it is so important. The phone calls that we get from the daughters and sons that are not here, they say that they are hearing things over the telephone that perhaps don't sound too good," says Shona Alexander, a nurse practitioner and director of clinical and home care services at Park Springs, a senior living community in Stone Mountain, Ga., with assisted living, skilled nursing and memory care units. "They feel so helpless that they can't be there to help their parents."

Regular assessments are critical

When someone moves into an assisted living or skilled nursing facility, an individualized service plan is created to outline the resident's current needs and the services the facility will provide.

Service plans are required to be updated a certain number of times as a year, depending on the state, and after a "change in condition," such as a hospital visit. Ask the facility how often they are required to update their service plans, or check with your state, through agencies such as departments of community health or health care services.

If you can make it, attend a meeting to discuss the service plan updates. If you live out of state, you should expect someone with the facility to call you about changes before providing a copy of the service plan to you.

Some family members also set up more routine visits or phone calls to discuss their parents' condition throughout the year and to be prepared for future changes, such as moving to a memory care unit or into skilled nursing for more round-the-clock care.

"I've had those hard conversations many times where I say, ‘it's not happening now, but I wouldn't be doing you a favor if I didn't explain to you that memory care is in the near future for your mom,' " says Casey Litton, executive director of Wyoming Springs Assisted Living and Memory Care in Round Rock, Texas.

Picking up the phone

When staff at a facility notices a major change in a resident, they should call the family, Litton says.

She recalls one situation where the staff noticed a female resident wasn't eating as much and not bathing routinely. They conducted a new assessment of her condition.

When changes in a resident's habits or personality becomes apparent, it is important to do a full head-to-toe assessment of the resident to ensure that theire needs are still being met, and to assess if additional care is needed, Litton says. She stresses that a senior community should conduct these routinely and when a change in condition is noticed, or when residents get sick.

Watching out for your parent

At the same time, the daughter, who did not live nearby, had noticed her mother was not calling her as often at night. She assumed her mother was becoming more socially engaged and not as dependent on those conversations. Unfortunately, that was not the case.

They called the daughter to let her know her mom's condition was worsening and that they needed to add some more services, such as helping her bathe and coming to get her for meals, instead of letting her arrive on her own.

Sometimes daughters or sons will call the facility, simply saying something seems different - even if they don't have an exact example. Or maybe they see a specific change, such as weight loss or are calling because they are concerned about how their parents are handling their finances, if they still have their checkbook.

If you call, ask to talk to someone such as the head nurse on staff, who should respond immediately, Litton says.

If the nursing staff notices a change in an assisted living resident's behavior, or family members express concern, the staff will evaluate them, which may require lab tests, Alexander says.

Depending on how significant the changes, the resident could see their physician for more tests, or may need to meet with a dietician or another specialist. Ask the facility how often it will follow up to monitor the parent, if they are in assisted living where they have more independence. The facility might assess them in a month or two months.

The results could be monitoring the parent more often or adding a medication, Alexander says. Or it may be severe enough to warrant a move from assisted living, which offers more independence, into memory care or skilled nursing.

"We're not perfect in our industry. Because we see mom every single day, there are times that we don't see the change like a family member that comes monthly might see a change," Litton says. "It has to be a team approach."

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My mother was recently moved from Assisted Living into a Memory Care Unit in the facility she is in, The transition was a difficult one for myself and siblings to accept but felt it was necessary for her socialization. The assisted living apartment she was in made her feel very secluded, especially after dinner time because many of the residents would go to their apartments and she felt very alone. The memory care offered her more socialization with the residents there and more caregivers to be able to keep an eye on her so the idea of moving her was in her best interest. The transition was difficult on her because she was in a smaller space (only 1 room w/ a bedroom) and new staff so it was like starting all over. She often becomes very agitated and non-cooperative with the staff and it causes her a lot of distress. She's been there about 2 months now and some things have improved and the level of care and attention from staff is better than in the assisted living but the disease has made her very confrontational and stubborn, not at all her normal personality. This has created problems for the staff dealing with her and other residents don't want to associate with her as much. She is very especially uncooperative with taking showers so the staff has asked myself and my sister to take on the task of bathing her. She resists and fights us about it too but we usually get the task done. I don't mind and if she is less agitated with us doing it ourselves then we are willing. We are fortunate to live nearby to visit weekly and assist when needed. We feel the need to possibly use medication to try to relax her more and keep her more calm but haven't started that yet. She is on depression meds but that does not seem to help the anxiety she experiences. I have found it best to remain calm and playful during my visits and treat her almost like a child. The behavior can be very frustrating at times but in the end it is THE DISEASE and not her. All we can do as children is show them kindness, caring, compassion and love to help her be happy and as healthy as we can.
I think so many assisted living facilities are not equipped with trained staff to help people with dementia. My mom has it and the assisted living facility she was in was not equipped to help her. Her anxiety resulted in the need to get 24 by 7 aides to help walk and bathe her. Other than the dementia, she was physically very healthy which made a nursing home not the next move.
It's amazing how there is a big wide gap between assisted living and a nursing home for dementia patients. When we did explore assisted living facilities in Florida that claimed they were expert in dementia, we found so many of them would just line the patients up in a row and turn on a very loud TV. Absolutely awful!
We finally had to move our mom back home and get medicine to calm her down and continue with 24 by 7 aides. I truly don't know how people do this without financial rewsources. I really feel for them.