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Deciding to help a loved one with Alzheimer’s or dementia move into a nursing home or assisted living facility can be stressful. You want to make sure they’ll be in the best possible facility, but it’s not always clear what’s the best.
Luckily, there are experts in our area who can help. Billy Van Elk, AIA, a project architect at Epoch Architecture in South Bend, has years of experience in memory care architecture. Barbara Dzikowski and Debbie Carriveau of Alzheimer’s and Dementia Services of Northern Indiana (a division of REAL Services) help local families in all stages of Alzheimer’s and dementia care. We spoke to them about what families should look for in a nursing home or assisted living facility. Here’s what they said.
1. Ask about the facility’s licensing
Nursing homes that have memory care facilities are required to be licensed through the state government, Carriveau said. The facility’s most recent licensing report should be in an organized file that anyone can ask to see. “That can give you a perspective on what they’ve been cited for and what their plan of correction was,” she said.
Unlike nursing homes, not all assisted living facilities that claim to offer memory care services are required to be licensed. Usually unlicensed facilities accept only private pay.
That doesn’t mean the facility isn’t a good one, but it does mean that family members should make sure to ask about specific standards and care practices to make sure their loved one is getting the proper help.
2. Use your senses when you visit the facility
Your senses can tell you a lot about the general environment at a facility, Dzikowski said. Does everyone look clean and tidy? Does the staff interact with residents and seem familiar with them? Are residents engaged in activities or lined up in front of a TV? Does the food taste good? How does the facility smell? If there’s a urine smell in the lobby, that’s a problem, but urine smells near residents’ rooms are more normal.
3. Ask specific questions about the care plan and how staff handles behaviors common with memory care patients
At some point, your loved one may end up lost in the facility or another resident may get lost and believe your loved one’s bedroom is their room. How does the facility prevent those things from happening and what do they do if it happens? How often will the staff renew your loved one’s care plan?
Carriveau also recommends finding a facility that creates individualized therapy programs that allow your loved one to do jobs or activities similar to their life story.
Someone who was a farmer for 45 years should have the opportunity to talk about farming or grow a garden. A former teacher should be able to teach a class or grade papers.
“It boils down to creating opportunities for people to have purposeful, meaningful interactions based on their life history that create moments of joy,” Carriveau said. This helps reduce anxiety and stress and can sometimes slow down symptoms. “Through routine, through consistency, through structure, people (with dementia) will stay functional longer. The old adage of if you don’t use it, you lose it, that’s absolutely true.”
4. Ask about the background and experience of the memory care staff
“I would ask about what is the level of expertise and training that the caregiving staff has in regards to the special needs of dementia patients,” Carriveau said. The best training involves hands-on, interactive experiences rather than computer classes and testing.
Carriveau also recommends asking about the person in charge of the memory care unit or program. “Look at the credentials of that person because that is who will drive the quality of how that program runs on a day-to-day basis,” she said.
5. Ask about the turnover rate
Don’t be afraid to ask about this, because it’s important. Facilities with high turnovers can be problematic for memory care patients, who rely on routine and familiar faces.
“It’s going to confuse a resident if they meet someone new every two months and have to ask who they are, especially when they don’t remember someone they’ve known for 25 years,” Van Elk said.
6. Ask about the facility’s philosophy on psychoactive medication.
“In many instances when environments are not therapeutic, when it’s a shortage of staff, when people are not well trained, we see a process that happens where people are sedated and overmedicated,” Carriveau said.
Most behaviors — especially in early stages of dementia — can be managed by well-trained staff members in a therapeutic facility. Sedatives and other medications should be used sparingly.
“It really becomes a quality of life issue,” she said. “We have a lot of elders in our community who are just existing. We want our loved ones in an environment where they’re thriving despite their dementia.”
7. Look for places that don’t have long hallways, especially dead-end hallways
It can be easy for someone with Alzheimer’s or dementia to get lost in hallways — especially if they are filled with locked doors and have a dead end, Van Elk said. If a resident gets lost and falls down and no caretaker can see them, it can be dangerous at worst and frustrating at best.
It can be hard to avoid places with long hallways because most traditional nursing homes are designed this way, so look for hallways that have an exit to a secured outdoor space.
The ideal facility is set up in pods or small neighborhoods that house 8 to 12 people at a time, Van Elk said. This allows residents to see the doorway to their room or home while always being in the line of sight with a caregiver.
8. Avoid places where your loved one can see the front door or “drop off spot”
This can be a daily reminder of all the places that your loved one can’t go and things they can’t do, Van Elk said.
It’s more helpful to focus on the things that your loved one can do, so look for facilities that have free access to secured outdoor spaces like courtyards and garden areas. Dzikowski said that some facilities might have beauty shops, religious spaces, libraries or other spaces that can create social opportunities and a sense of freedom. Make sure the offerings fit with your loved one’s values and personal hobbies.
Memory care patients do well when they have some freedom but will always be in a safe place with caregivers nearby.
9. Get a private room
Having a roommate sounds like a good idea, but it can lead to a negative feedback loop, especially with more severe symptoms, Van Elk said. It also drains the caregivers because they spend less time taking care of patients and more time dealing with arguments between patients. This leads to higher turnover, which can cause problems for some residents.
You may also want to look for individualized door decorations. If every door is a different color or if there are old photographs on the doors that jog residents’ memories, your loved one will always know which room belongs to them, Van Elk said.
10. Look for assisted bathing facilities
If the showers have roll-in or walk-in capabilities, it’s a lot easier for both residents and caretakers to handle bath time. Everyone feels better when they can take a hot bath or shower and caregivers tend to have less injuries with options like this, Van Elk said.
11. Make sure the facility has plenty of activities and socialization opportunities
“Unfortunately we have a lot of facilities across the country that claim to be specialized care but really they’re locked warehouse units. They’re not providing anything special or therapeutic,” Carriveau said.
That’s why it’s important to look for social spaces. Does the facility have a social area like a living room or a dining room where food is served? The smell of hot food draws people out to socialize and activities group people together who have common interests.
“Ask (the facility) to show you a program schedule,” Carriveau said. “Find out what kind of activities are happening on a daily basis and what will be helpful specifically for your loved one.”
12. Ask your parents if they’re comfortable in the facility
You might spend 30 minutes or two hours sitting at the facility and be comfortable, which is great, but does your loved one feel comfortable enough to spend months or years there? Do they feel comfortable, safe and happy at the facility? Does it feel more like a home and less like an institution?
Also watch out for clever marketing tactics. Many designs and amenities are geared towards people in their 50s, Van Elk said. While having the fastest WiFi and the latest TV might sound great to you, your parents may not care as much about those amenities — or even use them.
13. Know the plan for discharge or moving to a different unit or facility
At some point, your loved one will need to be moved from an assisted living facility to a nursing home or from a nursing home memory care unit to a standard care unit. While that change can be years off, it’s important to get information about that transition early on so that you can be prepared for it.
“Facilities need to be real clear about what they can and cannot accommodate so families aren’t surprised,” Dzikowski said.
She recommends asking the facility about what kind of symptoms or needs will require your loved one to need a different facility and what the transition between facilities or units looks like. Make sure to get it in writing so that the information is always accessible.
Most facilities will not be able to meet every standard. Talk to your loved one and their doctor to come up with a list of preferences and needs. If a facility meets all of your needs, most of your preferences and fits in your budget, that’s a win.