I’m often asked, “what’s the difference between a memory care unit, and dementia care that is provided in an adult family home?”
Other families are weary of institutions and wonder if they should consider, or avoid, institutional memory care units as offered by assisted living facilities.
This article defines memory care and addresses critical differences between settings, how your care might be impacted, and key points to help you decide what might be best for you.
Defining memory care
Most importantly, you should understand that “memory care” is not about the setting where one receives care, it’s about the specialized care and knowledge it entails. Dementia isn’t just about memory, or memory care.
Dr. Peter V. Rabins, co-author of The 36-Hour Day, suggests that “memory care” is far too narrow a label for the services and support that are likely to help older adults and their families in coping with dementia.
Memory care is a distinct form of nursing care that specifically caters to residents with Alzheimer’s disease, dementia, and other types of cognitive and memory impairments.
Assisted living facilities typically provide 24-hour semi-supervised care in a separate wing or floor of a facility. I say semi-supervised because when residents retreat within their private quarters at the end of a long hallway, behind closed doors, they receive little or no direct supervision, especially at night.
Caregivers will check on residents on a pre-arranged, when “scheduled,” but not necessarily “anytime when needed.” This can be an issue when the resident is unable to call for help, and it’s one of the biggest difference when compared to individualized care received in adult family homes.
Memory care settings
The physical layout and security of memory care unit is designed to suit Alzheimer’s and dementia patients by minimizing the negative impact of wandering behavior. For example, there is no easy way for a resident to wander off onto the street, or outside the locked unit.
But that is by no means the only suitable environment.
Although the term ‘memory care unit’ is typically associated with larger institutional assisted-living facilities (it’s a marketing message), many adult family homes do possess a dementia specialty license and offer excellent, more personalized care for seniors with Alzheimer’s disease and dementia.
How do I know how much care my parent would receive?
This questions will best be answered by you own observation rather than by what the marketing director or administrator tells you.
To get a sense of how much care, supervision and personal attention your parent would potentially receive, gather the following information during your visits:
- In assisted living facilities, a typical memory care unit has from 30 to 100 units.
- Find out how many beds your considered facility has.
- Ask how many caregivers are on duty during the morning, afternoon, and night shift.
- Now divide the number of residents in the facility by the number of staff to discover the staff-to-resident ratio.
Example: 2 caregivers for 30 residents = 1:15 (1 staff to 15 residents) = ~30 min. of potential personal time for an 8-hour shift. You should subtract time for staff breaks, lunch, meetings and paperwork, so realistically, 30 minutes turns into 15-20 minutes of 1-to-1 time.
Remember that caregivers, not nurses, provide primary care.
Considerations in Favor of Institutional Memory Care Units
- If your parent has challenging behaviors, for example screams, yells, hits, runs, and has other difficult behaviors, they can more easily managed in larger settings because they may have access to more [temporary] staff from other wings within the facility (but that is not a given!).
- Nursing and support staff is usually well trained and used to managing challenging behaviors.
- You don’t have to worry about your loved one fitting-in or disturbing others.
Considerations Against Institutional Memory Care Units
- Generally, institutional memory care environments are very taxing to a person with dementia because it’s often too stimulating for a brain that cannot process sensory input and information normally.
- The lights are typically on 24/7, further inhibiting the pineal gland’s ability to produce melatonin, a hormone that induces sleep and restoration.
- Too many people and caregivers overwhelm the brain’s ability to process stimuli, causing more stress and precipitating more challenging behaviors.
- Alzheimer’s residents often suffer from delusions and paranoia, so more people around them causes them to feel greater angst and paranoia.
- The continual change in staffing and residents make establishing routines and forming relationships very difficult.
- Residents retreat behind closed doors when they are in their own quarters, leading to less supervision and more accidents.
Is an Adult Family Home environment better for a senior with dementia or memory impairment?
Yes! (I am biased :-)
Having served hundreds of seniors in my 32-year career as a geriatric nurse, this is what I would choose for my own parent, applying careful selection before choosing the right care home. Here is why.
- The smaller and calmer environment requires less brain processing power, and therefore causes less stress and triggers fewer difficult behaviors.
