Rings that matter,
When will the willow fly.
Down in a hole
Moves that don’t show
Left the leave behind.
In Part 1 I defined four basic types of elder residence care to clarify their differences and give a “conceptual space” to what is a memory care residence. Part 2 will be suggestions about things to consider in making the choice.
Be prepared—gather information before a crisis
After my father developed Alzheimer’s my parents moved to Reno area planning to stay there, [through their death]. Before my father developed Alzheimer’s on one of their visits to me my parents and I visited some independent care residences and discussed them. Later I visited various residences, including assisted living and memory care in my area; they often have an “open house” which is a good starting place as the residences may be aggressively marketing and you can meet other people with a similar interest.
After dad’s passing and mom’s stroke it was clear that she could not stay in Reno. I revisited one residence which I had previously liked, found I still liked it and decided to bring her there. Yet even while she was there I continued to visit other residence facilities to maintain an up do date benchmark which later was fruitful.
Visit the residence
The first visit is formal, simply call up the residence, make an appointment for a presentation/tour and get a feeling for the “residence”— you need not only to determine if the residence is up to a “general standard” but is it appropriate for your specific “loved one”. Is it clean, what are residents doing, are their clothes clean, does the facility have an offensive, women’s hair combed, are dangerous objects put away—build your own list of things that you and your parents consider important.
As you take the tour consider the kind of relationship the tour person has with the residents, do they know them by name, do they welcome an approach by a resident or is it an intrusion into getting a new customer?. Look at some individual rooms, is there a “locked room” for medications, what does the dining area look like, what are the employees doing, what are their gestures and physical relations to the residents.
Aask if you can “drop in anytime” and do it. Visit for meals, look at the food, see how it is served and if residents enjoy it. Mealtime is a good opportunity to see how well organized is the facility. The staff has a limited time to prepare and serve food and its not always easy. Residents may need help getting to the table, some need help eating, some want to eat another person’s food. If staff is “dysfunctional” it can easily get out of control. And if a resident misses a meal what do they do?
Ask if you can take yourself and your loved one for a meal. The residence will likely have a professional dietician you can meet and ask to see the weekly menus. Is the food good , nutritious and suitable for your loved one. Are the dishes and utensils clean and adequate. How does staff deal residents who do not want to eat.
Go in mornings, afternoons, evenings, etc. and get a clear picture of how your loved one will be treated. Its fine if you drop in only for five minutes, chances are if you drop in for five minutes about 10 varied times you will get some accurate measurements on which to base a decision. There may also be a support group of family members with regular meetings which you might attend and ask questions.
Also have respect for the facility, you are just visiting, you do not need to do much more than watch and not get in the way. It is a workplace and the attention of the employees should be on the care and well being of residents. And if they say “no, you cannot just drop in” then its likely they would say the same if your loved one was a resident.
You can seek recommendations from others, you can meet them at an open house, or a support group meeting or talk to families you might meet when you visit the residence.
Relations between staff and residents are crucial. Dementia residents present all kinds of behaviour which is selfish, childish, aggressive, conflicting, rude, inconsiderate and situations happen. If one happens while you are there consider yourself fortunate that you will have the opportunity to see how the staff responds. No staff is capable of stopping incidents except by “lockdown” which is obviously undesirable and they happen mostly to a minor degree all the time. There is good training available, staff should have training, and there should be certificates easily visible.
Take your parent for a visit to spend an afternoon and see how they fit in. I always like to ask about teeth cleaning which is something that needs to be done daily and can be very difficult to do. In fact often when I would visit for lunch afterwards I would try to get mom to brush her teeth just as an added factor.
How does it smell?
Most of the residents cannot control themselves and use “adult diapers.” If there are 25 residents more than one is peeing and pooping every hour and there will be “offensive whiffs” sometimes, but there should be no regular smell. While caregivers cannot be expected to get everyone clean instantly, they should be expected to deal with the matter in a timely manner measured by “no regular offensive smell.” An “offensive smell” may also come from poor plumbing equipment.
At the same time when food is being cooked does it smell good in the residence, does it make the place feel like home? Do the rooms and facility smell clean and yet clear of the smell of cleaning solutions
Mom’s first residence was a “U” shaped hallway with rooms on the two arms of the “U,” a common area at the joined section and outside garden in the middle. Residents could walk freely but starting at one end of the “U” they could walk to the other end and then turn around and walk back.
The second residence had a circular hallway, rooms on the outside with full sized windows in the hallway overlooking a patio in the center. Residents could walk around and around and around and I noticed that they did walk considerably more in that setting—which is good exercise—and the windows provided a lot of light in the hallways.
I also look at the entrance, this is their home , does it look like what they wanted their home to look like? How will you feel everytime you visit Is there a convenient place to temporarily park a car to enable out excursions? or for ambulance which does show up sometimes.
