Choosing Dementia Care

J0101861Choosing a Facility for Dementia Care

Who can best communicate with, engage with, and provide loving care and a pleasant care environment for your family member diagnosed with dementia?  When it is time to make this decision, there are many details to explore before choosing a dementia care unit.

Many of the calls I receive ask for help in creating the best care plan for a husband, wife or parent who has Alzheimer’s Disease or other forms of dementia.  So appropriately called “The Family Disease”, Alzheimer’s Disease impacts the life of the person with the disease and ALL those involved in their care. The classic 1981 book, “The 36 Hour Day”, was named to recognize the extreme stress felt by those caring for someone with dementia. When the caregiver begins to suffer due to the 24 hour care required for someone needing constant supervision and care, it’s time to create a care plan of relief.

But making the decision to move someone you love to a facility for care is very difficult. It is often made harder by the uncertainty of just what care environment is best for your family member who has dementia.  Many people have told me they toured one nursing home and decided they could never go into another one.  With that one experience they committed themselves to months and years of home care that destroyed their physical and mental health. Good care can be found today.  Do not let one negative experience stop further search for the best care available.

The long ago experiences of unpleasant odors and lines of wheelchair-bound residents sitting along a wall are gone.  Today’s  care facilities have created special secure dementia care units, now available in both skilled care nursing homes and in assisted living facilities.  Knowing what to look for when choosing a good care environment for your family member will make choosing a care facility less stressful.

First, the closest facility to you is not necessarily the best choice.  Many elders say they don’t want to or cannot drive far, so they select the care closest to home.  Remember, though, that your family member will be living in the new care environment 24 hours a day.  It is the quality of care and the care environment that is most important to consider.  If transportation is a problem, make arrangements to visit, but do not make the decision based on where the facility is located.

When you enter a special care unit what is your first impression?  Does it remind you of a hospital with all beige walls, floor and ceiling or is it a home-like environment?  A good care environment for those who have cognitive impairment will closely replicate the home.  Note what you see of the following:

  • Is there a multi-purpose room/rooms offering comfortable seating, a pleasant interior of furnishings, colored walls, decorations, and pleasant smells?   Some bake cookies for a pleasant aroma and activity, with most community rooms serving as a dining room and for activity.
  • Is there visual contrast between the floors and walls and doorways and walls to help with the loss of ability to perceive depth and dimensionality?  Are the exit doors designed to minimize an obvious exit?  Are there glass doors exposing the adjoining halls and outside creating a desire to wander or escape?  Is there a high gloss on the floor causing glare?  The person who has an advanced cognitive impairment often benefits from special design recommendations to create a soothing and safe care environment.
  • Is there a pleasant secured outdoor space with safe walkways to provide for exercise and the enjoyment of the outdoors?
  • Are the residents rooms furnished with personal items and furnishings, and decorations on the wall? Having a personal item or portrait next to the entry door is often helpful for a person to find their own room on the dementia unit.  Familiar objects and using a quilt from home on the bed and familiar furnishings help provide emotional comfort and acceptance of the care environment.
  • What do you hear when you are touring the dementia care unit?  Is it calm and peaceful, or do you hear an overhead intercom calling out names?  If you lived on the unit, would you feel secure and peaceful or confused and agitated?  You should never hear overhead announcements on a dementia care unit unless it is an emergency.

Meet the staff at each facility.  Ask not only for a tour of the special dementia care unit, but talk to the director of the unit, the director of nursing,  the social services director, the activity director, and the administrator.  Make sure you get a full picture of what your future relationship will be with the facility staff as you visit your family member at the dementia care unit.  Ask about the following to learn details of the management of this facility:

  • What are the visitor’s hours?  Are you going to be allowed to visit freely and engage with your family member?  Unless your presence disturbs a roommate or creates behavioral changes and challenges, you should be allowed to spend as much time with your family member as you and they desire.
  • What about pets?  Can you bring the dog, cat or bird for a visit with the necessary proof of vaccinations?  One facility allowed a resident to move in with their pet bird for a trial period to see if the bird could be cared for by the resident. Explore therapeutic visits and outings desired.
  • What activities are planned and provided for the special dementia care unit?  Are activities provided daily on the unit?  Or do the residents have to request to participate in activities off the unit?  Are the activities supportive of independent living skills and communication?
  • Is family interaction with the resident encouraged and supported?  Is there a family council or quarterly meeting to bring family and staff together for a consultation?  Does the facility sponsor a caregiver or a dementia support group?
  • What special training is provided for the dementia care unit staff?  In addition to the dementia care training required of all nursing home care staff, what special training about stages of dementia, behavioral management, communication skills, activities and care of the individual with dementia is provided?
  • What exercise activity is provided on the special unit?  Is a regular activity or intervention provided for motor skills, sensory stimulation, and physical exercise?
  • Is the social services director educated in the progression of dementia and the needs of the family throughout the disease process?  Is there any caregiver support available to family members?  Is the staff knowledgeable about the end stages of dementia and hospice care?
  • What is the facility policy about ambulation and the criteria to remain on the special care unit vs. a transfer to the general resident population of the facility?  Be certain that you are clear in your understanding of the level of functioning required to remain on the special unit.
  • What is the facility policy if your family member displays aggressive behavior?  Is an immediate referral made for an inpatient hospital assessment, or is the staff capable of assessing triggers for this behavior?  Is there a policy to monitor behavior before a referral for outside assessment and treatment?

A quality care environment can be found today in most areas large enough to offer a selection of several facilities to choose from.  Tour facilities with these guidelines to find the one that tells you the care is what you wish for your family member.

Sara Cain-Bartlett, MSW, LCSW, C-ASWCM  CareSupport Services, PLLC
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