- There is more personal attention and redirection available whenever necessary, not just when scheduled.
- Decrease in “catastrophic events.” A smaller setting offers a greater sense of familiarity with fewer staff and more intimate surroundings, which helps decrease stress and the possibility of “catastrophic events.”
- It’s less expensive.
- I want to bring seniors home, and out of institutions and “units!”
What are catastrophic event in dementia?
Catastrophic events are emotional outbursts and overreactions to seemingly normal, non-threatening situations. Sometimes these reactions are accompanied by physical acting-out. The word catastrophic implies that there is a catastrophe, or a that a terrible event occurred, but that is usually not the case; catastrophic is the way it feels to the person experiencing the event. These catastrophic events can be triggered by such things as too much noise, recalling stressful memories, trying to provide personal care, or unnecessary changes in the environment such as staffing changes.
When is an Adult Family Home not the best choice for dementia or memory care?
- If your loved one has highly challenging behaviors such as aggressive, disruptive, or sexually inappropriate tendencies. In that case, you should choose a care home carefully.
- If he/she is very socially active, needs the company of others in staying busy, or likes many outings.
- If they like, need, or thrive on many stimulating activities throughout the day.
Some Adult Family Homes do offer a higher level of activities. But in general, some residents who are very social may become bored or feel more isolated in a smaller setting. For these more active folks, an Assisted Living facility may be a better option, where the levels of activity and socialization are higher.
Is it time to make a move?
There comes a time when a person with Alzheimer’s disease or dementia will need more care than can be provided in their current setting, unless they already reside in a facility who has the necessary skills, experience, and knowledge to provide competent quality care.
During the middle stages of Alzheimer’s, it will become necessary to provide 24-hour supervision to keep the resident safe. As the disease progresses into the late-stages, round-the-clock care will become required and intensive.
That being said, it’s very important to remember that moving is traumatic and difficult for people with dementia and cognitive impairments.
These questions may help you determine if a move is a good option
- Is the resident becoming unsafe in their current setting?
- Is the health of the resident, or his a caregivers at risk?
- Are the resident’s care needs beyond the physical or emotional abilities of his caregivers?
- Can adjustments be made in the current setting?
- Would the structure or social interactions in a different setting offer a clear benefit?
- Am I becoming a stressed, irritable and impatient?
- Am I neglecting work responsibilities, my family, or myself?
Impact of moving?
As mentioned earlier, it is very disruptive, in some cases even traumatic, for a senior with dementia to move. Their ability to process any change, and to learn anything new is greatly diminished and causes stress.
We’ve learned that changing something as simple as the sitting arrangement at the dining table can cause upset, and even precipitate a catastrophic reaction.
Sometimes, when the discomfort, distress, turmoil, confusion and anguish are significant enough, they experience what we call “traumatic adjustment disorder.”
Symptoms can include increased confusion, agitation, anxiety, paranoia, repeated questioning or shadowing (following caregivers around), and anger.
Moving is rarely easy, especially for the aged. What’s most important is to make sure you make a smart and calculated move to ensure you won’t need to move again in the future.
Cost impact
If you reside in an assisted living, the cost will increase proportionally, and in some cases you may be asked to provide – and pay for – your own caregivers. I routinely help families in the Seattle area who’s care fee went from $3,400 to $4,800 range (in a 1 bedroom apt.) to $8,500 to $11,000+ for their care, depending on a few variables.
If you reside in a dementia specialty adult family home, the cost may also rise, but the average range is typically between $5,000 and $7,500, and it’s usually all-inclusive.
About Spada Homes
Dementia dramatically affects how a person functions, and how that person perceives and relates to the world. Some people with certain types of dementia exhibit a host of erratic or difficult behaviors that have very little to do with memory loss. For that reason our program embraces a broad view of dementia.
We can’t, and don’t use a one-size-fits-all approach to address all types of dementias or to serve all individuals who struggle with these conditions.
My mission continues to be, “let’s bring seniors home, and out of institutions and units!“
This is a major reason why seniors and their families chose us over institutions.
This article is from my book, “How To Find The Best Adult Family Home Care” on Amazon.