These residences can be expensive and your loved one deserves the best they can get. There will be a standard rate for a single or double room and additional fees for increased levels of personal care which are usually formally defined and you can ask to have them explained. There maybe long term care insurance available and low income veterans can qualify for VA money for memory care. Medicare will pay for qualified hospice and rehab.
Also search on the internet. The state will have a section concerning information on specific facilities regarding licensing, ownership, legal issues and complaints. Propublica.org featured an article rating “nursing care” facilities in the US and some memory care residences were included in there. Confirm the residence is up to date on any state and local licenses and insurance as well as certificates of training for employees. If it is a national business you might check these matters in other states.
The most important thing is the care for your loved one so do not hesitate to ask questions or seek information to make good decision for the best care for a most important person.
There are different kinds of residences for elder people, “memory care” is one of them. It does not have a specific definition, or a legal one but it has some common boundaries. A residence for elders who are so strongly affected by dementia they cannot take care of of themselves but they do not need skilled nursing. They have some level of functionality and the better “memory care” residences try to enable their functionality.
There are four basic different kinds of residence facilities for elders differentiated by qualitatively different levels of of personal independence. It helps to have a general idea of the differences and I have often noticed that the news media mixes them up.
The residents have their own apartment with some facilities such as washer/dryer, stove, refrigerator, microwave and a common dining room where food is served at meal time. There is a common room for group events, there may be an event director, and usually some form of transportation, some cleaning help and a front door desk and employee. In this situation the individual residents are in good physical and mental health and make their own decisions. Generally there are no medical professionals at the residence. Residents take personal responsibility for their medications. There is usually a maintenance person to provide some basic help for which there maybe an additional fee. Individuals or couples usually have their own apartments.
Similar to independent living except residents need some help with daily personal matters. Its usually a room with fewer amenities, meals are provided and there are staff who personally help individual residents with physical needs. The residents are mentally competent. The employees may have varying degrees of skills, including some medical training. Skilled medical staff is usually on call and a “med tech” available to handle prescriptions and sometimes a skilled nurse is on site. “Help” provided may range from carrying heavy objects to dressing and bathing. Individual financial charges will reflect the amount or “level” of help the resident needs. Handicapped transportation is usually available on a regular schedule or by appointment. Residents may or may not take personal responsibility for their medications. An outside family member may have POA (Power of Attorney) but that is just precautionary, not necessary. Individual may usually have their own room.
In 1 and 2 residents are mentally competent, make their own decisions about what they are going to do and when they are going to do it. The front door to the outside world is open for them to come and go as they please, though for security it maybe locked at night.
Memory care residence
The front door is locked and residents cannot enter or leave by their own will or with a non-approved person. Someone else has POA. The employees (CNAs) have varying levels of medical training and include a nurse and med tech. A doctor may be on call. Food is prepared and served. Individuals may need various levels of personal help, including dressing, bathing, “disposable underwear changing,” bed preparation, bathing and even eating. All medications are distributed by the med tech and no drugs are prescribed expect by a doctor, usually the patient’s doctor.. In most states it is illegal for employees to “restrain” a resident which may include bed rails. Individuals may have their own room or share a room. There may or may not be furniture. In the below image we have provided the furniture as well as the wall art.
A nursing facility may have a variety of residents, ranging from temporary to permanent. Regarding dementia patients, they may range from temporary in Rehab (Rehabilitation) to a permanent resident that needs intensive levels of care and skilled nursing. Staff may physically restrain residents such as strapping into bed or strapping into a wheel chair. Rooms include a bed, a small chest of drawers and closet and generally individuals share a room with others. Dementia residents cannot leave on their own but usually they are not physically capable of doing so. There is a comprehensive range of skilled staff including nurses and often a doctor is there during the day and always on call. Staff physicians may prescribe prescriptions and medications are delivered by a med tech. Clothes may be washed/dried by the residence or you may take care of it yourself. If the former there is a good chance some things may get lost so regarding dementia patients I suggest to only supply clothes that you are willing to lose. There may be time restrictions for visiting.
I was involved with mom in selecting 1, 3, and 4. Both 3 and 4 may have different kinds of residents. Its a competitive business, financial compensation usually comes from private insurance , Medicacre or Medicaid and terms are often negotiable. A memory care facility my have residents who require some daily nursing care done by an outside provider or they may include residents in hospice. The atmosphere in a memory care residence is much less hectic than a nursing residence and more pleasant for someone in hospice,
There are other options, being wealthy enough to hire all the people, being too poor to to do anything, or having just enough to get by, such as owning a house and earning small wages, one spouse earning $65000.00/year the ather takes care of the parent at home, or having a fixed income and etc. In these situations I would not know what to say, and wish you the best.
The next post will discuss my reflections on choosing a memory care residence.