Researching Memory Care Facilities
As your family members grow older, their health may deteriorate to a degree that it's no longer safe or practical for them to live at home, even with in-home care. For most people, 24x7 private care is not an affordable alternative. You may find yourself faced with researching alternative living and care arrangements. In this post, I'll be discussing memory care facilities and things you may want to keep in mind as you explore this option.
Even though it was the right thing to do for their well-being, I will say that moving my parents out of their home was among the worst days of my life. When you have a family member with dementia or Alzheimer's disease, this transition can be extremely challenging since they may not be fully aware of why they need to move. For me, one the greatest stresses was feeling an overwhelming sense of responsibility – I was the one who was making the decision to move my parents from their home, due to my Dad's dementia.
As background, I initially moved my Dad to a memory care unit at a facility which also had independent living apartments and assisted living on the same campus. My Mom had an apartment where she could easily walk to see my Dad. Later, as my Dad's and Mom's condition deteriorated, I had to move both of them to a skilled nursing facility where they had rooms across the hall from one another.
Bear in mind that memory care facilities are not regulated to the extent that nursing homes are — that is there is no oversight by the federal Centers for Medicare and Medicaid Services (CMS). However, memory care facilities can be a wonderful alternative for people with dementia and Alzheimer's whose medical needs don't warrant the care provided by a skilled nursing facility. If you are investigating a memory care facility, I'd offer seven suggestions:
Ask friends for recommendations. Word of mouth information is one of the best ways to find out about which memory care facilities are good and which are lacking.
Inquire about staffing ratios. Find out how many aides are available for each resident. Ask how often a nurse is on duty. Many facilities only have a nurse on staff during regular business hours and on weekdays.
Ask about staff turnover. I had experience with two different memory care facilities. One had extremely high staff turnover and it showed. At the second, the head nurse had worked there for years, as had many of the aides. The team got along with one another well and they also developed meaningful relationships with the residents.
Find out how many personal care minutes are included in the base fee. If your family member requires additional time for bathing, dressing, or other activities of daily living, you may find yourself with significant additional charges for that time at the end of the month. This happened with my Dad, but that was a price I was willing to pay, as long as his condition was still appropriate for memory care.
Be realistic about your family member's condition. There are limits to the care that memory care facilities are allowed to provide and the staff should be honest about what they can and can't provide to your family member. For example, the staff can typically hand residents medications, but they can't put pills into their mouths. The staff usually can't administer injections. If a resident can't transfer themselves from their bed to a chair or wheelchair, memory care isn't a good fit. In some cases, people feel less guilty moving a family member to memory care, because they may have promised a parent or loved one that they'd "never put them in a nursing home." However, moving them to a place that doesn't meet their needs will not have a good outcome.
Consider whether a "fiblet" is the right thing, if your family member has cognitive issues. Often people advise telling dementia and Alzheimer's patients a white lie or "fiblet" about their move, assuming that they will soon forget the conversation. I think that you must evaluate your own situation and decide whether that approach is right. From the time I was a child, my relationship with my Dad was based on always speaking the truth. It was a value that we often talked about as a family. Lying about something as large as moving from his house felt wrong to me. Over several weeks, I tried having conversations with him about the fact that staying in the house was too much effort for my Mom. On some level, he reluctantly agreed to the move, but emotionally it was horrible for everyone. That would have been the case with or without a fiblet. (I will say that later, as my Dad's dementia progressed and he was living in another reality, I did end up making up half truths about different things to meet him where he was and to make him comfortable.)
Recognize that eventually, your family member will need more care. Even if your parent is a good candidate for memory care now, it's not too soon to start researching skilled nursing facilities. Eventually, dementia or Alzheimer's disease progresses and your family member will most likely need to move out of memory care. Good skilled nursing facilities often have wait lists. Be proactive and look into different alternatives. In the next post in this series, we'll explore the research process for skilled nursing facilities.
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